Highlight from PAIN (Volume 159, No. 8, August 2018)
Sources of Opioid Medication for Misuse in Older Adults: Results from a Nationally Representative Survey
Ty S. Schepis, Sean Esteban McCabe, Christian J. Teter; Department of Psychology, Texas State University, San Marcos; Center for the Study of Drugs, Alcohol, Smoking, and Health, School of Nursing and Institute for Research on Women and Gender, University of Michigan, Ann Arbor; Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME
As the baby boomer generation ages, rates of older adult prescription opioid (PO) misuse and PO use disorders (POUDs) are projected to increase. Investigators in this study found that PO misuse among adults 50 and older is underreported. Older adults are more likely to experience chronic pain, are prescribed more opioid and other central nervous system depressant medications, and experience more medication-related problems than younger groups. Older adults may have more PO access, leading to misuse and heightening the likelihood of dangerous interactions with alcohol or other medications.
Using 2009 to 2014 National Survey on Drug Use and Health data, this work aimed to quantify PO misuse sources in adults 50 and older, with separate examinations of the 50-to-64 and 65-and-older groups. Older adults were compared with younger age groups to investigate age-based differences in drug sources. Further analyses examined sex differences regarding sources and the association of specific sources with PO misuse consequences, nonopioid substance use, and substance use disorder (SUD) symptoms. Investigators hypothesized that older adults would use physician sources more compared to younger groups and that use of multiple PO sources and purchases would be associated with POUD and nonopioid SUD symptoms, considering their robust associations in younger groups.
Results strongly suggested that older adults, especially those 65 and older, are a unique group in terms of PO misuse sources. Adults 50 and older who use physician sources, purchases, or multiple sources had elevated levels of POUD symptoms compared to those not using those sources. Adults 65 and older had the highest use of physician sources, including use of one or multiple physicians, and the lowest prevalence of theft or fake prescription purchases, instead obtaining opioids at no cost from friends or relatives and through multiple sources. Nearly half (47.7%) of adults 65 and older reported physicians as their source for misused POs. Adults who were 65 and older had the lowest rates of PO misuse and POUD or nonopioid SUD symptoms across any time frame; adults 50 to 64 years were generally the second-lowest prevalence group on these outcomes. These data underline the increasing importance of clinician PO prescribing as a misuse source as individuals age. Increasing use of physician sources among older adults may reflect higher utilization of health care and a higher prevalence of chronic pain, joint replacement surgery, and cancer, all of which may involve PO therapy. Physician sources provide prescribers an opportunity to carefully monitor older adult patients for misuse and intervene when strong signals of misuse, such as early refill requests and doctor shopping, exist.
Education on proper medication storage and disposal and risks associated with PO medical misuse (including misusing one’s own prescription) emphasized the need to monitor for signs of concurrent substance and PO use, enhanced screening for potential SUDs, and increased monitoring for behaviors associated with PO misuse in older adults. Centers for Disease Control and Prevention guidelines for opioid use in the setting of chronic pain can aid clinician decision making when considering POs for older adults; while not strictly contraindicated, these guidelines suggest use of nonopioid therapy before opioid initiation and urge cautious and judicious PO use in older adults in consideration of their heightened potential for negative outcomes. The evolving literature on opioid misuse in young adults and adolescents cannot simply be applied to older adults.