As the medical community and lawmakers have responded to the crisis in opioid abuse by making the pills harder to get, there's one group whose needs are being largely neglected: the elderly.
More than 30 percent of people enrolled in Medicare Part D used opioid prescriptions, according to a top Medicare administrator's report to Congress in February 2015. Older people are more apt to have chronic pain from musculoskeletal disorders like arthritis, from nerves damaged by diabetes or shingles, or from cancer. They're more likely to have surgery.
New state laws and guidelines from the federal Centers for Disease Control and Prevention, over recent months, have sought to tighten controls on who receives the pain meds and how much.
While many view opioid addiction as a youthful problem, many older Americans are struggling with dependency and pain. Alternatives to opioids aren't always clear.
I've heard from older people who say please don't allow public pressure to make these completely unavailable. They fear returning to a life of constant pain - mostly physical but sometimes also emotional. Addiction counselor Clare Waismann calls opioid use "a blanket between you and reality."
So the problem becomes, how to weigh relieving pain against the possibility that strong, habit-forming drugs derail one's quality of life? American medicine must release its dependence on popping pills and force health insurers to recognize there's a healthier path for many people.
Opioid pills decrease the pain, particularly at first. Then, as time goes on, they have less effect, and people take more to stop from hurting. The higher doses can lead to confusion and depression, even rendering people homebound. Some are misdiagnosed with dementia.
Older people also don't metabolize the drugs as well, so they stay in the body longer. Opioids can bring on vomiting or constipation, increase the risk of falls and fractures, and damage kidneys and hearts with long-term use.
Most seniors recognize the signs of growing drug dependence, but they're ashamed to talk about it, says Waismann, who runs a medical detox and treatment center in Southern California that serves older people - a rarity. They grew up in a time when drug addiction and alcoholism were viewed as evil, and so they remain silent about the problem. They don't want to identify as "drug addicts," nor do many rehab centers accept older people because of the risk of death involved as people are weaned off opioids.
Nationally, opioid prescriptions have begun to decline, and some doctors have completely stopped prescribing them. Many are recommending non-drug alternatives to manage pain, such as exercise, acupuncture, weight loss, therapy, meditation, tai chi or yoga.
Yet, insurers often don't pay for those, or for costly inpatient clinics like Waismann's.
But even without special treatment, people can speak to their doctors about slowly reducing the dosage. Waismann believes there are alternative medicines to manage muscular and nerve pain. And even at an advanced age, people should think 10 years down the road.
Waismann told me this story. An 83-year-old woman went to the clinic last month. She never had a drug problem, but over the last eight or 10 years had a number of hip and neck surgeries. She was taking more opioids but was still in pain.
She had been worried about her growing drug dependency for nearly four years but didn't know how to stop.
After detox, she was more clear-headed and able to return to driving, traveling, golfing, volunteering at a foundation and visiting with her grandchildren.
She still has a full life ahead.
First published in Newsday. Anne Michaud is the Interactive Opinion Editor for Newsday.