Opioids, a class of prescription pain relievers, have increased in prevalence in the last decade, with an estimated 191 million prescriptions dispensed in 2017 alone, according to the Centers for Disease Control and Prevention (CDC).

Yet these common medications have come under scrutiny in recent years due to the increased risk of side effects and addiction. Such risks may be even more prevalent in older adults.

Learn more about why older adults may be prescribed opioids, the risks involved, and the possible alternatives for chronic pain management a doctor can discuss with you.

Opioids work by preventing your body from processing pain. This can work in various areas of the body, including the brain and the skin.

Opioids, such as hydrocodone, methadone, and oxycodone, have been historically prescribed to help treat moderate to severe pain.

Doctors may prescribe opioids to older adults for the following reasons:

While such health concerns may affect anyone, the chances of certain pain-related conditions, such as osteoarthritis and cancer, may increase with age. This, in part, explains an increase in long-term use of opioids among older adults.

In general, opioids are safe when used to treat short-term (acute) pain. Examples include pain related to a recent surgery or an injury. However, anyone who uses opioids may be at an increased risk of overdose or dependence.

It’s also important to know that taking opioids for any length of time may cause side effects, such as:

  • dizziness
  • sleepiness
  • dry mouth
  • nausea and vomiting
  • constipation
  • confusion
  • itchy skin
  • sweating
  • depression

Older adults who take opioids may also be at an increased risk of cognitive changes, breathing problems, and falls leading to bone fractures.

Opioids may also result in greater tolerance to the medication and increased sensitivity to pain. Dependence can occur when you experience symptoms of withdrawal. The chances may be greater if you take opioids for longer than your doctor recommends.

While the risks of side effects, overdose, and dependence apply to all adults, they may be higher for older adults. This is because older adults metabolize medications differently, with such substances staying in the body for longer.

Doctors may not recommend opioids for adults with a personal or family history of drug or alcohol use disorders.

You also should not take opioids with benzodiazepines, as this may lead to fatal side effects. Examples of benzodiazepines include:

Also, while doctors sometimes prescribe opioids for chronic pain, they may try other methods first. Due to the risks involved, opioids are best used for short-term treatment. Doctors should only prescribe them for chronic illnesses as a last resort.

In certain circumstances, such as surgery, pain medications may be necessary for a few days. However, a doctor may recommend other medications instead of opioids, particularly for mild to moderate pain.

In such cases, options may include one of the following over-the-counter (OTC) pain relievers:

For long-term pain, your doctor may refer you to a pain management specialist, where you may learn about alternatives to OTC and prescription pain medications, such as:

Questions for my doctor about opioids

Due to the higher risk of side effects and dependence in older adults, it’s important to carefully consider the benefits versus risks of opioids with a doctor. Below are some key questions you can ask:

  • Why might I need opioid treatment?
  • Are there any other pain management options I can try?
  • What are the side effects of opioids I should be aware of?
  • What are the signs of possible dependence on, or increased tolerance to opioids?
  • How long do I need to take opioids?
  • Is there anything I should avoid while taking opioids (alcohol, other medications, supplements etc.)?

Any older adult who is prescribed opioids should be monitored carefully for both short-term and long-term side effects. This is especially important in considering the risk of opioid use disorder (OUD), which is more common in cases where doctors prescribe opioids for chronic conditions.

OUD describes the chronic use of opioids because of a dependence on them, despite no longer needing to take these medications.

While OUD is a health concern in the United States more generally, it’s also important to consider that older adults may be at an increased risk. This may be due to taking opioids for longer periods, or dependence that results from metabolizing the drugs differently than a younger adult might, resulting in higher levels of the drug in the body.


If you suspect that you or a loved one may be experiencing OUD, it’s important to seek medical treatment. It’s best not to stop taking your prescription suddenly, as this can increase withdrawal symptoms and subsequent relapse.

Treatment for OUD in older adults may involve medications to help alleviate withdrawal symptoms. Opioid replacement therapy and CBT are other options that may help.

Help for people with opioid use disorder

If you need help with OUD, consider calling SAMSHA’s National Helpline, a free and confidential information and referral service, at 800-662-4357 (HELP). You can also find behavioral health services in your area through SAMSHA or the Healinggeeks FindCare Tool.

Opioids pose serious risks for anyone but especially older adults.

Despite the significant health risks opioids pose, these medications may still be a necessity in treating acute pain. In older adults, this may include acute pain caused by recent surgery or a serious injury.

Doctors should prescribe opioids at the lowest dose and for the shortest time possible. However, some doctors prescribe opioids for longer periods for chronic pain, such as those associated with arthritis, cancer, or other long-term illnesses.

It’s important to carefully weigh the pros and cons of opioid medication with a doctor before beginning a treatment regimen. You should also seek medical attention right away if you’re experiencing serious side effects or possible signs of OUD.