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; non-medical use; prescription pain relievers; screening; substance use.

Figure 1.

Screening tools that can be used to identify non-medical use of prescription pain relievers and opioid use disorder in older adult patients* *Characteristics are based on research of adult samples, rather than strictly older adult samples. ¹ (NIDA, n.d.a; NIDA, n.d.b; “NIDA Quick Screen & NIDA-Modified Alcohol, Smoking, and Substance Involvement Screening Test (NM-ASSIST).”) ² (WHO ASSIST Working Group, 2002; Humenuik et al., 2010) ³ (Ali et al., 2013; SAMHSA, 2020) ⁴ (ASSIST; VHA, 2014) ⁵ (Cacciola et al., 2013; McNeely et al., 2016; US Department of Health and Human Services)

Figure 1.

Screening tools that can be used to identify non-medical use of prescription pain relievers and opioid use disorder in older adult patients* *Characteristics are based on research of adult samples, rather than strictly older adult samples. ¹ (NIDA, n.d.a; NIDA, n.d.b; “NIDA Quick Screen & NIDA-Modified Alcohol, Smoking, and Substance Involvement Screening Test (NM-ASSIST).”) ² (WHO ASSIST Working Group, 2002; Humenuik et al., 2010) ³ (Ali et al., 2013; SAMHSA, 2020) ⁴ (ASSIST; VHA, 2014) ⁵ (Cacciola et al., 2013; McNeely et al., 2016; US Department of Health and Human Services)

Figure 2.

Resources for substance use-related trainings for providers* *Curricula have been developed to increase substance-related trainings for providers. These are not specific to older adults. ¹ (CDC, 2020) ² (COPE, 2021) ³ (NIDA, 2014)