How Common is Opioid Abuse in the Elderly?
Close your eyes and imagine an opioid addict. Who do you see? Would you think of a young, poor male injecting heroin and obsessing over how they will need to score their next hit to satisfy their compulsive use? Or would you think of a grandparent taking more pills than prescribed because they got addicted after a painful surgery?
Most likely, you’d think of the first, but the world of opioid abuse is expanding and changing. Now, people from many age groups, income brackets, and ethnic backgrounds are abusing opioids heavily. The tentacles of the opioid epidemic are extending into the elderly population and grabbing hold like never before.
Older Americans misusing opioids is nothing new, but as the baby boomers age, the number of them doing so is growing. The trend is set to continue, with 2.4% of older Americans expected to abuse opioids by 2020, which is double the number of those who abused opioids in 2004.1
Pain Management or Drug Abuse?
So, we know older Americans are using opioids at higher rates, but why?
First off, we know that as you get older you’re more likely to live with pain and/or chronic illness. Up to 76% of the elderly will complain of pain that is chronic or persistent.2 This rate is even higher in those people living in nursing homes or assisted living, with up to 93% of individuals in these environments suffering from pain.2
Older people are also susceptible to conditions like:2
- Neuropathies – a type of nerve pain that can result in loss of feeling, numbness, and other chronic, troublesome sensations known as paresthesias.
- Bone fractures.
- Organ failure.
Elderly folks seeking treatment for pain or coming out of a surgery are often given opioid medications like OxyContin, Vicodin, and Percocet.2 In some cases, these medications may be overprescribed, may be contraindicated given the range of other medications the patient is on, or simply prescribed at doses that are too high for the patient. In fact, in 2016, more than 500,000 older Americans on Medicare received opioids from their physicians, with average doses “far surpassing” the manufacturer’s recommendations.1
When it comes to patients with chronic and persistent pain issues, some doctors may begin prescribing opioids for long-term pain management, which can be a seriously dangerous move. It doesn’t take very long (a matter of weeks) for a user to become physically dependent on opioids and to develop a tolerance, needing to up their doses to get the effects they’re looking for.3Because risks like these increase over time, opioids are generally safer and more effective when used for a week or less.4
Someone who’s become dependent on their painkillers may keep taking them long past the point they need them for pain because taking it away or cutting back can bring about some really uncomfortable withdrawal symptoms that include:3
- Low mood.
- Feeling sick to your stomach and vomiting.
- Severe aches.
- Trouble sleeping.
- Profuse sweating.
An aging patient who has been given opioid painkillers by their doctor may begin abusing them without realizing they’ve entered dangerous territory.
So, what does it mean to abuse a painkiller? Abusing an opioid occurs anytime you are NOT following the prescription for your medication. This can happen by:
- Taking the drug more often than prescribed.
- Taking higher doses of the drug without your doctor’s knowledge or approval.
- Using the medication for pleasure instead of pain relief.
- Mixing the medication with other drugs or alcohol.
- Taking a medication that was not prescribed for you.
Abusing opioids can quickly lead you to becoming addicted to them, and opioid addiction is an all-consuming condition that requires help to overcome. Addiction to opioids, sometimes called an opioid use disorder, is the compulsive desire to get and use more opioids, even when you know you shouldn’t. You might have an opioid use disorder if you:3
- Spend a lot of the day getting, using, or recovering from use.
- Constantly seem sedated, confused, or forgetful.
- Crave more of the drugs when you don’t have any.
- Show signs of tolerance and physical dependence.
- Can no longer take care of yourself or your responsibilities.
- Argue with your friends and family members more often.
- Have changing moods or feel consistently irritable.
- Continue to use opioids despite physical, mental, or legal hazards.
- Schedule multiple doctor visits to get more painkiller prescriptions.
About 35% of people 50 or older report misusing their opioids within the last month.1 If you’re worried about your own opioid use or that of someone you love, talk to a doctor or addiction professional without delay. It can only get worse the longer you wait. We know that as an older person who never considered that they might become addicted, it can be hard to admit you have a problem and reach out, but there’s no shame in reaching out.
Why Are Older People More at Risk?
High prescription rates in the elderly is only one reason that older people are at risk of opioid abuse. So what are the other factors?
The second factor involves the cognitive state and abilities of the individual. Obviously, as people age, their mental and physical abilities decline. They may be more likely to be confused, forgetful, or have problems with their hearing. This can cause some serious problems when it comes to taking their prescription as directed. They might not fully hear their doctor’s instructions, they might take the wrong dose, or forget if they took it already—all of which can lead to misuse, significant negative side effects, or even overdose.5
Differences in how older bodies handle opioids also adds to the risks. Older people may develop some insufficiencies in liver and kidney functioning, and this can make it harder for the drugs to be eliminated from the body.5 Other issues like changing body composition (e.g., increased fat and decreased water) can result in changes in the ways the drugs are distributed throughout the body.6 This is why opioid painkillers should be started at a low dose and increased only with careful supervision.6
Lastly, older people tend to have many medical conditions that require a number of medications to treat. They may also be dealing with chronic pain from one or more injuries or illnesses and need opioids. However, they are also at risk of the interactions of multiple medications.2
An elderly person on opioids may suffer from a lengthy list of side effects, which may be compounded when combined with other drugs. These effects might include:5
- Problems thinking clearly.
