Opioids and Older Adults: Painkiller Abuse is Not Limited to Young People — Addiction Afflicts Older Adults as Well
The topic of seniors and prescription drug abuse is one most of us choose to avoid. Yet the danger of addiction is all too real, and many experts are sounding the alarm, warning that everyone needs to take the issue more seriously. Abuse of the class of pain killers referred to as opioids is especially devasting, since these addictive compounds can ensnare unsuspecting seniors in a cycle of drug dependence that can have devastating, even deadly consequences.
For the latest on this timely and important topic, we turn to this just-published article from NextAvenue, reported by science and health writer Rebecca Hill. Her warning: opioid abuse can literally ensnare just about any of us.
Tragic Over-Confidence Leads to Devastating Loss
Hill begins her article with the story of Marilyn Grimes, a woman who started taking opioids for pain at 45 years old. “I can actually remember saying to myself there’s nothing that’s addictive that I couldn’t quit,” Marilyn said. But by age 50, she had a drug problem, one she could not shake.
“I ate those words, and lost everything,” Marilyn remarked, after serving ten years in prison in Indiana for drug offenses, while losing both her home and her plumbing business.
Hill writes, “Grimes’ story is not unique. Since the 1990s, millions of people have been affected by the three waves of the opioid epidemic. Overdose death rates have persisted and soared in each wave, with the CDC reporting that the opioid epidemic has killed more than 900,000 people since 1999; 110,236 people died in 2022-2023 alone.”
Large Majority of Opioid Deaths are Older Adults
Despite the stats, Hill says that very little has been written about the opioid epidemic’s effect on people over the age of 55. “ Data shows that opioid abuse killed 79,893 people in this cohort from 1999 to 2019,” she writes. “Of those victims, 79 percent were 55 to 64 years old and mostly men.”
And tragically, the numbers continue to increase. Hill explains, “Between 2000 and 2020, age-adjusted rates of drug overdose deaths among people aged 65 and over rose from 2.4 to 8.8 deaths per 100,000 people. Overall, emergency room visits for opioid misuse rose 220 percent from 2006 to 2014, according to the study.”
Many Older Adults are Given Opioids for Pain
Chronic pain, a condition common in adults over 65, is a primary motivator for opioid use, as the pain can limit life and work activities, inhibit overall functionality, and can be detrimental to both physical and mental health.
“People with opioid use disorder (OUD) who depend on opioids and cannot manage their use may find their pain worse because opioids can sensitize nerve endings,” Hill writes. “Plus, as their bodies adapt to a medication, patients may need to take it more often to feel its effect. But increased use of opioids often comes with side effects like constipation, cognitive impairment, nausea and increased risk for overdose.”
She adds, “With advancing age, uncontrolled use of opioids can alter neurotransmitters in the brain and increase a person’s potential for neurotoxicity, or brain damage caused by exposure to a toxic substance. According to a Psychiatrist.com study, if physicians use an opioid, they should introduce it at doses 30 percent to 50 percent of those given to younger patients.”
Opioids Take a Harsh Toll on Aging Bodies
Not only are older people being left out of an important discussion, but they are much more likely to experience harsher effects from the same drugs, says Dr. Roopa Sethi of the University of Kansas (a co-author of the study). The reason for this is that a younger person’s body metabolizes opioids much faster than an aging person’s body does.
“Typically, the organ systems become slower [with age], so they tend to retain medications, drugs or illicit drugs longer,” Sethi says. “Their liver metabolism decreases. Kidney function decreases, so these drugs are in their system hanging out for longer periods. As people age, they have more adipose tissue [fatty tissue], which means more fat and less water content in the body.”
This means that opioids stay in the system of an aging person much longer, released more slowly from the fatty tissues. Hill writes, “Because of this, older adults must be more cautious when using opioids. In addition, people with OUD or who use opioids for pain management must be aware that using opioids can complicate existing medical conditions affecting the kidneys, lungs or heart.”
Fear May Inhibit Medically-Necessary Opioid Use
Screening for opioid use is common among good physicians. But the ongoing coverage of the opioid crisis in the news may mean that aging patients could be afraid, reluctant, or even refuse to take opioids, even when they are medically necessary.
Some physicians may even fall into this fearful or reluctant thinking, especially since training on the use of opioids is not universal. This lack may leave physicians feeling less confident about prescribing opioids. “After the FDA in 2017 adopted new regulations governing prescribing practices, some physicians felt pressured by various regulatory bodies, licensing boards, their institutions and even by insurance companies and pharmacists to stop prescribing opioids for pain treatment,” Hill explains.
A Critical Need, but How Much Is Safe?
Despite their reputation, opioids are critical to the treatment of certain chronic conditions in older adults, such as osteoarthritis and cancer. Suddenly stopping or reducing the dosage of these drugs can be detrimental to the management of these conditions.
But the more uncomfortable physicians were becoming with prescribing opioids, the less seemed to be understood about safe use.
“What is safe use?” Hill writes. “Patients who take opioids for pain or chronic disease or even those for OUD must be evaluated for functionality and actual use. Can that person walk with no trouble? How do they function in daily life? Do they have pain, and to what extent? What is their cognitive function? And what other medications do they use?”
Alternative Therapies and Hope for Recovery
Thankfully, doctors are becoming more and more aware of alternative therapies for chronic pain, whether opioids are involved in any capacity or not. Many of these therapies include physical therapy, yoga, massage, and gentle exercise, because “motion is lotion” to an aging body, as Hill notes.
The good news for Marilyn Grimes, the woman featured at the start of this article? Despite her challenges, she reinvented herself after her release from prison, earning a bachelor’s degree in social work. “She now lives in Bloomington, Indiana, and manages Courage to Change Sober Living, a 12-step, low-barrier sober living environment for recovering addicts, helping others get back on their feet,” Hill concludes. “She’s found her way out, and now she’s helping others find their way out too.”
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(originally reported at www.nextavenue.org)