The Heightened Risk of Opioid Addiction in Older Adults and How to Heal

Drug addiction is often imagined to be an affliction of the young—the result of experimentation gone awry, manifestations of youthful risk taking, expressions of pain that take hold early in life. However, older adults face heightened risk of some types of addiction, particularly opioid addiction, precisely due to their stage of life. These unique risk factors include:

Increased Prescription Opioid Use

As we age, our vulnerability to physical ailments increases exponentially as part of the natural aging process. Thanks to modern pharmacology, we now have more and better therapies than ever before to help alleviate many of these ailments, whether chronic or acute in nature. For older adults, opioids are a particularly prevalent part of the pharmacological arsenal physicians use to treat pain-related conditions; according to the National Survey on Drug Use and Health (NSDUH), “over 40% of older adults have chronic pain that is often treated with opioids, sometimes for long periods of time.” In addition to chronic pain, opioids are prescribed postoperatively for seniors and in other ostensibly short-term contexts, resulting in nearly one third of Medicare recipients being prescribed at least one opioid in 2016 alone and 500,000 receiving “high amounts” of opioids.

This is driven has been driven in part by efforts by pharmaceutical companies and even health organizations to normalize opioids in pain management strategies, particularly for older adults; in 2009, the American Geriatric Society (AGS) issued guidelines urging physicians “to consider using opioids for older patients who have moderate to severe pain.” While those guidelines are now outdated, the perspective they reflected and promoted continues to permeate medical practice. As a result, adults over the age of 50 have a higher prevalence of prescription opioid use than adults aged 18 to 49.

Although opioid addiction in older adults if often initiated by prescription, increased availability of prescription opioids via non-prescription means is also a concern. As Lisa Esposito of U.S. News writes, “’You got a bad hip? I do too—here, I’ve got some of these old pills left.’ That’s what seniors may hear from well-intentioned friends.” This increased access to opioids, whether through legitimate or illegitimate means, heightens vulnerability to misuse, dependence, and addiction.

Assumption of Low Addiction Risk

While the risk of opioid addiction is becoming increasingly recognized amongst the general population, older adults are often assumed to be a low-risk demographic, particularly if they do not have a history of addiction. “You don’t see people in this age group stealing a car to get their next dose,” said Dr. Bruce Ferrell, a geriatrician and pain specialist at the time the 2009 AGS guidelines were issued. Indeed, norms for prescribing practices have been driven by an assumption of low addiction risk for years and while that is changing, profound damage has already been done; physicians may not only be more likely to prescribe opioids due to heightened incidents of physical pain, they may also be more likely to prescribe higher doses, prescribe for longer periods of time, and fail to closely monitor patients for misuse, dependence, or addiction.

However, older adults have no inherent protection against addiction. “There is no factual, scientific basis for [the idea that seniors are a low-risk population],” says addiction specialist Dr. Mel Pohl. “The drug takes over the brain. It doesn’t matter how old the brain is.” While this is now being recognized by a growing number of physicians, the myth of low addiction risk will take time to overcome. In the meantime, physicians aren’t the only ones affected by these misconceptions; patients and those around them may fail to see addiction take hold or take steps to minimize it because they underestimate risk.

Increased Impetus for Misuse

Rather than age acting as a protective factor against addiction, the challenges of aging may actually increase impetus for opioid misuse. According to the NSDUH report, “the most common motivation [for misuse] was relief from physical pain (66.3%), followed by relaxing (11.2%).” Only 10.8% reported that their motivation was “getting high.” Because seniors are more likely to suffer from physical pain in both chronic and acute contexts, they may be more likely to misuse in order to relieve that pain. This is particularly true for those using medications whose duration of action is in fact shorter than advertised, making misuse necessary to achieve adequate pain relief. Age-related physiological changes, such as weight, metabolism, and body fat, can also increase the potential for opioid abuse due to their impact on how these drugs affect the body. At the same time, slower healing times may increase the duration of opioid addiction treatment, in turn augmenting the risk of misuse.

