It took a lot of convincing for John Evard to go to rehab. Seven days into his stay at the Las Vegas Recovery Center, the nausea and aching muscles of opioid withdrawal were finally beginning to fade.
鈥淎ny sweats?鈥� a nurse asked him as she adjusted his blood pressure cuff. 鈥淟ast night it was really bad, but not since I got up,鈥� replied Evard, 70, explaining that he鈥檇 awakened several times with his sheets drenched.
Even for him, it was hard to understand how he ended up 300 miles away from his home in Scottsdale, Ariz., at this bucolic facility in the suburbs of Vegas. 鈥淭his is the absolute first time I ever had anything close to addiction,鈥� he said. He prefers to use the term 鈥渃omplex dependence鈥� to describe his situation: 鈥淚t was, shall we say, a big surprise when it happened to me.鈥�
As the nation grapples with a devastating opioid epidemic, concerns have primarily focused on young people buying drugs on the street. But America鈥檚 elderly also have a problem. Over the past several decades, physicians have increasingly prescribed seniors pain medications to address chronic pain from arthritis, cancer, neurological diseases and other illnesses that become more聽common in later life.
Evard has a consultation with the acupuncture therapist at the Las Vegas Recovery Center. Evard suffers from hearing loss and pain after an ear surgery. (Heidi de Marco/KHN)
found that in 2011, 15 percent of seniors were prescribed an opioid when they were discharged from the hospital; three months later, 42 percent were still taking the pain medicine.
One in three Americans who have taken prescription opioids for at least two months say they became addicted to or physically dependent on the medications, according to a recent Washington Post-Kaiser Family Foundation poll. (KHN is an editorially independent program of the foundation.)
It鈥檚 no surprise, then, that some seniors end up addicted.
Evard spent his life working as a corporate tax attorney. He鈥檚 spry and white haired, with a contagious grin. A few years ago he and his wife retired to Arizona with their eyes on the golf course. The dream didn鈥檛 last long. Just months later, a virus infected Evard鈥檚 left ear. Overnight, he lost half his hearing and was left with chronic pain. In January, he had surgery to fix the problem.
鈥淔rom the surgeon鈥檚 standpoint, the operation was successful. The problem was, the pain didn鈥檛 go down. It went up,鈥� he recalled.
His doctors prescribed opioids, including Oxycontin. 鈥淭hey decreased the pain, particularly at first,鈥� said Evard. 鈥淎s time went on they had less and less effect, and I had to take more and more.鈥�
As the doctors increased his dosage, Evard鈥檚 once active life fell apart. He was confused, depressed, and still in pain. 鈥淚 was effectively housebound. I couldn鈥檛 play golf anymore. I couldn鈥檛 go to social events with my friends or my wife.鈥�
He couldn鈥檛 think of anything except the pills and when he could have the next one. He knew he was in trouble 鈥斅燿espite having taken them exactly as his doctor instructed.
鈥淚 was a rule-follower,鈥� he said. 鈥淎nd I still ended up, in a mess!鈥�
In 2009, the American Geriatric Society came out strongly in favor of opioids, that seniors with moderate to severe pain be considered for opioid therapy. The panel cited evidence that seniors were less likely than others聽to become addicted.
鈥淵ou don鈥檛 see people in this age group stealing a car to get their next dose,鈥� Dr. Bruce Ferrell, chairman of the panel that issued the Society鈥檚 guidelines, at the time.
Mel Pohl, medical director of the Las Vegas Recovery Center, called that conclusion a 鈥渉orrible misconception.鈥�
Evard receives acupuncture treatment for his hearing loss as part of his stay at the Las Vegas Recovery Center in Las Vegas. (Heidi de Marco/KHN)
鈥淭here鈥檚 no factual, scientific basis for that. The drug takes over in the brain. It doesn鈥檛 matter how old the brain is.鈥�
The problem is that chronic pain is common as people age, and there aren鈥檛 many good options to treat it. Even aspirin and ibuprofen carry bleeding risks. The 2009 AGS guidelines are no longer in use, but opioid medications remain a crucial tool to treat pain in older people. Most people are able to take opioids in small doses for short periods of time without a problem.
鈥淲e really don鈥檛 use opioids necessarily as the first line of treatment because we understand what the risks are. But we also don鈥檛 want to see our patients suffering needlessly if we can provide them with relief,鈥� said Dr. Sharon Brangman, past president of the AGS. The trick, she said, is to try聽non-pharmacological options such as acupuncture first and to use the smallest effective opioid dose possible, if necessary.
Still, most of the seniors at the Las Vegas Recovery Center have taken the drugs as prescribed by a willing doctor trying to address their pain, said Pohl. That pattern sets them apart from many of the younger patients, many of whom start buying drugs on the black market after being turned away by physicians.
Nonetheless, in the past 20 years, the rate of hospitalization among seniors that is related to opioid overuse . But relatively few of them end up in rehab. Pohl said that鈥檚 due to a combination of factors.
鈥淭hey鈥檝e grown up in an era where drug addiction and alcoholism [were] evil, and I think that鈥檚 internalized for some of the folks that I鈥檝e seen,鈥� he said, so they don鈥檛 seek help, particularly from an in-patient facility. Also, some rehabs not are equipped to deal with the complex medical problems common among older people.
Another problem are patients whose addictions have been misdiagnosed as dementia. 鈥淲e鈥檒l have a family come [visit], three weeks into treatment, and it鈥檚 like 鈥極h my God, you鈥檙e back! I haven鈥檛 seen that glimmer in your eye in 20 years!鈥欌�� said Pohl.
It took John Evard about a week to get over the vomiting and flu-like symptoms of detox, which can be particularly hard on older patients. He鈥檚 speaking out now because he doesn鈥檛 want other seniors to fall into the same trap.
鈥淒on鈥檛 just take the prescription because it鈥檚 part of the checkout process from the hospital,鈥� he cautioned. 鈥淚t鈥檚 your body, take charge of it, and push for alternatives at all costs. And if you do go on, get off them as fast as you can.鈥�
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