Seniors & Opioids

April 20, 2022

Table of Contents

Close to 1 million adults over the age of 65 have a substance use disorder (SUD). Aging can create changes socially and physically that can increase vulnerability for substance misuse.[1]

Seniors often suffer from conditions that can contribute to chronic pain. As a result, they are often prescribed prescription opioids.

Opioids can impact older adults differently than the general population due to changes related to aging. These medications can have significant complications, including overdose and a higher risk for opioid use disorder (OUD), even when taken as medically directed.

Opioids & Seniors

Seniors, or adults ages 65 and older, were over 2.5 times more likely to be prescribed an opioid medication in 2018  than young adults between the ages of 20 and 24. A quarter of seniors at the time of the study had filled at least one opioid prescription during the year.[2]

Increased and prolonged use can lead to a higher risk for opioid misuse and OUD. The effects of aging can also change the way the body breaks down opioids, which can enhance their effects and increase potential risk factors and side effects of these medications. This also leads to faster physical dependence and a higher rate of OUD.

For many seniors, nonmedical use of opioid drugs can be used as a method for self-medicating ailments and pain.

Elderly adults are also at a higher risk for substance and opioid misuse due to physical and social changes and challenges. This can include increased social isolation, loneliness, and depression.

As one’s social circle shrinks and family visits less often, drug abuse can often go unnoticed and develop into addiction. Changes in living situations — like having to leave a long-term family home, loss of independence, and grief related to the death of a spouse, family member, or friend — can raise the risk for turning to drug abuse as a coping mechanism.

Agism can contribute to substance misuse, as family members and friends can often overlook drug use in the elderly. This can be part of the idea that grandma or grandpa deserves their pills since they have lived a long and difficult life. Frequently, the younger generation does not want to “take away” any sort of pleasure from an older adult.

Uses for Opioids Among Seniors

Seniors are more likely to struggle with medical conditions, such as cancer and chronic pain, as they age.

Older adults are at an increased risk for significant and persistent pain. Studies show that pain is prevalent in between 25% and 80% of the elderly living in community dwellings, nursing homes, and long-term care facilities.[3]

Acute pain can turn into chronic pain, which often will be managed with a strong opioid medication that is prescribed to be taken on a long-term basis. Prescribing stronger opioid medications for pain is increasingly common in the elderly population. These medications are often overprescribed as well as prescribed inappropriately.[4]

One of the issues is that non-opioid pain medications (analgesics), such as nonsteroidal anti-inflammatories, are not well tolerated in older adults. This is regularly related to underlying health conditions, such as cardiac risks and hypertension as well as impaired liver and/or kidney functions, or the use of other necessary medications like anticoagulant therapy. Pain control can then be tricky in the older population, necessitating the use of opioid drugs.

Side Effects & Complications of Opioids

Opioid drugs are highly addictive, especially more potent (stronger) opioids that are taken regularly for a long period of time.

Taking opioids long term can build up a physical dependence that will cause withdrawal symptoms and cravings when the drug is not active in the system. This can lead to opioid misuse, including dosage escalation or taking more opioids in between doses. Behavioral changes related to opioid use can develop into an OUD.

Opioids have a high potential for unintentional overdose, especially in the elderly population. The body changes as part of the aging process, slowing down metabolism and the absorption rate of drugs. This can cause the drug to build up quickly in the system and overwhelm it, leading to a potentially fatal overdose.

Seniors are more vulnerable to the negative potential side effects of opioids. Even when taken as medically directed, they can have significant risk factors and complications, resulting in hospitalization or even death.[5]

Seniors are impacted differently by opioids than other age groups. Opioids can exacerbate the following issues in this population:

  • Incontinence
  • Increased rate of falls and therefore hip fractures or injuries
  • Memory issues
  • Sedation
  • Constipation
  • Breathing issues

Older adults are also more likely to be taking other medications for additional health complications and conditions. These medications can interact with opioids, raising the chances of potential side effects for each medication, including elevating the odds for an unintentional overdose.

Chronic Pain’s Connection to OUD

Older adults are likely to struggle with multiple health conditions, which can increase and complicate persistent and chronic pain. Up to 40% of outpatients ages 65 and older report persistent pain. In addition, 77% of heart disease patients and nearly 80% of patients with advanced cancer report persistent pain.

Pain receptors and the body’s response to pain change with aging. This can mean that older adults experience more pain as they age as well as more intense pain.

Chronic pain is often missed or underdiagnosed in the elderly. This can be due to a lack of access to care, increasing social isolation, cognitive issues, stoicism, and differences in pain reporting.

Elderly adults are often hesitant to report pain or use different terminology than their younger counterparts, which can cause treatment providers to overlook it. Pain is also often passed off as a natural part of aging. Therefore, it can be undertreated in seniors.

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

Even when taken as medically directed, opioid use in seniors can lead to the development of an OUD. This is largely the result of long-term use of strong opioids that are commonly given at doses too high for this population. Metabolism changes and issues related to aging often require the dosage to be lowered to half or even a quarter of what a dose for a younger person would be.

