Opiate Addiction & Older Adults

As physicians, caregivers, and patients navigate a culture of widespread opioid misuse, the national focus has primarily been on reducing illegal street drug sales. However, a growing number of providers are just as concerned about painkiller dependency in aging adults. Painkiller use and abuse are growing among senior populations, and Kaiser Health News reports that prescribing doctors must achieve a delicate “balancing act” between maintaining a patient’s independence and quality of life while minimizing the risks of side effects or addiction.

According to KHN, “Beyond the obvious dangers of addiction, opioids can pose serious risks for seniors. Common side effects include constipation, breathing problems, confusion, and problematic interactions with other medications. Seniors taking opioid medications are also four to five times more likely to suffer a fall or fracture than those taking a non-opioid pain medication.”

For physicians utilizing opioids for palliative care and treatment of older adult conditions like arthritis, neurological diseases, or cancer pain, new opioid regulations are a constantly evolving challenge. The New England Journal of Medicine (NEJM) Catalyst publication reports that concern over the U.S. opioid epidemic has many clinics and frontline providers feeling “caught in the middle – acknowledging the national crisis of opioid addiction and wanting to adhere to the new guidelines, but also wanting to decrease patients’ pain.”

When it comes to deciding whether to prescribe opioids for seniors, Dr. Carla Perissinotto, an assistant clinical professor in the Division of Geriatrics at the University of California San Francisco, says she considers an individual’s quality of life, their goals, what has been tried and what has not worked for them. She also mentions the potential benefit of painkiller alternatives like topical analgesics, massage, acupuncture or chiropractic care.

Regarding seniors and their place in the national conversation about opioid addiction, Dr. Perissinotto says, “I think that the challenge is how do we keep this national dialogue going so that we educate providers to prescribe safely? How do we educate patients to know how to look for signs of withdrawal and look for signs of an overdose? So that we’re not discriminating against people with chronic illness and chronic pain who really do need these medications to function when other therapies have failed.”