Over the past several years, opioid use and abuse statistics have been on the rise. Healthcare professionals have observed and encountered greater numbers of patients using or abusing opioids — leading the Centers for Disease Control to call the situation an epidemic. One of the reasons for the concern among healthcare professionals is the long-term side effects of opioid abuse, which can include constipation, liver damage, brain damage, tolerance, and dependence. Simply put, opioid abuse can wreak havoc on a patient’s health, utterly destroying their ability to live a healthy, well-adjusted life. Opioid abuse may also lead to additional side effects such as mental and behavioral changes, which put additional stress on the healthcare system and society at large. In this blog, we examine the opioid epidemic and its affects one of our most vulnerable patient populations: older adults.
Opioid Tolerance and Dependence
As individuals abuse opioids, their tolerance and dependence on opioids increases — meaning the more opioids individuals take, the more they become physically dependent on opioids. Without intervention, opioid abuse becomes a vicious cycle of use, dependence, and tolerance. Once an individual begins the cycle of dependence, it becomes very difficult to break it. Also, mental and behavioral changes may occur with dependence. Users may become irritable, unreliable, and may exhibit drug-seeking behavior. While all of the previously mentioned mental or behavioral changes can affect society as a whole, drug-seeking behavior has had the most detrimental effect on the healthcare system.
Over the past few years, organizations such as the U.S. Food and Drug Administration (FDA) have enacted new policies, procedures, and laws to combat opioid misuse, abuse, and drug-seeking behavior. Their aims have been to tighten regulation and control over opioids, which may have led to a massive perception change among healthcare professionals when it comes to opioid medications. In other words, due to the increase in regulation and control of opioids as well as the overall tighter approach to opioid management, healthcare professionals may no longer view opioids in the same light.
Healthcare Professional Views on Pain Medications
In the past, when a healthcare professional thought about an opioid medication they may have viewed it as first and foremost a medication used to relieve a patient’s pain and suffering. They may now see it as a medication that possesses the potential for misuse and abuse, that elicits drug-seeking behavior among patients, or as a medication used to relieve a patient’s pain and suffering. Unfortunately, this perception change of opioids does not necessarily stop at opioid medications; it may also extend to the patients on opioid medications.
Before the start of the opioid epidemic, a healthcare professional may have simply viewed a patient on opioid medications as a patient suffering from pain. Now, when a healthcare professional encounters a patient on opioid medications, they may view him or her as a potential drug abuser or drug seeker — leading to an overall aura of suspicion among individuals taking opioid medications. What does this mean for those receiving pain therapy? Essentially, it means the patient’s pain therapy can be greatly affected by a healthcare professional’s perception of opioid medications. For example, if a healthcare professional has suspicions regarding a patient’s motivation for opioid pain relief for any reason, he or she may question the use of opioids for that patient. This can result in a delay of or change in pain therapy, both of which can harm patient populations, especially older adults.
Managing Pain in Older Adults
Many older adults suffer from conditions that lead to pain. As a result, they often require medications, including opioids, to manage their pain. Any pain medication delay in administration or change in regimen may affect the overall health, well-being, and quality of life for older adults. It is therefore important for healthcare professionals to think of them as patients first, to ensure they receive the care they require.
For example, if an 58-year-old male patient is admitted into a hospital suffering from a debilitating pain and requires or requests an opioid medication for his condition, perhaps it is truly because he is in pain and not because he is a potential drug seeker. Some painful conditions like Fibromyalgia are difficult to recognize and diagnose in the short term. Thinking of the 58-year-old as a patient first may enable healthcare professionals to better serve the patient’s pain needs and manage his overall health. With that said, older adult patients are not immune to opioid misuse/abuse and long-term narcotic use, which does pose dangers to older adult patients. Healthcare professionals should not lose sight of a patient’s pain needs just because he or she is on an opioid medication. An opioid medication does not always equate to a medication used to get “high.” Sometimes, an opioid medication used to treat pain is just that — a medication used to treat pain — especially when it comes to older adults.
Unfortunately, pain is widely undertreated among older adults. Thousands all across the country are currently suffering from pain, which may be directly diminishing their mobility, activity, overall health, and quality of life. Pain is a very real and potentially life-crippling daily battle for many older adults. Healthcare professionals should be aware of the needs of their individual patients, especially older adults, and keep in mind that patients suffering from pain are indeed patients who may require help. Healthcare professionals must find a balance between observing for potential opioid misuse and abuse and treating patients to ensure they receive the safe and effective healthcare they require, and do not have to live their lives plagued by undertreated pain.