Overdose deaths rising among older Minnesotans

Jeffrey's prognosis for tonsil cancer wasn't good. As the 66-year-old Twin Cities businessman's hope for recovery waned, he said, there seemed to be no limit to the painkillers his doctor would prescribe.

"I would walk out with a gallon of Oxycodone," said Jeffrey, who asked to be identified only by his middle name due to stigma. "Whoever heard of such a thing? But I did. And I could go back pretty much as frequently as I wanted."

Jeffrey said his physician appeared unconcerned about prescribing such addictive opiates.

"At one time, my wife said in my presence to a physician, 'Isn't this a lot?'" Jeffrey said. "'He said, 'What difference does it make?' Meaning, 'He's going to die anyway. It doesn't matter.'"

Jeffrey didn't die. But when he completed cancer treatment he had developed a deep dependence on the prescription drugs that helped carry him through the illness. He said it took two weeks of "hell" to quit.

"Your insides are being turned inside out," Jeffrey said. "It's like someone is ripping you apart, but it's like no one can see it, including you, but that's what's happening."

But complications from the cancer led to more surgery, and more pain pills. Two years later Jeffrey found himself sitting in a Woodbury methadone clinic trying to wean himself off opiates for the second time.

Jeffrey's situation isn't all that uncommon. Drug overdoses — from both heroin and painkillers — are a growing problem in Minnesota and across the country. Prescription opiates and heroin caused a combined 24,492 overdose deaths in the United States in 2013.

Media coverage often focuses on young people who overdose on illegal drugs like heroin but prescription pain drugs cause most opiate overdose deaths nationwide. And older people are increasingly the victims.

"As my generation ages, and as we incur more and more medical procedures, we're going to be prescribed pain meds, opiates, and there's going to be a larger and larger percentage of people who find it challenging to get off," Jeffrey said. "This problem is not going to go away."

An 'epidemic' of overdose deaths

The Centers for Disease Control and Prevention describes the prescription drug overdose crisis as an epidemic.

While heroin overdose deaths have seen a fourfold increase since the year 2000, prescription opiates led to the bulk of fatal overdoses, with 16,235 reported deaths in 2013, according to the most recent CDC data. Almost twice as many people died of opiate pain pill overdoses than heroin in 2013.

"What grabs the headlines is a young, heroin-using, young adult who is making poor choices generally in life, including impulsive drug use behavior," said Dr. Charles Reznikoff, an assistant professor of medicine at the University of Minnesota and addiction medicine specialist at Hennepin County Medical Center.

With older adults drug abuse can be less obvious, Reznikoff said. "They sometimes use them as prescribed by doctors, sometimes they overuse slightly — it's less attention grabbing."

There are signs that public health efforts, including making drug overdose antidotes more widely available, are having an impact on younger groups. But the efforts don't appear to be reaching aging Baby Boomers.

The rates of those dying from prescription opiate overdose deaths for those ages 55 to 74 increased about sixfold between 1999 and 2013, according to CDC statistics, even as all other age groups have seen the rate of increase slow or stabilize.

Minnesota data mirrors those trends, with the number of prescription opiate-related deaths among those 55 and older rising from just 10 in 2013 to 47 a decade later. Public health officials worry the U.S is unprepared to deal with the influx of older opiate users.

When addiction goes unnoticed

Family members often miss signs of drug dependency in older relatives, according to addiction counselor Carol Colleran, who helped create Minnesota-based Hazelden's addiction treatment track for older adults in the early 1990s.

"They start calling them and they're slurring their words," Colleran said. "So many of their symptoms mimic either the aging process or some other form of disease or illness. They'd all rather it be some other disease or illness than have it be [addiction]."

Colleran calls many older people who got hooked on medication "accidental addicts." She realized when she was clinical director at a Florida treatment facility that older people weren't being well served by the traditional group treatment approach.

"Older men tend to downplay their using and they're very fussy about language, and they don't like the f-word, and younger men on the unit use the f-word," Colleran said. "And older women tend to mother the young ones and, consequently, it took their focus off themselves."

Illnesses that sometimes accompany aging, like Jeffrey's cancer, are only the most obvious triggers of a possible drug dependency, said Hazelden Florida Executive Director Brenda Iliff, who directs the BoomersPlus program in Naples which focuses on the specific needs of older adults struggling with addiction.

When accompanied by more benign signs of age — a slowdown in people's metabolic rates, a decline in tolerance and more frequent prescriptions for pain pills — a drug dependency can emerge quickly and unexpectedly.

"Those are the types of pills that are really addictive, then you mix those together and that can add to the possibility of addiction," Iliff said. "Then you add just those one or two drinks they've had all their life, no big deal, but you add it to the pills and you've got a really serious, possibly even fatal, combination going on." The social changes that accompany getting older can further alienate those who develop a drug dependency.

