One of the inevitable experiences of aging is pain. At some point, as we grow older, we’ll have an injury, surgery or a deterioration of some part of our body that will hurt. While opioid prescriptions such as hydrocodone (Vicodin) or codeine can seem like the simple solution for caregivers who want to relieve the pain, opioids can quickly become addictive if they’re not appropriately managed.
To complicate matters further, many older adults are prescribed benzodiazepines – such as diazepam (Valium) and alprazolam (Xanax) – for anxiety and insomnia, which are also highly addictive and, when mixed with opioids, can create serious health risks.
The reason for this? Older adults metabolize these medications – and alcohol – differently than younger people do—which means caregivers must be vigilant about overseeing the consumption of alcohol and opioids, along with benzodiazepines.
“We should be worried not only because these older adults are misusing alcohol or other substances, but because their aging bodies and brains are more vulnerable to harmful effects of these substances,” geriatric psychiatrist Susan Lehmann tells Johns Hopkins Medicine.
Who is taking pain medication?
Among older adults, many conditions require pain management that includes opioids. According to the National Institute on Drug Abuse, certain patients experience the most severe pain:
- 80% of advanced cancer patients
- 77% of heart disease patients
- 40% of outpatients 65 and over
In the United States, 27.6% of those aged 65 to 84 years and 33.6% of those 85 years and older have chronic pain, and 9% of those over 65 are taking opioids for their pain.
Older adults are also more likely to be prescribed opioids than younger people – nearly double according to one CDC study – and in 2016 almost one-third of all Medicare Part D subscribers were given an opioid prescription.
While opioids are often the only way to manage pain effectively, the problem begins when physicians prescribe 100 pills for pain that will be severe for only a few days. Patients may like the euphoric feeling they get from opioids and continue to take them to avoid feeling any pain, not just the post-surgery or injury pain the opioids are meant to treat.
What causes drug abuse among seniors?
The transition to being a senior is filled with life changes and adjustments, and for many people, physical discomfort is just one of the challenges of this stage of life. Depending on their situation, there can also be traumatizing experiences that can lead to self-soothing through drug abuse, including:
- Retirement
- Death of a spouse or partner
- Feeling aimless or bored
- Moving to a new home in a senior community and giving up independence
- Insomnia
- Financial challenges
- Memory loss
- Giving up driving
- Depression
The number of adults 55 and older increased in the United States by about 6% between 2013-2015, but the number needing treatment for opioid addiction went up nearly 54% during the same period.
According to a December 2017 report for the Administration for Community Living, from 2005-2014 the rate of opioid-related hospital and treatment center services among those 65 and over increased by 85% for inpatient stays and 112% for emergency room visits.
These numbers are startling, and any caregiver needs to keep them in mind if their older loved one is prescribed opioids, whether post-surgery or for a chronic pain condition. Older adults are much more susceptible to the effects of opioids because their systems are slower and take longer to metabolize medications. In fact, opioid abuse accounts for a large number of falls each year among older adults, and they are one of the leading causes of death in the 65 and older population.
How do I know if my loved one is abusing opioids?
The signs of drug abuse can gradually become apparent as the dependency grows. For those with their older family member daily, it may be easy to see indications of addiction, but for part-time caregivers, it could be more challenging to recognize a problem, which could include:
- Loss of memory
- Sleeping more or less
- More bruising for no reason
- Irritability, sadness and depression
- Different appetite or food cravings
- Isolation
- Lack of hygiene
- Less communication
- Lethargy and antisocial behavior
What should I do if my loved one is abusing opioids?
If you sense your loved one is beginning to use their medications for more than just pain management, intervene and find ways to get them engaged and busy in the community so they will feel a sense of responsibility to themselves and others. Some ideas are:
- Sign up to volunteer together
- Start a project such as organizing family photos or creating a memory book
- Take an art or photography class
- Start a book group for two
- Clean out closets and drawers
- Get involved in their house of worship activities
To help keep your loved one from abusing their opioids, you should closely manage their intake of opioids and all other medications as well. A locking pill dispenser is a good start. However, because many older adults are taking opioids, it’s possible they can get pills from their partner, spouse or friends. Keep an eye on their behavior after you’ve taken control of their medications to see if they aren’t improving.
Make an appointment to see their primary care physician and make a list of all of the medications they’re taking. Sometimes different doctors can prescribe various medications that, when combined, can cause severe health problems. If necessary, have a HIPAA release form signed by your loved one so that you can discuss their medical situation freely with their doctors.
Ask these questions:
- Do any of these medications cause dangerous drug interactions?
- What should I do now that I suspect my loved one has become dependent on opioids?
- What is the safest way to organize and store medications to prevent abuse?
- How do I know if rehab is needed?
What if rehab is recommended?
Because opioid abuse is such a big problem among older adults, there are treatment plans and facilities specifically for them. According to Brenda Iliff, the former director of the Betty Ford Hazelden treatment center in Naples, Florida, half of the inpatients at their center are 65 and over. “We’re seeing a lot of opioids but usually [that] comes with other chemicals,” she told U.S. News and World Report. “Many, many times it comes with benzodiazepines for older adults—anxiety and sleeping drugs.”
Your older loved one will likely be resistant to the idea of rehab, whether inpatient or outpatient and, as with many who are abusing drugs, will not think they have a problem. Therefore, it’s up to you to get the information, the support, and the medical experts in their life to help you to show them that treating their addiction is a matter of life and death.
Contact the Substance Abuse and Mental Health Service Administration (SAMHSA), a branch of Health and Human Services, for referrals to an addiction treatment center in your community, or call 800-662-HELP (4357).
