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Possible New Concerns for Opioid Use in Older Adults

Published March 28, 2011 2:57 PM by Brian Garavaglia

Opioid medications are those that belong to the narcotic drug class.  Opioids or narcotic agents are opiate or opiate derivative drugs that medic ally are used to treat severe and intractable pain issues.  Drugs such as morphine, oxycontin, vicodin, codeine, and heroin belong to this drug classification.  As is evident be the names that are presented in the previous sentence, one automatically not only associates these drugs with powerful pain management, but also with the potential for abuse and addiction.  Older adults often use many of these powerful medications and it is now thought that they may potentially lead to certain risks that were once not thought to be associated with these drugs.  In addition, it was thought that opioids as a drug class all incur a similar risk profile and this also may not be true. 

In a recent study led by Dr. Daniel Solomon and reported in the Archives of Internal Medicine, older adults who took codeine for more than 180 days were at increased risk for experiencing cardiovascular complications.  Furthermore, those elderly who took oxycodone or codeine for only 30 days had increased levels of mortality due to any cause (Arch. Intern. Med, 2010).  However, this 30 day level of increased mortality was not found to exist for all opioids. 

The study also evaluated the risk of opioid medications in comparison to two other medication groups frequently used to treat pain among older adults—non-steroidal anti-inflammatory agents, frequently referred to as NSAIDs, and selective cyclooxygenase-2 inhibitors such as Celebrex.  Solomon’s study found that the rate of adverse events was high for all three groups.  Solomon and his group calculated the rate of adverse events as a ratio of incidents experienced by elderly individuals taking one of these three drug classifications per 1000 person years.  However, although the rates were elevated for all three groups, those taking opioid medications experienced the highest rates of severe adverse occurrences often leading to hospitalization.  The surprising results showed that the rate of pelvis, hip, wrist and humerus fractures was 101 per 1,000 person-years in the opioid group!  This was in comparison to 19 per 1,000 person-years in the selective cycloxygenase-2 inhibitor group and 26 per 1,000 person-years in the group that took NSAIDs. 

Although this study demonstrates some important clinical complications that could be associated with extended opioid usage, it is not attempting to nullify the value that these medications can have if used judiciously.  However, it does provide an important reminder to those working clinically with the older adult that one should closely monitor the need of the opioid and the type of opioid used, closely track its duration of use, and possibly look for another medication that may have a safer profile and a similar efficacy if extended use will be necessary. 

A final thought also has to be inserted here as well.  Since medication abuse among the elderly is not a rarity and since many older adults frequently misuse or even take pain medication they get from other older adults, medical professionals have to also start educating and warning older adults about the potential complications of doing this.  Especially in light of the new information from the Solomon study, educating older adults about the possibly severe, and even life-threatening effects, of taking opioid medications in an unauthorized and unsupervised manner needs to be done more aggressively.  As a person who has witnessed this type of behavior among the elderly, as well as who has worked and counseled older adults on the serious consequences of this type of behavior, I understand the potential and the serious consequences that all too frequently happen when older adults abuse these powerful forms of medication.

posted by Brian Garavaglia
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About this Blog

    Brian Garavaglia, PhD
    Occupation: Long-term care administrator
    Setting: Sterling Heights, Mich.
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