Opioid Use in Senior Living Communities
What is your facility doing to combat this risk?
Almost daily, you hear about it from a friend, see it on the news or read about it on the internet: another death as a result of a drug overdose. This scene, unfortunately, is playing out throughout the United States, even in senior living facilities. Often times, when you think of a drug addiction or overdose, illicit drugs like heroin, cocaine or methamphetamine may come to mind. Addiction and overdoses from prescription opioid painkillers, however, are becoming ever more prevalent.
The sale of prescription opioids in the U.S. nearly quadrupled between 1999 and 2014, according to the Centers for Disease Control and Prevention. The agency estimates that providers wrote 259 million prescriptions for painkillers in 2012. In 2014, 61% of the more than 47,000 overdose deaths that occurred were related to some form of opioid. These statistics are so alarming that many authorities consider opioid use a national emergency.
Research provided by the National Safety Council also revealed that, when comparing individuals who took a nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) versus those who took opioids, patients prescribed opioid painkillers experienced:
- A greater risk of having a cardiovascular event
- Four times as many fractures
- 68% greater risk for being hospitalized for an adverse drug event
- 87% greater risk of dying
Think about the impact this could have on your facility.
Falls are more likely for seniors on opioids, significantly raising their risk for potentially devastating fractures. "A common example of a drug-disease interaction would be someone with mild cognitive impairment," according to Dr. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. When a person with this condition gets an opioid product, he says, it increases the risk for confusion, falls and other adverse events.
Understanding Opioid Addiction in Seniors
Unfortunately, addiction doesn’t just impact the young. Seniors are also at risk of becoming addicted to opioids. Some common factors that contribute to opioid addiction in seniors are:
- Addictive nature: Opioids such as Percocet®, hydrocodone (Vicodin®), oxycodone (OxyContin®) and morphine are extremely addictive and can cause a strong dependency.
- Healthcare treatment options: Medication prescribed for injuries/illness is often an opioid. Opioids are often over-prescribed and poorly managed.
- Aging: Chronic disease can cause pain or the need for surgical intervention. Cognitive impairment may lead to dosage errors.
- Boredom: Resulting from transitioning away from the workforce and other meaningful roles.
- Freedom: They are participating in activities that may make them more prone to injury. They may take medications more liberally since they no longer have strict responsibilities such as the need to report to work or drive a vehicle.
- Identity concerns: With no need to report to work or difficulty participating in meaningful activity due to physical limitations, retirees can “lose their purpose” and at times feel worthless, which in turn leads to depression.
Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing and chief medical officer of the Phoenix House Foundation said, “People addicted to opioids really believe the drugs help their pain because they feel so awful - and anxious - if they don't take them. They're feeling agonizing pain [and] if they take the opioid, the pain goes away. They believe the opioid is relieving their underlying pain problem. What's probably happening is that the opioid is treating their withdrawal pain."
Recognizing Symptoms of Addiction
You may assume that it is easy to identify someone who has a drug addiction problem. However, it is not always as simple as it seems. Take a look at the following symptoms:
- Drowsiness and increased sleeping
- Nausea and vomiting
- Impaired coordination
- Confusion or inability to concentrate
- Loss of motivation
- Social withdrawal/seclusion
- Defensiveness or anger when asked about opioid use
When you see some of these symptoms you might think they are common side effects of medications offered to your residents. Unfortunately, they are also some common indicators of opioid abuse.
Opioid Management Controls for Your Facility
You might be thinking, "I have controls in place at my facility already, or we haven’t had any issues regarding opioid use." Even so, challenge yourself to review your practices and protocols regarding medication distribution at your facility.
The National Safety Council has concluded that healthcare facilities, including nursing homes and assisted-living facilities, can implement safety measures to control the risks associated with opioids. Some actions you can take include:
- Review your overall medical management plan for your facility and increase focus on the use of opioids.
- As part of your admission process, determine the medical needs of the resident and evaluate your facility’s ability to meet them.
- Implement a strategy to work with physicians to reduce prescribing opioids to residents. Monitor the medications being used in your facility and evaluate alternatives that may be substituted.
- Some facilities have also developed partnerships with pharmacists to assist in this effort.
- Dr. Andrew Kolodny says health providers can reduce overdose risk by prescribing lower-dose painkillers such as 5-milligram Vicodin or 10-mg Percocet tablets. "If they accidentally double their dose, it's not going to hurt them," he says. “That is, it’s not as dangerous as with a high-dose pill.”
- Educate caregivers to recognize the warning signs of opioid abuse and determine those residents who may have a higher likelihood to become addicted from opioid use. Document incidents or behaviors that occur and work with the resident’s family members when signs of dependency are noted.
- Train caregivers on the use of naloxone (Narcan®) and have an adequate supply on hand if permissible under state law. You should also have a policy for tracking the use of naloxone at your facility. You could be unaware of how often it is actually being used.
- Implement facility specific policies and procedures to ensure you are adequately monitoring all medications used and ensure you are providing a safe resident environment.
- Establish medication handling and control practices which includes:
- All medications should have appropriate labels with physician’s name.
- Track the medications administered to each resident daily.
- Review the medications administered to verify they can be taken in conjunction with others.
- Document the dosage of medication administered.
- Secure each medication to prevent tampering.
- Implement procedures to prevent the use of medications by anyone other than the prescribed user.
- Consider implementing access controls to opioids for employees. Conduct pre-hire screenings of all potential staff members to identify candidates who have exhibited risky behaviors relating to drugs in the past.
- Consider implementing a strategy to conduct reviews of resident related events and determine if they were medical or opioid-induced.
- Develop practices and work with a licensed disposal operation to properly dispose of all unused or expired medication by residents.