The Truth About Treating Pain in Senior Citizens

Objections to Senior Citizens Receiving Opioids

According to a recent report by the Office of Inspector General for the U.S. Department of Health and Human Services, opioids are commonly prescribed for senior citizens in pain. Almost 12 million Medicare beneficiaries received at least one prescription for an opioid painkiller last year. The report goes on to say the cost of those prescriptions was $4.1 billion.

The report includes opioids prescribed for all pain, not only for chronic pain, which is what makes the statements from the Office of the Inspector General especially puzzling. It seems that the Office of the Inspector General is confused about the realities.

Here’s an example:

Although I am disappointed, I am not surprised to read what sounds like an objection to prescribing opioids to seniors. The report from the Office of the Inspector General for the U.S. Department of Health and Human Services seems to raise an objection to the cost of treating seniors’ pain.

“We are concerned about the high spending and the number of people receiving opioids,” said Miriam Anderson who led the recently-released study. “This raises concerns about abuse. This is a serious problem facing our country.”

Consider the implications of Anderson’s question and ask yourself: What is our priority regarding seniors?

Quality of Life or Cost

Do we care more about the quality of life seniors can live, or about the cost of providing seniors with the best possible quality of life?

I have been saying that the war on opioids is really about money for ten years. Anderson seems to unabashedly admit that I’ve been correct.

In addition, when Anderson learned that one in three Medicare recipients are prescribed an opioid, she concluded that abuse must be involved. Her line of reasoning misses one obvious fact.

One out of every three Americans have chronic pain.

It’s reasonable, therefore, that it costs a lot of money to treat chronic pain. Do we have the same concern about how much money we spend on statins to lower cholesterol as we do about how much money we spend on opioids to manage pain?

In 2010-2011, more than $20 billion dollars were spent on generic statins by nearly 27 million Americans. However, during that time period, only 11.5 million people — less than half as many as those who required statins — were prescribed an opioid. Does this mean statins improve the quality of life more than an opioid?

Let’s remember that a portion of these opioid prescriptions were prescribed for post op pain and cancer-related pain. No one accuses doctors of overprescribing painkillers for cancer-related pain. There may be more pills prescribed than are needed for acute pain, but it is hard to predict the exact amount of medication each patient may require, so surgeons often provide enough to cover patients’ medication needs for most situations. This may leave some extra medication unused, but that doesn’t mean the drugs are abused by the seniors.

Yet the magnitude of opioid use among seniors is “astounding,” according to Frederic Blow who directs addiction research at the University of Michigan’s medical school and was not involved in the study.

I don’t understand why Blow finds the amount of opioids used among seniors to be surprising. If 50% of all seniors (aged 65 years and older) have chronic pain, and if other treatments are ineffective or unavailable, what would Blow (or any other researchers) see as an alternative?

I refuse to believe that Blow is suggesting that seniors’ pain should go untreated.

“[Opioid addiction is] not just a young person’s problem,” Blow points out. The overdose risk for older Americans is heightened by medication interactions and the use of alcohol.

Addiction is also a risk, Blow continues, so doctors should help patients consider alternatives — such as meditation, yoga, walking, and weight loss — for treating chronic pain. This would allow patients to minimize opioid use.

Of course, alternative therapies should be used. However, this platitude is more easily preached than practiced. Alternative therapies are rarely adequate for treating most people with moderate to severe pain. When they are adequate, they are rarely affordable for most people.

Reevaluating Priorities in Treating Senior Citizens

The Office of Inspector General for the U.S. Department of Health and Human Services should reevaluate its priorities. Its real concern should be about the enormous prevalence of chronic pain in seniors and the lack of payer coverage for some of the more effective alternative treatments.

It is unfortunate that researchers and the Office of Inspector General seem to ignore the needs of seniors in pain and blame them for the opioid crisis.

There has to be an adjustment in our attitudes. Instead of complaining about the cost of opioids used by senior citizens, we should be asking why we don’t have safer and more effective therapies for seniors.

These are our parents. These are our grandparents. These are the people who cared for us when we needed them.

Isn’t it our turn to attend to their needs as best as we can?

Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.

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Copyright 2016, Lynn Webster, MD