Opioids are commonly prescribed to treat individuals with chronic malignant pain; however, many of these individuals do not adhere to their medication regimen, resulting in misuse and abuse and significant social, occupational or health problems.
Older adults are especially at high risk for health complications related to prescription misuse and abuse, including accidents, mood changes, cognitive decline, drug interactions, opioid-induced respiratory depression and organ dysfunction. Furthermore, adults over the age of 50 represent the largest consumers of prescription medications, and people in this age group are more likely to be prescribed opioids. With over 76 million aging baby boomers in the United States, these problems will continue to escalate.
In a recent study funded by NIH/NIDA and the Patricia H. Garman Behavioral Health Nursing Endowment, Yu-Ping Chang, PhD, RN, FGSA, associate dean for research and scholarship, explored the prevalence of prescription opioid misuse among older adults, identifying factors associated with misuse. In this study, 35 percent of participants acknowledged misusing prescription opioids.
Chang found those with higher education (some college or above) were 2.5 times more likely to abuse opioids than those people who did not go to college. This preliminary work suggests that education plays a role in predicting opioid misuse.
Other contributing factors with a positive correlation to opioid misuse include a history of moderate depression, alcohol abuse and illicit drug use.
Depression is highly prevalent in this population but is often under-recognized. It is possible that older adults might use prescription opioids to cope with untreated mental health problems. It is crucial that providers routinely screen for mental health and substance abuse other than opioid abuse.
Participants who reported higher levels of pain while doing normal activities of daily living, such as walking, were also more likely to misuse opioids. Those factors identified in the study should be taken into consideration when developing interventions and treatments for older adults with chronic pain.
Prescription opioid misuse in older adults is a significant concern for health care providers. Stressing the importance of increasing awareness and risk identification in this population, Chang plans to follow up this preliminary study with research using longitudinal approaches to better understand the trajectory of prescription opioid misuse and risk factors that contribute to abuse. She also plans to explore methods to better identify and treat the opioid misuse in older adults with chronic pain.
The need for better pain management, screening, prevention programs and treatment, along with appropriate referrals, cannot be over-emphasized in efforts to combat this growing health issue. There is a major lack of epidemiological and clinical research evidence on prescription opioid abuse in the older adult population. Research on the efficacy of multimodal approaches, including behavioral and pharmacological treatment to prevent and reduce prescription opioid misuse in older individuals, is urgently needed.
-DONNA A. TYRPAK, YU-PING CHANG
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