Opioid Use Among Elders Presents a Unique Challenge

When considering the opioid crisis, older adults don’t necessarily come to mind. But the fact is, they are among this country’s largest demographic prescribed opioids for pain management

It’s estimated that 10 million seniors fill at least one opioid prescription each year. Other research that tracks prescribing in U.S. hospitals noted that one-third of older adults hospitalized for non-surgical conditions were prescribed opioids, suggesting that these medications were being prescribed to older adults who may not need them. Even more concerning is that, compared to the community setting, opioid use may be even higher in nursing homes.

These dramatic increases in medical opioid use have been paralleled by rises in nonmedical use, or misuse. Nonmedical use is defined as taking a prescription opioid that was not prescribed to the user or in ways the prescriber did not intend (e.g., using in higher doses, improper ingestion method). Unfortunately, nonmedical use of opioids among older adults has been steadily rising for approximately two decades.

This rise in opioid use and misuse is concerning because older adults are more vulnerable to the adverse effects of opioids than younger age groups. Older adults experience a variety of age-related changes that affect opioid absorption, distribution, metabolism, and elimination. They are also usually more sensitive to opioids, leading to over sedation and accidents.

Pain management for chronic pain does not require opioids, particularly not for older patients, says Dr. Albert Arius of the Medical College of Virginia and VCU Health. “In fact, a number of studies have failed to show any benefit from opioids and treating chronic pain over other treatments. Non-steroidal anti- inflammatories, acetaminophen, and similar drugs can be just as effective if not more effective.” There are also many non-medication options to consider, including cognitive behavioral therapy, yoga, water aerobics and other gentle exercises, massage and acupuncture, and meditation.

It can be a challenge to slowly wean an older patient off an opioid medication, but the benefits of doing so will far outweigh the risks of continued opioid use.