Many older Americans are prescribed opioids because they can’t afford alternative treatment.
Among Americans aged 65 and older, the poorest are the most likely to have used prescription opioids, according to a University at Buffalo study released this week. “The poor had about double the rate of opioid use compared to wealthier groups,” said Hanna Grol-Prokopczyk, an assistant professor in the university’s sociology department and the study’s author. “The poor are the ones who have been disproportionately relying on these medications — and it’s not always easy for them to switch to other ways of dealing with chronic pain.”
‘The poor are the ones who have been disproportionately relying on these medications — and it’s not always easy for them to switch to other ways of dealing with chronic pain.’
There are long-term risks from opioid uses even when they are used exactly as prescribed, Grol-Prokopczyk said. These risks include increased risk of depression, suppressed immune systems and an increase in mortality from causes other than overdose, including cardiovascular and respiratory events. “Policies and practices should make sure that disadvantaged groups receive information about the risks of opioids and have access to alternate pain treatments,” she said.
The study was published in the latest issue of the Journal of Gerontology: Social Sciences and was based on responses from 3,721 participants in the nationally representative Health and Retirement Study’s 2005-2006 Prescription Drug Study. Low-income is defined as the bottom quartile of wealthy. These data were gathered during the “peak period of opioid use” in the U.S., Grol-Prokopczyk said. “Participants also self-reported their pain level as low, moderate or severe, and gave their opinions of the prescription drugs they were using,” she added.
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Older Americans on a low income may not be able to afford alternative care or surgery, which would mean they would have less or no need for opioid prescriptions, or may not be able to afford to travel to clinics for regular care. “Some pain researchers argue that the country is simultaneously experiencing an opioid crisis and a crisis of undertreated pain,” she said. The Centers for Disease Control and Prevention recommends alternatives to opioids where possible, including non-steroidal anti-inflammatory drugs like Aspirin and Ibuprofen, and cognitive and physical therapy.
Physicians who completed their initial training at top medical schools write significantly fewer opioid prescriptions than those from lower-ranked schools.
The poorest people on opioids were also more likely to be on Medicaid, the study found. “Together, pain and Medicaid enrollment explained about 38% of the association between low wealth and prescription opioid use,” Grol-Prokopczyk said. Lack of transportation and/or flexibility with work hours may also present problems. “Pain treatments such as physical therapy, acupuncture, hypnosis, etc., might be under-covered or not covered by insurance, and might require patients to attend appointments repeatedly over many months — something not everyone can easily do.”
Another theory: Using national data on opioid prescriptions written by physicians from 2006 to 2014, a study published in the Summer 2018 edition of the American Journal of Health Economics found “a striking relationship” between opioid prescribing and medical school rank. “Even within the same specialty and practice location, physicians who completed their initial training at top medical schools write significantly fewer opioid prescriptions annually than physicians from lower-ranked schools,” it found. If such doctors disproportionately served poorer patients, Grol-Prokopczyk said this could help explain the link between low wealth and opioid use.
Earlier this year, U.S. Surgeon General Jerome Adams said that more people should carry naloxone, a drug that aims to reduce the effects of an opioid overdose by restoring a person’s ability to breathe. It’s approved by the Food and Drug Administration and can be administered via a nasal mist or injection. It’s a temporary solution, but it can buy precious time before an ambulance arrives. “Each day we lose 115 Americans to an opioid overdose,” he said. “That’s one person every 12.5 minutes.”
Some 2.1 million people in the U.S. are battling opioid addiction. The number of opioid overdose deaths doubled to 42,000 from 2010 to 2016, according to the Department of Health and Human Services. The rate of drug overdose deaths in 2015 was more than 2.5 times the rate in 1999, partly due to a fall in the price of heroin and accessibility to prescription drugs. Opioid overdoses jumped 30% from July 2016 to September 2017 in 52 areas across 45 states, the CDC said. They increased in the Midwest by 70% and spiked 54% in the largest cities in the country.
The economic cost of the opioid crisis in 2015 was $504 billion, far higher than previous estimates, according to a recent report from The Council of Economic Advisers, part of the Executive Office of the President. Opioids include prescription pills (including Vicodin and Oxycontin), as well as heroin and fentanyl. Last year, President Trump officially declared the opioid crisis a public health emergency.
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