WASHINGTON – The number of senior citizens getting narcotic painkillers and anti-anxiety medications under Medicare's prescription drug program is climbing sharply, and those older patients are being put on the drugs for longer periods of time, a USA TODAY examination of federal data shows.
From 2007-2012, the number of patients 65 and older getting Medicare prescriptions for powerful opioid pain medications rose more than 30% to upward of 8.5 million beneficiaries, the data show. Use of some of the most commonly abused painkillers, such as hydrocodone and oxycodone, climbed more than 50%. And the supply of each narcotic provided to the average recipient grew about 15% to about three months.
The figures suggest that one in five of the nation's 43 million seniors get Medicare prescriptions to take pills like Vicodin or Percocet for their aches and pains, often on a long-term basis.
Meanwhile, the number of seniors getting Medicare prescriptions for anti-anxiety medications, such as alprazolam (also sold as Xanax), busipirone and lorazepam (also sold as Ativan), rose about 25% to more than 700,000. By 2012, the average patient got about five months' worth – about 10% more than in 2007. The data for anti-anxiety medications are less comprehensive than for narcotics because one of the most popular classes of anti-anxiety drugs, benzodiazepines, got very limited coverage until last year under the Medicare drug benefit, known as Part D.
While often helpful on a short-term basis, many narcotic painkillers and anti-anxiety medicines carry considerable risks of abuse and dependence if their use is not closely supervised over longer periods. They also can contribute to confusion and physical injuries. As a result, public health officials have been urging prescribers to be far more judicious in determining which patients should be put on the drugs.
The increased prescribing to seniors "is something we really need to be concerned about," says Michael Von Korff, an investigator for the Group Health Research Institute in Seattle.
Von Korff says seniors on the drugs risk injuries from falls, impaired breathing and cognitive problems, and those risks often are magnified when the medications are used in combination. What's more, he says, "misuse and abuse of these medicines is not uncommon among the elderly. They do get into trouble with these drugs."
In a story last month, USA TODAY found that the number of seniors misusing painkillers and anti-anxiety drugs climbed substantially over the past decade. In 2012, an estimated 336,000 seniors had misused or become dependent on prescription pain relievers, according to data from the Substance Abuse and Mental Health Services Administration.
The rise in such prescriptions reflects "old teaching" that led many physicians to over-prescribe the drugs, especially for long-term treatment, says Jane Ballantyne, anesthesiologist and pain medicine expert at the University of Washington Medical Center. The newer consensus is that the drugs' use should be much more limited, particularly in patients with a history of substance abuse or among groups, such as seniors, who are more vulnerable to side effects, she adds. "But it takes a lot of time and effort to turn the old teaching around."
By drug type, the data show:
- Hydrocodone-acetaminophen, also sold as Lortab, Norco and Vicodin, has consistently been the most prescribed opioid painkiller for seniors under Medicare's drug program. It was prescribed to more than 5 million patients in 2012, up 52% from 2007, and the average patient got more than two months' worth – 20% more than 2007.
- Among other popular painkillers, the use of oxycodone–acetaminophen, also sold as Percocet, grew 58% to 1.2 million patients. The average patient got about a month's worth –12% more than 2007. Use of Tramadol grew the most. It was prescribed to 2.4 million patients in 2012, up nearly 140% since 2007.
- Despite limited coverage, the benzodiazepine Alprazolam still was the most prescribed anti-anxiety medication. There was a 25% rise in recipients from 2007-2012 to 244,000. The average patient got about four months' worth.
- The number of patients getting buspirone, another anti-anxiety drug, grew 46%, to 209,000. The average patient got nearly six months' worth. There also was an 11% increase in patients getting Lorazepam to 162,000. The average supply was four months.
"The big surprise for me is the amount of time that people are being left on these drugs – it's really concerning," says Linda Simoni-Wastila, a professor at the University of Maryland School of Pharmacy.
Simoni-Wastila notes that many anti-anxiety medications should not be taken for months at a time. And the same is true for painkillers, she adds. "Most folks don't need to be on long-term opioids; there are a lot of risks associated with that."
Officials from the Centers for Medicare & Medicaid Services (CMS) declined requests for an interview. In a statement, CMS said: "Medicare takes instances of prescription drug misuse very seriously and recently put in place aggressive new rules that take further steps to prevent drug abuse and overutilization."