Opioid misuse and overdose in the aging population needs increased attention

Opioid misuse can arise through incremental reliance on prescription medications

If a person takes a prescribed medication in a way that it isn’t intended, for example taking too much or too often, gradually they can feel the need to take more to achieve the same benefits. As a person’s tolerance to a drug increases, they develop a dependency that leads to changes to the brain’s reward system. These brain changes drive a person to take more to avoid withdrawal symptoms. The opioid epidemic across the US grew out of the over-prescribing of drugs by physicians. There is greater awareness now of the dangers of patients becoming addicted to prescription painkillers, however the American Medical Association states that approximately 3%-19% of people who take prescription painkillers become addicted to them(x).

Older adults often experience multiple physical and mental health needs

Complex health needs, such as chronic pain, make this population more likely than younger people to take prescribed opioid medication(xi). Around 80% of adults aged over 65 years are living with two or more chronic conditions, yet opioid misuse in older adults is not always fully recognized(xii). If an older adult is taking several different drugs at the same time, they may experience overlapping side-effects, with some patients at risk from polypharmacy (5 or more drugs)(xiii). They may be under the care of several healthcare professionals for a number of needs, which can make them vulnerable to ingesting medications that interact with each other or cause unwanted side effects.

Previous, or existing, mental illness is a known risk factor for opioid use, with up to half of people diagnosed also having a substance use disorder during their lifetime(xiv). Older adults are at risk even when taking opioids as prescribed, for example from falls, fractures and alterations in metabolism linked to aging(xv). Some drugs can impair a person’s decision-making abilities, coordination or reaction time, which can lead to accidents and injuries(xvi). An additional consideration for older adults is that they may already experience the effects of cognitive impairment, which can impact self-awareness. Furthermore, older adults are more likely to face complications after surgery, and these may become more serious as people age(xvii). If surgery is needed, such as to repair any injuries sustained through slips, trips or falls, there are health risks to consider, such as blood clots, infections, and respiratory complications. While these risks must be balanced with the benefits of increased mobility, independence, and comfort that pain relief offers, the importance of safety cannot be overestimated.

Some older adults may choose to use opioids and alcohol recreationally

Misuse of drugs or alcohol among people in this age group could be missed by providers with uninformed or stigmatized perceptions about lifestyle and behaviors(xviii). Marijuana use, for example, is becoming increasingly accepted, both recreationally and medicinally, and is known to cause a number of health risks, including problems with short-term memory(xix). A history of drug taking or alcohol use, or misuse, can also place older adults at risk, as well as mental illness, social isolation or previous trauma. Many of today’s older people were young adults during the 1960s and 1970s, which were times associated with greater freedoms and experimentation with drugs and alcohol. They are increasingly carrying on the drug habits from their youth into later life(xx). However, the drug landscape has changed significantly since then, with highly potent illicit fentanyl now widely available. It is up to 100 times stronger than morphine and a tiny amount can be enough to cause an overdose.