By Mac McLean • The Bulletin

Every month, Colin Taylor sees a handful of people — most in their 50s, some in their 60s and 70s — walk through the main door at Best Care Treatment Center’s Redmond detox facility and sign up for an emergency round of treatments.

“They need to get off their medication,” said Taylor, the addiction treatment center’s program manager. “They just can’t stop.”

Men and women between the ages of 45 and 54 had Oregon’s highest overdose death rate — 23.3 deaths from an overdose per 100,000 deaths for men, and 19.7 per 100,000 for women — between 2008 and 2012, according to a report the Oregon Health Authority released in May 2014.

Taylor wasn’t surprised by these findings and said people in this age group have such a high death rate because they live with circumstances that can complicate their addictions, and they are often unwilling to seek help on their own.

“There’s usually an intervention involved,” said Taylor, who’s thankful health care providers like Mosaic Medical — which runs a clinic just down the street from his company’s Bend outpatient treatment center — are teaching their staff how to recognize the signs an older person may have a prescription drug problem and give that person the extra push needed to get help.

The problem

According to the report, an average of about 116 people in Oregon between the ages of 45 and 54 died from an alcohol poisoning or an unintentional overdose of illicit and prescription drugs each year between 2008 and 2012. Prescription opioids like fentanyl, hydrocodone, hydromorphone, methadone, morphine and oxycodone were the most commonly overused drugs among members of this age group and deemed responsible for about 62.4 deaths each year during this time period.

They were followed by:

• Acute alcohol poisoning, which was linked to 39 deaths among members of this age group each year.

• Overdose of antipilpeptic, sedative hypnotic or psychotropic drugs, which were linked to 32 deaths each year.

• Overdose of heroin, which was linked to 23.6 deaths each year.

• Overdose of psychostimulants, which were linked to 12.4 deaths each year.

• Overdose of benzodiazepines, which were linked to 9.6 deaths among members of this age group each year.

The report identified cases where the person who died was using more than one drug — a common combination involved mixing prescription opioids and benzodiazepines — and several others where doctors and medical examiners could not determine what drug was responsible for the death.

But painkillers, which were linked to 85 overdose-related hospitalizations among 45- to 54-year-olds each year, were far and away the leading cause of overdose deaths among people in this age group, according to the report.

Taylor said most of the people who check into his clinic seeking help for a painkiller addiction/dependency started taking the medications for a legitimate reason. But over time, the effects of their prescribed dosage wore off and they needed more and more pills to manage their pain.

“People get dependent on them,” Taylor said, and many of the clinic’s older clients don’t show any signs of addictive behaviors — a compulsive need to use the drugs despite the consequences — and instead suffer from a physical dependence that can be treated through detoxification alone.

But there are a number of older clients who do have a full-blown addiction, he said, and these people can be among the most difficult to treat.

Taylor said one of the reasons people in their late 40s and early 50s are so hard to treat is that they tend to experience more stress than other people and that can create problems if they don’t have a way to manage it. He said these increased stress levels can magnify the amount of pain a person feels from an injury or illness, which in turn makes them take more drugs and puts them at a greater risk of physical dependence.

People may also start using their medications to escape their increased stress levels, Taylor said, and this initial misuse of the medication often results in full-blown addiction. He compared a painkiller addiction to gambling and said that while some people can use the medications and walk away once their pain has subsided, others can’t. Those are the people who need the most help.

Christine Pierson, chief medical officer for Mosaic Medical, said people in this age group are also prone to depression or other mental illness that can both increase their risk of developing an addiction and interfere with their ability to get treatment.

If someone in this age group has abused the medications for an extended time, she said, they’re also more likely to have lost their jobs or alienated friends and family members — making it harder to get help and complicating their recovery.

Though these issues can worsen an older person’s situation, they are dwarfed by the fact that many people in their late 40s and early 50s think their behavior is fine and are in denial about their situation.

“We get a lot of patients who aren’t willing to admit they have a problem,” she said, and there’s really nothing a doctor can do to address a person’s addiction/physical dependence until that person admits he or she has a problem and needs help.

The solution

The report’s authors included a series of recommendations the state could follow to reduce the number of people who die from an overdose each year.

They included removing methadone for pain management from the Oregon Health Plan’s drug formulary (this drug alone was responsible for 27 deaths among 45- to 54-year-olds each year,) teaching patients and the general public more about the risks associated with using and abusing prescription drugs, and increasing access to pain management clinics that provide people a way they can manage their symptoms without prescription drugs.

They also called for the development of new strategies to give primary care providers and other physical health providers a chance to work directly with substance abuse counselors and other behavioral health providers. The joint effort could create a seamless way of identifying people who have a physical dependence/addiction to painkillers and get them the proper treatment as soon as possible.

“It’s part of a national effort,” Taylor said, explaining most of the older people who come by his clinic do so only after a physician recognized they have a problem and sent them there for treatment. “Some doctors are intuitive. … They recognize (these signs) and they can tell something is going on right away.”

Taylor said several Central Oregon physicians have sent him clients over the past few years. But he said Mosaic Medical stands out as one of the best.

Pierson said a few of Mosaic Medical’s providers have learned how to use SBIRT protocols (Screening, Brief Intervention, Referral to Treatment), which provide ways to find help as soon as a patient displays an inconsistent refill history, abnormal behaviors or any other signs he may suffer from an addiction/physical dependence to prescription painkillers.

She said this process differs from patient to patient depending on their situation — the conversation with a patient who is suspected of having a problem carries a much different tone from the one involving a patient who has just come back from the hospital after an overdose — but ultimately ends with a phone call to a place like Best Care and placement in an in- or out-patient treatment program as soon as a patient admits he needs help.

“It takes a lot of time and maneuvering,” Pierson said, adding that while some older patients are open to the idea that they need help, others are not and will refuse to get help no matter what she or any one else does on their behalf.

— Reporter: 541-617-7816, mmclean@bendbulletin.com

9483080