Because older adults often take multiple medicationsand because slowed metabolism makes the body less efficient at absorbing and processing drugsthey can be far more susceptible to opioids' side effects than younger people, even at lower doses. But you can take advantage of the benefits opioids offer and minimize their associated risks by thoroughly discussing your specific needs for pain relief with your doctor.
In addition, you should take the following precautions:
- Begin with the lowest dose. Opioids should be started at the lowest potentially effective dose and gradually increased as needed. Once an optimal dose is achieved, it generally doesn't need to be increased unless pain worsens owing to disease progression. Never take extra doses before consulting with your doctor.
- Use drugs only as directed by your doctor and pharmacist. Don't skip, stop or double up on doses and don't stretch out or hoard drugs to make them last longer. Don't use the drug for any purposes other than prescribed, and never share opioids or acquire them from a family member or friend. Store your medication in a secure place, preferably in a locked box. If you dispose of unused drugs, follow any disposal directions on the label.
- Remember that timing is important. For effective relief of continuous pain, opioids should be taken around the clock. Therefore, sustained-release oxycodone is frequently preferred for convenience. Fentanyl, which has a lower potential for gastrointestinal side effects such as constipation and nausea because it's administered via a skin patch, or sustained-release morphine may be other options.
- Be prepared for side effects. When you first start opioid therapy or if your dose is increased, anticipate fuzzy thinking, drowsiness or dizziness. If these side effects occur, they usually subside in a few days. Until they disappear, take commonsense precautionsdon't drink, drive or operate heavy machinery; remove household hazards (such as throw rugs); hold onto stair rails and chair arms when moving around; and don't plan to make any important decisions. Often the most troublesome side effect with opioid therapy is constipation, which can be eased or prevented with exercise, adequate fluid intake and stool softeners such as docusate (Colace). If side effects don't subside, tell your doctorhe or she may need to decrease your dose or put you on a different drug.
- Keep a written list of all your medications. Tell your doctor and pharmacist about all prescription and nonprescription medications you take. That includes vitamins, nutritional supplements and herbal products. Your doctor may need to monitor you carefully for drug interactions or change your drug dose. Keep your doctor and pharmacist up to date on any changes to your medication regimen.
Srinivasa N. Raja, M.D., Director, Pain Research and the Division of Pain Medicine; Professor of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine
Although older adults are more vulnerable to adverse reactions than younger patients, the possibility of side effects can usually be minimized with good care and a few precautions. Research shows that, in treating chronic pain conditions, combination therapycombining two or more types of medications, such as a nonsteroidal anti-inflammatory drug, an anticonvulsant or an antidepressant with an opioidmay provide better pain relief than a single drug and requires lower doses of the opioid.
Some patients feel they experience fewer side effects with a combination drug treatment. However, scientific evidence remains equivocal on whether combination therapy significantly reduces side effects of opioid drugs. Avoid alcohol intake while on opioid drugs.
Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50