The Opioid Epidemic and Its Impact on Older Adults

1. The Opioid Epidemic and Its Impact on Older Adults Carol Girard, MA Bureau of Substance Abuse Services Ma Department of Public Health Family Caregiver Support Program July 11, 2017

2. Today • Massachusetts’ Single State Agency • Aging, AOD Use, Diversion • Family - Grandparents Raising Grandchildren • Possible Resources and Messages

3. Single State Agencies • Administer SAMHSA Substance Abuse Prevention and Treatment (SAPT) Block Grant which: • Supports publicly funded substance use disorder (SUD) prevention, treatment and recovery system in every state • Requires 20% to prevention • States must to contribute a portion

4. Bureau of Substance Abuse ServicesMA Department of Public Health Oversees substance use disorder and gambling prevention and treatment services in Massachusetts Funds and monitors prevention, intervention, treatment and recovery support services; develops/implements policies and programs • Prevention coalitions, screening, early intervention, overdose prevention • Several levels of SUD treatment: • Primary funder of public residential treatment programs in the state • ‘Payer of last resort’ for addictions treatment services • Recovery support: 10 statewide Recovery Support Centers (and 5 Recovery HS) • Workforce Development and Training • Regional presence – ongoing linkages with treatment providers Licenses treatment programs and counselors, enforces quality assurance Tracks statewide substance use trends Linkages with other state agencies Prevent • Treat • Recover • For Life

5. Number of Adults Aged 65 or Older Who Used Alcohol, Marijuana or Cocaine on an Average Day: Annual Averages, 2007 – 2015 NSDUHs

6. Older Adults and Binge Drinking Older Men: • 4 or more standard drinks on a drinking occasion Older Women: • 3 or more standard drinks on a drinking occasion Massachusetts binge rate: 9% for ages 65+ Massachusetts Healthy Aging Data Report: Community Profiles Older Americans Behavioral Health Issue Brief 2: Alcohol Misuse and Abuse Prevention. SAMHSA 2012

7. Alcohol/Medication http://pubs.niaaa.nih.gov/publications/Medicine/Harmful_Interactions.pdf Commonly Used Medicines That Interact With Alcohol Both Prescription and Over-the-Counter

8. Changes in Older Adult Use Alcohol Admissions: Ages 50 and older reporting alcohol misuse only and combined alcohol and drug use: 1992 and 2009

9. Lifetime Illegal Drug UseMore exposure and earlier use 50% + 47.6% 19.3% National Survey on Drug Use and Health, 2012

10. Recent AARP Bulletin…..

11. MA Opioid Overdose Deaths and Reversals http://www.mass.gov/eohhs/gov/ departments/dph/stop-addiction/current-statistics.html

12. Opioids • A class of drugs including: prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others and illicit heroin and fentanyl. • Interact with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain. • Drug overdose is now the leading cause of accidental death in the US: • 52,404 lethal drug overdoses in 2015 https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

13. Opioid Use: What We Know Nationally (all ages) • Roughly 21 - 29% of patients prescribed opioids for chronic pain misuse them • Between 8 - 12% develop an opioid use disorder • Only about 4 - 6% who misuse prescription opioids transition to heroin • About 80% of those who use heroin first misused prescription opioids https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis

14. More on Opioids • Addiction is a primary, chronic and relapsing brain disease • characterized by an individual pathologically pursuing reward and/or relief by substance use and other behaviors. • Of the 20.5 million Americans (12 or older) who had a substance use disorder (SUD) in 2015: • 2,000,000 had a SUD involving prescription pain relievers & • 591,000 had a SUD involving heroin https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

15. Make the Right Call

16. Polypharmacy ‘America’s Other Drug Problem’: Copious Prescriptions For Hospitalized Elderly’ Nearly 20% of older adults discharged had a medication complication within 45 days of discharge • ~ 35% preventable • ~ 5% life threatening Kanaan A et al. Adverse Drug Events After Hospital Discharge in Older Adults: Types, Severity, and Involvement of Beers Criteria Medications. J AM Geriatr Soc. 2013; 61(11):1894-9. Epub 2013 Oct 1.

17. Opioid Prescriptions Medicare Part D Beneficiaries • More than 30% filled multiple opioid prescriptions from 2 - 4 healthcare providers • Those with 4 or more opioid prescribers are more than twice as likely to be hospitalized for narcotic-related complications than those with 1 prescriber Jena AB, et al. Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims. BMJ 2014.348g1393.19 February 2014

18. Number of Emergency Department Visits for Drug Misuse on An Average Day for Patients Aged 65 and Older, By Selected Types Of Drugs: 2011 DAWN

19. Safe Storage

20. Growing Problem • ~20% (1 in 5) of US adults shared pain meds with someone else - friend/family member Kennedy-Hendricks, et al. Medication Sharing, Storage, and Disposal Practices for Opioid Medications among US Adults. JAMA Intern Med. 2016;176(7):1027-1029.

21. Access to Pain Meds Over half who misused prescription painkillers got them from a friend or relative for free SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHSI 2013 and 2014)

22. Unused Meds • DEA Take Back Days • Next one October 28, 2017 • Also check local, safe, drop boxes

23. Disposal of Unused Medicines

24. A Serious Drug-Related Concern Per 2013 census data : • 34,000 MA Grandparents are raising grandchildren • 20% increase since 2005 Approximately 80% of placements with grandparents are due to substance use issues Survey conducted by the Commission on the Status of Grandparents Raising Grandchildren

25. Not All Grandchildren Are Small • Pre-teen and adolescence: ages where they or friends may think about experimenting • These grandchildren have higher risk for substance use problems • Genetic predisposition • Possible trauma • Other environmental factors

26. Watch Your Language • Substance Use, Alcohol Use, Drug Use • Use of alcohol, drugs • Unhealthy or Risky Use • Range of use beyond guidelines • Substance Use Disorder – mild to severe • Meet specific DSM-V criteria ABUSE

27. Judgmental Language Perpetuates Stigma

28. What Massachusetts is Doing Prescribers & pharmacists must use Prescription Monitoring Program Limit initial prescription to 7 days or less Make the Right Call Prescriber Training on Pain Medication/Signs & Symptoms Safe community disposal sites

29. Resources and Help BSAS website – http://www.mass.gov/dph/bsas

30. Support for Family Members • Learn to Cope 22 chapters statewide for family members • (508) 738-5148 http://learn2cope.org • Allies in Recovery MA residents have free unlimited membership using their zip code • http://alliesinrecovery.net

31. Tell all your doctors… • …about ALL your: • Prescriptions • Over the counter meds • Herbs, etc. • AND alcohol use

32. Messages For ALL • Keep pain and anxiety medications secure • Medicine cabinet NOT the safest place • Get a lock box AND use it • Don’t share any meds • Properly dispose of meds when no longer needed • Support people whose family members suffer from substance use disorders

33. Questions? Carol Girard MA Department of Public Health Bureau of Substance Abuse Services Carol.D.Girard@state.ma.us