Weeks before my recent oral surgery, the dental office gave me prescriptions for two pain medications in case I needed them later. One was ibuprofen (500 mg); the other actually scared me.
An orange warning sticker on the cap, CAUTION: OPIOID, caught my eye. The next line bluntly summarized the danger: RISK OF OVERDOSE AND ADDICTION.
Inside, I found four white pills.
Like many Americans, I’m aware of the risk of opioids. People of all ages have taken these meds, experienced strong side effects and battled addiction.
Overdose deaths linked to opioids rose from 21,088 in 2010 to 46,802 in 2018. The grim tally grew to 49,860 overdose deaths in 2019.
The older you are, the more pain you might face. Back problems, arthritis and muscle aches can intensify with age.
As pain mounts, older adults may seek the strongest drug on the market for relief. But by taking opioids, are they trading one problem (pain) for a far greater one (addiction)?
The answer largely depends on how often you take it, says Dr. Andrew Kolodny, medical director of Opioid Policy Research at Brandeis University’s Heller School for Social Policy and Management.
“Doctors might prescribe opioids to be taken every day round the clock, as a patch or in long-acting or extended-release formulations,” he said. “Seniors should be very afraid of that. The risk of addiction is related to the duration of use.”
Even short-term usage carries risk. I avoided opioids after my oral surgery. Still, it’s frightening to think that taking just a few pills could slightly elevate the long-term risk of addiction.
“Taking opioids for five days is easily enough for physiological dependence to set in,” Kolodny said. “On day six, if you don’t take it, you may experience mild withdrawal symptoms like anxiety or insomnia, and that’s if the dose was low.”
Yet taking a low-dose opioid once or twice a month shouldn’t pose a problem. Intermittent use is not only safer but also increases the drug’s efficacy, Kolodny says.
Even better, stick to nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium to relieve pain.
“They are very effective for severe pain and generally safer than opioids,” Kolodny said.
While age has little to do with whether you’re more or less prone to addiction, seniors are more likely to suffer adverse effects of opioids such as constipation or bone fractures from a fall, he adds.
Older adults facing back pain, surgical procedures or other serious ailments might find it hard to stick to intermittent use of opioids. Instead, they can wind up integrating these pills into their daily regimen.
For example, a 2021 study found that many seniors who undergo surgery after breaking a hip remain on opioids months after leaving the hospital.
In tracking nearly 30,000 U.S. older patients, investigators found that nearly 17% were still taking opioids as much as half a year after hip surgery. At three months after surgery, that figure was nearly 70%, while almost 84% of the patients were on opioids during the first month following surgery.
“Our study found that at 3 to 6 months after hip fracture surgery, one in every six elderly patients was still taking opioid pain medications,” said Dr. Kanu Okike, an orthopedic surgeon at Kaiser Permanente in Honolulu and the study’s lead author.
“Prolonged opioid usage was more common among patients who were aged 60 to 69, female or obese. Prolonged opioid usage was also more common among patients who smoked, had a greater number of medical comorbidities or had a history of substance abuse,” he said.
Back in the 20th century, seniors often treated their physician as a god. They rarely if ever questioned their doctor’s orders.
Today, polite pushback is more common.
Some healthcare providers may not appreciate the risks of prescribing opioids to older people. Furthermore, they may see younger adults as more likely to engage in substance abuse—or mistake early signs of a senior’s descent into drug misuse as anxiety or depression.
“Well-meaning doctors may not realize that Grandma can easily get addicted to opioids too,” Kolodny said.