Horizontal view of male pensioner taking pills

People over the age of 65 in the United States make up one-third of all outpatient spending on prescription medications even though seniors only comprise 13 percent of the entire population, the National Institute on Drug Abuse (NIDA) publishes. Elderly individuals are more commonly prescribed multiple and long-term medications than their younger counterparts. Many of these medications may be habit-forming and have psychoactive properties, making them targets for improper use, especially when used for a long period of time. Studies indicate that in 2011, nearly 3 million older adults misused prescription medications, a number that is projected to reach close to 4.5 million by 2020, Medscape Medical News publishes.

Opiates, or prescription painkillers, are commonly prescribed to senior citizens for chronic and acute pain. Opiates bind to opioid receptors in the brain, which block pain sensations, slow down functions of the central nervous system, and increase levels of dopamine in the brain. Dopamine is a neurotransmitter that the brain produces and uses to send signals around the central nervous system. Dopamine is involved with functions related to movement, motivation, learning, memory, reward, and pleasure sensations.

Opiate drugs, include both prescription pain relievers like OxyContin (oxycodone), Vicodin (hydrocodone/acetaminophen), and fentanyl, and the illicit drug heroin. These medications are considered highly addictive and major targets of abuse in all demographics, and they can carry additional risk factors and negative consequences in the elderly.

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Increased Risk Factors in the Elderly Population

Handful of white tablets or pills in the hands of an elderly woman, top view, toned

Older adults may suffer from a type of prejudice referred to as ageism, wherein medical providers and family members alike may overlook issues related to substance abuse or may prescribe potentially addictive medications for long-term use in order to enhance quality of life. People are not generally inclined to want to deny an older person certain vices even if they are potentially harmful.

Opiate drugs are not designed to be taken long-term due to how quickly and easily the brain can become dependent on them. With chronic opiate use, the brain may no longer function as it once did and instead may begin rely on the drugs to keep activating opioid receptors and producing dopamine at normal levels. It can become difficult to feel happy or at ease without the presence of an opiate at this point. This may encourage a person to misuse the medication if the prescription runs out or the dosage has become tolerated.

Drug tolerance occurs as the brain gets used to certain levels of the medication, and more is needed for it to continue working the same way. Prescribing information for OxyContin by the U.S. Food and Drug Administration (FDA) warns of potential tolerance and opiates’ addictive potential, for example. Withdrawal symptoms can be significant when the drug isn’t active in the body and compulsive use (i.e., addiction) may arise.

Medical providers may continue to prescribe these drugs to older people for long-term use, however. They may overlook warning signs that drug dependence, abuse, or addiction is present simply because the patient is elderly. Doctors may be less likely to screen for substance abuse or even to ask about it with elderly patients as well.

Social isolation can be another potential risk factor for both opiate abuse in the elderly as well as for problematic use and addiction going unnoticed. As loved ones grow up and move away, peers begin to retire, and spouses pass on, an elderly person’s social circle will begin to shrink. As children get more involved in their own lives and visit less often, medication misuse may go undetected. In addition, major life changes, such as the death of a spouse, retirement, change in living arranges like moving into an assisted-living home, cognitive decline, increased rate of co-occurring medical issues or mental health disorders like anxiety or depression, and a potential for increased rates of accidents or injuries requiring the use of pain medications, can also make it more likely for an older adult to turn to drug use for self-medication.

Prescription drug abuse is especially common in older females. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports on a study that showed close to 11 percent of females over the age of 60 abused prescription medications. The New York Times publishes that prescription drug abuse is much more common in older females than males.

As a person ages, their metabolism changes and slows down, meaning that opiate drugs may have greater affect on older brains than younger ones. Elderly people may therefore develop tolerance and drug dependence faster than younger adults.

Older adults are often also on a fixed income, which means that money may be tight, making prescription medications more difficult to obtain licitly. This may lead to medication sharing between those living in retirement communities and to prescription drug abuse.

The use of heroin is on the rise in the older adult population. The Boston Globe reports that of the elderly people admitted for substance abuse treatment in Massachusetts, heroin had become the second most common drug of abuse (after alcohol) as 15 percent of admissions for seniors involved the opiate in 2011. Heroin is often a cheaper and more accessible alternative to prescription opiates.

Recognizing Elderly Opiate Abuse

Opiate abuse is dangerous for any demographic, but it can carry even greater risks for the elderly. Opiates interact in the brain in such a way that they impair decision-making abilities, memory functions, and motor control, all of which can already be declining in an older adult. Seniors may therefore be at a higher risk for memory problems, injuries related to falls, fatal overdose, addiction, physical and mental health issues, and problems functioning normally in everyday life when opiates are abused. Older adults are less likely to use opiates in an attempt to get “high” like younger adults may, which may make it easier to overlook medication misuse.

There are several warning signs to watch out for if opiate misuse in an older adult is suspected, such as:

  • Increased memory loss, cognitive decline, and mental confusion
  • Taking prescribed medications in between doses or after a prescription has run out
  • Seeking additional prescriptions without a legitimate medical need, or doctor “shopping”
  • Taking or “borrowing” medications from other people who have prescriptions for them
  • Physical decline and lack of concern over personal hygiene
  • Increased risk-taking types of behaviors
  • Secrecy and social isolation
  • Depression and anxiety
  • Lack of interest in social and recreational activities
  • Increased health complaints that may be unfounded
  • Hostility and possible change in personality

Addiction is a treatable disease, and with proper care, seniors can experience an enhanced quality of life in recovery.

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Abuse and Addiction Help for Seniors

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Addiction treatment often includes a variety of modalities and options for care. Things like detox, therapy, counseling, support groups, educational programs, relapse prevention tools, life skills training, medication management, and more are generally included in a comprehensive care plan. In the elderly population, special considerations are often necessary too. For instance, chronic pain and co-occurring medical and mental health issues will often need to be attended to simultaneously. Pain management that is not opiate-based may need to be explored. Complementary and adjunctive methods like acupuncture, mindfulness meditation, yoga, chiropractic care, and massage therapy are all viable options. Older adults may need help managing medical complications, require monitoring and supervision during treatment, and benefit from ongoing education on how to properly handle medications into recovery.

Opiates are not drugs that can be stopped “cold turkey.” Stopping them after perpetuated use will likely require medical detox and potentially a slow and controlled tapering schedule to wean them safely out of the body. Medical detox is generally considered the safest and smoothest method for allowing opiate drugs to process out of the brain and body, and medications like buprenorphine are often used to ease the process.

Addiction treatment can be done in either an inpatient or outpatient setting, both of which will include therapeutic and supportive methods. A detailed assessment by a trained professional prior to admission into a program can determine the proper level of care as each person is different.

Group therapy and counseling sessions, as well as support groups, that can attend to the specific circumstances and demographics of the elderly population are beneficial for recovery. It can be very helpful to be surrounded by peers in similar circumstances during treatment and recovery; therefore, programs designed especially for older adults are optimal. Family therapy can also help loved ones and caretakers understand how to manage and enhance recovery, and help to minimize relapse. Behavioral therapies serve to teach people how to cope with potential triggers, stress, and emotional strain without drugs and how to positively modify thoughts and therefore actions moving forward.

Many addiction treatment facilities have specialty programs populated by elderly adults. In these programs, senior citizens can receive the highest level of care, building a foundation to improve their physical and mental wellbeing and overall quality of life.