Jim Martin, President Of The 60 Plus Association, December 16, 2003

“As President of a national seniors organization that calls on 5 million seniors for support, I have increasingly become more aware of the silent crisis many of America’s seniors face — the so-called “invisible” disease of chronic pain. Seniors are among one of the largest segments of the population that suffer from chronic pain and inadequate treatment of that pain. As our age rises, so do the number of aches and pains. Nearly 1 in 5 over the age of 60 regularly take medication for chronic pain conditions. Clearly, pain is a serious and widespread problem among seniors that desperately needs our attention, and I would like to thank the Association of American Physicians and Surgeons for hosting this forum today to spotlight the importance of this issue and to begin to look for viable solutions to the problems surrounding good pain treatment for seniors.

I am one of those lucky seniors who thankfully lives a life without chronic pain. I play on four senior citizen basketball teams and a senior citizen softball team that travels coast to coast for competitive tournament play. One of my grandchildren (I have 13) asked if our basketball was real, that is, full-court with referees and so forth. I said, “Sure, when you see the videotape that is not slow-motion, that’s us!” So I am blessed. However, living with undertreated persistent pain has serious, even deadly, results for many American seniors.

Again, I want to thank the Association of American Physicians and Surgeons, and especially Kathryn Serkes, for hosting this important forum on how to address a growing crisis, the increase in prescription drug abuse. I have a prepared statement and it is available as a handout and is on our website, www.60plus.org. But I am here today more as an observer and an interested advocate for senior citizens, to listen and to learn from the experts about how to resolve the epidemic increases in prescription drug abuse and the long arm of the law in trying to cope with this growing crisis. Let me highlight a couple of comments from some of the information I’ve been reading about this problem.

First of all, when used appropriately, prescription drugs make complicated surgery possible, they relieve pain for millions, and they enable people, especially seniors, with chronic medical conditions to control their symptoms and lead productive lives. However, prescription drug abuse is a serious public health concern with some 10 to 11 million people abusing prescriptions drugs in the year 2001. Nearly half of these were as young as 12 years old (they were in the 12-25 year range). One third of all drug abuse in the United States is prescription drug abuse. The number of new users of stimulants went up over 250% in the past decade. Recent data shows that in the year 2001 the most dramatic increase in new users occurred among young adults. There are other just as startling statistics.

But in my age group, seniors are barred from their normal, daily activities and hobbies by chronic pain, slowly losing their ability to live an independent lifestyle. Even more serious is the link between pain and depression. Almost 70% of pain sufferers report feeling anxious and depressed because of their pain. This is especially alarming in regard to seniors, who have the highest suicide rate in the nation — four times higher than the national average. For many seniors, pain not only begins to kill their enjoyment of life, but sometimes ultimately leads to death itself.

Unfortunately, recent studies show seniors are not receiving the help they need. A study by Brown University revealed that 40% of nursing home patients do not receive adequate relief for their pain. There are several reasons behind this lack of treatment. Many of the reasons are the same for other populations, such as healthcare providers’ fear of legal consequences and regulatory scrutiny as well as inadequate education among the medical community on pain management and addiction. But seniors also face unique challenges.

Many seniors face difficulties in simply affording treatment. Prescription medications are the most common remedy for chronic pain, but with ever-increasing prescription drug costs and no Medicare drug coverage, many seniors have been unable to afford the relief they need. Until now.

Less than two weeks ago, President Bush signed the Medicare Prescription Drug Improvement and Modernization Act, finally providing our seniors with affordable access to the prescription drugs they need. 60 Plus supported new prescription drug benefits and believes it can be a significant step forward in helping seniors receive the pain management they need. As President Bush stated, “We must keep our commitments to the elderly, and help bring the healing miracle of modern medicine to the people who need it in our time.” Economic barriers no longer need be the obstacle to seniors’ relief from persistent pain.

It is important that we continue to work on the myriad of other roadblocks to effective pain management for all seniors. A high prevalence of dementia, communication barriers, and multiple medical conditions often make it difficult to accurately assess pain in older persons. The medical community has begun serious work on setting out guidelines for better assessment and treatment of pain for seniors – and 60 Plus applauds the hard work done on this issue and are exited about future developments.

Also, seniors, more than any other group for obvious reasons, have to deal with the complex issues surrounding end-of-life pain management. Studies have repeatedly suggested we have too few hospitals, doctors, and nurses providing the end-of-life care our seniors need. A recent study by Last Acts, a national coalition to improve care and caring near the end of life, reported that only 14 percent of hospitals nationwide offer specialized end-of-life care programs to provide pain relief, along with emotional and spiritual support. Furthermore, less than half the hospitals in the U.S. offer any kind of pain management program at all. The study also pointed out that several state laws regarding the use of painkillers have created considerable barriers to sufficient pain management for dying patients. We know many doctors are sincerely frightened to prescribe needed pain medication to their dying patients. State and federal laws must be crafted to ensure that dying patients receive the medicine they need to die in comfort, but these laws should not constitute a “free pass” for the practice of euthanasia.

It is vital that we begin to address these issues. The law should work to facilitate patients, physicians and pharmacists working together to wisely use medications that can provide pain patients a better life. Opening lines of communication between the medical community and law enforcement agencies is vital. We recognize that some medications do need to be controlled, however, doctors should be able to effectively treat their patients for pain without fear of legal harassment — and protections for patient privacy need to be part of the solution.

I believe we must turn to our state medical boards to become the first line of defense in preventing pain medication abuse. The medical community should work hard to self-regulate the use of pain medication and to help prevent abuses. Other doctors best know the type of treatments that are safe and acceptable to use, not policemen and prosecutors. If seriously egregious situations arise, law enforcement should become involved, but we should turn first to the medical community.

These are difficult issues that present complicated challenges. Together we must work to discover solutions that enable our doctors and nurses to do their job — providing patients the care and relief they need and deserve. The 60 Plus Association looks forward to working with all of you in our endeavor to find real solutions for seniors, and all those who suffer from the “invisible” disease of pain. Thank you.