Reducing Opioid Abuse Among Older Adults Dr. Arlesia Mathis and - - PDF document

10/31/2019 1 Reducing Opioid Abuse Among Older Adults

• Dr. Arlesia Mathis and Denesha Merchant, MPH

Florida A&M University – Institute of Public Health November 4, 2019

Learning Objectives

 Compare levels of opioid abuse or misuse among older adults by gender, race and geographic location.  Formulate strategies for improving appropriate medication use among older adults with chronic health conditions

Presenter Disclosures

Arlesia Mathis, Ph.D. The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

 Opioid misuse among older adults is an important public health concern  Nonmedical use of prescription pain relievers among older adults is associated with negative health

• utcomes, including falls, hip fracture,

and traffic accidents  Older adults with opioid use disorder are at a higher risk of death compared to younger adults.  From 1996 to 2010, the number of

• pioid prescriptions provided to older

patients increased ten times over

Tilly, J. et al (2017) The Opioid Public Health Emergency and Older Adults. Administration for Community Living

 Over the past two decades, as the prevalence of chronic pain and health care costs have exploded, and opioid epidemic with adverse consequences has escalated.  People 50 years and older consume more prescribed and over the counter medications than any other age group in the United States.  Older adults have several unique risk factors that make them particularly susceptible misuse of prescription drugs.  Pain in older adult poses unique challenges in their lives.  Frail elders show declines in muscle strength, balance, mobility, physical activity, cognition, endurance, nutrition, and weight.  Opioids reduce the perception of pain and produce a sense of well-being by binding to opioid receptors distributed in the brain, spinal cord, and other peripheral tissues.

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 The use of multiple medications is a common concern among older people.  It has been estimated that 20% of Medicare beneficiaries have five or more chronic conditions and 50% receive 5 or more medications. Among older adults with cancer, 43% receive 10 or more medications.  In the US, 33% of Medicare, Part D beneficiaries have at least one opioid prescription.

Nightingale, G., et al. (2015) Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. Journal of Clinical Oncology. Vol. 33 (13), pp. 1453 – 1459 (PMID 25800766).

 Opioids have a stronger impact on older adults because bodily processes slow as people age.  From 2005 to 2014, inpatient stays rose 85 percent for those aged 65 and older (Weiss et al., 2017). Emergency department visits for this group rose 112 % during the same period.  In 2011, on an average day, 80 adults aged 65 and older visited the emergency department for problems with narcotic pain relievers and seven older adults’ visits involved heroin (Mattson et al., 2017).

Weiss A.J., Bailey M.K., O’Malley L., Barrett M.L., Elixhauser A., Steiner C.A., Patient Characteristics of Opioid-Related Inpatient Stays and Emergency Department Visits Nationally and by State, 2014. HCUP Statistical Brief #224. June 2017. Agency for Healthcare Research and Quality Mattson, M., Lipari, R.N., Hays, C. and Van Horn, S.L., 2017. A day in the life of older adults: Substance use facts. The CBHSQ Report: May, 11

• As the baby boomer generation ages and the population of older

adults in the United States grows, opioid misuse among older adults is becoming an increasingly urgent public health concern.

• In addition to the threat of addiction, opioid use can also pose health

risks such as breathing complications, confusion, drug interaction problems, and increased risk of falls, which can be more dangerous in the older adult population

 Senior adults are one of the fastest-growing sectors of the American society.  Currently one in eight Americans is 60 and over, but by 2030, this number will increase to one in three.  Older adults make up the largest consumer segment for prescription drugs in the United States.  The estimated annual expenditure on prescription drugs by senior adults in the United States is $15 billion.  Older adult women take an average of five prescription drugs, for longer periods of time

Horgas, Ann L. Pain Management in Older Adults , Nursing Clinics , Volume 52 , Issue 4 , e1 - e7

 Medicare beneficiaries have among the highest and fastest-growing rates of diagnosed opioid use disorder at more than 6 of every 1,000 beneficiaries (CMS, January 2017).  Nationally, one-third of Medicare Part D beneficiaries or 14.4 million people had at least one opioid prescription in 2016, with over 500,000 beneficiaries using very high amounts of the medication (DHHS/OIG, 2017).

