Editor’s Note: I would like to state that the information in this article is not meant to address the needs of individuals in hospice care.
Experts are calling the opioid epidemic the defining health crisis of our time – and with good reason.
According to the Centers for Disease Control, about 72,000 Americans died last year from drug overdoses. It is a record number that reflects a 10 percent increase from the year before.
In Marin County, opioids are the leading cause of accidental death. Since 2011, opioid-related deaths have been more than double the number of fatalities from motor vehicle crashes, which are the second leading cause of accidental deaths in Marin County.
However, if you think the opioid crisis is only of importance to those who mix prescription opiates with “street” drugs, it is time to think again. Older adults are also vulnerable to the dangers of opiate addiction and overdose.
“We see opioid overdoses at all ages,” says Dr. Matt Willis, Marin County Public Health Officer. “The pattern is that younger people may use illicit or street opioids, while older adults may mix opioids prescribed for pain with other medications used to treat anxiety or sleep issues.”
Willis calls the opioid crisis “a particular challenge” when it comes to older patients who often are prescribed opioids (including hydrocodone, oxycodone, codeine and morphine) to treat chronic pain conditions.
“We know that opioids can increase cognitive decline, the risk of falls and the chance of motor vehicle accidents in older people,” he says. “But we also know that one reason to take opioids – pain — also increases with age.”
Willis maintains that opioid overdose deaths among the elderly are probably under-reported. “When someone who has a history of heart disease is found deceased in bed, it may not create a forensic investigation,” he explains. “The coroner is likely to report it as a natural death.”
However, Willis believes that, in some cases, if someone were to examine the patient’s medical history, opioid use may have contributed to the cause of death.
While Willis is quick to point out that opioids can be very useful in palliative care when addiction is not a concern, he says that alternative strategies are needed for treating certain types of pain.
“We are learning that ibuprofen and acetaminophen can be just as effective for certain types of joint pain as opioids,” he offers as an example. “Also, there is no long-term evidence that opioids are effective for certain back pain.
“We need to do a better job of tailoring the medication for the specific type of pain…And we are learning that these medications (opioids) are not as effective as we once thought.”
He says that many older adults are susceptible to the dangers of polypharmacy, or the combination of multiple medications in their systems. “Our data shows that as we age, the more likely it is that we are taking more than one medication.”
Willis emphasizes that opioids are “easy to start and difficult to stop.” As a result, he encourages all patients – but especially older adults who may be taking several drugs – to discuss new prescriptions with their medical providers. “We are all re-learning how to approach pain and the treatment of pain,” he says. “Be empowered to ask your doctor, ‘Do I need this medicine?’ and ‘Are there safer alternatives?’”
The Marin County Department of Health & Human Services (HHS) is working to fight the opioid crisis with several strategies. One is to encourage medical providers to choose one substance to treat their patients’ symptoms, rather than more than one, and to assist patients in tapering off multiple medications when possible.
In addition, Marin County HHS launched a new system earlier this year for identifying and treating survivors of an opioid overdose. Research indicates that patients are at risk for a deadly overdose within one week of a previous overdose event. The new program uses Marin County Emergency Medical Services ambulance records to identify potential opioid overdoses and to contact survivors within a week of the event for follow-up treatment.
A big part of fighting opioid-related deaths is the use of a medication called naloxone. During an opioid overdose, a person stops breathing. Currently administered in a nasal spray, naloxone (trade name Narcan®) can reverse an opioid overdose when given before the person stops breathing or within a few minutes after breathing stops. Pharmacies, health centers and ambulances now are equipped with naloxone, and Marin HHS has been leading efforts to distribute the medication throughout the community, including police vehicles, public schools and libraries. Willis reports that police officers recently have been able to reverse eight overdoses with this use of naloxone before the ambulances arrived.
Willis points out that more lives can be saved from fatal opioid overdoses with more education and training in the use of naloxone. “However, Narcan is not the solution to the problem of opioids,” he stresses. “We are concentrating our efforts on preventing the overdose in the first place.”
Cannabis as an alternative pain medication
Another way to fight opioid dependency is by using cannabis for pain relief. “Cannabis can be the exit strategy when it comes to (reducing) any pharmaceuticals – opioids included,” according to Dr. Jeff Hergenrather M.D.
Hergenrather, who has experience in general medicine, OB-GYN, pediatrics, neonatal care and emergency medicine, began a private practice in cannabis consultations and general medicine consultations in 1999. He offers cannabis recommendations to Californians with serious medical conditions and cannabis consultations throughout the world through phone and online appointments.
In recent years, Hergenrather has seen the demographics of his practice change with an increase of older adults and children as patients. “The increase in older patients is partly due to the aging of the Baby Boom population,” he acknowledges. “But it is also due to the new street knowledge that cannabis can be helpful in treating pain.”
The use of cannabis to treat pain has suffered from “a whole lot of misinformation,” Hergenrather says. “Many people still believe it is an addictive substance or they are concerned that THC (the principal psychoactive constituent of cannabis) is dangerous…These assertions and allegations are not supported by the literature.”
In preparation for a research paper, Hergenrather recently reviewed 100 patient charts and discovered that about one-third of his patients were able to discontinue their use of opioids or only use them intermittently after they began cannabis treatments.
Hergenrather advises his new patients to add low doses of cannabis while still taking their other pain medications. ‘If you are taking opioids three times a day, I would suggest you begin by taking cannabis three times a day.” As his patients become used to cannabis, then he can offer suggestions for tapering off the opioids.
“Some older people are afraid of THC and they tell me, “I don’t want to get high,’” he says. “There is this underlying fear that cannabis is dangerous. But it is a mistake. The THC in cannabis is easy to prescribe and is a safe form of pain management for most people.
“I do appreciate that there is a role for opioids in acute pain management, but I find it sickening how opioids are overprescribed. This herb (cannabis) is such a safer alternative.”
To learn more about cannabis treatments as an alternative to opioids, visit drjeffhergenrather.com and cannabisclinicians.org.
For more information on opioid use in Marin County, visit insight.livestories.com