Prescription Opioid Abuse: One of the Foremost Public Health Challenges Facing Our Nation

Millions of older Americans experience pain associated with such conditions as bone fractures, cancer, post-surgery recovery, and end-of-life illnesses.  Studies have shown that as many as 50 percent of older adults living at home and 85 percent of older adults living in residential facilities may suffer from chronic pain.  For these older Americans, prompt delivery of pain control is a medical imperative.

For many years, patients faced unacceptable barriers to effective pain management for debilitating symptoms and illnesses, and their treatment was often needlessly less than optimal.  More recently, however, the pendulum appears to have swung too far in the other direction.

It is alarming that Americans consume opioids at a greater rate than any other nation, including twice as many opioids per capita as Canada.  The ubiquity of these prescription painkillers is fueled in part by current federal reimbursement policies that may be unintentionally encouraging doctors to overprescribe opioids.

Our physicians now face the complicated task of treating pain in an environment where abuse of prescription painkillers is one the foremost public health challenges facing our nation.  Prescription opioid abuse, which can lead to addiction, is having devastating effects on our families and our communities.  This problem is increasingly affecting older Americans.  A recent study found that hospital stays resulting from opioid overuse among adults over age 65 increased more than five-fold between 1993 and 2012.  In addition, the abuse of prescription painkillers is also fueling the resurgence of heroin use across America.

In response to this growing crisis affecting Maine and our nation, I recently chaired an Aging Committee hearing to examine the medical use of these drugs for pain relief and policies that may contribute to our nation’s vast supply of prescription opioids.  I invited Steven Diaz, M.D., Chief Medical Officer and Emergency Medicine Physician atMaineGeneral in Augusta, to testify about his experience on the frontlines.

Seniors are prescribed more opioids than people in any other demographic group.  While these prescriptions canprovide critical pain relief, the home medicine cabinets of our seniors often become an unintentional supply source for younger family members to either experiment with opioids or to fuel their addiction.  According to the Substance Abuse and Mental Health Services Agency, more than 70 percent of prescription drug abusers report obtaining pills from family members’ medicine cabinets.

I am saddened by stories about younger individuals who are breaking the law – and breaking into older adults’ homes – in order to steal prescriptions to feed their own addictions. In some cases, it is even the grandchildren stealing pills from their own grandparents.

Funeral directors in Maine have told me that they sometimes advise grieving families not to cite the cause of a loved one’s death in obituaries because the obituary may inadvertently advertise what prescription medications may be in the home and when the home may be empty for ransacking.  In one tragic example, thieves broke into a home in northern Maine and stole prescription medications while the family was attending the funeral of a loved one.

During the hearing, I underscored the concerns raised in a recent letter I wrote to the U.S. Department of Health and Human Services. The letter, which was signed by a bipartisan group of 26 U.S. Senators, requests that the agency review a patient survey that seeks to gauge how well a patient’s pain was managed during his or her stay.  The results of this survey help determine the amount of federal funding a hospital receives.  The survey may inadvertently penalize hospitals if physicians, in the exercise of their best medical judgment, opt to limit opioid pain relievers to certain patients. Consequently, physicians may prescribe more opioids than the patient needs.

Dr. Diaz also referenced this patient survey in his testimony and stated that it may be leading doctors to overprescribe. In addition, Dr. Diaz said that he believes the current system for treating chronic pain, which prioritizes prescription opioids over other pain control methods, leads to higher incidents of opioid addiction, diversion, and overdoses.

Drug abuse is a national crisis that has its greatest effect at the local level -- in our homes, on our streets, in our schools, and in our communities – and that touches all lives, from infants to adults.  The Aging Committee is committed to addressing this tragic and serious crisis.  It is encouraging that so many of my Senate colleagues from both parties who represent states across the country share my concern and are committed to finding solutions.