considered the worst drug epidemic our society has experienced in recent times, is a crisis of growing concern for aging people.1
Many elderly people struggle with a substance use disorder that includes opioids and other addictive substances.
Historically, issues relating to problem substance use among older people receive little attention. Researchers indicate that the increase of opioid use with persons 60 and older during the past two decades appears to occur when opioids are used for “psychotropic effect” rather than for physiological concerns for debilitating pain.2
Opioid prescription use increases when opioids are used as an intervention to ameliorate and cope with the intensity of pain.
Chronic pain is one of the most predominant and consistent nagging symptoms among older adults, who most often experience multiple medical conditions when pain is a part of the sequelae. Pain is a significant clinical issue that affects the quality of life of this population more than any other age group.3
Discrimination Can Cause Physical Pain
For persons of color, physical pain may present that is somaticized stemming from the experience of oppression, living with the stigma of racism, perpetrated physical violence, and a lifetime of traumatic psychological assaults.4
Nearly Six Million Baby Boomers to Experience Substance Use Disorders in 2020
Older persons may turn to opioids to self-medicate to address the intrapsychic pain. It is expected that the opioid crisis for the Baby Boom generation—those individuals born from 1946 through 1964 with an extended life expectancy—will increase dramatically. Baby Boomers are reported more likely to report their use of psychoactive drugs compared with earlier cohorts.5
It is projected that 5.7 million of this population will experience a substance use disorder in 2020.6
According to Olfson, Wang, Iza, Crystal, and Blanco, a significant increase in the prescription of opioids is associated with office medical visits that are related to chronic pain during the period of 1995–2010.7
Multiple Illnesses Complicate Treatment
Among older adults, the prevalence of chronic pain, the complexity of clinical and medical management, and sensitivity to pain create ongoing challenges. The older adult can present with multiple illnesses with pain, which places the person in a vulnerable position psychologically and clinically. These patients are completely dependent on the medical prescribers (who may be physicians, nurse practitioners, or physician assistants) to be knowledgeable regarding their medical issues to be able to manage their pain. Of concern, as pointed out by SAMHSA8
and by Manchikanti and colleagues,9
is a lack of evidence-based practice guidelines, training, and awareness of the many factors that increase the risk of pain medication with this complex patient population.
Few Age-Specific Treatment Programs
Most often the older adult patient is not properly educated on the side effects by the prescriber or pharmacist and may be more vulnerable to taking higher-than-prescribed doses or taking the medication for a longer period than prescribed for the management of her or his pain or other medical conditions. In addition to the lack of patient education, there is a short supply of clinically trained health practitioners who are gerontologist/geriatric practitioners trained to provide appropriate, sensitive care to this population. There also are few age-specific treatment programs.10
Treatment resources need to change quickly to absorb the increase in need.
A Need for Social Workers Trained in Gerontology
While our nation battles an opioid epidemic, our aging population steadily increases and grows increasingly diverse. There is a compelling need for practicing clinical social workers who are trained in gerontology in healthcare delivery environments where this population is being treated. Along with this need, social workers must be prepared to work in interdisciplinary teams providing care and in patient-centered medical homes (PCMHs) where collaborative and integrative healthcare practice is a model that encourages “deliberate . . . and sustained coordination of care among healthcare practitioners . . . .”11
This collaboration and coordination of care is aimed at improving health outcomes. In these developing PCMHs, medical health providers and behavioral health providers work together in the assessment and care of the patient, which is a critical adjunct to working with this medically complex patient population. Trained gerontological social workers have nuanced knowledge and experience of the unique biopsychosocial and environmental treatment needs of the older adult struggling with an opioid substance use disorder, and who also are more likely than not to have concurrent medical issues. Social workers are trainined in advocacy and can best assist with providing the necessary suggestions to the interdisciplinary team for improving treatment accessibility nationwide.
Working with aging persons who experience opioid addiction and concurrent complex health issues confront many mulifaceted issued for the healthcare practitioners. Social work’s presence on the interdisciplinary, integrated, primary and behavioral healthcare team is a clinical necessity and requires a sensibility that will significantly contribute to the enhancement of health outcomes for this population.
1N. D. Volkow, T. R. Frieden, P. S. Hyde, & S. S. Cha. (2014). Medication-assisted therapies—tackling the opioid-overdose epidemic. New England Journal of Medicine, 270, 2063–2066.
2N. A. West, S. G. Severtson, J. L. Green, & R.C. Dart. (2015). Trends in abuse and misuse of prescription opioids among older adults. Drug & Alcohol Dependence, 149, 117–121.
3D. K. Weiner. (2007). Office management of chronic pain in the elderly. American Journal of Medicine, 120, 306–315.
4D. M. Mouzon, R. J. Taylor, V. M. Keith, E. J. Nicklett, & L. M. Chatters. (2017). Discrimination and psychiatric disorders among older African Americans. International Journal of Geriatric Psychiatry, 32(2), 175–182.
5R. A. Johnson & D. R. Gerstein. (1998). Initiation of use of alcohol, cigarettes, marijuana, cocaine, and other substances in U.S. birth cohorts since 1919. American Journal of Public Health, 88(1), 27–33.
6B. Han, J. C. Gfroerer, J. D. Colliver, & M. A. Penne. (2009). Substance use disorder among older adults in the United States in 2020. Addiction, 104(1), 88–96.
7M. Olfson, S. Wang, M. Iza, S. Crystal, & C. Blanco. (2013). National trends in the office-based prescription of schedule 2 opioids. Journal of Clinical Psychiatry, 74, 932–939.
8SAMHSA. (2014). Results from the 2013 national survey on drug use and health: Summary of national findings. NSDUH Series h–48, HHS Publication No. (SMA) 14–4863. Rockville, Md.: Author.
9L. Manchikanti, S. Helm II, B. Fellows, J. W. Janata, V. Pampati, J. S. Grider, & M. V. Boswell. (2012). Opioid epidemic in the United States. Pain Physician, 15, ES1–ES7.
10H. E. Doweiko. (2014). Concepts of chemical dependency (ninth ed.). Stamford, Conn.: Cengage.
11F. G. Reamer. (2018). Ethical issues in integrated health care: Implications for social workers. Health & Social Work, 43,(2), 118–124.