Opioids and aging: What you need to know

⏱ 5 min read, 3 min video

What are opioids?

Opioids are a class of drugs derived from (or chemically manufactured to act like) opium from the poppy plant. They work in the nervous system to produce feelings of pain relief and pleasure. They are prescribed for acute use, which means for short-term use, typically a few hours or days, for example, after surgery, or chronic use for more than 45 to 90 days on a near-daily basis to control pain caused by advanced-stage cancer or for palliative or end-of-life care.¹ Opioids are also prescribed for the management of chronic non-cancer pain. The most recent Canadian data reported that 43.9% of adults over 55 years of age used a prescription opioid in the prior year, and 1.1% of that group have done so daily or almost daily.²

Common opioids prescribed for pain include³: 

• Morphine: Often used for severe pain, especially after surgery or for cancer-related pain.

• Oxycodone: Available in combination with acetaminophen (Percocet) or as a standalone medication (OxyContin).

• Hydromorphone: Also known by its trade name (Dilaudid), and frequently prescribed for moderate to severe pain. Also available in extended-release preparations.

• Fentanyl: A very potent opioid used for severe pain, often in patch form for chronic pain management.

• Codeine: Typically used for mild to moderate pain and often combined with other pain relievers like acetaminophen, in various doses.

Prescription opioids are usually used to treat moderate to severe pain. Some people take non-prescribed opioids because they can also make them feel very relaxed or “high”.

If opioids are taken for long periods, the body becomes used to them and the opioid does not help with pain the way it once did.  This is called tolerance and may lead to people taking more of the drug than is safe. There are also some people who may develop a paradoxical condition called opioid-induced hyperalgesia, where some individuals may experience greater pain sensitivity with opioids.

Opioids and older adults

As we age, our bodies change, and this influences how substances, including opioids, affect us and how strong the effects are. Our bodies break down substances more slowly, and we have less water and muscle and more fat than when we were younger. These changes can affect how medications work. 

Older adults are more vulnerable to the physical effects of opioids, making them more susceptible to side effects and adverse outcomes such as dizziness, falls, cognitive impairment, delirium, and overdose.

In a study of older adults, adverse events from opioids accounted for 9.2% of emergency department visits and hospitalizations, ranking third behind anti-coagulants and anti-cancer agents.⁴ 

Vision and memory problems that can develop with age can increase the risk of overconsumption of prescribed opioids, especially for those who are on multiple medications or complicated daily regimens. Confusion as an adverse effect of the medication may also lead to accidental overconsumption.

As the number of prescribed medications increases, so does the risk of potentially harmful drug-drug interactions increase. A healthcare provider should review medications regularly to reduce the risk of unintended harmful effects. Regardless of age, opioids should not be taken at the same time or on the same day with alcohol, cannabis, or sedatives/sleeping pills (e.g., benzodiazepines).

Side effects and other risks from opioids

There are many side effects associated with taking opioids, including:

• Nausea and vomiting
• Itching
• Constipation
• Trouble urinating 
• Confusion and changes in mood
• Drowsiness
• Falls
• Slowed breathing
• Sleep apnea (pauses in breathing or periods of shallow breathing during sleep)

And in severe cases,

• Heart attack
• Overdose, including death
• Opioid use disorder (or addiction)

What is opioid use disorder?

Opioid use disorder (OUD) is a medical condition where a person has trouble controlling their use of opioids. There is a growing number of older adults developing opioid use disorder (OUD) and many who have longstanding OUD (including people who use illicit opioids).

In this 3-minute video, Dr. James MacKillop explains opioid use disorder, its symptoms, the significant health risks associated with it, and highlights various treatment strategies.

Download a transcript of this video.

The 11 signs that point to problematic use of opioids are:

• Taking a larger amount than what was prescribed 
• Taking it for a longer period of time than what was prescribed
• Wanting to cut down and control your intake but find it difficult 
• Spending a lot of time taking and thinking about taking opioids
• Feeling like you must always take the opioid 
• Failing to meet your obligations at home or work because of opioid use 
• Continuing use even though it is resulting in or exacerbating physical or mental health problems
• Using opioids in dangerous situations, such as driving
• Feeling the need to take more of the opioid to feel it working 
• Feeling it doesn’t work as well as it used to 
• Taking it because you feel a lot of physical pain if you don’t

Depending on the number of symptoms, a diagnosis of mild (presence of 2-3 symptoms), moderate (4-5 symptoms) or severe opioid use disorder (6 or more symptoms) is given.

How can you manage chronic pain without opioids?

There are effective non-medicine-based therapies and non-opioid medications to help to manage pain. Non-medication therapies include:

• Physical therapy 
• Massage therapy 
• Acupuncture 
• Counselling and psychotherapy (e.g., cognitive behavioural therapy) 
• Exercise
• Mindfulness and meditation 
• Yoga

Several non-opioid medications can help relieve chronic pain, including: 

• Acetaminophen 
• Non-steroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen and naproxen)
• Topical NSAIDs, such as creams and gels that you rub into the affected area
• Gabapentinoids (gabapentin, pregabalin) or some antidepressant medications 

Non-opioid medications can also cause side effects, so speak with your healthcare provider to find out what medications are safe for you.

Learn more about chronic pain and how it can be managed in this video, 'Chronic Pain: A common but invisible disease', with Dr. Norman Buckley.

What should I do if I am already taking an opioid?

If you are taking an opioid for chronic pain and the dose you are taking is effective, is helping you remain active, and is not causing side effects, it might not be necessary to stop using it. See your healthcare provider regularly to monitor your pain relief or side effects. If there are concerns, your healthcare team can work with you to develop a plan to slowly reduce the amount you’re taking or eventually stop altogether. A slow, gradual tapering of the opioid helps to prevent withdrawal symptoms and will help you continue to feel well. Do not change your dose of opioids without talking with your healthcare provider first.

Download the handout ’Opioid Use Among Older Adults' from the Canadian Coalition for Seniors’ Mental Health.

Tell us what you think of this content by completing this 2-question survey.