As the body ages, it often aches. In the United States, 81 percent of adults over 65 endure multiple chronic conditions such as arthritis, hypertension, heart disease, and diabetes. There also can be emotional pain from the loss of relatives and close friends, and concerns about the continued ability to live independently.
For those whose physical ailments prove almost paralyzing and chronic, health providers often prescribe opioid painkillers, such as hydrocodone and oxycodone. But that can lead to trouble. Last year, the Department of Health and Human Services declared the opioid crisis a public-health emergency. The department has spent almost $900 million on treatment services and other initiatives, but still more and more Americans are dying of overdoses on opioids—in the forms of prescription pain pills, heroin, or synthetic drugs. While older adults are not the age group most affected by the crisis, the population of older adults who misuse opioids is projected to double from 2004 to 2020.
A lot of factors contribute to this rise among the elderly. Many undergo several surgeries and are prescribed opioids they use for a long time, which heightens their chances of developing a use disorder. Some take more than they need, because the opioids they’ve been prescribed aren’t holding their pain at bay. Older adults of color, who face more barriers to getting the medications they need for pain, may get prescriptions from friends or family without proper instructions. But a recent poll highlights just how widespread another factor might be: doctors failing to warn their own patients about the risks that come with prescription pain relievers.
RGS9-2, a key signaling protein in the brain known to play a critical role in the development of addiction-related behaviors, acts as a positive modulator of oxycodone reward in both pain-free and chronic pain states, according to a study conducted at the Icahn School of Medicine at Mount Sinai and published online January 17 in the journal Neuropsychopharmacology. The mechanisms of oxycodone action uncovered through this study will help scientists and physicians develop strategies and tools to dissociate the analgesic (pain relief) actions of opioids from the addiction-related effects.
Using mouse models of acute and chronic pain, Mount Sinai researchers found that RGS9-2, the intracellular protein that controls the function of opioid receptors in the brain reward center, promotes addiction to oxycodone in pain-free, acute, and chronic pain states. Mice that lacked the gene responsible for encoding RGS9-2 (RGS9KO mice) showed less propensity to develop addiction-related behaviors. Furthermore, the loss of RGS9-2 function does not affect the acute analgesic effects of oxycodone. The research team also found that RSG9-2 plays a protective role towards the development of oxycodone tolerance, as RGS9KO mice became tolerant to the analgesic effects of the drug earlier than those that had the gene. Researchers found that the same mechanisms control sensitivity to oxycodone addiction in pain-free as well as chronic pain states.
The use of opioids (narcotic pain medication), often prescribed for chronic musculoskeletal pain, has skyrocketed in recent years with 98 percent of the world’s opioid prescriptions filled in North America. Two research studies presented this week at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), link decreased opioid use prior to joint replacement surgery with improved patient satisfaction and outcomes, fewer complications, and a reduced need for post-surgical opioids.
In the poster, “Pre-opioid use: Is there an association with outcomes following TKA?” researchers reviewed Humana, Inc. insurance data for 84,685 patients between 2007 and 2014. Patients undergoing total knee replacement (TKR), their comorbidities, prescriptions and 90-day outcomes were identified using condition/disease codes. An opioid user was defined as someone with an opioid prescription filled during the three months prior to TKR; patients with no history of opioid prescriptions were categorized as non-users.
Nearly 59 percent of the patients (49,617) did not use opioids prior to surgery, while 41.4 percent did. The top three prescribed opioids were hydrocodone/acetaminophen, oxycodone/acetaminophen, and oxycodone.