Opiate misuse among our seniors Presented by: Christy Perry, DNP, PMHNP Tanya Stuart, LCSW-BACS,LAC,CCS

Objectives What are Opioids? Identifying other prescribed medications that may be abused. How to recognitive misuse and abuse. Are we seeing opioid misuse rising in the older adults? Best practices for prescribing opioids in older adults Things we can do to improve quality of life and provide safe care What treatments and services exist for the older adults

What are Opioids? Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.

Identifying other prescribed medications that may be abuse Other medication and supplements that may be abused: Benzodiazepines Stimulants—ADHD meds, diet pills, steroids Illicit drugs Random OTC/off the internet medications Diphenhydramine (Benadryl, Tylenol PM, Advil PM)

How to recognize misuse Opioids are often taken in larger amounts or over a longer period of time than intended. There is a persistent desire or unsuccessful efforts to cut down or control opioid use. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects. Craving, or a strong desire to use opioids. Recurrent opioid use resulting in failure to fulfill major role obligations at work, school or home. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids. Important social, occupational or recreational activities are given up or reduced because of opioid use. Recurrent opioid use in situations in which it is physically hazardous Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids. *Tolerance, as defined by either of the following: (a) a need for markedly increased amounts of opioids to achieve intoxication or desired effect (b) markedly diminished effect with continued use of the same amount of an opioid *Withdrawal, as manifested by either of the following: (a) the characteristic opioid withdrawal syndrome (b) the same (or a closely related) substance are taken to relieve or avoid withdrawal symptoms Total Number Boxes Checked: _________________ Severity: Mild: 2-3 symptoms. Moderate: 4-5 symptoms. Severe: 6 or more symptoms *Criteria from American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,. Washington,

Are we seeing opioid misuse rising in the older adults?

Best practices for prescribing opioids in older adults Review medications (Prescribed and OTC). Be aware of herbal and dietary supplements. Be aware of illicit drugs and alcohol. Use the lowest possible dose. Review the Beer’s List. Consider non pharmacological treatment options. The combination of opioids and benzodiazepines should be avoided.

Things we can do to improve quality of life and provide safe care Make sure the client knows their medication—even if they have to keep a written/printed copy. Have someone assist with medications in the home if necessary—the client may know their medications but if their eye sight is poor they may not be able to read the label. If there are memory problems work with the client to develop a system to improve compliance—alerts, someone giving the medication or pill packets for daily dispensing. As providers we must assess for the potential for abuse. The LA PMP website provides the information on the controlled substances filled by the client. It is our responsibility to review this information when prescribing to hopefully avoid any drug-drug interaction.  

What treatments and/ or services exist for the older adults Outpatient services are available for substance use disorder including opioid use disorder. Inpatient detox is not needed for opioid abuse. Alcohol and benzodiazepine withdrawal requires inpatient hospitalization in most cases—general medical unit or an inpatient psychiatric hospital.

Resources: https://www.drugabuse.gov/drugs-abuse/opioids *Criteria from American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,. Washington, DC, American Psychiatric Association page 541. For use outside of IT MATTTRs Colorado, please contact ITMATTTRsColorado@ucdenver.ed