When you think of the opioid epidemic, you usually think of a younger population. However, the problem is growing among the older population, who are being prescribed these narcotics at an alarming rate.
New Yale study
A new study shows that many opioid-dosage combinations have no restrictions under Medicare’s drug formulary, causing too many opioids to be prescribed at too-high dose combinations.
The study findings suggest that restricting formulary coverage of these narcotic drugs would be one way to decrease the amount that doctors are prescribing. The study found that more than two-thirds of drug-dosage combinations had no opioid prescribing restrictions in 2006 and 2011, and approximately one third had no restrictions in 2015.
Risk of long-term use
Another study found that in 2011, 15% of Medicare recipients were prescribed painkillers after a hospital stay, and 42% were still on them after 3 months. The longer one stays on the opioid, the more likely he or she is to become addicted, at no matter what age. In the past 20 years, the rate of hospitalization due to opioid overuse in the elderly has quintupled.
Due to the risks involved with unintentional overdose and injury, the Centers for Disease Control and Prevention (CDC) put out new opioid prescribing guidelines in 2016, however the Medicare drug formulary doesn’t appear to have changed as a result.
The Office of Inspector General (OIG) at the Department of Health and Human Services released a report in July of 2017 titled “Opioids in Medicare Part D: Concerns about Extreme Use and Questionable Prescribing.” The report stated that 90,000 beneficiaries are at serious risk: 70,000 people on Medicare Part D received “extreme” amounts of narcotic painkillers in 2016, and more than 22,000 appeared to be “doctor shopping.” Alabama and Mississippi had the most people on at least one opioid, at 46% and 45%, respectively. Among the lowest were Hawaii and New York, with 21% and 22% who received a prescription painkiller in 2016.
In some cases, extreme prescribing could mean that someone’s identity is stolen or a patient is selling the drugs to others.
Many of these prescriptions may be valid. Older people do have more aliments, such as cancer, arthritis, osteoporosis, neurological diseases, and other illnesses that cause pain. Yet the high amounts of opioids being prescribed may be causing more harm than good.
In some situations, there are alternatives to treat the pain, such as mindfulness, meditation, exercise and heat therapy. Dr. Sharon Brangman, past president of the American Geriatric Society, said “the trick is to first try non-pharmacological options such as acupuncture, and to use the smallest effective opioid dose possible.”
Prescription drug monitoring programs
There are prescription drug monitoring programs in place to try to keep “doctor shopping” from occurring. Doctors can search on databases where they can see whether a person has tried to get opioids from several different doctors. These programs are in place in every state except for Missouri.
A study published in Addiction in February 2017 found that the states with more robust prescription drug monitoring programs have “fewer prescription opioid overdose deaths than states with weaker PMPs.” In addition, doctors are encouraged to check if a person has a past history of drug abuse before prescribing. And if an addiction is present, a slow tapering off of the drugs in a treatment center is the safest path to recovery.
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