Perceptions of opioid policies and implications for pain treatment in older adults
Wednesday, April 24, 2019
Pain management can be complex for the 66 million individuals in the United States experiencing acute pain and the 100 million suffering from chronic pain. Opioids successfully alleviate pain for many; however, morbidity and mortality rates are rising.
State responses to this public health threat include the creation of prescription pain management policies, such as limiting the number of pills that can be dispensed and timing for refills.
Some worry that these policies don’t accommodate specific and unique needs of all patients who rely on opioids for the management of their pain. This includes older adults who represent a significant and growing, proportion of healthcare consumers.
A University of Michigan National Poll on Healthy Aging examined the views and experiences of adults aged 50 to 80 years on opioid prescribing and related policies.
The findings reflect their fears and concerns about cost, logistical barriers, and access when pain medication is needed. Patient tolerance levels, the risk of addiction, and education from providers can all vary and influence the behaviors of this population.
Unused Pain Medication
- Almost half of poll respondents who filled at least one opioid prescription in the last two years reported having left over pills.
- 86% saved unused medication in case they had pain again.
- Of those who did not have leftover medication, 68% said they would save it for future use if they did have unused pills.
Disposal of Unused Pain Medication
- Only 13% of older adults report disposing of unused medications at a police station, authorized pharmacy, or community takeback event.
- Even fewer (9%) disposed of unused medications at home — by flushing it down the toilet or putting it in the trash
- 39% of respondents said they would definitely use over-the-counter products that deactivate medications if they were available for free. 38% said they might use these products for free.
- 70% of respondents said they would not purchase a product if the cost was $5 to $10
- Even if given a medication disposal product for free, 24% would still not use it. The most common reason (62%) being they would rather save the medication for future use.
- 53% do not support a policy of required disposal of unused opioids.
- A majority of respondents support opioid-related policies that assess patient risk by requiring providers to review prescription records (54% strongly support, 41% support) and requiring patients to disclose prior opioid medication use (51% strongly support, 43% support).
- Older adults strongly support (38%) or support (42%) special training for healthcare professionals in prescribing and dispensing opioids.
- Only 60% report they were told by their prescriber or pharmacist about side effects or when to reduce prescription pain medication use.
- Less than 50% of respondents say they were told about the risk of addiction or overdose, or what to do with leftover pills.
- 95% of poll respondents indicated strong support or support for required review of patient prescription records.
- 26% of those responding don’t support any prescribing limits.
State policies that are written for the “typical” acute or chronic patient don’t always meet the needs of patients; nor do they recognize variations in what might be deemed appropriate opioid use for each individual.
Older adults are concerned about their access to prescription pain medications and fear they won’t have what they need — when it is needed. They also see public health disposal requirements as jeopardizing their individual ability to treat pain, especially when their access to the healthcare system can be limited.
To be successful and avoid unintended consequences, prescribers and state policymakers will need to find ways to address the fears and education needs of older adults. Cost, mobility, transportation and other barriers that are common in this population will also need to be considered in the design of policy to ensure the desired consumer behavior changes.
Source: National Poll on Healthy Aging/University of Michigan
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