Anesthesia Management: The Changing Face of Opioid Addiction

The image of the opioid addict as a young person is fast becoming outdated, a new study suggests. Today, someone abusing opioids could be a working mom, or even a senior, a new review suggests.

According to various sources, Americans aged 50 to 69 years represent the fastest growing population of opioid addicts, and the number of people aged 65 years and over who have at some point abused opioids increased by 34% from 2011 to 2012.

“What this tells us is that there’s some evolving demographics for opioid addiction and guess what, it’s not just that young college student who is the addict; it’s actually also working people and it’s more mature adults,” said Joseph V. Pergolizzi Jr., MD, assistant professor, medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

“Practitioners should employ universal precautions because we don’t have any verifiable biomarker for who’s addicted, who’s abusing, missing or diverting drugs.”

Such precautions should include looking at predictors of potential aberrant behavior, for example, a personal or family history of mental disorders or abuse of medicines other than opioids, Dr. Pergolizzi said.

The statistics come from a report based on recently released data from the medical literature, government sources, authoritative Web sites, and financial analyses. The report was compiled by NEMA Research, a clinical research network.

Dr. Pergolizzi presented the new data during a poster session here at the 2014 PAINWeek meeting.

Universal Precautions

While the number of older addicts is growing, the very young (those aged 12 to 17 years) still composes a large proportion — about 26% — of the total population of those with opioid addiction.

The research shows that opioid addiction is a growing problem. Some 24 million Americans (9.2% of the population) used an illicit drug in 2012, which was an increase from 8.1% in 2008, and the numbers are expected to continue to rise, according to Dr. Pergolizzi.

Today’s drug addicts are quite educated. About 47% of heroin users and 45% of prescription drug abusers are high school graduates, and 22% and 30%, respectively, have completed some college.

These more sophisticated addicts “may want pharmaceutical grade instead of street grade” drugs, said Dr. Pergolizzi. “They may think the price is the same and there are risks for both, so why not get the pharmaceutical grade.”

As for heroin addicts, most (90%) are white and their mean age is 22.9 years. Women are just as likely to be heroin addicts as men.

The research also uncovered a possible problem with polysubstance abuse. Of 22.2 million substance abusers in 2012, 4.5 million used a drug but not alcohol, 14.9 million abused alcohol but not drugs, and 2.8 million abused both drugs and alcohol.

“Migratory” Patterns

Some of the polysubstance abuse may be due to new tamper-resistant technology. “Before, abusers may have been on a single type of molecule, but now that molecule is in a tamper-resistant formulation, so they migrate to other things,” said Dr. Pergolizzi. “Unfortunately, one of the migratory patterns that we see is an increase in heroin use.”

Although the biggest segment (41%) of opioid abusers lives in large urban areas, followed by smaller urban centers and then rural area, the abuse rate per person is higher in rural areas.

The new evidence also seems to confirm that marijuana truly is a gateway drug for heroin users. The route to drug abuse typically starts with marijuana and progresses to prescription painkillers before ending with heroin.

Lynn Webster, MD, a pain specialist and vice president, scientific affairs, PRA Health Sciences, has also been taking note of the changing face of opioid addiction.

“Unfortunately, there are lot of people who are inappropriately using opioids at any age, and that includes senior citizens,” said Dr. Webster when asked his views on the evolution in the field.

“Fifteen to 20 years ago, there were not many people over the age of 50 who were abusing opioids because they weren’t exposed,” Dr. Webster said. “Abuse and addiction are driven by the environment and exposure to a drug in people who are genetically susceptible.”
While in the past older patients may not have received any pain therapy at all, today they may be getting an opioid because there are few other treatment options available, said Dr. Webster.