Seniors & Opioids

We might think of opioid use disorders (OUDs) as a disease of the young. In reality, many older people develop serious problems with medications like Vicodin, OxyContin, and Percocet. Sometimes, older adults take so many of these medications that they overdose. 

Experts say opioid overdose rates in seniors increased 1,886% between 1999 and 2019.[1] These numbers will only change when people who misuse these medications get the help they need. 

Effective therapies exist, and they can help anyone with an OUD get better. 

Keep reading to find out why seniors misuse opioids, how an OUD is treated, and why prevention matters. 

Key Facts About Seniors & Opioids

• Of the 1.2 million seniors diagnosed with a substance use disorder in 2019, only 23.6% got treatment for it.[2]

• Between 4% and 9% of seniors use prescription opioids for pain relief. Between 1995 and 2010, opioid prescription rates in adults increased by a factor of nine.[3]

• The proportion of older adults using heroin doubled between 2013 and 2015. Some seniors switch to street drugs as they cannot afford or obtain prescription painkillers.[3]

• Of seniors using opioids, about 1 in 20 admitted to taking pills more often and in higher doses than their doctors recommend.[4] 

Why Do Seniors Use Opioids?

Seniors use opioids for the following reasons:

• Acute pain: Surgeries, dental procedures, falls, and lacerations are all common in older people. Each one causes an intense, short-lived form of pain that can block healing. A short course of opioids could be helpful.
  
• Chronic pain: People 65 and older have the highest rates of chronic pain of any demographic group.[5] Illnesses like cancer and arthritis can cause a grinding pain that interferes with everyday life. While opioids aren't very effective for this type of pain, some seniors lean on their pills for relief.
  
• Fewer options for pain medications: Non-opioid pain medications (analgesics), such as nonsteroidal anti-inflammatories, muscle relaxers, or nerve agents may not be safe for older individuals to use depending on their other medical conditions. Therefore, a doctor may jump to prescribing an opioid more quickly.  

Opioids & Seniors 

Opioids can impact older adults differently than the general population due to a mixture of age-related changes and societal assumptions.

Seniors face challenges due to the following reasons:

• Dosing: Prescribing stronger opioid medications for pain is increasingly common in the elderly population.[6] High doses and prolonged use can lead to faster physical dependence and a higher rate of OUD.
  
• Metabolic changes: Aging can change how the body breaks down opioids, enhancing their impact and increasing side effects. A dose that was once well tolerated may suddenly become too much, increasing the risk of sedation, dizziness, falls, physical injury, or even respiratory depression and overdose.
  
• Societal assumptions: As one’s social circle shrinks and family visits less often, drug misuse can go unnoticed and worsen. Ageism can contribute to substance misuse, as family members and friends can often overlook drug use in the elderly.

These medications can have significant complications, including overdose and a higher risk for opioid use disorder, even when taken as medically directed. 

Opioid Side Effects & Complications in Seniors 

Seniors may be more vulnerable to the negative potential side effects of opioids.[7] Even when taken as medically directed, they can have significant risk factors and complications, resulting in hospitalization or even death.

Common issues seen in seniors include the following:

• Misuse: Long-term opioid users develop a tolerance and experience withdrawal symptoms and cravings when the drug is inactive. Opioid misuse, including dosage escalation or taking more opioids in between doses, quickly develops.
  
• Overdose: Opioids have a high potential for unintentional overdose, especially in the elderly. The body changes as part of the aging process, slowing down metabolism and the absorption rate of drugs. Opioids build up quickly in the system and overwhelm it, leading to a potentially fatal overdose.
  
• Worsening medical conditions: Opioids can exacerbate incontinence, fall risks, memory loss, sedation, constipation, and breathing problems, all of which are more common in elderly patients.
  
• Drug interactions: Older adults are more likely to take other medications for additional health conditions. These medications can interact with opioids, raising the chances of potential side effects for each drug, including elevating the odds of an unintentional overdose.

The Role of Chronic Pain In OUD

The older we get, the more risk we have for developing a condition that causes chronic pain. Chronic pain is often missed or underdiagnosed in the elderly due to the following:

• Lack of access to care
• Increasing social isolation
• Cognitive issues
• Stoicism, as pain is also often passed off as a natural part of aging
• Differences in pain reporting, as elderly adults use different terminology 

Undertreated, misdiagnosed, or unreported chronic pain can lead to misuse of opioid drugs. Any misuse of an opioid drug can raise the risk of developing an OUD.

Opioids have an analgesic effect, which can be highly desirable for someone in constant pain, as the opioids provide temporary relief. When the drug wears off, however, the pain can be intensified, resulting in the “need” to take more to reduce the pain. 

