Here’s a shocking statistic: Deaf and hard of hearing people are twice as likely to develop a prescription opioid-use disorder than their hearing counterparts. That finding was uncovered by Dr. Michael M. McKee, a family physician with hearing loss who leads the Deaf Health Clinic at Michigan Medicine.
Dr. McKee noticed that many of his new patients were taking controlled substances to address chronic pain. He began to wonder if hearing loss was a factor, and set out to formally explore the relationship between hearing loss and substance use. His findings were published the American Journal of Preventative Medicine.
Dr. McKee’s key finding was that adults (aged 18-49) with hearing loss were significantly more likely to develop an opioid use disorder when compared to their normal hearing peers, especially for those younger than 35. Older adults with hearing loss were no more vulnerable than their peers.
Understanding the hearing and pain connection
Dr. McKee became concerned that his patients’ high number of prescriptions might be due to communication issues. If information isn’t fully shared, it presents challenges to receiving optimal care. “Whether it’s back pain, fibromyalgia, [or both] of those conditions, chronic pain requires a lot of communication to address it,” Dr. McKee said. “Most doctors want to avoid controlled substances because of [the risk of] dependency. But when communication breaks down…these issues pop-up.”
During the current COVID-19 pandemic, communication barriers have intensified. Masks block lipreading; a dearth of interpreters at some in-person appointments due to social distancing requirements may also make matters more difficult. If deaf or hard-of-hearing patients cannot understand their doctors, “they are not being taken care of properly,” said Gregory Shuler, RN. BC. MSN., of Worcester Recovery Center and visiting instructor at Worcester State University, when talking with Hearing Tracker.
Why aren’t older Americans with hearing loss at risk?
Interestingly, the occurrence of opioid use disorder among older patients (50+) was the same regardless of whether they had hearing loss or normal hearing. Dr. McKee attributes this to doctors being more aware that older patients may experience age-related hearing loss, leading to improved communication about pain management with older adults with hearing loss.
Advocating for better care and communication
Dr. McKee finds it essential to empower patients to get their needs met but knows this isn’t always easy. Some are simply not comfortable discussing how their hearing loss affects them. “They get to a point where they give up because the barriers are huge. There’s stigma,” Dr. McKee says. “On top of that, some people are not comfortable saying ‘I can’t hear.’”
Dr. McKee cites the Hearing Loss Association of America’s Communication Access Plan as a way that those with hearing loss can address the situation with their doctors. It all boils down to “explaining what is the way to best communicate with me,” he said, “trying to be more proactive instead of reactive on how we address communication needs or combinations needed.” Having this alignment between patient and healthcare professional can improve how well symptoms and sentiments are shared, leading to better care.
How healthcare professionals can help
The medical community can also play an important role in diminishing opioid-use disorder. Previously the charge nurse at the deaf unit for psychiatric adult and adolescent patients at Worcester State Hospital, Shuler—along with other health professionals—outlined how providers could improve communication with deaf patients in Nursing. These steps could also apply to interacting with those who are hard of hearing, too.
- Ask the patient what you can do to help improve the communication process.
- Don’t assume the patient can hear and understand what you’re saying just because they are wearing a hearing aid.
- Ask the patient what communication tools (such as a whiteboard, computer, or tablet) work best for them
- Only one person should talk at a time in a group situation.
Shuler also advocates for professional sign-language interpreters in medical settings instead of relying on the patient’s family or friends, who may have their own biases when signing. “You need someone who is following a specific code of ethics, is a neutral party, and is trained to interact between the deaf person and the hearing person,” Shuler said. Patients may want to request an interpreter prior to their appointments as well.
Overcoming the opioid issue
To address the heightened risk of substance-use issues in deaf and hard of hearing patients, Dr. McKee says that doctors could benefit from communication training, starting in medical school. He says doctors must learn to take a step back and recognize risks that hard of hearing people face.
“These people often have higher rates of mental-health issues, which can go hand in hand with opioid-use disorders,” Dr. McKee said. “Many deaf and hard-of-hearing individuals have depression, anxiety, interpersonal violence, abuse from past, and they may struggle with lower socio-economic statuses.”
As the healthcare community recognizes this issue—and as patients demand appropriate communication—the link between hearing issues and prescription opioid-use disorder will hopefully be unraveled and eliminated.