Opioid Use Among Older Adults

Part of getting older means that you may deal with aches and pain. To treat pain, your doctor may prescribe an opioid. You’ll join a large group of older adults: As many as 9% of adults age 65 and older take an opioid for pain.

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

But they also come with serious side effects, and older adults are at a greater risk. If they’re not taken as prescribed, opioids can lead to a dependence or even addiction. “As doctors, we’re constantly questioning if opioids do more good than harm,” Reid says.

Why So Many Older Adults Take Opioids

“As you age, your body does, too,” says anesthesiologist Halena M. Gazelka, MD, chair of the Mayo Clinic Enterprise Opioid Stewardship Program in Rochester, MN. You’re more likely to have a painful condition, such as arthritis, back injuries, or cancer.

If you need surgery for one of these issues, your doctor may prescribe an opioid to help you get better. “Opioids are the go-to drugs to treat severe acute pain,” Reid says. They’re also given for chronic pain, usually as a last resort.

All this explains why someone age 65 and above is three times more likely to take an opioid compared to someone in their early 20s. Nearly 20% of seniors fill a prescription for an opioid in a given year.

How Opioids Affect Older Adults Differently

Older adults often metabolize, or process, opioids differently. “When we age, our bodies have more fat,” Reid says. This raises the level of an opioid in the bloodstream. Your kidneys may not filter the drug out as efficiently, causing it to linger longer in your body.

What’s more, opioids can interact with other drugs that older people take, such as medicines for sleeping, seizures, and nerve pain. “This is why older adults are more likely to have side effects compared to someone in their 20s or 30s,” Reid says. In one study, nearly 30% of men 65 and up had a reaction from taking an opioid.

Common side effects include:

Risk of Opioid Misuse

Opioids increase brain chemicals called endorphins, which ease pain and triggers feelings of pleasure. It’s these feel-good sensations that can set the stage for misuse, abuse, and addiction.

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

Opioid misuse is a growing problem among older adults. One study found that 7% of adults aged 50 and up admitted to misusing their prescription opioid. This can lead to risky side effects, Reid says. You may build up a tolerance, where you need a higher dose of the drug to feel good.

Misuse opens the door to opioid use disorder. That’s when opioids take a toll on your life. You can’t quit or cut back. Or your use affects your ability to work or care for your family. Other red flags include craving the drug or taking them in risky situations, such as when you’re driving, Reid says.

Prescribing Opioids to Older Adults

Over the past two decades, a spike in opioid addictions and overdoses created a public health crisis. Experts once thought older adults weren’t as likely to misuse opioids, but they discovered that wasn’t the case. Anyone of any age can become dependent on opioids, Gazelka says.

As doctors and patients became more aware of these issues, prescriptions for opioids dropped nationwide. But they’re still the most common in older adults. 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, acupuncture, and nerve blocks.

On the other hand, there’s also concern that some doctors are too cautious about prescribing opioids. “There may be people not getting these medicines who may benefit from them,” Reid says. Or a person in serious pain may refuse an opioid because they’re worried about addiction.

How to Take Opioids Safely

If your doctor suggests an opioid, have a talk about the risks and side effects. It’s important that you start the conversation, Reid says. Less than half of older adults with an opioid prescription say that their doctor warned them about addiction or overdose, according to one survey.

Ask these questions:

• Do I have other options instead of an opioid?
• Did you prescribe the lowest possible dose?
• What side effects should I expect and how can I manage them?
• How will we decide if this drug is working? Can we try something else if it doesn’t?
• How often will you need to see me to keep track of my progress?
• Will this opioid interact with any of my other medicines?
• Are you worried that I could become addicted?
• How will taking this opioid affect my daily life, such as my driving?

While taking an opioid, tell your doctor if you have any side effects or changes in your pain. You’ll also need follow-up appointments, where your doctor can make sure that the benefits of taking an opioid still outweigh the risks.