Q: What should I do if I suspect my elderly father is addicted to prescription pain medication?

A: This may be a problem for many seniors, families and caregivers but such problems have many dimensions and need to be given careful consideration before deciding the course of action.

First, some patients may be "addicted" to their medication because their medical condition warrants aggressive, routine treatments. Patients who have terminal medical conditions are sometimes denied pain medications or pain medication refills a day or two early because of a lack of understanding of the patient's condition. Some healthcare providers may be adversely opposed to providing medication for fear of contributing to possible addiction. If a patient is terminally ill or in irretractable pain, pain medication may be the only source of relief. It is important to understand the difference between addiction and physiologic dependence. A slightly more flexible approach to the use of opioid pain medications may be necessary when dealing with a terminally ill patient.

New standards of care now require healthcare providers to evaluate pain control as they would the patient's other vital signs. You may see the use of rating scales, e.g. 1 through 10, blue to red scales, etc. These are being put into use to assist healthcare professionals in getting a more consistent evaluation from the patient. Use of one of these scales can also be helpful to caregivers in supporting care of their loved one.

But on the other hand, some patients have been continually prescribed medications that may be addicting without attempting other medications to address pain relief. Older patients today have been taking some of the older addictive medications for a longer period of time because there were no other medications to treat painful conditions some 5, 10 or 20 years ago.

While maybe not addicted to a certain medication, elders taking a medication with addictive potential may develop a sense of euphoria or well being that would make them less inclined to change to newer medications to treat a variety of pains.

Your elderly father's specific medical condition, pain control, the medication currently in use and its side effects should all be discussed with your dad's physician. Ask about other medications that have been used to treat the specific pain. Ask about a plan to transition to a new therapy, these transition plans are as individual as the patient.

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There are also special pain management physicians who may be helpful in development of a transition plan, but be sure the specialist you choose has had extensive experience with older patients. If this is the road you will be taking, I would encourage you to ask for a referral to a pain management specialist with geriatric experience.

If you suspect your father is addicted to a medication, you should discuss your concerns with his physician. Ultimately, your father's medication use is between him and his prescriber until such time that you are empowered to actively seek control over his medical decisions and care.