Opioid Use Disorder and the Senior Citizen

As they age, many people find themselves facing increasing health challenges. Bone and joint issues caused by osteoarthritis and years of wear and tear are common in older adults. With increased age, there is also a higher incidence of many types of cancer that result in significant pain. Numerous other conditions can also cause increased daily pain levels. To help these patients manage pain levels, there is increased use of opioid pain medications which can contribute to opioid use disorder in the elderly.



According to an article in the New England Journal of Medicine, between 4 – 9% of adults aged 65 or older were using prescription opioid medications. During the period between 1995 and 2010 opioid prescriptions given to older adults increased by a factor of nine. While the US population of adults 55 and older increased by about 6% between 2013 – 2015, the number of people over 55 who sought help for opioid use disorder increased by almost 54%.


This same group also has shown a higher instance of secondary effects from opioids or benzodiazepines. Individuals in this age group who misuse prescriptions are more likely to experience suicidal ideation and other adverse effects. As the senior group becomes dependent on these prescribed medications, they too are at risk for using illicit opioids such as heroin. When their source for prescribed opioids dries up, they may already have developed a dependency and they turn to illegal and lower cost drugs as they suffer from their opioid use disorder. Between 2013 – 2015, it is estimated that the number of older adults using illegal opioids more than doubled.


Aging adults are already experiencing social and physical changes that might make them more vulnerable to substance abuse. Changes in living arrangements, loss of spouse or other loved ones, decline in their ability to participate in favorite activities and greater health challenges are all increase the probability of substance use disorder.


Studies have shown that older adults may be more sensitive to drugs based on how their bodies metabolize the substances. These drugs can impair coordination and reaction times resulting in a higher incidence of accidents such as falls or motor vehicle incidents.


When the older adult is prescribed opioid medications, there is an increased probability that these medications will be taken with multiple other prescribed medications. In a study of patients aged 57 – 85, more than 80% were taking at least one prescribed medication per day and more than 50% were taking five or more medications. These scenarios further increase the risk of drug-drug interactions and other adverse effects.


One recent study estimated that abuse of prescription drugs in the elderly may be as high as 11%. The National Center for Health Statistics reported that baby boomers (born between 1947 – 1964) are the age group most affected by the opioid epidemic. This same group of baby boomers has experienced a significant increase in rates of death from prescription opioid overdose.


While many of these statistics are sobering, there is also hope since the senior population has demonstrated success with treatment for substance use disorder. Often the senior person may have better results with treatment models over a longer period. It is important for providers to be carefully attuned to their senior patients and avoid confusing the misuse of drugs with other symptoms of aging such as decreased cognition or physical impairment.

If you are a senior or a family member of a senior here are some helpful watchpoints:

  • Ensure that your senior family member is taking all prescribed medications as directed

  • Make certain that all providers who are working with your senior are aware of prescriptions from other providers.

  • Encourage your senior to have all medications filled at one pharmacy. Your pharmacist can be a helpful resource in watching for medication conflicts or misuse.

  • When your senior family member is facing a condition or procedure that may require opioid medications for pain control, have an open discussion with the provider to assess other options or a transition plan to move off the opioid medication and over to another choice for pain control.

  • If you suspect that your senior family member may have a substance abuse disorder, seek help right away by talking with their physician and identifying resources in your area to support them

Substance Abuse and Mental Health Services Administration (SAMHSA) provides a helpful resource center specifically focused on older adults. The SAMHSA resource center focuses on multiple issues for seniors including special paths for helping them with substance abuse. Click here for more information: Resources for Older Adults | SAMHSA



References:

Lehmann S, Fingerhood M. Substance-use disorders in later life, N Engl J Med. 2018 December 13; 379(24): 2351-2360. doi: 10.1056/NEJMra1805981


Schepis TS, Simoni-Wastila L, McCabe SE. Prescription opioid and benzodiazepine misuse is associated with suicidal ideation in older adults. Int J Geriatr Psychiatry. 2019; 34(1): 122-129. doi: 10.1002/gps.4999


Huhn AS, Strain EC, Tompkins DA, Dunn KE. A hidden aspect of the U.S. opioid crisis: Rise in first-time treatment admissions for older adults with opioid use disorder. Drug Alcohol Depend. 2018 Dec 1; 193: 142-147. doi: 10.1016/j.drugalcdep.2018


Colliver JD, Compton WM, Gfroerer JC, Condon T. Projecting drug use among aging baby boomers in 2020. Annals of Epidemiology. 2006; 16(4): 257–265.


Bartzokis et al. Magnetic resonance imaging evidence of “silent” cerebrovascular toxicity in cocaine dependence. Biol Psychiatry. 1999; 45: 1203-1211


Substance Abuse and Mental Health Services Administration. (2019). Results from the 2018 National Survey on Drug Use and Health: Detailed Tables.

Culberson, J.W., & Ziska, M. (2008). Prescription drug misuses/abuse in the elderly. Geriatrics, 63(9), 22-31.


Huang, X., Keyes, K.M., & Li, G. (2018). Increasing Prescription Opioid and Heroin Overdose Mortality in the United States, 1999–2014: An Age–Period–Cohort Analysis. American Journal of Public Health, 108(1), 131-136.


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