By Calista Harbaugh, Preeti Malani, Rebecca Haffajee, Jennifer Waljee: For More Info, Go Here…
Pain is everywhere. In the United States, nearly 66 million individuals experience acute pain from a surgery or procedure each year, and 100 million individuals suffer from chronic pain lasting weeks to years. The US has garnered the dubious honor of becoming one of the world’s largest consumers of prescription opioid analgesics, in part fueled by the changing perception of pain and pain management in the late twentieth century. However, there is no evidence to suggest that the US provides better pain management than our global counterparts, and morbidity and mortality attributable to opioids continue to rise.
In response, numerous state policies related to prescription pain management have emerged. Many of these policies are aimed at limiting the upstream source of opioids diverted into communities by reducing opioid prescribing, more so than combatting the “late effects” of opioid use such as addiction, dependence, and overdose. However, these upstream targets are also the source of pain management for many Americans with acute and chronic pain conditions, and the public perception of these policies is underexplored. Examining the cultural acceptability of these policies is key to predicting whether they will have their intended effect—to mitigate opioid-related harms by reducing the dispersion of opioids in the community.
Older adults may be especially affected by policies that restrict opioid access and impact pain management. Acute and chronic pain disproportionately affect older adults given their increased burden of health conditions, and older adults have historically high rates of being prescribed opioids. Although the population of older adults continues to grow, their views on opioid policies have remained largely unheard. The University of Michigan’s National Poll on Healthy Aging (NPHA) is a recurring, nationally representative poll of US older adults ages 50–80 years. In March 2018, the NPHA asked about older adults’ experiences with opioid prescribing and their perceptions of opioid-related policies that limit prescribing or encourage disposal of unused opioids.
Opioid Prescribing Limits: Does One Size Fit All?
Opioids lingering in medicine cabinets are a major contributor to the current public health crisis. By the end of 2018, 33 states had enacted policies to limit the number of pills that can be provided in a single opioid prescription. For prescriptions for acute pain, this limit usually ranges from 5 to 14 days. While this prescription length was meant to encompass the period of time in which acute pain would be expected to resolve, this may not correlate well with appropriate opioid use for any given condition. Moreover, limits may not account for the nuances of pain related to specific surgical procedures or other patient factors, such as tolerance, exposure, and preference.