One day at a time
When music legend Prince died recently from an overdose of fentanyl, it looked like just another example of celebrity excess. But his death is more a cautionary tale for some of his peers: aging baby boomers.
After decades of energetic stage performances in his trademark high heels, the 57-year-old superstar treated his aches and pains the same way millions of other middle-age Americans do: with powerful prescription opioids.
Prince’s subsequent addiction to those painkillers shows the peril facing a generation of baby boomers trying to manage pain from surgery, physical trauma and chronic or periodic illness.
Ranging in age from 51 through 69, boomers are at the stage of life when it’s common to develop long-term pain. That can put them at greater risk for dependence, addiction and possible overdose from prescription opioids, experts say.
44% Amount of Florida’s opioid deaths in the first half of last year that were of people 50 and older
Oxycodone and hydrocodone are two of the most common prescription opioids involved in overdose deaths.
In Florida, people 50 and older accounted for 121 – or 44 percent – of the state’s 274 oxycodone overdose deaths in the first six months of last year, a recent state report found.
During the same period, 56 – or 52 percent – of Florida’s 108 hydrocodone deaths involved people 50 and older.
The problem is particularly worrisome in the Bradenton/Sarasota area, the epicenter of Florida’s heroin and opioid crisis and a haven for older vacationers and retirees.
Youthful drug use, and now more aches
As they grow older, boomers are likely to develop multiple ailments and to see several doctors who prescribe them different medications simultaneously – often without realizing it. When those drugs interact, they can cause adverse effects such as accidental poisoning, said Siobhan Morse, the director of research and fidelity at Foundations Recovery Network, which operates drug treatment facilities in several states.
Nearly 15,000 people suffered fatal overdoses on opioid pain medications in 2014, according to the Centers for Disease Control and Prevention. About 40 percent – or nearly 5,900 – were 50 or older. That’s almost an elevenfold increase since 1999.
Prescription drug abuse by those ages 50 to 59 has been increasing, along with illicit drug use among people ages 50 to 64, Morse said. That’s not a surprise, since boomers came of age in the 1970s and ’80s, when rates of drug use among young people were particularly high.
But mixing street drugs or alcohol with prescription meds could cause older users to overdose or die even if they consume at lower levels, she said.
“The older you get, the more compromised your systems are,” Morse explained.
Boomers whose drug problems began many years ago also are more likely to feel isolated and stigmatized by their problem. That can delay or keep them from seeking treatment.
You can’t say that the addiction or mental health problem began at age 50. It may have begun at 35. And so it’s been going on longer, exacerbating just how compromised their systems might already be depending on their age.
Siobhan Morse, Foundations Recovery Network, which operates drug treatment facilities in several states
Kelly Pierce of Bradenton, Florida, who’s 52, was in his 30s when he began using prescription opioids to deal with painful back and eye injuries suffered in a work-related fall. Within two years, he was addicted to the painkillers.
“If you didn’t get pills from the hospital or from a doctor, then you’d buy them off the street. And they’re very expensive and you spend all your money on them, because otherwise you’d be sick. Plus, in pain too,” Pierce said.
After he moved to Bradenton, Pierce got an apartment next to a methadone clinic run by Operation PAR, an addiction and mental health service provider. He enrolled in the program in 2009 and began weening himself off the opioids with daily doses of methadone, an opioid that reduces withdrawal symptoms from heroin and other narcotics.
At first, Pierce needed 125 milligrams of methadone a day. Over several years, his daily dose fell to 80mg, then to 40mg.
“You don’t want to do it fast,” Pierce said. “You want to go slow,” or risk the nausea, sweats, and hot and cold spells that come with opioid withdrawal.
Several years ago, Pierce relapsed and and became dependent on prescription opioids he’d begun using for painful dental problems. He re-enrolled in the methadone program and has worked his way down to just 10mg of methadone per day. He plans to leave the program when he reaches 5mg.
The spread of opioids
Up until the 1990s, the medical community didn’t use opioids to treat chronic, non-malignant pain because of the risk of addiction and because patients’ increased tolerance made the drugs ineffective as a long-term solution.
“The available data show they don’t do a good job in the long run for the majority of people with chronic pain,” said Dr. Beth Darnall, a pain psychologist and associate professor in the Division of Pain Medicine at Stanford University.
But as doctors began to re-examine the debilitating effects of pain, opioid use for chronic pain took off in the 1990s, helping to trigger the crisis.
To help curb prescription opioid use, the Obama administration wants doctors to prescribe them only for acute, short-term pain rather than long-term, chronic pain which is less severe.
Opioid use for chronic pain took off in the 1990s, helping to trigger the current crisis.
But Dr. Charlotte Yeh, chief medical officer at AARP, isn’t ready for the opioid pendulum to swing back to the days when chronic pain sufferers had to do without access to some of the world’s best painkillers.
She said chronic pain was a serious condition that limited a patient’s independence, social interaction and mobility.
While the opioid addiction crisis is a major concern, it’s important that “we don’t forget that people were on the medicines because they started with pain,,” Yeh said. “I don’t want to lose sight of that.”
One way to limit prescription opioid usage is to re-examine the way doctors treat pain, said Darnall.
While pain is typically treated as a negative sensory experience, it’s partly defined as “an unpleasant sensory and emotional experience” by the International Association for the Study of Pain. Unfortunately, Darnall said, the “emotional” part is seldom addressed.
That’s the big secret. Pain is what you feel in your back combined with the emotional experience. We’re overlooking half of the definition of pain.
Dr. Beth Darnall, pain psychologist, Stanford University, on treating pain with psychological assistance
Darnall said psychological treatment, not pills, worked best for chronic pain. “It’s physical therapy. It’s getting active. It’s getting good sleep. It’s lifestyle management. It’s doing all the things we need to do so that we have less pain.”
Prescription drugs are part of the treatment, “but fundamentally, we have to get moving again,” Darnall said. “We have to learn how to build our tolerance to activity so that we’re able to do more and more of the things that are meaningful to us.”