August 14, 2017

Anita Wadhwani 

Pain pills are sending more senior citizens to the hospital in Tennessee, according to data that sheds new light on how opioid addiction has spread to the state’s aging population.

The rate of hospitalizations for Tennesseans 65 years and older due to painkillers has more than tripled in a decade.

Older adults are being hospitalized for reasons that range from falls and auto accidents after taking pain pills to unintentional overdoses, interactions with other medications and weakened kidney or liver functions in aging bodies that fail to metabolize the drug in the same way as younger people.

“It’s not that easy to believe your grandmother has a drug abuse problem,” said Dr. Peter Martin, a psychiatrist and director of the Vanderbilt Addiction Center.

“The biggest problem is that no one in the past was worried about an elderly person becoming an addict,” Martin said.

“But opioids affect the brain no matter how old you are. If a person in their 60s and 70s is running out of their prescription early, most physicians are less likely to look on that with suspicion” as they might do with a younger person, he said. “They’re thinking, ‘Oh, they probably forgot it somewhere.’ “

The U.S. Agency for Healthcare Research and Quality data ranks Tennessee No. 6 in the nation for the rates of opioid-related hospital admissions among senior citizens. In 2005, 467 out of every 100,000 people aged 65 and older spent time in the hospital for opioid-related use. In 2015, that rate shot up to 1,505.

In his Nashville practice, gerontologist Dr. Jim Powers addresses the problem where it typically starts — in the exam room.

The conversations can be awkward when patients have regularly taken opioids for legitimate pain.

Some patients began taking opioids a decade or more ago when they were in their 40s and 50s and suffered back pain or arthritis at a time when opioids were considered the first line of pain treatment, he said. They never stopped.

“It’s a difficult conversation to have when you’re a physician and seeing a new patient,” Powers said. “Most physicians have to negotiate, and say, ‘We’ll continue this, but let’s try other things. Let’s get an X-ray.’ About 90 percent of physicians will continue (opioid) prescriptions although they have misgivings.”

Powers works with those patients over time to introduce alternatives — physical therapy or spinal injections of cortisone. About a third of his patients are eventually willing to try to stop taking opioids, he said.

Other patients “need professional help. They need tapering,” he said. “But the system is not ready to receive as many older patients with substance abuse disorder. As the population has grown older, we have not seen a corresponding increase in drug treatment programs.”

Federal data shows that seniors continue to be more likely to be prescribed opioids.

One-third of seniors enrolled in Medicare Part D prescription coverage filled at least one prescription for an opioid last year — about 14.4 million people, according to the U.S. Department of Health and Human Services.

More than half a million of those beneficiaries received higher-than-average opioid dosages for at least three months.

Federal and Medicare data doesn’t make distinctions between people in their 60s and 70s and those who are in their 80s or 90s.

Experts say it’s more likely that baby boomers on the younger end of that spectrum are using — and in some cases abusing — opioids.

“There’s a definite difference between baby boomers and the generation above them who lived through the Great Depression and are in their 80s and 90s and are much more likely to say ‘I don’t want to be on a pill,’ ” Powers said.

Baby boomers are also more likely to have experience with drugs and alcohol, perhaps making them more likely to turn to pain medications, Martin said.

The huge spike in opioid-related hospitalizations left some advocates who work with seniors puzzled.

Could a key to the problem not be opioids themselves, but the way they’re prescribed to seniors who are known to respond to medications differently?

“We know that as America grows older there’s going to be more hip replacements or more falls, but I don’t think that counts for a nearly fourfold increase in opioid hospitalizations for this group,” said Grace Sutherland Smith, executive director for the Council on Aging of Middle Tennessee.

“We have to ask whether doctors are taking into account how someone over 65 metabolizes medications differently than a young person,” she said. “Whereas you and I might be able to work, an older person might become sleepy or numb or incoherent.”

Seniors who do seek addiction treatment may face challenges in finding and paying for it.

Medicare covers inpatient detoxification, partial hospitalization, residential treatment and outpatient individual and group therapy, according to information provided by BlueCross BlueShield of Tennessee.

It does not cover intensive outpatient treatment or medication-assisted treatment for addiction. The latter can be a key treatment for opioid addicts, substituting a maintenance drug that allows people to abstain from opioids.

But there are signs that more older individuals want help.

At a Nashville admissions center for Foundations Recovery Network, a nationwide network of treatment facilities for mental health and addiction, there was a 55 percent increase in calls from people in the 65-plus age group seeking treatment between January 2015 and January 2017.

“Many people assume that addiction is impacting only young people,” said Lee Pepper, chief medical officer at Foundations Recovery Network. “As our population is living longer and aging we are seeing addiction impact our parents and grandparents. Treatment options for elderly Americans become more difficult due to lack of access because of medical complications and mobility.”

Read more on The Tennessean.

Anita Wadhwani is an investigative reporter at The Tennessean. She joined the newspaper in 2001. Her previous beats have included diversity, religion, healthcare and social issues. She was selected for a fellowship in healthcare journalism by the Kaiser Family Foundation.