Screening the “Invisible Population” of Older Adult Patients for Prescription Pain Reliever Non-Medical Use and Use Disorders

ABSTRACT

Background: In the United States, the number of older adults reporting non-medical use of prescription pain relievers (NMUPPR) between 2015 and 2019 has remained constant, while those meeting criteria for opioid use disorders (OUDs) between 2013 and 2018 increased three-fold. These rates are expected to increase due to increased life expectancy among this population coupled with higher rates of substance use. However, they have consistently lower screening rates for problematic prescription pain reliever use, compared to younger cohorts. Objectives: This commentary reviewed trends in older adult NMUPPR and OUDs and reviewed several available screening tools. We then considered reasons why providers may not be screening their patients, with a focus on older adults, for NMUPPR and OUDs. Finally, we provided recommendations to increase screenings in healthcare settings. Results: Low screening rates in older adult patients may be due to several contributing factors, such as providers’ implicit biases and lack of training, time constraints, and comorbid conditions that mask NMUPPR and OUD-related symptoms. Recommendations include incorporating more addiction-related curricula in medical schools, encouraging participation in CME training focused on substance use, attending implicit bias training, and breaking down the silos between pharmacy and geriatric, addiction, and family medicine. Conclusions: There is a growing need for older adult drug screenings, and we have provided several recommendations for improvement. By increasing screenings among older populations, providers will assist in the identification and referral of patients to appropriate and timely substance use treatment and resources to ultimately ameliorate the health of older adult patients.

KEYWORDS:

• Older adults
• prescription pain relievers
• non-medical use
• substance use
• screening

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under University of Florida and Florida State University Clinical and Translational Science Awards TL1TR001428 (CCH: August 2022–Present, PI: Wayne T. McCormack, University of Florida, Gainesville, FL) and UL1TR001427 (PI: Duane A. Mitchell, University of Florida, Gainesville, FL). This work was partially supported by the University of Florida’s Department of Epidemiology (AMF: May 2022–Present; CCH: May 2022–August 2022) and the UF Substance Abuse Training Center in Public Health from the National Institute of Drug Abuse (NIDA) of the National Institutes of Health under award number T32DA035167 (PI: Linda B. Cottler, University of Florida, Gainesville, FL) (AMF: May 2019–May 2022; CCH: May 2020–May 2022; VS: June 2020–May 2022). In addition, this work is supported by award number K01DA046715 (PI: Lopez-Quintero, Gainesville, FL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.