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

10/31/2019 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 Reducing Opioid Abuse Among Older Adults Dr. Arlesia Mathis and Denesha Merchant, MPH Florida A&M University – Institute of Public Health November 4, 2019 Presenter Disclosures  Opioid misuse among older adults is  Older adults with opioid use disorder Arlesia Mathis, Ph.D. an important public health concern are at a higher risk of death compared to younger adults. The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:  Nonmedical use of prescription pain  From 1996 to 2010, the number of relievers among older adults is No relationships to disclose associated with negative health opioid prescriptions provided to older outcomes, including falls, hip fracture, patients increased ten times over and traffic accidents 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  Pain in older adult poses unique challenges in their lives. have exploded, and opioid epidemic with adverse consequences has escalated.  Frail elders show declines in muscle strength, balance, mobility, physical activity,  People 50 years and older consume more prescribed and over the counter cognition, endurance, nutrition, and weight. medications than any other age group in the United States.  Opioids reduce the perception of pain and produce a sense of well-being by binding  Older adults have several unique risk factors that make them particularly susceptible to opioid receptors distributed in the brain, spinal cord, and other peripheral tissues. misuse of prescription drugs. 1

10/31/2019  Opioids have a stronger impact on older adults because bodily processes slow as people  The use of multiple medications is a common concern among older people. age.  It has been estimated that 20% of Medicare beneficiaries have five or more chronic  From 2005 to 2014, inpatient stays rose 85 percent for those aged 65 and older (Weiss et conditions and 50% receive 5 or more medications. Among older adults with cancer, al., 2017). Emergency department visits for this group rose 112 % during the same period. 43% receive 10 or more medications.  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  In the US, 33% of Medicare, Part D beneficiaries have at least one opioid (Mattson et al., 2017). prescription. 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 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 Research and Quality among ambulatory senior adults with cancer. Journal of Clinical Oncology. Vol. 33 (13), pp. 1453 – 1459 (PMID 25800766). 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  Senior adults are one of the fastest-growing sectors of the American society. • As the baby boomer generation ages and the population of older  Currently one in eight Americans is 60 and over, but by 2030, this number will increase to one in three. adults in the United States grows, opioid misuse among older adults is becoming an increasingly urgent public health concern.  Older adults make up the largest consumer segment for prescription drugs in the United States. • In addition to the threat of addiction, opioid use can also pose health  The estimated annual expenditure on prescription drugs by senior adults in the United States is $15 billion. risks such as breathing complications, confusion, drug interaction problems, and increased risk of falls, which can be more dangerous  Older adult women take an average of five prescription drugs, for longer periods of time in the older adult population 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 1. What causes the misuse of opioids more than 6 of every 1,000 beneficiaries (CMS, January 2017). among older adults?  Nationally, one-third of Medicare Part D beneficiaries or 14.4 million people had at least one opioid 2. Is the misuse more prevalent among men prescription in 2016, with over 500,000 beneficiaries using very high amounts of the medication (DHHS/OIG, and women compared to other areas? 2017). 3. What percentage of the aging community misuse opioids? 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. 2

10/31/2019  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 GENDER  Women is 40% GENDER  Women is 40%  Men is 26.5%  Men is 26.5% [VALUE]% [VALUE]%  Women are more sensitive to pain than men and  Women are more sensitive to pain than men and more likely to have chronic pain, which contribute more likely to have chronic pain, which contribute to the high rates of opioid prescriptions among to the high rates of opioid prescriptions among 40% 40% women women  The elderly are more likely to be prescribed several different medications at once and for a prolonged duration of time Hispanic  17.3% of Hispanics  Social factors, such as limited English language proficiency, and low health literacy impede adherence Black/African American  12.1% of Black/ African American  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 White  60.7% of Whites  The elderly do not fit the typical drug abuser profile or stereotype and therefore awareness and services for Other  10% of Other this population is lacking 0% 10% 20% 30% 40% 50% 60% 70% Ethnicity 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 3

10/31/2019 MISUSE 80  Doctors in Florida were prescribing at a rate of 71.4 No % compared to doctors in New York prescribing at 70 a rate of 43.9%  81.1% responding yes to misuse 60 50  Doctors in Florida were prescribing at a rate of  18.9% responding no to misuse 40 67.1% compared to doctors in New York prescribing at a rate of 45.1% 30 20 Yes 10 0 2014 2015 Florida New York Percentage of Misuse 80.00% 50% 70.00%  More older adults report misusing hydrocodone 45%  45% represents large metro compared to morphine and oxycodone. 40% 60.00% 35% 50.00% 30%  Sixty-five percent of older adults reported misusing  36.5% represents small metro 40.00% 25% hydrocodone. 20% 30.00% 15%  20.5% represents non-metro 20.00% 10% 5% 10.00% 0% 0.00% Large Metro Small Metro Nonmetro Morphine Hydrocodone Oxycodone Percentage of Misuse Responded No Response  Older adults are misusing prescription opioids.  Whites seniors were mostly likely to misuse opioids, followed by Hispanics older adults.  More older adults living in the south receive opioid prescriptions for  Of the three most commonly prescribed opioids (morphine, pain management. hydrocodone, and oxycodone), hydrocodone is the most likely to be misused by senior adults.  Women are misusing opioids more than men. 4

10/31/2019  The ‘BEERS Criteria’  The overall number of older adults who misuse or abuse prescription drugs will likely increase as the size of the population continues to grow.  Prescription drug monitoring programs  There is a concern that increased monitoring and fear of prescription  Screening older patients drug abuse can be associated limiting access and increasing ethnic or racial disparities. Acknowledgements  Older adults are likely to receive prescriptions for opioids due to chronic, o Dr. Cynthia Harris and the Institute of Public Health painful conditions that often accompany age.  This population is at risk for particularly severe side effects because o Denesha Merchant, MPH bodily processes generally slow with age.  Protocols should be implemented and adhered to for older adults using o Dr. Rima Tawk proven alternatives to opioids. 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 5