The Heightened Risk of Opioid Addiction in Older Adults and How to Heal
We often associate opioid addiction with younger generations, but older adults are also vulnerable to this destructive disorder. Unfortunately, opioid addiction in older adults is rising due to the unique vulnerabilities of this population and understanding the risk factors involved is essential to breaking through myths and identifying potential issues. Getting help for opioid addiction in a treatment program that recognizes the challenges faced by older adults and helps clients break through shame can create a strong foundation for recovery.
John never thought he would become an addict. As a retired judge, he had never touched a recreational drug, drank in moderation, and had only smoked a few cigarettes decades ago in law school before deciding it wasn’t for him. And yet, at age 69, he was entering rehab. “It was a very sad and frustrating time for me,” he remembers. “It was difficult to admit I had a problem and when I finally admitted it I was very angry. I had spent so many years caring for my health, eating right, exercising, visiting my doctor for preventive care. I didn’t engage in risky behaviors, I didn’t take drugs for fun. The idea that I needed rehab seemed absurd.”
The drug John was addicted to was oxycodone, prescribed to him to treat his pain after knee replacement surgery. He had been told it would help with not only acute postoperative discomfort, but also with his ability to participate in physiotherapy and regain functionality. And it did. But as the months wore on, John’s relationship with the drug changed. “At first it was just something I needed to take to get better physically. But at about the three-month mark, it became something I needed to feel normal emotionally,” he explains. “Those little pills became my world. When my doctor wanted to begin the process of tapering down, I felt a panic come over me and I found myself pleading with him to not lower my dose. It was dehumanizing.”
But if that day in his doctor’s office planted a seed in his mind that he may be struggling with addiction, it would take many more months before the idea fully took root. “I was having coffee and reading an article about the opioid epidemic and I saw myself in these interview subjects,” he says. “They were from completely different walks of life, but I saw myself in them. Their relationship with opioids may have looked different from the outside, but at its core, it was like my own—a dependence that surpassed the physical and had become deeply psychological. Their words opened my eyes to what I had not wanted to see.”
John’s story is one shared by many older adults who find themselves in the grip of opioid addiction in their golden years. Unfortunately, many such addictions flourish due to the circumstances of seniors, both germinating and staying hidden as the result of age. As such, coming to understand the risks of opioid addiction in older adults is essential for both people who may be struggling with such addiction and their loved ones.
Understanding the Risk of Opioid Addiction in Older Adults
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.
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Getting Help for Opioid Addiction
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.
Breaking Through Shame and Isolation to Find Recovery
Often, one of the most difficult issues for older adults is admitting their struggles due to shame, particularly if their opioid addiction arose from legitimate prescription use. There can be a sense that both addiction and the need for treatment are profound personal failures, feelings that arise in part due to older perspectives on addiction as a moral issue. Older adults may also struggle to feel like they fit in in a residential addiction treatment environment, particularly one that is not designed to meet the needs of seniors. As a result, it is imperative that the program you choose works from a place of compassion and medical knowledge in order to break through shame and create meaningful treatment experiences tailored to both the physical and emotional needs of older adults. With the guidance of expert clinicians who understand the challenges faced by seniors and can guide them through the recovery process with dignity and grace, you or your loved one can develop a deeper understanding of addiction as a medical issue while creating a warm, inviting, and relevant treatment environment that makes healing possible.
Addiction treatment should never be a source of shame. Rather, it is a brave endeavor to regain control of your life and reclaim your health. By working with a treatment program that honors your individual needs and helps you overcome the barriers to recovery, you can create a richer, more fulfilling life in your golden years.
Alta Mira is a residential opiate addiction treatment center focusing on the treatment of drug and alcohol addiction and co-occurring mental health disorders. Contact us to learn more about our renowned Bay Area programs and how we can help you or your loved one start the journey toward recovery.