The COVID epidemic contributed widely to the worsening of substance use disorders in people of all ages. This increase in the misuse of drugs was symptomatic of people’s struggle with lockdowns, regulations and an uncertain future. Opioid abuse was central to this trend – as a category, opioids are among the most addictive drugs and have potent effects. But in itself, this phenomenon was nothing new – opioids have been wreaking havoc on certain sections of society for two decades. To the extent that phrases like “opioid crisis” and “opioid epidemic” have been coined, to describe this wave of opioid addiction and overdose spreading across the US.
The World Health Organization (WHO) estimated in 2021 that of the half a million deaths each year related to drug use, more than 70% were linked to opioids. And of these, more than 30% were due to opioid overdose. It would be easy to surmise that overdose deaths stem mainly from the use of illegal drugs. And certainly, there are increased risks to using drugs sold on the street: not only are they far more potent than anything a doctor would prescribe, they can be mixed with other, dangerous, substances. This can create all kinds of health issues, including medical emergencies. Although treatment for opioid misuse is usually covered by healthcare insurance policies, it is still a process and does not solve addiction problems right away. Prevention and information are basic steps which can help solve the issue on a greater scale.
Prescription opioids carry almost as great a risk of overdose, if abused. Also, in the majority of cases, addiction to opioids generally begins with a prescription to some of the most common ones such as Oxycodone and Methadone. While purchasing illegal drugs appears more prevalent among young people, prescriptions can be given to anyone, at any age. And in recent years, it has become apparent that older age groups are increasingly in danger of prescription opioid overdose.
A Brief History of Opioid Use in the USA
Origins
Opioids first appeared on the scene as painkillers, and it is mainly for pain relief that they continue to be prescribed to this day. The first opioid to be used medically was morphine, which is derived from the seeds of a species of poppy. It was first used widely in the 1860s, to treat soldiers injured in the civil war. However, it became apparent that many of those treated remained dependent on morphine in the years that followed. At the turn of the 19th century, the pharmaceutical company Bayer produced heroin. The claim was that it was a less habit-forming alternative to morphine. It goes without saying that heroin was never going to be safe – in the decades that followed, its use and prescription became illegal. Furthermore, the government established restrictions on the use of opioids and narcotics. And made formal prescriptions for them compulsory.
Recent Decades and the Present Day
The Controlled Substances Act was passed in the 1970s. This act divided medications into groups and classes, according to the risk of abuse and dependence associated with each. The aim was to lay the foundation for safe prescription, appropriate to each case. But the road to hell is paved with good intentions, the idiom says. In the 1990s, there was a rise in the prescription of opioid medication. This was partly due to its efficiency. It also coincided with the release by Purdue Pharma of OxyContin (a derivative of oxycodone). Doctors embraced this and other opioid painkillers as the most effective option for pain relief, and continued to prescribe them enthusiastically for twenty years. In this way, they unwittingly created a whole generation of opioid addicts. Many of these subsequently switched to illegal opioids, first heroin, then synthetic opioids such as fentanyl, as their drug habits worsened. The US is currently still in a state of public health crisis, as of around 2017.
Risk of Overdose Among Older Adults
Earlier this year, Time Magazine labeled older Americans the “ignored victims of the opioid epidemic.” And the National Safety Council recently noted that the number of opioid deaths among individuals aged 55 and older was growing rapidly. It estimated that the huge leap in preventable opioid deaths was “the byproduct of the overall disruptions and stress induced by the COVID-19 pandemic.” This we have mentioned above, but in fact, several years prior to this, high-risk opioid use was already an observable trend among older adults. In 2016, the Centers for Disease Control and Prevention (CDC), had noted a marked increase in overdose deaths among over 65s in previous years.
The problem is that opioid misuse in citizens aged 55 and above is almost never illegal drug abuse. It originates from legitimate, legal and above-board prescription medication. As a result, there is a severe lack of studies and data documenting this trend. Older Americans have suffered “in the shadows” as it were, and the risk of opioid use in their age group is still not being adequately addressed.
Why Older Adults are at Risk
There appear to be various contributing factors to high-risk opioid use in older people. One is, quite simply, over prescription by doctors. This alone suggests that not all prescribers are as scrupulous and ethical as they should be. Another is long-term use – with the natural aging process, chronic pain can appear, requiring continued medication. This increases the risk of addiction, which in turn can lead to overdose. Yet another parameter is the association of opiates with other medicines – their joint prescription with benzodiazepines, for example, appears to be a combination particularly conducive to dependence.
Opioids that are commonly used for pain relief in older adults include morphine, oxycodone, hydrocodone, hydromorphone, codeine, tramadol, buprenorphine and more. In spite of the alarming length of this list, CDC guidelines state that opiate treatment is not first-line treatment for pain, except in the case of cancer patients. Instead, it recommends other approaches such as physical therapy, occupational therapy, or even spiritual resources. Hopefully, with greater awareness of the risk of opioid overdose among older adults, these guidelines will be followed more closely.
If you have a parent, elderly relative or loved one in the older citizens age bracket, who is currently on prescription opioids, it is important to be aware of the dangers this may entail. Speak to them, or their MD if you have any concerns – prevention is better than a cure.
