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Doctor: Seniors have 'highest rate of drug overdose death'

Andrew Kolodny of Physicians for Responsible Opioid Prescribing discusses 'hidden epidemic' of elderly painkiller abuse

In “Take as Prescribed,” Fault Lines explores why so many elderly Americans are becoming addicted to painkillers—and what's being done to stop it. The film premieres on Monday, Aug. 31, at 10 p.m. Eastern time/7 p.m. Pacific on Al Jazeera America. | Click here to find Al Jazeera in your area.


Of the nearly 23,000 deaths in the U.S. attributed to prescription drug overdose in 2013, more than 70 percent resulted from the abuse of opioid painkillers, according to figures released this year by the Centers for Disease Control and Prevention. These drugs—the most common of which are oxycodone and hydrocodone (sold under the brand names Oxycontin and Vicodin, respectively)—are increasingly being prescribed to older Americans. Medicare data released last year showed that 8.5 million Americans aged 65 or older received opioid scripts from their physicians.

Andrew Kolodny, chief medical officer of the Phoenix House, a drug and alcohol rehabilitation center with locations throughout the U.S., took note of an emerging opioid drug epidemic as a young practitioner. In recent years, he’s been a leading voice on the issue, warning of the consequences of the over-prescription of this class of drugs, most often for chronic pain.

Fault Lines spoke to Kolodny, who is also the executive director of Physicians for Responsible Opioid Prescribing, about misconceptions surrounding the use and misuse of these painkillers, as well as who is most at risk of abusing these drugs. An edited transcript of that conversation follows: 


Fault Lines: When talking about people being addicted and overdosing on painkillers, we tend to think of young people abusing these types of opioids. Is this only a problem for the young?

Kolodny: Many people think of the opioid problem as something that's affecting young people who are abusing painkillers that were not prescribed to them. The opioid problem is perhaps even more severe in older Americans who are receiving legitimate prescriptions from doctors. We see the highest rate of drug overdose death in older Americans. And when you look at the groups that have had the greatest increase in problems associated with prescription opioids—for example, visits to hospital emergency rooms because of opioid misuse—it's Americans over 65.

Nobody wants Grandma's body to go to the medical examiner for toxicology and autopsy. They want Grandma to go to the funeral parlor. No one wants Grandma to have died of a drug overdose.

Andrew Kolodny

Physicians for Responsible Opioid Prescribing

Why is opioid addiction among the elderly being called a “hidden epidemic?"

When an older person doesn't wake up in the morning, let's say, because they overdosed on prescription opioids in their sleep, what typically happens is the family will call 9-1-1. And if EMS or the police come to the scene, there's nothing suspicious there.  And if the patient had multiple medical problems, what's often done is the patient's doctors are called and asked to come to the home and fill out the death certificate. Very often, a natural cause is listed as the reason for the death, rather than an opioid overdose, even in a situation where everybody knew Grandma had a problem with her pills.

Nobody wants Grandma's body to go to the medical examiner for toxicology and autopsy. They want Grandma to go to the funeral parlor. No one wants Grandma to have died of a drug overdose. So there's very good reason to believe that even with the already high overdose death statistics in older Americans that we have, there may be a massive undercount.

What’s causing more elderly patients to get hooked on opioids?

Our population is aging. The baby boomers are getting older—and as we get older, part of aging is that we're likely to experience aches and pains more frequently. We're more likely to visit a doctor with a complaint of pain. In the campaign to encourage aggressive prescribing of opioids, which was launched by drug companies, much of it focused on exaggerating the risks of alternative treatments like Advil or Tylenol and minimizing the risk of drugs like opioids. So many physicians have been taught that the best pain reliever you can prescribe an older person would be an opioid.

According to Medicare data released last year, 8.5 million Americans aged 65 or older received opioid prescriptions from their physicians.
Víctor Tadashi Suárez for Al Jazeera America

A promotional pamphlet by opioid manufacturer Janssen pharmaceuticals targeting elderly patients says that opioids are “rarely addictive when used properly for the management of chronic pain.” Do you agree with that?

I would love to introduce whoever wrote that to many of the patients that I've treated who developed addiction to opioids later in life. It's just totally false.

When we talk about opioid painkillers, we're essentially talking about heroin pills. Now that doesn't mean we should never prescribe them. They're very important medicines to ease suffering at the end of life—and they're also useful if you're using them for a few days, for example, after major surgery. But if you expose somebody repeatedly, on a daily basis, that person can easily become addicted to an opioid, and it doesn't make a difference whether or not they're young or old.

What’s wrong with using opioids to treat chronic pain in the elderly?

For the vast majority of people who might be suffering with chronic pain, opioids are a lousy option. They're on it around the clock. Within a week, you've made your patient physiologically dependent on that opioid, meaning it's going to be hard for them to come off. And the longer they stay on it and the higher the doses get, the more difficult it will be for that patient to ever come off of the opioid. And the message there is that the patient shouldn't have to feel any pain. They should just take the medicine around the clock, whether or not they're experiencing pain. That message, that way of promoting opioids, has led to a public health crisis.

Do not prescribe opioids for fibromyalgia, for chronic headache, for low back pain. You're more likely to hurt the patient than help them.

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