In addition to physical phenomena, emotional pain is known to be a significant risk factor for addiction and older adults face unique psychological and environmental risk factors that may make them more vulnerable to dependence and misuse. These include:

• Social isolation and loneliness
• Loss of significant loved ones
• Loss of purpose, particularly following retirement
• Financial difficulties
• Disease diagnosis
• Loss of independence
• Decreased physical mobility

These factors can make the emotional effects of opioids highly attractive; opioids are known to induce a sense of well-being and can provide a temporary escape from troubling thoughts and feelings related to stage-of-life issues. In this context, it’s important to remember that misuse does not only mean taking opioids more frequently or at higher doses than prescribed; while some older adults certainly do so, taking them as prescribed in order to fulfill a psychological need rather than as a therapeutic measure for physical pain is also a type of misuse.

Invisibility of Misuse, Dependence, and Addiction

If a young person experiences confusion, memory loss, lack of coordination, mood swings, self-isolation, and loss of interest in the things they once enjoyed, friends and family will often be concerned, as these experiences are aberrations from what is to be expected at that age. As such, youth can act as a kind of protection—it allows symptoms of addiction to become visible. Older adults, however, often have no such protection, as signs of addiction often mimic both health conditions we associate with old age and what we mistakenly assume to be natural parts of aging. As such, opioid addiction may be less likely to be recognized by family, friends, and even medical professionals. However, it’s important to take notes of these symptoms; while aging is a natural part of life, there is deep misunderstanding about what is natural as we age, and these factors are not simply a normal part of the aging experience; they are cause for concern and should be addressed, whether addiction specifically is suspected or not.

Additionally, older adults can often use prescription opioids openly without awakening the concern of themselves or others; prescription drug use, including opioid use, has become an expected part of aging to the point where it is often unquestioned. While opioids do have a valuable role to play therapeutically and many seniors do in fact require pharmacological intervention for a variety of health conditions, opioid use should never be unquestioned; it must be carefully monitored in order to identify misuse, dependency, and addiction and intervention must occur if these issues are detected. Drug-seeking, negative psychological and physical effects, and reluctance to discontinue use should all be taken as warning signs of potential problems. Alternatives to opioid use should ideally be explored in order to minimize risk, regardless of whether addiction has already developed.

While opioid addiction in older adults remains a growing concern, there is also growing awareness of the issue and increased recognition of the need for opioid addiction treatment. Unfortunately, Medicare is often insufficient in providing high-quality treatment; as a result, seniors may be best served by seeking out private rehab programs that can provide accurate diagnosis and comprehensive care. However, just as older adults face unique circumstances in the development of opioid addiction, they also face unique challenges when it comes to recovery.

As we age, our bodies undergo physiological changes that may extend the withdrawal process. As such, finding an addiction treatment program with a medically supervised detox component that can be tailored to each person’s individual needs is paramount to making detox as safe and comfortable as possible. These programs will use appropriate medications that can minimize or eliminate painful and distressing withdrawal symptoms, including Suboxone, which is considered the gold standard for opioid detox. They will also provide emotional support during this critical time to help you or your loved one feel safe and create a positive start to the recovery process.

In addition to recognizing the challenges of withdrawal, older adults also often have co-occurring substance use disorders owing in part to the prevalence of pharmacotherapy amongst seniors. “Many, many times [opioid addiction] comes with benzodiazepines for older adults—anxiety and sleeping drugs,” says Bredna Iliff, a clinician and healthcare executive specializing in addiction. However, prescription drugs are not the only concern. “Usually there’s alcohol too. Sometimes pot—that’s the No.1 illicit drug older adults are using.” Not only does simultaneous use of these substances increase health risks, it can also complicate the recovery process, as all addictions must be addressed simultaneously.

It is also essential that the addiction treatment program identify any co-occurring mental health disorders or phase of life issues that may be influencing opioid abuse. By examining these issues, you or your loved one can come to a deeper understanding of the roots of addiction and work to remove the barriers to healing in order to create long-lasting relief from suffering and prevent relapse. At the same time, many older adults struggle with fear of discontinuing prescription medications of abuse for fear of distress caused by their underlying health condition re-emerging, including physical pain. As such, it is critical that the addiction treatment program works closely with outside physicians in order to create an effective pain management plan that will allow you or your loved one to find both physical and psychological wellness.