Nonpharmacologic and nonopioid treatments associated with improvements in pain and/or function that appear comparable to opioid treatments.
Intentional and unintentional misuse of opioids has increased hospitalizations by 34% and emergency department visits by 74% between 2010 and 2015 for American adults aged 65 years and older. Due to pharmacokinetic changes, comorbidities and polypharmacy, older adults are at an increased risk of opioid-mediated adverse effects, including sedation, respiratory depression, constipation, cognitive impairment, impaired motor coordination, falls, and fractures.
In 2022, the Centers for Disease Control and Prevention (CDC) released the updated Clinical Practice Guideline for Prescribing Opioids for Chronic Pain. It expands guidance for weighing opioids’ benefits and risks and finding alternative pain management options for treatment of acute and chronic pain.
Clinical evidence reviews found that nonpharmacologic and nonopioid treatments are associated with improvements in pain and/or function that appear comparable to opioid treatments. Thus, the guideline includes a new recommendation to maximize the use of nonpharmacologic and nonopioid therapies as clinically appropriate for the patient’s condition.
A study published in the Journal of the American Geriatrics Society demonstrated that a brief educational intervention focused on safe opioid prescribing in older adults can increase future health care professionals’ knowledge and confidence. Clinicians at an academic medical center developed and implemented an interprofessional geriatric rotation for students, residents, and fellows.
The monthly rotation consisted of 10 hours of didactic sessions, including opioid training and core geriatrics topics, coupled with 112 clinical hours in a geriatric outpatient setting. The opioid training incorporated literature reviews and clinical practice guidelines, focused on the following:
Of the two-thirds of learners who completed the post-rotation survey, 35% reported an increase in knowledge of safe opioid prescribing for older adults. Furthermore, 32% reported an increase in confidence for considering non-opioid treatment options for older adults. The learners conveyed that they will now be able to communicate with and educate patients, caregivers, and other providers better.
Collaborative opportunities are impactful in providing training focused on safe opioid prescribing in older adults. Further assessment of how educational interventions may influence future prescribing behaviors, such as consideration for non-opioid treatment options, are needed. Although the current study focused on future health care professionals, similar educational interventions would be beneficial as a refresher for current, practicing health care professionals.
With the unique challenges of pain management for vulnerable, older adults, health care professionals must be properly trained to be vigilant when prescribing and dispensing opioids.
Research Protocol: Prevention, Diagnosis, and Management of Opioids, Opioid Misuse and Opioid Use Disorder in Older Adults. Content last reviewed August 2020. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Accessed June 25, 2023.
Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep 2022;71: 1-95.
Balasanova AA, Kim J, Wang H, et al. Interprofessional learner perceptions of a brief educational intervention about opioid prescribing for older adults. J Am Geriatr Soc. 2023;71(6): E19-E22. doi:10.1111/jgs.18358