- Poor appetite leading to malnutrition.
- Nausea and vomiting.
- Bowel obstruction.
- Respiratory depression.
- Bladder urinary retention.
- Orthostatic hypotension leading to increased fall risk.
Elderly people intoxicated by opioids may also suffer falls and related injuries that can be very serious in an aging body.
Fortunately, there’s no reason that opioid addiction has to be a life sentence. Programs that help to address medical issues and pain alongside the treatment of addiction are available and can help to undo the damage of opioid abuse.
The news is currently flooded with horror stories from the opioid overdose crisis. People dying from opioid overdoses is a national crisis that continues to worsen with time. In 2016, about 50 people died from an opioid overdose every single day.1
Grandma and grandpa are not immune to this crisis. Overdose from opioids can occur accidently when an aging patient’s prescriber begins a painkiller at a high dose or increases the dose too quickly without accounting for individual differences and the other medications the person takes.2
An elderly person may also overdose when:
- They take alcohol or sedating medications with their painkillers.
- They take more than directed to overcome a growing tolerance.
Intentional overdose is also a risk for aging patients suffering from chronic pain who have a sense of hopelessness about getting better.2
It’s extremely important if you are using opioids or living with someone who is taking opioids that you know the signs of an overdose:7
- Looking very pale and feeling clammy.
- Blue or purple fingernails and lips.
- Body going limp.
- Vomiting and gurgling noises.
- Being unconscious or unable to speak.
- Slowed or stopped breathing.
- Slowed or stopped heartbeat.
Another risk comes from opioid combination products that contain other medications like acetaminophen. Many people don’t realize that their painkillers contain acetaminophen and may take additional acetaminophen products, and this is really dangerous. Someone consuming large amounts of acetaminophen alone or in opioid combination medications can suffer damage to their liver.8 This may be an especially high risk for older individuals who may already have some impairments to their liver function.
Any overdose can be fatal if not treated swiftly. If you suspect someone has overdosed, call 911 immediately. If you are trained to use naloxone (Narcan) and have some on-hand, administer it right away and call 911.
Fighting the Stigma to Get Help
Stigma stands in the way of mental health treatment. Older people might think that only younger people struggle with addiction, or they might think no one could become addicted to a prescribed medication. And after having lived a long and successful life, they may feel too ashamed to admit they’re now struggling with drug abuse.
Of course, it doesn’t matter if you’re older, if you’re successful, if you’ve gotten your drug from your doctor—anyone can become addicted to opioids. It doesn’t mean you’ve failed in some way, and you shouldn’t feel ashamed.
The powerfully addictive nature of opioids combined with short period of time it takes to become physically dependent on them makes them an easy drug to abuse. So many people struggling with opioid addiction began with a prescription from their doctor. These are not bad people but people who may not have realized the inherent dangers of a drug they got from their physician. Like any other disease, addiction has a predictable set of symptoms and requires treatment to overcome.
Admitting the need for treatment is a great start to the process. Speaking to your physician or an addiction professional is the next step. They will ask you questions about your opioid consumption to see if you have an opioid use disorder, determine the severity of the problem, and help you make a plan to stop using.
Getting off opioids can feel pretty terrible. People often describe it as the worst flu you could possibly imagine. You might have nausea and vomiting, cold sweats, depression, and other symptoms that make you want to turn back to opioids for relief. This is why it is a great idea to get support through this first step in the process by attending either a stand-alone detox program or an inpatient rehab program that incorporates supervised detox.
Depending on the severity of your opioid dependence, some programs will provide medications like methadone or buprenorphine to lessen the pain of withdrawal and lower your cravings for more. This can help you to feel better and focus on taking the crucial next step in your recovery, which is therapy. Detox without therapy is likely to end in relapse. You must address the underlying reasons behind your addiction and learn healthier ways to cope in order to achieve lasting sobriety.
Therapy may take place in an inpatient or outpatient treatment program and will address the impact of addiction in your life, as well as how to build the skills you need to stay clean in the long-term.9 If pain management was the reason you began using opioids, you will need to work with your treatment team to find less risky options to alleviate your pain. This might include approaches like non-addictive medications, physical therapy, or meditation.
Treatment takes a lot of time and determination. Just remember, sobriety is hard, but life with addiction is so much harder. Reach out to us today if you or someone you love is struggling.
- Substance Abuse and Mental Health Services Administration. (2017). Opioid Use in the Older Adult Population.
- Guerriero, F. (2017). Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults. World Journal of Clinical Cases, 5(3), 73–81.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Psychiatric Times. (2018). Opioid Use in the Elderly.
- Medscape. (2009). Prescribing Opioids to Older Adults: A Guide to Choosing and Switching Among Them.
- Chau, D. L., Walker, V., Pai, L., & Cho, L. M. (2008). Opiates and elderly: Use and side effects. Clinical Interventions in Aging, 3(2), 273–278.
- Substance Abuse and Mental Health Services Administration. (2016). Opioid Overdose.
- Kaiser Permanente. (2015). Opioid Use and Safety.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.