12 Ways Opioid Addiction and Treatment Differ in Older Adults

Older adults aren't immune from the opioid epidemic sweeping the U.S. However, seniors have unique backgrounds, vulnerabilities and needs for addiction treatment. Many feel ashamed to seek help for problems with prescription painkillers like OxyContin or street drugs like heroin. But age-tailored treatment can save lives, salvage family relationships and restore meaning and purpose to existence. Below, experts lay out generational issues in opioid addiction.

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Addiction rises as the senior population grows. Across the board, the proportional risk of addiction is constant for adults, says Dr. Stuart Gitlow, former president of the American Society of Addiction Medicine. The difference lies in individual response, he says. When given an opiate drug, most people will feel some nausea and physical discomfort, and wake with an unpleasant sensation. "But about 20 percent of the population will say, 'Oh, that feels amazing,'" he continues. "Those are the people we worry about. And you're just as likely to run across those 20 percent in older age as you are in younger age." With 65 million Americans now 60 or older, that adds up to a significant number at risk.

Years of chronic-pain treatment add up. The medical community has awakened to the need for greater caution in prescribing opioid painkillers. According to new guidelines, for most patients, these drugs should be used for short periods only to ease acute pain, like after surgery, and as a last resort for hard-to-treat chronic pain. Yet that doesn't address seniors who've been prescribed these drugs for decades, Gitlow points out, such as laborers like miners or truckers with chronic back pain. Age-related conditions like arthritis, with its debilitating joint pain, can also contribute to opioid overreliance.

Other substances complicate opioid addiction. Older adults make up half of those in addiction treatment at Hazelden in Naples, Florida, says Brenda Iliff, executive director. The center, part of the Hazelden Betty Ford Foundation, offers programs tailored to people ages 45 to 85-plus. "We're seeing a lot of opioids but usually [that] comes with other chemicals," Iliff says. "Many, many times it comes with benzodiazepines for older adults -- anxiety and sleeping drugs. Usually, there's alcohol, too. Sometimes pot -- that's the No. 1 illicit drug older adults are using."

[See: 14 Ways Alcohol Affects the Aging Process.]

Health stakes are higher. It's never a good idea, at any age, to take sedative and opioid drugs together, Gitlow emphasizes. However, patients seeing multiple specialists for different medical conditions may inadvertently receive these dangerously interacting medications through oversight. "Older adults are more prone to risks from both types of drugs, especially when taking them simultaneously," he warns. "Respiratory depression is what we worry about -- for someone to stop breathing from being on the combination." Older adults, who are already more prone to falls, broken bones and cognitive impairment, increase all these risks with opioids.

Drug-sharing is a problem. "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, Iliff says. As addictions develop, some older adults begin to obtain prescriptions illegally. Even when used as ordered, these drugs are subject to another kind of shared use. When seniors don't store medication safely, drug diversion by visiting relatives or houseguests, including kids, poses an unfortunate but real threat.

Overdoses are rising, too. In Naples, Florida, an area with a high concentration of seniors, up to half of recent overdoses have occurred in people over 50, Iliff says. Opioid-related hospitalizations may be underreported, she adds. "Usually overdoses are attributed to age-related [conditions]: They fell, broke their hip, caught pneumonia and died," she says. "Well, they fell and broke their hip because they had too many pills in their system and got up during the night."

Detox may take longer. Treatment for addiction starts with helping the person get through withdrawal. Opioid withdrawal can be extended for seniors, Iliff says, with the process lasting up to nine days in some cases. "Because they're older, it takes longer to detox because you have to bring them down slower," she says. "We don't want people to be uncomfortable." However, as Gitlow points out, a drug called Suboxone can ease the process and also be used for maintenance treatment.

Shame prevents some seniors from seeking treatment. Especially among "older, older" adults in their 70s, 80s and beyond, even the need to be in a treatment center causes "huge shame," Iliff says. They're often traditionalists, some from families with Prohibition-era attitudes. Addiction can feel like a major failure for someone who's led a long, successful life. She recalls a recent patient with a glowing career and wide philanthropic interests. "I have no idea what a guy like me is doing in a place like this," he told her. He just couldn't fathom it, Iliff says.

Even among seniors, generational differences exist. Younger seniors, notably baby boomers, bring a different attitude to drug use and treatment, Iliff notes: "'Sex, drugs and rock 'n' roll' was big for these people," Iliff says. For the 1960s Woodstock generation, it's more about, "I have a problem; I need an instant solution and pills will do that for me." Baby boomers are more likely to use the word "treatment," she says, while older seniors tend to refer to their "classes."

Age-tailored treatment helps. Senior Hope, Inc., an outpatient substance use program in Albany, New York, is geared to people ages 50 and older. Of the adults who seek counseling there, many grew up when discussing mental health and addiction issues was uncommon, and when such services weren't readily available, says executive director Nicole MacFarland. Mature adults benefit by being treated alongside others of similar ages and life stages, she says, because they're better able to relate and connect with one another. General-age support groups may leave seniors feeling like parental figures, she adds, taking on the role of helping others while their own needs go unmet.

Environment counts. A treatment approach known as cognitive behavioral therapy helps people manage their addictions and decrease harmful behaviors, MacFarland explains. Older adults appreciate being treated in smaller groups by professionals with background in geriatric addictions and mental health, she says. Seniors may not be able to hear or see as well as younger adults, she points out, or to process a fast-paced group dynamic. Group facilitators should speak loudly and slowly, she says, and written material should be in larger print. "Older adults prefer a respectful, nurturing environment where the use of profanity is not present," she says. That's not always the case in 12-step groups, for instance.

[See: 4 Opioid Drugs Parents Should Have on Their Radar.]

Seniors in treatment tend to thrive. "One of the things that's really positive in this population is: They show up," Iliff says. "They follow the rules, for the most part. So they're engaged. They've had lives. There's real hope for these people. You're not talking about habilitation like a 17-year-old who's on opiates. You're talking about rehabilitation and just getting them back to life."

Lisa Esposito is a Patient Advice reporter at U.S. News. She covers health conditions, drawing on experience as an RN in oncology and other areas and as a research coordinator at the National Institutes of Health. Esposito previously reported on health care with Gannett, and she received her journalism master's degree at Georgetown University. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.