Public health officials and addiction specialists are concerned about the growing prevalence of opioid use among older adults and increasingly looking outside Medicare for non-drug strategies to ease pain.
Those over age 60 now make up a quarter of long-term opioid users.
Physical therapy, telehealth services, acupuncture and yoga are all being touted as effective strategies to ease chronic pain in older adults, while avoiding the dangers of over-using opioids.
Approximately half of community dwelling older adults and most residents of nursing facilities report persistent pain. They often juggle multiple providers and multiple health problems, seeking pain relief from surgeries or conditions like osteoporosis, arthritis or fibromyalgia.
Opioids have a stronger impact on this population, because aging affects how the body processes and excretes drugs. Older adults also tend to be on multiple medications, which can interact with pain medications and cause serious side effects.
They are more likely to use prescription opioids for longer periods than younger adults, increasing risk of misuse and abuse, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
In 2016, more than a third of Medicare Part D beneficiaries, or about 14.4 million people, had at least one opioid prescription, and a half-million seniors used very high amounts of the drug, according to a report by the Office of the Inspector General at the Department of Health and Human Services.
Yet many older patients do not realize they are addicted until their prescriptions run out, according to Edward Harper, a licensed clinical social worker and a drug and alcohol counselor in Knoxville, Tenn. “Then, if they can’t get their meds refilled right away, they go into withdrawal, and suddenly, there’s an epidemic,” he said.
Alternative strategies to manage pain are gaining interest, including acupuncture, yoga and massage, said Wayne Jonas, a family physician and former head of the Office of Complementary and Alternative Medicine at the National Institutes of Health.
Crucial supports for older individuals are often lacking, however. Even for those seeking alternatives to opioids, barriers like accessibility and cost make non-drug pain management approaches difficult to implement.
Traditional Medicare does not typically pay for non-drug therapies to address pain or imposes limits, despite recommendations by the American College of Physicians, the Centers for Disease Control and Prevention, and the Food and Drug Administration. That leaves many seniors on the hook for the total cost.
Even covered services can be difficult to access. For example, physical therapy is a proven pain management strategy. Medicare may offer some reimbursement. Yet, many older adults may depend on family or friends to drive them to physical therapy, limiting their options, especially if they need to go three or four days a week, Harper explained. In some regions, particularly rural areas, public transit may be limited or non-existent.
The good news is that the private sector may be starting to take notice. Ride sharing services Uber and Lyft are partnering with physician offices, hospitals, clinics, and therapists to get patients to and from appointments. The facility or practice picks up the cost of the ride.
Often, assisted living communities bring in physicians, nurses, and therapists so residents don’t have to travel. Others offer therapies like meditation, dance or yoga.
Health IT is also well positioned to address access and cost challenges. Medicare and other insurers do pay for certain telehealth services; other complementary services can be found online for little to no cost.
“Online behavioral counseling, physical therapy, yoga or meditation could supplement in-person care,” Harper said. He envisions more opportunities for Internet-based, patient-centered, personalized care, from nutrition counseling to stress management.
This strategy would fill in some of the gaps in care, mitigate the costs, allow physicians to monitor prescription adherence and expand use of recovery support programs to those who develop addictions.
It’s all out there in the Internet, he said. “With us becoming much more of a digital society, we can do that, we can do e-training, we can do e-physical therapy and take a telemedicine approach.” He also thinks opportunities abound for personalized care through virtual reality technology. “If somebody can provide it for them, there will be options out there to do something different.”
These ideas are particularly relevant for the Baby Boomers and the age group just behind them, who are comfortable with digital solutions. Innovative strategies like these are adjunct opportunities to help people remain in treatment, obtain counseling and reduce dependence on opioids.