For patients struggling with opioid abuse, the beginning of their relationship with the drugs often started off in a mundane way — a back injury at work, a flare up of arthritis pain or even just dealing with persistent migraines.
“A patient I saw recently, she’s in her 60s now, but about 15 years ago was prescribed a medication for migraines that had codeine in it. She was taking it pretty regularly for three years and at some point, her doctor cut her off and she went into pretty serious withdrawal and ended up in a methadone clinic… She wanted to come off of opioids and really found nobody who could help her do that, who could help manage her pain. And at some point, she tried to stop her methadone herself and went into terrible withdrawals. And [she] ended up on heroin because a friend of hers suggested that that might be something that could help her out.”
Dr. Ruben Halperin specializes in internal medicine at Providence Medical Group, serves as vice chair of the Oregon Pain Management Commission and sits on the board of the Tri-County Opioid Safety Coalition. He spoke with OPB's All Things Considered about the relationship between seniors and opioid abuse.
On seniors being prescribed opioids for decades:
"For a lot of them, they probably started in their 40s or 50s and were treated for conditions like back pain, fibromyalgia or chronic headaches and were just given just regular doses of pain medicine. And they work pretty effectively — at first.
Over time, people find they need higher and higher doses, and they start running into issues with complications or side effects. So I think the issue is not that seniors are being prescribed [opioids], it’s that people are aging into being seniors on prescriptions."
On the challenges of treating someone who has aged into an opioid dependence:
"Even if you could get rid of their opioids, there’s still the underlying issue that led to them being on opioids. Some of them may have started for back pain, but as they’ve gotten older, they now have arthritis or [have had an] accident in the interim. But they are also dependent on opioids, and so you need to treat that [because] stopping anything abruptly will put them into withdrawal and make them actually feel a lot worse.
"People who have developed some of the other 'illnesses of growing older,' they have to come off [of opioids]. Either they start developing dementia, or they have other psychiatric problems that aren’t compatible with being on chronic opioids .... The other thing that’s a big issue is falls. As people get older and frailer, they fall, and opioids are a huge contributor to that."
On the difficulty of addressing opioid use among seniors:
"It’s a really nuanced conversation; you have to shy away from blaming the patient. A lot of them were prescribed [opioids] and were doing what doctors said. You also have to be really careful about the language you use, like addict or substance abuser.
"For better or worse, even though we understand them as medical illnesses, we don’t treat them as medical illnesses. Opioid addiction is one of the few medical illnesses that can get you arrested ... You don’t see a whole lot of people who have opioid abuse disorders who are saying, 'Oh yeah, I’ve been using heroin every day for 30 years.' There’s a lot of stigma."
Listen to the whole conversation between All Things Considered host Kate Davidson and Dr. Ruben Halperin by clicking on the audio file above.