Blog Post

Opioid addiction in senior population is rising

By Constance Garcia-Barrio

Opioid addiction seems to have launched a stealth attack on seniors. Falls and forgetfulness, which are possible signs of addiction, may masquerade as normal issues of aging. Family and friends of an addicted person may chalk up the individual’s more negligent grooming and housekeeping to the decreased energy of advanced age. And a senior with an addiction may be seen as simply following the doctor’s orders by repeatedly refilling a prescription for pain medication.

“Opioid addiction has been dubbed “the hidden illness,” and the soaring number of affected seniors has led experts to call it an epidemic. The Substance Abuse and Mental Health Services Administration (SAMHSA) says that the number of elderly people who need substance abuse treatment will increase to 4.4 million by 2020, up from 1.7 million in 2003.

Pain may push seniors to use opioids, which include fentanyl, hydrocodone, codeine, morphine and methadone, as well as the illegal drug heroin, but other factors may lead to the abuse of the drugs, which reduce the perception of discomfort. “Older adults may attempt to self-medicate due to depression and isolation or the person may feel at loose ends after retirement. Opioids seem like a temporary solution, but before people know it, they’re dealing with full-blown addiction,” said Sharon Matthew, clinical director of the Older Adult Program at the Caron Foundation, which provides treatment for addictions at facilities in Plymouth Meeting and Wernersville in Pennsylvania, as well as in Florida.

The risk of addiction

Al Meyer, 75, agrees that it’s all too easy to slip into addiction. Meyer is a counselor at Gaudenzia, a Philadelphia-based drug and alcohol rehabilitation center with 90 facilities in Pennsylvania, Maryland and Delaware that treat people with co-occurring substance abuse and mental illness. “I was prescribed Vicodin, which contains an opioid, after having dental surgery,” said Meyer, who teaches addiction studies at the Community College of Philadelphia. “It was for far more pills than I needed. The dentist just wanted to make sure that I didn’t have pain. But I’m a recovering alcoholic, so I’m very aware of the possible effects of opioids. I have an addictive background, so I discarded what I didn’t need.”

Andrew Rosenzweig, M.D., chief of the division of geriatric medicine at Einstein Medical Center, has seen many similar situations. “The problem creeps in when people get too much medication for too long,” he said. “Opioids are to be used in acute cases – for instance, to ease pain from a broken bone or in cases of cancer.”

Problems sometimes have arisen when doctors have prescribed opioids inappropriately, said psychiatrist David Gastfriend, M.D., a consultant for the American Society of Addiction Medicine in Philadelphia. “Big pharma players such as Purdue, developer of Oxycontin, marketed drugs that were meant for terminal cancer pain as suitable for mild to moderate pain and then induced doctors to seek the elimination of pain completely,” he said. “But pain is a natural, valuable phenomenon that shouldn’t be chemically eliminated. It’s the body’s way of telling the brain to protect the body and foster healing.” This strategy sold billions in these drugs (and ultimately put some of the pharmaceutical executives in jail).

Seniors may be at risk of an opioid overdose, and also of a toxic cocktail of opioids and other medications. “Some medicines in combination with opioids can lead to decreased breathing – in other words, problems from a lack of oxygen,” Rosenzweig said. “In addition, if a person drinks even moderately, it can have an ill effect.”

A growing demand

More and more seniors are seeking treatment for opioid addiction. Matthew pointed out that seniors face a longer road to recovery than their younger counterparts. “You have to go slower with older people,” Matthew said. She noted that withdrawal can be managed with massage therapy, hydrotherapy, mind-body therapy and other approaches.

While seniors can recover from opioid addiction, the best defense is a good offense: avoiding addiction in the first place. Seniors may want to ask questions about situations that might involve pain, Rosenzweig said, such as by asking about non-opioid pain killers. He also suggested that one’s family or other loved ones get involved. A family member or friend can accompany a senior to the doctor to ask questions about how pain will be managed and how prescription pain medications will be tapered down. Family and friends can also keep an eye out for falls, confusion, isolation, lax grooming and other signs that may indicate addiction.

Gaudenzia’s Meyer had other suggestions. “You have to be careful not to take more medication than you need or for a longer time than you need,” he said. “Don’t borrow other people’s medication – not your wife’s, not your friend’s. We seniors ourselves and our communities can make a big difference.”

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If you suspect opioid addiction in a friend or family member, experts suggest the following steps:

  • Talk with the prescribing physician about the signs you see. Ask the doctor for help.
  • Check to see if the person is taking the medication as prescribed. Sometimes patients take more medication than the doctor has indicated.
  • See a pain management specialist about alternatives.
  • Look into facilities that treat addiction in older adults. Senior centers and hospitals may be able to offer guidance.

CAPTION: The soaring number of seniors addicted to opioids has led experts to call it an epidemic. (iStock)