The lack of awareness of the opioid epidemic in this age demographic can also contribute to OUD, as pain medications are increasingly prescribed. Less than a third of the time substance misuse and abuse are actually screened for in this population.[6]

Health care providers need to be aware of the issues of medication interactions. Further, they need to watch for signs of opioid misuse and the potential for opioid-related complications, including the development of an opioid use disorder.

Alternative Treatment Methods for Chronic Pain

Opioids can often be administered safely to the older adult population, when dosed correctly and under the supervision of a trained and aware medical professional. Opioids are not often the best choice, however, due to medication interactions, additional health conditions, and the potential side effects and complications of opioids themselves.

There are many alternatives to opioid pain medications and pain medications in general. They may include the following:

  • Physical therapy
  • Cognitive behavioral therapy
  • Educational interventions

It is important that pain management takes a comprehensive approach that can also manage co-occurring disorders and other issues, including depression, isolation, physical disabilities, and health conditions.[7]

Overdose Prevention

Older adults can be more at risk for an unintentional overdose, even at lower doses of opioid medications. These drugs are not metabolized the same way as they are with younger adults, and they can interact with other medications that seniors are taking.

To prevent overdose, the first step is to make sure that medications are being taken exactly as medically directed and in the lowest tolerable dose. Seniors often need to take a much lower dose of an opioid drug to minimize risk.

Any misuse of an opioid drug increases the odds for adverse reactions, including overdose. Do not alter the drug or take it in a way that it is not intended to be administered. Ensure that seniors are only taking medications that are prescribed to them directly, and they are not sharing medications or taking someone else’s prescription.

Older adults may need help remembering to take their medication properly. It can be helpful to have a family member or friend aid with dosages and ensure that the medication is being used properly. Do not double up on a dose if one is forgotten, and do not stop taking opioid drugs suddenly without consulting the prescribing doctor.

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

Treatment for OUD for Seniors

Opioid abuse and OUD in seniors are undertreated and often overlooked. Screening protocols should be sensitive and tailored to this population.

Treatment needs often differ from treatments that are appropriate for younger adults. As such, treatment methods will need to serve this demographic specifically to offer the best results. Treatment starts with assessment, and it is important to understand the unique needs of the person seeking care.

Patient-centered care is vital for treating OUD in seniors and should take into account the person’s needs, values, and preferences.[8] Treatment options can include brief structured treatment, education programs, and substance use disorder (SUD) treatments that can include both inpatient and outpatient programs and Medications for Addiction Treatment (MAT).

Treatment programs will need to use age-sensitive approaches that can include: 

  • Managing physical needs, such as hearing issues, vision problems, or difficulties with mobility. 
  • Managing cognitive issues, such as memory and attention difficulties. 
  • Managing learning abilities, which can require repetition of information and moving at a slower pace. 

There are also treatment programs that are age-specific and made up solely of other seniors. This can help to combat social isolation and address unique treatment needs.

Social support and community resources are important with OUD treatment, and these can be especially beneficial when treating seniors who often feel isolated already. Treatment options include a range of methods that can combine pharmacological and behavioral therapy approaches.

Dual diagnosis treatment is optimal when a senior has both a mental health disorder and OUD. It can integrate care to manage both disorders simultaneously.

Pharmacological treatments, including MAT, can be offered on an outpatient basis. They can provide long-term low-dose partial opioid agonists that can aid in reducing pain, withdrawal symptoms, opioid misuse, and drug cravings.

All medications need to 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?

In short, yes. The aging process slows metabolism and the way that drugs are absorbed and processed in the body, which makes seniors more sensitive to them.

Should elderly adults take opioids?

Elderly individuals should consider other treatment options when possible, but often, opioids are still the best choice. Opioids can be taken safely when used in the lowest tolerable dose and under strict medical direction and supervision.

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 health conditions. The optimal type of pain medication will be specific to each individual. Often, opioids are still necessary.

What barriers to treatment do seniors have?

Seniors face several barriers to treatment, including people overlooking their substance abuse and addiction, lack of access to care, social isolation, and less mobility along with potential agism.

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 both inpatient and outpatient treatment options with varying levels of care.

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  1. Substance Use in Older Adults DrugFacts. National Institute on Drug Abuse (NIDA). July 2020. Accessed February 2022.
  2. Variation in Adult Outpatient Opioid Prescription Dispensing By Age and Sex – United States, 2008-2018. Centers for Disease Control and Prevention (CDC). March 2020. Accessed February 2022.
  3. Opiates and the Elderly: Use and Side Effects. Clinical Interventions in Aging. June 2008. Accessed February 2022.
  4. Factors Influencing Trends in Opioid Prescribing for Older People: A Scoping Review. Primary Health Care Research & Development. September 2020.  Accessed February 2022.
  5. Prevention, Diagnosis, and Management of Opioids, Opioid Misuse and Opioid Use Disorder in Older Adults. Agency for Healthcare Research and Quality (AHRQ). August 2019. Accessed February 2022.
  6. The Impact of the Opioid Epidemic on the Aging Services Network and the Older Adults They Serve. National Council on Aging (NCOA). December 2019. Accessed February 2022.
  7. Cureus. September 2018. Accessed February 2022.
  8. Treating Substance Use Disorder in Older Adults. Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed February 2022.

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