If the stereotypical victim of America’s opioid epidemic is a millennial looking for a cheap high, recent statistics tell a different story. Of the more than 33,000 overdose deaths in 2015, more than 6,200 victims were over the age of 55, according to data from the Henry J. Kaiser Family Foundation.
Those baby boomers aren’t just statistics. They’re people’s parents. And now many of these boomer’s adult children are finding themselves in the unexpected position of trying to help them recover from addiction to painkillers.
“Often families are in crisis, and they’re fearful they can’t manage it alone. But unlike other diseases where there’s a network of experts you can tap into, with addiction we often don’t know who to call,” said Emily Feinstein, director of health law and policy at the National Center on Addiction and Substance Abuse, a nonprofit research organization. “We’re left on our own with the internet, and that’s not usually how we search for medical care.”
Knowing how to handle a parent’s painkiller dependency can be especially tricky for adult children because it’s often not obvious that the parent has a problem at first. Unlike younger populations, older groups are more likely to use opioids for chronic pain, whether it’s a long-term prescription or a sudden influx of pills to manage symptoms after a major surgery. “They’re hurting, and for the most part they’re staying on a prescription for legitimate reasons, so it’s harder for family members to identify an opioid use disorder in this age group,” said Dr. Kimberly Johnson, director for the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration .
Detecting drug abuse becomes even more challenging if a parent has multiple prescriptions from different doctors or a cognitive issue like dementia.
How to tell if a parent has a problem? Common signs of abuse include being preoccupied with medications and running out of prescriptions too quickly. Another clue is whether the parent seems unusually sedated, which is a side effect of opioid medications.
“Are they not able to think clearly? Do they seem sleepy and slow? Are they not following conversations?” Johnson asked. “You might see frequent falls, or their driving could be erratic. They’re hitting the garage door or getting into more fender benders.”
Even if it’s clear that a parent is developing a painkiller dependency, it can be hard to know how to broach the topic. The parent might refuse help because they’re in denial or don’t want to stop taking their pills, said Dr. Mark Willenbring, founder and chief executive officer of the Alltyr Clinic in St. Paul, Minnesota, which specializes in treating addiction disorders.
“They don’t think they can live without these medications, and they’re terrified inside. Their main problem is that they wanted relief from pain. They weren’t trying to get high,” he said.
How to have the conversation
Contrary to tear-filled scenes in movies and television shows, experts say that staging a family intervention, during which members confront the parent, is the one of the worst possible approaches. “It’s extremely traumatic and often results in schisms in the family and usually doesn’t work. It’s so awful,” said Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism.
“You don’t want to have a fight. The more you can deliver the message in a loving, neutral way, the more likely they are to hear it.”
Willenbring suggested being specific and focusing on observations. He offered the following script: “I notice that you often run out of your meds early. I notice that when you’re taking them a lot of times you seem really out of it. You’re disoriented and your speech is slurred. I wish you’d talk to a doctor about this. I understand this might be hard to hear, but I hope you’ll think about it. If there’s anything I can do to be of assistance, let me know.”
It’s common for parents to deny they have a problem or accuse the adult child of interfering in their lives, Willenbring added. He suggested bringing up the topic every month or so. If there’s no improvement, insist on going to the doctor with the parent. As a last resort, contact the prescribing doctor on your own.
“You can say to the parent, ‘I think any doctor would want to know if one of their patients seemed to be misusing their prescription, and I’m not going to stand by and watch something happen to you if I could have prevented it,’” he said.
If the uncooperative parent is getting painkillers illegally, Willenbring suggested advising a parent’s partner or spouse to keep a dose of naloxone on hand, often sold under the brand name Narcan, which can reverse an opioid overdose.
Although Narcan is available by prescription, many states allow consumers to purchase it directly from a pharmacist. “Sometimes you might be between a rock and a hard place, and there might be nothing you can do unless there’s a hospital admission,” he said.
Rehab isn’t always the best option
Although the popular notion of drug addiction treatment often involves a stint in a pricey rehab facility, patients have more options than they think, Feinstein said. According to a National Center on Addiction and Substance Abuse report, misunderstandings about addiction treatment are a primary reason that nine out of 10 people with drug or alcohol dependency don’t get the help they need.
“Often we hear ‘Let’s send mom to California and pay $30,000 for residential treatment,’ but that might not be the best care for her,” she said. “There are a lot of addiction providers who have claims that are often too good to be true.”
There are likely good providers in your community. Feinstein suggested finding a physician, a licensed psychologist or social worker with training in addiction treatment who can do a thorough assessment of the patient’s needs, which is critical for making the case for insurance coverage.
“You could go to a mental health clinic or a teaching hospital or even call your primary care doctor for a referral,” she said. “Just like you’d get a surgical consultation or physical therapy plan, you’ll need an expert opinion on what kind of treatment a parent needs.”
The National Center on Addiction and Substance Abuse recently released a patient guide on treatment options, which can include outpatient visits and medications to prevent overdose and reduce cravings.
Educating patients ― and their family members ― is more important than ever, since the problem isn’t going away. Recent data-crunching by The New York Times put the number of 2016 opioid-overdose deaths at more than 59,000 people.
Treating drug addiction as a medical condition, rather than a character defect, is the first step to reducing stigma, which is one of the biggest barriers to care. “We’re trying to move past the stigma and approach this as a health conversation,” Feinstein said.