Why Opioids Are More Dangerous for Seniors

One of the most fascinating aspects of learning about side effects of drugs has been to discover that many side effects are predictable based on how the a drug works in the body — what is called “method of action.”

Opioids, for example, work by slowing pain receptors and increasing dopamine, a chemical that controls the brain’s reward and pleasure center, which is an effective way of inhibiting the body’s ability to feel pain and makes you feel great.

This colorful and informative video explains how opioids work (there’s no sound).

However, opioids not only go to the brain but also move throughout the entire body affecting (and most often, slowing) all body systems. The most obviously inhibited one, after pain, is the digestive system. Hence the well-known problem of “opioid-induced constipation.”

And Then There’s Aging

Aging bodies add another dimension. Medicines accumulate more easily in a body (especially in the kidneys) where all systems are naturally slowing down from age. If you’re a senior, ask your doctors to give you the lowest effective dose of the lowest level of pain med, which is good advice at any age. The choice of pain killer should be very different for a healthy 40-year-old who plays squash weekly than for an 80-year-old with high blood pressure who walks a few blocks a day and has a delicate stomach.

Elderly adults taking opioid painkillers have 4 times as many bone fractures, are 68% more likely to be hospitalized and are 87% more likely to die as those taking over-the-counter pain medication.

Side effects from most drugs, and especially opioid drugs, are more pronounced in seniors. Falls, dizziness, headaches, sedation, worse constipation and slow reaction times are much more common when using opioids. (Should you be driving while using even a mild opioid?)

Elderly adults taking opioid painkillers have 4 times as many bone fractures, are 68% more likely to be hospitalized and are 87% more likely to die as those taking over-the-counter pain medication, according to the National Safety Council.

When Options Become Limited

Why take any opioid if you’re a senior who isn’t in end-of-life care? Your options become limited as your stomach becomes more sensitive, your kidneys and liver process more slowly and you take other medicines that might interact badly with some meds. Some of the less extreme painkillers, like Aleve or Tylenol, aren’t tolerated well. For example, aspirin and NSAIDs can upset stomachs. Note that some studies indicate that opioid drugs are just as upsetting to stomachs.

Weaker opioids like codeine don’t work for many people. The next step up, morphine, is hard on the kidneys, an organ that is commonly compromised in old age. Hydromorphine is easier on the kidneys but much more potent, stronger than might be needed with stronger side effects. Opioid choices get stronger and affect the body more from there.

What to do if your doctor recommends an opioid-based drug? Consider refusing them. They are NOT RECOMMENDED for headaches or migraines, and the benefits of using them for fibromyalgia or chronic back pain probably don’t outweigh their very significant risks, the AAN (American Academy of Neurology) states.

Work with your doctor on a multifaceted approach to pain management, as recommended by the AAN. Cognitive-behavioral therapy and activity coaching have been very successful not only at lowering pain but increasing the ability to function.

Fix the source of the pain and take opioids for the shortest time period possible. Do your best to make sure a temporary severe pain doesn’t turn into a chronic one.

Watch for Drug Interactions

If you’re a senior and taking drugs for high blood pressure, cardio issues, diabetes, etc., prescribing is complicated and risky. Drug-to-drug interactions are not only possible, they are likely. Assume any new symptom is a side effect and call your doctor before it becomes life threatening or limiting. This is one of the many reasons that we at MedShadow encourage you to discuss thoroughly your options for alternatives to drugs wherever possible — this way, when you need drugs your doctors have more options.

Opioids are known for being highly addictive. And as discussed in our recent article, 3 Steps from Pain Management to Heroin, seniors are not immune to addiction.

Whether you are a senior, care for a senior or expect to become a senior one day, it’s always important to discuss with your health care provider why you are taking a drug, how long you can expect to take it and what the effect of it will be on your entire body, not just the problem area.


Suzanne B. Robotti

Suzanne B. Robotti

Suzanne Robotti founded MedShadow Foundation in 2012. Learn more about Su and her mission.


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