Care Partner Information Sheet

Opioid Use in Older Adults

Opioids are a type of drug used by doctors to help with pain. Opioids can be very helpful for short-term pain caused by problems such as broken bones or surgery. Opioids are also helpful for persons who have serious problems like advanced cancer, or are near the end of their life. 

But many people use opioids for long-term chronic problems like low back pain or arthritis pain. Opioids often don't work well when used long term, and can be dangerous. Addiction to opioids can start after taking them for only a few days or weeks. Older adults can be very sensitive to opioids. The dangers of using opioids are greater for older adults.

Signs of an opioid overdose

  • Shallow or slow breathing
  • Small pupils
  • Sluggish and less alert than normal

If any of these signs are present, call 911

Drinking alcohol or taking some other types of medications with opioids can raise the chances of an opioid overdose. Anyone using opioids should not drink alcohol or take sleep medications. Some medications used for anxiety and nerve pain can also increase the chances of an overdose. Talk to a doctor if opioids are prescribed for someone who takes any of the drugs listed in the table below.

Common drugs that increase the chances of opioid overdose
  • Alprazolam (Xanax)
  • Diazepam (Valium)
  • Eszopiclone (Lunesta)
  • Gabapentin (Neurontin)
  • Diphenhydramine (Benadryl, Tylenol PM)
  • Lorazepam (Ativan)
  • Zolpidem (Ambien)
  • Zaleplon (Sonata)
  • Pregabalin (Lyrica)
  • Promethazine (Phenergan)

It is important to pay close attention to side effects when an older adult takes an opioid. Some people who use opioids have nausea, itching, muscle twitches, or feel sleepy with the first few doses. People who take opioids may get constipation. Opioids can also cause falls or confusion.

Tips for older adults to take opioids safely

  • Always take opioids as prescribed by a doctor.
  • Almost everyone who takes opioids has constipation. Use a strong laxative when taking opioids. Stool softeners and fiber don't work for constipation caused by opioids. Ask a doctor of pharmacist about what type of laxative to take. Call a doctor if laxatives do not stop the constipation after a few days.
  • All opioids should be kept out of the reach of young children. They also should be kept in a safe place so that others are not able to take the opioids to sell or use for getting high. 

Ask the doctor about other medications that help with pain

  • Acetaminophen (Tylenol) can help reduce pain, and is safe in most adults. It should not be used by people with liver disease. It should not be used with alcohol. Most frail older adults should not take more than 3,000 mg (3 grams) daily.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve) can help with arthritis. But these drugs can cause ulcers and kidney injury. They should only be used if a doctor says it's okay. 
  • Many non-opioid drugs are available for nerve pain. These drugs must be prescribed by a doctor.
  • Creams applied to the skin that contain capsaicin, NSAIDS, or lidocaine can help with arthritis or nerve pain.
  • Cannabinoids (marijuana type drugs) may help with pain. But very little is known about how safe they are for older adults or how well they work.

Other ways to help with pain

Many people find that some non-drug activities can help with pain. Tai Chi (pronounced tie-chee), gentle yoga, meditation, massage, or acupuncture may help to reduce pain. Using a heating pad or ice pack can also help with muscle pain.

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Written By: C. Bree Johnston, MD