Invisible and Older Faces of Canada’s Opioid Crisis
Opioids, commonly referred to as
“narcotics,” are potent medications used widely to treat pain — but they also
have strong potential for misuse and addiction. Over the past decade, the
opioid crisis in Canada has become a major, growing public health emergency.
Two comprehensive factors have contributed to the acceleration of the opioid
crisis in Canada. First, opioid prescription rates have risen steadily over the
past 30 years to today’s extremely high levels, and despite recent decreases in
opioid prescription rates, Canada remains one of the largest consumers of
prescription opioids in the world.
Second, there has been a steep rise in the use of street
opioids, many of which are extremely potent (i.e., fentanyl), which have been
linked to skyrocketing rates of opioid overdoses and deaths across Canada.
As more attention is being paid to
the opioid crisis in Canada, various responses have been launched in an attempt
to curb some of these alarming trends. However, older adults have been largely
left out of the conversation. Simply put — older Canadians in this crisis have been left out of sight and out of mind.
With this report,
Out of Sight,
Out of Mind,
the National Institute on Ageing (NIA) aims to raise awareness of the serious risks to older adults related to
the opioid crisis, and to explain why this group will require particular
attention in order to stem the crisis.
While current perceptions of the opioid
crisis tend to focus on younger adults
consuming non-prescribed opioids and experiencing high rates of
overdose, many people are unaware that older Canadians actually bear the
largest burden from opioids — mostly from prescription sources. Compared to all
other age groups, older adults have the highest rate of prescription opioid
consumption, as well as the highest rates of side effects, overdoses and
mortality associated with prescription opioids. This is strongly related to the fact that older adults experience more chronic pain compared to any other age group, and opioids are very
commonly used in this population to manage pain symptoms. There are several
factors that make older adults more likely to experience an overdose when using
opioids, including age-related metabolic changes; a higher likelihood of also taking multiple other medications — including other sedatives — which
increases the risk of dangerous drug interactions; and higher rates of more
severe chronic pain that require higher doses of opioids to manage symptoms.
Together, these factors put older adults at higher risk of overdose, hospitalization,
and death when consuming opioids. Older adults are also at greater risk of
other side effects from opioids,
including nausea and constipation, which can negatively impact their overall
quality of life.
Given the high rates of prescription
opioid use among older adults, alongside the
higher risk of negative outcomes linked to opioid use in this age group,
Canadian healthcare professionals need to re-examine pain management strategies that are taught
to current and future
prescribers. In this report, they detail a concerning, ongoing over-reliance on
opioid therapies for older Canadians, while the use of other methods — such as
topical analgesics or multidisciplinary pain clinics — remains seriously
lacking in Canada. This over-reliance on opioids persists despite some evidence
suggesting pain in many older Canadians often goes undertreated. The National Institute on Ageing (NIA)also reviewed research on which groups of older adults are at greater
risk of consuming opioids longer-term for the management of pain symptoms, and the current challenges with deprescribing
opioids in older adults. Unfortunately, much work is left to be done in this
area worldwide, and there is a particular dearth of data on these issues in the
Canadian context.
Related to the current over-reliance
on using opioids in older Canadians are the underappreciated and rising rates
of opioid use disorder (OUD), which is the technical term for the disease of
opioid addiction. Research suggests this is a growing problem in Canada, but
awareness surrounding OUD in older adults is lacking. Further, while the
proportion of Canadians living with OUD is likely underreported, research
suggests the number of older adults in Canada with OUD will likely grow in the
years to come. However, the current
public health response
to the opioid crisis in Canada largely
ignores older adults living with OUD. This report discusses these issues
and reviews the prevention, screening,
and treatment sections of the recently developed Canadian Guidelines on Opioid Use
Disorder Among Older Adults, produced by the Canadian Coalition for
Seniors Mental Health.
Another key group that has been
largely left out of the discussion thus far is older Canadians living in
long-term care (LTC) homes who use opioids. While recent research indicates that opioid prescriptions are increasing in Canadian LTC settings, there remains
little research about policies, guidance, and training on the appropriate prescribing and use of
opioids in these settings. In this report,
they discuss research
from other jurisdictions and highlight key considerations for improving opioid
prescribing policies in Canadian LTC settings.
The National Institute on Aging also
explored research on older adults’ knowledge of opioids, as well as their
perspectives on opioid-related policies. Sadly, there is once again a paucity
of research and policy on this front in Canada, but research done elsewhere
suggests that many older adults know little about opioids and the potential
risk of serious outcomes such as overdose.
There are also important opioid
policy implications for older adults that require specific consideration. For
instance, a recent national poll of older Americans found that many older
adults hold onto unused opioids out of fear they will need them again and that
many opioid disposal options are inaccessible to older Americans. Further,
opioids remain the medication of choice in suicide attempts among older adults
in the U.S. and Canada.
In response to the scarcity of
Canadian data about opioid use and outcomes in older adults, the NIA obtained
and analyzed data from the Canadian Institute for Health Information (CIHI) on
opioid-related prescriptions, hospitalizations, and emergency department visits
from 2015 to 2020. Their analysis suggests that, despite variations between
provinces and territories, there is a high rate of prescription opioid use
among older Canadians. Between 2015 and 2020, prescription rates for older
adults have tended to decline overall, particularly for some stronger
formulations (i.e. fentanyl and oxycodone), and increased or remained stable
for others (i.e. hydromorphone), while rates
of some lower-strength opioids (i.e. codeine)
have shown some decline but remain
high.
The NIA’s analyses found that older
Canadians experience very high rates of opioid-related harms — particularly
adverse events from prescription medications. Combined with findings on
prescription rates, their analyses provide an important, high-level perspective on some of the impacts
of the Canadian opioid crisis on older
adults. Opioid-related
deaths in Canada spiked during the COVID-19 pandemic. In this report, they
outline how the “twindemic” of the COVID-19 pandemic and opioid crisis epidemic
has likely had a disproportionate — albeit under-investigated — impact on older Canadians. As was the case with our COVID-19 pandemic
responses, societal ageism
has likely played a role in the widespread lack of
research, policy, awareness and understanding of the opioid crisis in older
Canadians to date.
Originally Published on https://boomersnotsenior.blogspot.com/