CMS (Centers for Medicare & Medicaid Services). January 5, 2017. Opioid Misuse Strategy DHHS/OIG (Department of Health and Human Services/Office of the Inspector General). 2017. Opioids in Medicare Part D: Concerns about Extreme Use and Questionable Prescribing.

• 1. What causes the misuse of opioids

among older adults?

• 2. Is the misuse more prevalent among men

and women compared to other areas?

• 3. What percentage of the aging

community misuse opioids?

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 The National Survey on Drug Use and Health (NSDUH) 2014  Specific Age Group: United States households 50 years and older  Questions included: age at first use as well as lifetime, annual, and past-month usage for various drug classes including nonmedical use of prescription drugs including pain relievers, tranquilizers, stimulants, and sedatives

40% [VALUE]%

GENDER

 Women is 40%  Men is 26.5%  Women are more sensitive to pain than men and more likely to have chronic pain, which contribute to the high rates of opioid prescriptions among women

40% [VALUE]%

GENDER

 Women is 40%  Men is 26.5%  Women are more sensitive to pain than men and more likely to have chronic pain, which contribute to the high rates of opioid prescriptions among women

0% 10% 20% 30% 40% 50% 60% 70% Other White Black/African American Hispanic Ethnicity

 17.3% of Hispanics  12.1% of Black/ African American  60.7% of Whites  10% of Other  The elderly are more likely to be prescribed several different medications at once and for a prolonged duration

• f time

 Social factors, such as limited English language proficiency, and low health literacy impede adherence  Screening for drug abuse in the elderly can be complicated. Symptoms can be masked by normal or perceived signs of aging; the elderly may deny symptoms of abuse, and may be unaware of their misuse  The elderly do not fit the typical drug abuser profile or stereotype and therefore awareness and services for this population is lacking

Solomon, J. (2017, August 15). Opioid Use in The Older Adult Population. Retrieved from SAMHSA: https://www.samhsa.gov/capt/sites/default/files/resources/resources-opiod-use-older-adult-pop.pdf

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Yes No

MISUSE

 81.1% responding yes to misuse  18.9% responding no to misuse

10 20 30 40 50 60 70 80 2014 2015 Florida New York

 Doctors in Florida were prescribing at a rate of 71.4 % compared to doctors in New York prescribing at a rate of 43.9%  Doctors in Florida were prescribing at a rate of 67.1% compared to doctors in New York prescribing at a rate of 45.1%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Large Metro Small Metro Nonmetro

Percentage of Misuse

Percentage of Misuse

 45% represents large metro  36.5% represents small metro  20.5% represents non-metro

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% Morphine Hydrocodone Oxycodone Responded No Response

 More older adults report misusing hydrocodone compared to morphine and oxycodone.  Sixty-five percent of older adults reported misusing hydrocodone.

Older adults are misusing prescription opioids. More older adults living in the south receive opioid prescriptions for pain management. Women are misusing opioids more than men. Whites seniors were mostly likely to misuse opioids, followed by Hispanics older adults. Of the three most commonly prescribed opioids (morphine, hydrocodone, and oxycodone), hydrocodone is the most likely to be misused by senior adults.

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 The ‘BEERS Criteria’  Prescription drug monitoring programs  Screening older patients  The overall number of older adults who misuse or abuse prescription drugs will likely increase as the size of the population continues to grow.  There is a concern that increased monitoring and fear of prescription drug abuse can be associated limiting access and increasing ethnic

• r racial disparities.

Older adults are likely to receive prescriptions for opioids due to chronic, painful conditions that often accompany age. This population is at risk for particularly severe side effects because bodily processes generally slow with age. Protocols should be implemented and adhered to for older adults using proven alternatives to opioids.

Acknowledgements

• Dr. Cynthia Harris and the Institute of Public Health
• Denesha Merchant, MPH
• Dr. Rima Tawk

Presenter’s Contact Info.

 Dr. Arlesia Mathis  Associate Professor/Track Leader  Florida A&M University – Institute of Public Health  203B FSH Science and Research Center  Phone: (850) 599-3104  e-mail: Arlesia.Mathis@famu.edu