Ask anyone my age about what hurts and you will likely get either “don’t ask” or a long litany of assorted aches and pains. And some of us suffer from chronic, unremitting pain that can make life miserable and falling asleep almost impossible.
Given the confluence of senior pain and the US opioid epidemic, it’s not a bit surprising that recently published Medicare data show incredibly widespread use of opioid painkillers among seniors. This is a wakeup call – we must work to change senior attitudes toward pain, doctor prescribing practices, and Medicare monitoring.
The Inspector-General of the Department of Health and Human Services recently reported on last year’s opioid use among the 43 million seniors and disabled people who are covered by Medicare Part D insurance.
Fully one third of Medicare Part D participants (over 14 million people) filled at least one opioid prescription last year. Almost ten percent received opioids for at least six months. One and a half million patients were receiving very high doses – as much as 120 milligram equivalents a day of Vicodin. And seventy thousand people were prescribed such extremely high levels that fatal overdose was a lurking risk.
And there is poorly controlled doctor shopping and pharmacy shopping – patients who get pills from multiple doctors and multiple pharmacies, acquiring enormous quantities for their own use or for resale into the secondary market. And it is not hard to identify doctors who carelessly prescribe far too many pills to far too many patients.
The geographic imbalance in opioid use among Medicare patients is also remarkable – 45 percent in Mississippi and Alabama; only half as much in New York and Hawaii. Pain doesn’t know state boundaries, so differences in patient expectations and physician prescription habits must be at work.
The frequent overuse of prescription opioids is especially alarming because they are often over-prescribed with several other anti-anxiety and sleep meds that can interact with opioids, causing confusion, sedation, delirium, falls, overdoses, and even deaths.
How Does US Opioid Usage Compare to Other Times and Places?
Aging has always been a pain, but never before in human history – and nowhere else but in the United States – has it ever been the occasion for such massive addiction to opioid drugs.
The US comprises only 5% of the world’s population, but we consume 80% of worldwide opioid prescriptions. Seniors in other countries around the world are living with their pains, without adding the enormous additional burden of developing an opioid addiction.
Seniors in the US also managed to gracefully tolerate the pains of old age until twenty years ago, when the combination of greedy Pharma and careless docs got us hooked on seductively addicting opioid drugs.
Our US Medicare system has fallen into Pharma’s trap. It has mindlessly funded a fantastic giveaway to the profit hungry drug companies, without considering the dire health impact on its beneficiaries and without attempting to discipline the careless prescribing habits of the doctors it has been subsidizing.
The terrible US opioid addiction problem would have been much less terrible if Medicare had been on its toes and stepped in earlier. Having collaborated in creating the problem, Medicare must now step in to become a big part of the solution.
What Can Medicare Do to Help Solve the Opioid Epidemic?
Seniors in the US hooked on prescription opioids can’t just go cold turkey. Any draconian effort to suddenly turn off the spigot will cause enormous hardship to them and will drive many into the cheaper, illegal heroin market.
In order to solve the opioid crisis, Medicare must take the following five steps:
- Step #1 – Medicare should identify the doctors who have become drug pushers and force them to follow standardized protocols to prevent them from hooking new patients and to guide their treatment of those already hooked.
- Step #2 – Medicare patients who are already hooked on prescription opioids should be offered a free second opinion consultation to review treatment options. Some will have terminal illnesses, for which opioids make perfect sense. Many will want to attempt a slow and careful detox – which should be provided to them free of charge. Some will need maintenance treatment, which should also be provided free of charge. And many more people should be offered free methadone and Suboxone treatment, which are much less dangerous than long-term prescription opioids.
- Step #3 – We need to find funding sources for all the free treatment that will be needed to manage the opioid epidemic. Some will come from government, but Pharma should be another source. The Big Tobacco settlements twenty years ago provide a model. Pharma drug pushing has caused the current mess and Pharma should have to pay its share to clean it up. All the pertinent governmental agencies should join forces in identifying legal recourses so that Pharma profits are clawed back to fund the cleanup. The burden should not be just on the patents hooked or US taxpayers.
- Step #4 – We need to change the rules so that Medicare can negotiate drug prices – to end current and ridiculous Pharma price gouging. This would radically reduce taxpayer subsidized drug costs across the board and would specifically reduce Pharma’s incentive to hook people in order to reap huge rewards.
- Step #5 – We should establish a real-time system for tracking drug dispensing from pharmacies. If Visa can immediately detect an unapproved credit card purchase anywhere in the world, Medicare should be equally able to stop the rampant doctor and pharmacy shopping documented in the IG report. A computer system should be developed to detect – in real time – whether patients are doctor and pharmacy shopping.
Medicare opened the door to the opioid epidemic in seniors. Now it must switch gears to help close it.-Allen Frances
Advice to Fellow Pain Suffering Seniors
I feel your pain every time I try to go up or down a flight of stairs, but prescription opioids are not a safe answer. The short-term gain in pain relief is not nearly worth the risk of a lifelong devastating addiction.
Prescription opioids are indicated only narrowly – in terminal illness and for the first few days after some surgical procedures in people who are at very low risk for addiction. Any other or longer term use may have a very unhappy ending. Using opioids for chronic pain is usually a recipe for disaster.
How, then, should we elders deal with pain? Try some combination of exercise, yoga, meditation, socializing, music, distraction, hot baths, or cold presses, cognitive/behavior therapy, and/or non-opioid painkillers. Whatever helps short of opioids. And as we age, we must recognize that being pain free is no longer a reasonable goal. Living with pain gracefully is part of the wisdom of the ages.
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