The cover story in the June issue of the AARP Bulletin took me by surprise. Generally, the free paper for retired folks can be a bit of a snore. But this time, extensive coverage of a new type of drug addiction, that which deals with legal prescriptions from licensed doctors or dentists, paints a whole different picture.
The first page, signed by Editor-in-Chief Robert Love, describes a nationwide addiction to opioids as it threatens older Americans in particular. Having had post-surgical painkillers pushed on me by well-meaning dentists, I was pleased to learn that organizations representing these medical experts have sent out letters to their memberships, warning of the problems and how to solve them. That means writing prescriptions for three days, instead of 30.
Recently, I attended a Smart Women’s Seminar featuring local narcotics officers, and learned how these addictions begin. It seems that after surgery or injury, when pain is a real problem, doctors often overprescribe strong painkillers. The lecturer noted that he was given a 30-day supply but that side effects drove him back to ask the doctor for something less strong. The doctor then prescribed a different drug, again in a 30-day supply. He returned one more time for something even weaker and was given another prescription for a 30-day supply.
Faced with a three-month supply of drugs he no longer needed, the officer then had to figure out how to get rid of the drugs. Don’t put them down the toilet, he warned. They wind up in the water-treatment plant, where they are not destroyed by chemicals, then into rivers and creeks where they harm fish and other wildlife. They also contaminate the drinking water supply of unsuspecting residents.
Experts say that drug dependence can set in after just a few days. “Within one week, you’ve made that person physiologically dependent on the drug, meaning they feel some discomfort or side effects when they stop using,” said Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing.
The statistics are frightening. In 2015, nearly 14,000 people age 45-plus died from an opioid overdose — 42 percent of all such deaths in the U.S., according to the Centers for Disease Control and Prevention (CDC). The actual number is likely much higher, as overdoses in older people are often misdiagnosed as heart failure or falls, according to Kolodny.
We overestimated the benefits of opioids and underestimated the risks, a senior medical adviser at the CDC said.
And pharmaceutical companies have marketed opioids aggressively to physicians, especially after the Federal Drug Administration Approved OxyContin in 1995, the AARP article said. So beginning in the late ’90s, when older patients suffering from chronic conditions asked for pain relief, their doctors innocently wrote prescriptions for OxyContin, Vicodin, Percocet and other opioid painkillers.
The problem may start with medical schools, where students have been told that opioid medication is not addictive as long as it is given to someone in legitimate pain. Doctors now realize this is not true.
Even though the CDC issued guidelines last year, doctors are still overprescribing. A 2016 survey found that 99 percent of physicians prescribe opioids beyond the dosage limit of three days recommended by the CDC.
As prescription drugs become harder to obtain, some patients turn to heroin, which is generally cheaper. However, heroin has been laced with carfentanil, a drug that is 100 times stronger than the opioid fentanil, the AARP article explained. The primary use of carfentanil is to sedate elephants.
Some federal agencies are addressing the problem. For instance, 46 states now have caps on the quantity of opioid drugs that a Medicaid patient can receive. And 42 states have established medical criteria that a person must meet before getting a prescription through Medicaid.
While these rules are somewhat effective, there also needs to be a major attitude shift. Some people still hold the mistaken belief that addiction is a moral failing instead of a chronic medical condition that requires treatment.
A drug dealer currently serving a 12-year sentence says older people are willing to sell their pills to make ends meet. They have become a new source of illicit prescription painkillers sold on the open market and are often recruited by drug dealers. In some cases, caregivers and family members are pilfering medications for profit or to feed their own addictions.
To avoid addiction, tell doctors and dentists not to prescribe opioid painkillers. Try an over-the-counter N-SAID such as Advil along with an ice pack. Bromelain, Papain (enzymes), vitamins A and C, Arnica, and the herb turmeric are all useful in reducing swelling and pain.
The June issue of AARP Bulletin is still available and can also be found on AARP.com.