Opioid use in the elderly


Part of aging means that you may face aches and pains. To treat the pain, your doctor may prescribe a opioid. You will join a large group of older adults: Up to 9% of adults 65 and older take an opioid for pain.

Opioids are one of the strongest types of pain relievers. They can be very effective, especially for severe pain, says Cary Reid, MD, PhD, associate professor of medicine at Weill Cornell Medical College in New York and a pain management researcher.

But they also have serious side effects, and older people are at greater risk. If not taken as prescribed, opioids can be addictive or even addiction. “As physicians, we constantly wonder if opioids do more good than harm,” says Reid.

Why so many older adults take opioids

“As you get older, so does your body,” says anesthetist Halena M. Gazelka, MD, president of the Mayo Clinic Enterprise Opioid Stewardship Program in Rochester, MN. You are more likely to have a painful condition, such as arthritis, back injuries, or Cancer.

If you need surgery for any of these problems, your doctor may prescribe an opioid to help you heal. “Opioids are the drugs of choice for treating severe acute pain,” says Reid. They are also given for chronic pain, usually as a last resort.

All of this explains why someone aged 65 and over is three times more likely to take an opioid than someone in their early 20s. Almost 20% of seniors fill a prescription for an opioid in any given year.

How opioids affect older people differently

Older people often metabolize or process opioids differently. “When we get older, our bodies have more fat,” says Reid. This increases the level of an opioid in the bloodstream. Your kidneys may not filter the medicine as effectively, causing it to persist longer in your body.

In addition, opioids can interact with other medications that older people take, such as sleep medication, seizures, and neuralgic pain. “That’s why older people are more likely to have side effects compared to someone in their twenties or thirties,” says Reid. In one study, nearly 30% of men 65 and older had a reaction after taking an opioid.

Common side effects include:

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Risk of opioid abuse

Increase in opioids brain chemicals called endorphins, which relieve pain and trigger feelings of pleasure. It is these feelings of well-being that can set the stage for misuse, abuse, and addiction.

Misuse is when you use a drug in a way your doctor didn’t expect, says Benjamin Han, MD, assistant professor of geriatrics, gerontology, and hospice care at UC San Diego School of Medicine. For example, you take an extra dose for your back pain. Or you pop a pain reliever to relax and to sleep better.

Opioid abuse is a growing problem among older people. One study found that 7% of adults aged 50 and over admitted to abusing their prescription opioid. This can lead to risky side effects, says Reid. You can develop a tolerance, where you need a higher dose of the medicine to feel good.

Misuse opens the door to opioid use disorder. This is when opioids take a toll on your life. You can’t stop or cut back. Or your use affects your ability to work or take care of your family. Other red flags include craving for drugs or taking those drugs in risky situations, such as when driving, Reid says.

Prescribing opioids to the elderly

Over the past two decades, a surge in opioid addictions and overdoses has created a public health crisis. Experts once thought that older adults weren’t as likely to abuse opioids, but found that they were not. Anyone of any age can become addicted to opioids, Gazelka says.

As doctors and patients became more aware of these issues, opioid prescriptions have plummeted across the country. But they are still the most common among the elderly. Often, older patients don’t have as many options for pain, Gazelka says. Or they don’t know about or can’t get other treatments, such as physical therapy, acupunctureand nerve blocks.

On the other hand, there are also concerns that some doctors are being overly cautious about prescribing opioids. “People who don’t get these drugs may benefit,” says Reid. Or a person in serious pain may refuse an opioid because they are worried about their addiction.

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How to take opioids safely

If your doctor suggests an opioid, discuss the risks and side effects. It’s important that you strike up the conversation, says Reid. Less than half of seniors with an opioid prescription say their doctor has warned them about addiction or overdose, according to a survey.

Ask these questions:

  • Do I have other options instead of an opioid?
  • Have you prescribed the lowest possible dose?
  • What side effects should I expect and how can I manage them?
  • How will we decide if this drug works? Can we try something else if we don’t?
  • How often will you need to see me to monitor my progress?
  • Will this opioid interact with any of my other medications?
  • Are you worried that I will become addicted?
  • How will taking this opioid affect my daily life, such as my driving?

While you are taking an opioid, tell your doctor if you experience any side effects or changes in your pain. You will also need a follow-up appointment, where your doctor can make sure that the benefits of taking an opioid still outweigh the risks.

Sources

SOURCES:

Benjamin Han, MD, assistant professor of geriatrics, gerontology and palliative care, UC San Diego School of Medicine.
BMC Geriatrics: “Risk factors for side effects induced by opioids”
Clinical interventions in aging: “Opiates and the Elderly: Use and Side Effects.”
Cary Reid, MD, PhD, associate professor of medicine, Weill Cornell Medical College in New York; pain management researcher; spokesperson, American Geriatric Society.
CDC: “Opioid Basics: Commonly Used Terms”, “Opioid Overdose: Understanding the Epidemic”.
Halena M. Gazelka, MD, anesthesiologist; Chairman of the Mayo Clinic Corporate Opioid Management Program in Rochester, MN.
Innovations in aging: “Rising Rates of Opioid Abuse Among Seniors Visiting Emergency Departments.”
Mayo Clinic: “How Opioid Addiction Occurs,” “Opioids and Other Drugs: What to Watch Out For.”
Proceedings of the Mayo Clinic: “Opioids in the Elderly: Indications, Prescribing, Complications and Alternative Therapies for Primary Care.”
Michigan Opioid Prescribing Engagement Network: “Seniors Experience With Opioid Prescriptions: National Survey on Healthy Aging.”
Morbidity and Mortality Weekly Report: “Change in adult outpatient opioid distribution by age and sex – United States, 2008-2018.”
National Institute on Drug Abuse: “Substance Abuse in Older Adults”.
Preventive medecine: “Prescription Opioid Abuse Among Middle-Aged and Older Adults in the United States, 2015-2016.”


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