"We have folks here too who are former CEOs of companies and they talk about, 'It's hard not to be asked my advice anymore,'" Iliff said. "One guy here called himself a 'formerly important person,' a FIP. But even people who are stay-at-home moms, who's asking their advice anymore?"

Since Hazelden introduced the treatment track for older adults, similar programs have popped up across the country, although not yet in Minnesota. Minnesota is among the states trying to stop overdose deaths through a new law allowing wider access to the anti-overdose drug naloxone. Earlier this month, President Barack Obama announced $133 million in new funding to prevent overdose deaths.

"There's a lot of hidden people, we have no idea where they are, they could be in assisted living, that could be anywhere," Iliff said. "We don't know how big it is, because we attribute [addiction] to medical issues. Many times it is medical issues, but many times it's not."

Struggling with addiction, a second time around

The nation's 75 million Baby Boomers are the first generation in the U.S. in which illicit drug use became commonplace and societal attitudes grew more tolerant. But for those people who struggled with drug dependency earlier in life, the health complications of aging pose a second round of risk.

Minnesota native Moya Chase has lived that Baby Boomer experience. At the age of 24, she had two kids and a dependency on benzos and pain pills. She found help through Alcoholics Anonymous and was sober for 30 years.

But four years ago, she needed knee surgery. She started abusing her pain pills as soon as the surgery was done.

"As soon as he left the room, I said it was party time, and started taking handfuls," she said. "I could get as much as I wanted from the surgeon, so I would just call and say I had a lot of pain and I'd get more pills."

Chase said her next two to three years were a fog, as the studio she used for painting became her sanctuary for drugs and alcohol.

"The whole head trip was exactly the same as in my 20s," Chase said. "Fear, fear and more fear."

Her children were the first to notice that Chase had a problem.

"It was terrible because they're adults now, and it was the furthest thing from their minds, then they started putting the pieces together," Chase said. "Between the pills and the wine, my husband finally crawled out of his denial and saw me falling down the stairs."

Chase enrolled at the Hazelden Betty Ford treatment program in Naples, Florida. She's since regularly began attending support meetings and working through a 12-step recovery program. Her husband joined Al-Anon, which supports friends and families of drug and alcohol users. Chase also reaches out to other baby boomers struggling with addiction.

"I feel so grateful that I can go anywhere and do anything and be comfortable in my own skin without any drug or alcohol in my body," Chase said. "I can just take myself and that's enough."

Doctors quick to prescribe, slow to treat addiction

Public health policy makers are drawing attention to overdose rates among older Americans, but prescription drug abuse has been a longtime taboo subject among doctors and in traditional medical education.

Jeffrey, the 66-year-old who had tonsil cancer, said he broached his concerns about his growing dependence on opiates with the two doctors who prescribed him the pain pills.

"The first time it was just cold indifference," Jeffrey said. "The second was a much more sympathetic view, but not very helpful because they had no idea where to send me."

Addiction medicine is still a very new school of medical practice. Doctors have been urged to prescribe opiates to deal with pain but haven't been trained to counsel patients on addiction, HCMC's Reznikoff said.

"If you get prescribed opioids, there's a small chance you'll get addicted, no matter who you are," Reznikoff said. "It's not misbehavior. It's a reaction your body is having to these medications — it's almost like a side-effect of the medications." There are signs that doctors and medical educators are paying more attention to addiction issues in Minnesota and nationwide.

The University of Minnesota is making addiction a larger part of its medical school's curriculum. And groups like the Steve Rummler Hope Foundation in Minneapolis, which lobbied state government successfully for wider access to anti-overdose drugs, have been individually reaching out to doctors throughout Minnesota to educate them about addiction issues.

And addiction treatment centers that focus on older people, like the BoomerPlus program in Florida, are becoming more common. Similar programs have opened in Mississippi, Connecticut and other states in recent years.

There's currently no elder-focused addiction treatment program in Minnesota. But there are treatments available in Minnesota for "accidental addicts" like 66-year-old Jeffrey.

Counselors at Valhalla Place addiction services in Woodbury helped him transition from methadone to a drug called Suboxone, which can sometimes tamp down cravings with fewer side effects. He hopes to be off that drug within a year, but is willing to take it slow if that's what his counselors' advise.

When he was growing up, Jeffrey remembers reading in Life Magazine about methadone users, who he says seemed to populate only far off places like New York City. He was ashamed and embarrassed to tell his family about his struggles with opiates. But he couldn't imagine going through treatment without them.

"You'd be foolish to try to do this by yourself — the more help you get the easier it is," Jeffrey said. "The support that's provided, the encouragement, the text message that says 'Good job, Dad' — that means a lot."