I live in a walk-up building three floors above an old lady with the name of a Neil Simon character: Mildred Plotkin. Mildred is 84 years old, approximately five feet tall, and batshit crazy. She regularly greets my upstairs neighbor with a heartfelt “Hello, Bitch,” and a few months ago accompanied the hello with a punch to the stomach. Last week, Mildred assaulted another person in the building. Cops were called, heated discussions ensued, but little was done. What can you do? As the cop said, “I don’t want to haul an old lady to the nuthouse.”     

So What Do We Do? Prescribe and Hide.

We all have the instinct to protect our elders. Cops—and doctors—are no exception. That instinct could, however, be not only why doctors are prescribing seniors opiates at alarming rates but also why their overdose deaths are going under-reported. As Andrew Kolodny of Physicians for Responsible Opioid Prescribing told Al Jazeera, “No one wants Grandma to have died of a drug overdose.”

So many senior overdoses are falsely marked down as being of natural causes. And odds are that this is happening all the time. According to the CDC, more than 70 percent of prescription drug deaths in America are the result of opioid painkiller abuse. And 20% of our 40.3 million seniors received opiate prescriptions from their doctors in 2014. That’s 8.5 million prescriptions last year. As the population continues to age (the senior population will more than double in the next few decades), how are we going to manage pain without causing death? Seniors’ family members don’t know where to turn, and reputable doctors are torn as to whether they should write these prescriptions or tell their patients to live with pain.

How Marketing Changed Grandpa’s Trip to the Doctor

Kolodny, who is chief medical officer at Phoenix House, says that pain management for seniors changed due to drug corporation marketing. Previously used treatments like Tylenol or Advil began to be described as risky when used for long-term pain management. Enter the new opiates—admittedly expensive and constipatory but also ravishingly effectual drugs that were (according this Braun Medical media pamphlet) “rarely addictive when used properly for the management of chronic pain.”

Of course, that’s bullshit. Which might not be Kolodny’s idea of le mot juste, but he would support the sentiment. Kolodny says, “When we talk about opioid painkillers, we’re essentially talking about heroin pills.” Opiates, in his opinion, are useful for end-of-life care or for short-term pain issues. But otherwise people exposed to opiates on a daily basis “can easily become addicted…and it doesn’t make a difference whether or not they’re young or old.”

To Further Complicate The Issue. . .

There are two things that make it more difficult for our seniors as chronic pain becomes a part of their lives. First is our cultural Pollyanna-ism: We’ve all been taught that, in our endless American pursuit for happiness, there should be no pain. This point of view allies nicely with pharmaceutical marketing. Kolodny states, “The message there is that the patient shouldn’t have to feel any pain. They should just take the medicine around the clock, whether or not they’re experiencing pain. That message, that way of promoting opioids, has led to a public health crisis.” In short, we need to stop replacing reality with advertorial fantasies of pain-free existence.

Secondly, it turns out that there can be issues with taking Advil or Tylenol too frequently. In 2012, the British Medical Association reported that that normal three-times-a day doses of Ibuprofen triple the risk of strokes and increase the chances of a heart attack. And frequently ingesting slightly too much Tylenol can seriously damage our over-worked livers and lead to what the British Journal of Clinical Pharmacology calls a “staggered overdose.”

Caught Between Pain Management, Inertia, and Mistrust

So it’s a minefield, choosing when and how we as a culture will manage pain. Preventing or managing pain through healthy living and physical therapy is of course ideal. Perhaps it’s not a case of us marketing a better answer for the issue, but one of accepting the realities of life (pain and all) as it is. But that’s a pretty brutal thing to tell an elderly person with chronic spinal pain.

I don’t know if poor Mildred’s craziness is caused by dementia, drugs, or a combination of the two. And, as with so many seniors across the country, no one knows what to do with her. One thing seems clear, though—just like Mildred, opiates are best avoided or treated with a great deal of wary, mistrustful respect.