A Bangor physician told U.S. senators Wednesday that the opioid epidemic poses unique challenges to older people, including those who are dependent on the drugs for management of chronic pain.
“In addition to being at risk for crime such as having their medications stolen and diverted by caretakers, family members and others, we are seeing many cases in which people who have become dependent on these medications seem to be tapered off them too quickly with little offered in the way of alternative pain management,” said Dr. Charles Pattavina, an emergency room physician at St. Joseph Hospital and former president of the Maine Medical Association.
Pattavina testified before the Senate Special Committee on Aging, chaired by Maine Sen. Susan Collins, in a hearing that examined the issue of seniors being over-prescribed opioids.
Maine and many parts of the country are in the midst of an opioid crisis. Largely fueled by painkillers and heroin, drug overdose deaths in Maine were a record 418 in 2017.
“Many perceive the face of opioid addiction as young. The epidemic, however, intersects just as much with older adults,” Collins said in her opening statement. “According to the (Office of the) Inspector General, one in three Medicare Part D beneficiaries received an opioid prescription in 2016, and the CDC estimates that the number of people age 55 or older treated in emergency rooms for opioid overdoses increased by 32 percent from 2016 to 2017.”
Collins said seniors using opioids are “four to five times more likely to fall” compared with those using other kinds of pain treatment.
“Regrettably, health care providers sometimes miss substance abuse and misuse among older adults, as the symptoms can be similar to depression or dementia,” she said. “Alternatives to opioids are critical, yet those alternatives may also be more expensive and less convenient for patients.”
Collins cited the Press Herald’s “Lost” series, a comprehensive examination of the opioid crisis published in 10 installments in 2017, and pointed out that the crisis has affected all walks of life.
Pattavina noted that older patients present unique challenges in treating pain. Some common pain medications that could be alternatives to opioids, such as ibuprofen and naproxen, “cannot be used in patients with compromised kidney function or certain other medical problems that are common in older people,” he said.
“Patient perception of pain is a real challenge, particularly among those who have been on opioids for long periods of time for chronic pain because they are used to the status quo and fear that nothing will work well for their pain,” he said. “Barring exceptions for cancer, end-of-life care, hospice or palliative care, people in Maine are now (by law) limited to 100 morphine milligram equivalents per day.”
Pattavina said some Maine patients have been taking the equivalent of 2,000 MMEs. “Great care and time must be taken to taper anyone’s dose, and real alternatives must be offered.”
Prescribing opioids for chronic pain skyrocketed in the late 1990s and 2000s, but, according to the U.S. Centers for Disease Control and Prevention, there is no proof that opioids are effective.
A study published this spring in the Journal of the American Medical Association, the first long-term research of its kind, found that common over-the-counter painkillers were as effective, and in some cases more effective, than opioids in controlling chronic pain.
Collins said that while there’s been some progress on opioids, more needs to be done, and she recommended Congress approve the Opioid Peer Support Networks Act, which would fund $25 million per year in grants to “peer support” networks that would help prevent relapses among people in recovery.
“While these steps all represent progress, we must continue to re-examine this issue from every angle, as the opioid crisis continues to tighten its grip not only on older adults, but also on the future generations of America,” Collins said.
Joe Lawlor can be contacted at 791-6376 or at:
jlawlor@pressherald.com
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