Escalating drug use, increasing dosages, and long-term use all contribute to physical and behavioral dependence and the development of an OUD.

Alternative Chronic Pain Treatments 

Opioids aren't the only solution for pain management in seniors. A comprehensive approach integrating plenty of elements into a combination the senior agrees with can be incredibly useful. 

Doctors might suggest some or all of these options, depending on the senior's pain and preferences. 

Non-opioid medications 

There are many non-opioid medications that are arguably much safer for elderly patients, including non-steroidal anti-inflammatory medications (NSAIDs), acetaminophen (Tylenol), muscle relaxers, nerve agents, gabapentinoids, muscle relaxers, etc.

Therapeutic Exercise 

Gentle movement and stretching can be helpful for orthopedic pain problems, like arthritis. Some seniors find relief through yoga classes. A combination of group and at-home classes can help seniors overcome osteoarthritis pain.[8] 

Other gentle exercise options include the following:

• Swimming
• Walking 
• Pilates
• Tai Chi

Meditation

A meditation practice involves focusing the mind on the breath, not on discomfort or pain. For people who feel consumed with distraction due to discomfort, breathing exercises could help them retrain their brain cells and focus on what's good about their lives.

Acupuncture

Needles enter pressure points and trigger endorphins and other brain chemicals. For some people, these sessions are incredibly relaxing and can ease discomfort due to very painful conditions like arthritis. 

Topical Medications

Creams with capsaicin (a form of pepper) can ease discomfort due to neuropathy, and some people like its warm and soothing feeling. Lidocaine cream can help with surface pain too. 

Opioid Overdose Prevention for Seniors

Older adults can face high overdose risks, even at lower doses of opioid medications.

To prevent overdose, follow these steps:

• Ensure that medications are taken exactly as medically directed and in the lowest tolerable dose.
• Do not alter the drug or take it in a way that it is not intended to be administered. 
• Do not double up on a dose if one is forgotten, and do not stop taking opioid drugs suddenly without consulting the prescribing doctor.
• Make sure that you or your loved one knows the medications they are taking. Using pill boxes or alarms to remember to take medications at the appropriate times 
• If there is concern about remembering to take medications, make sure you have a loved one of professional (home health aid, etc.) to help remind you.

Watch for potential risk factors and behavioral changes indicating opioid misuse or addiction. Depression, isolation, and unmanaged pain can all increase rates of opioid misuse and the potential for overdose.

Treatment for OUD in Seniors

Patient-centered care is vital for treating OUD in seniors. Treatment should consider the person’s needs, values, and preferences. Therapy combined with medication is often best for seniors.

Treatment programs should assist with all addiction triggers and help the person live a healthier life. Programs might help seniors to manage the following:

• Physical needs, such as hearing issues, vision problems, or difficulties with mobility
• Cognitive issues, such as memory and attention difficulties
• Social isolation
• Underlying mental health issues that complicate recovery

Pharmacological treatments, including Medication for Addiction Treatment, can be offered. Long-term, low-dose partial opioid agonists can reduce pain, withdrawal symptoms, opioid misuse, and drug cravings.

All medications should be taken under the direction and supervision of trained medical professionals and managed appropriately for the senior population.

Opioid Use Among Seniors FAQs

Are older adults more sensitive to opioids?

Oftentimes, yes. The aging process changes metabolism and the way drugs are absorbed and processed in the body, making seniors more sensitive to them. In addition, older adults may have other medical comorbidities that make them more susceptible to side effects of opioids. Lastly, they may be more likely to be taking other medications which have the potential to interact with opioids.

Should elderly adults take opioids?

Elderly individuals should consider other treatment options when possible. If Opioids are the best or only option for pain management, they can be taken safely in elderly adults. They should always be used in the lowest effective doses for the shortest amount of time necessary, and under guidance from a medical professional. 

What is the best pain medication for the elderly?

Pain medications can be tricky in older adults, as they often interact with other medications or be contraindicated with other health conditions. The optimal type of pain medication will be specific to each individual. There are many safe options including anti-inflammatory medications, tylenol, topical creams, lidocaine patches, muscle relaxers, nerve agents, antidepressants, etc. All of these are non-opioid medications and do not have addiction potential. 

What barriers to treatment do seniors have?

Seniors face several barriers to treatment, including increased medical complications, increased number of medications, more chronic pain, lack of access to care, social isolation, less mobility, and potential ageism on the part of medical providers. These increase the risks of inadequate recognition and treatment of opioid use disorders in this population. 

Are there specialty treatment options for seniors?

There are age-specific treatment options that cater to the older adult population. They are sensitive to the specific needs of this unique demographic. They often include inpatient and outpatient treatment options with varying levels of care.