Older Adults’ Experience with Opioid Use, Deprescribing

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Data show that 30% of Americans 65 years of age or older have experienced chronic pain, with more than 10% indicating that high-impact discomfort is impacting their activities.¹ As a potential solution, primary care physicians (PCPs) may prescribe opioids, which can lead to complications such as addiction, sedation, and death from an unintentional overdose; television shows such as Dopesick and Painkiller have also put a spotlight on the ravages of the opioid epidemic.

In fact, though representing the general population, the Centers for Disease Control and Prevention reports that from 1999-2021, nearly 645,000 people died from an overdose involving any opioid.²

Although much of the garnered attention revolves around younger adults, more than 15% of those aged 65 years or older had filled an opioid prescription in 2019, and 5% were given long-term opioids. A study published in JAMA Network Open¹ sought to dig into these individuals’ experiences with reducing long-term opioid use, along with PCPs’ thoughts on deprescribing.

Investigators started off the qualitative study by conducting 45-minute interviews with 29 patients and 18 PCPs at a Boston-area health system. The patients were to have been prescribed long-term opioids—which is considered at least three prescriptions for 28-day supplies during the prior 180 days—between Sept. 15, 2022, and April 26, 2023.

Patients were asked about their experiences using opioids and discussing these medications with their PCPs, while the PCPs were interviewed about their experiences prescribing and deprescribing opioids to older adults.

Of the 29 participating patients, the mean [SD] age, was 72 [5] years, while 19 were female [66%]. Regarding the PCPs, 18 of them were younger than 50 (12 [67%]); 10 were female [56%]; and 14 were located at an academic practice [78%].Participants revealed to the investigators that conversations between PCPs and patients on opioid use for chronic pain were normally quite difficult, while any discussion surrounding deprescribing and opioid risks were uncommon.

Among the patient and PCP interviews, there were three main themes that arose:

1. Opioids were taken as a “last resort.”
2. Opioids were used as a way to improve function and quality of life.
3. Trust is absolutely necessary in fostering a clinician-patient relationship.

However, there were differing opinions on risks of opioids, as patients referenced addiction and PCPs discussed adverse drug events. The deprescribing conversations were not beneficial, being that the differing viewpoints made it difficult to have a productive conversation. Essentially, patients believed that deprescribing was usually unnecessary unless an adverse event took place, given that many patients had prior negative experiences with tapering or “weaning off.” The PCPs noted that there were gaps in knowledge on how to properly taper, a lack of clinical access to monitor patients during tapering, and concerns surrounding patient resistance.

As a result, the authors concluded that “…PCPs and older adults viewed opioid use as an effective last resort for treating chronic pain and expressed discordant views on the risks of opioids and reasons opioid deprescribing is often unsuccessful. Safely reducing opioid use among older adults with chronic pain is likely to require the development of materials to foster more informed conversations on the benefits and harms of opioids as well as payment and policy interventions to support the time and teams needed for deprescribing opioids.”

References

1. Anderson TS, Wang BX, Lindenberg JH, Herzig SJ, Berens DM, Schonberg MA. Older Adult and Primary Care Practitioner Perspectives on Using, Prescribing, and Deprescribing Opioids for Chronic Pain. JAMA Netw Open. 2024;7(3):e241342. doi:10.1001/jamanetworkopen.2024.1342

2. Understanding the Opioid Overdose Epidemic. Centers for Disease Control and Prevention. https://www.cdc.gov/opioids/basics/epidemic.html