House call: Keep Narcan on hand for seniors using opioids

Many older adults rely on opioid pain medications to help relieve short-term pain or for persistent chronic pain. But seniors might not be the first group that pops into your head when you think about overdose or dependence on opioid drugs. Realistically, they have just as much risk (and sometimes more) of dependence, substance use disorder and overdose as any other person prescribed opioid pain medication.

Clearly, pain medications can be useful to relieve suffering, but opioids can also cause a life-threatening overdose. In Spokane County, the number of opioid overdoses deaths doubled from 2020 to 2021. Unfortunately, fatalities from overdose of opioids are on the rise for older adults. Deaths from overdose of opioids in adults 55 years and older rose tenfold between 1999 and 2019 in the U.S.

Common opioid medications prescribed for pain and other issues include oxycodone (Roxicodone or OxyContin); hydrocodone (Vicodin); oxycodone with acetaminophen (Percocet); morphine (MS Contin); and tramadol (Ultram); among others. Opioids purchased without a prescription are made to look exactly like one of these prescription pills. These counterfeit opioids contain fentanyl, which is powerful and likely to cause overdose. For anyone taking opioid medications, including seniors, it’s helpful to be wide eyed and aware of the potential for side effects, life-threatening overdose and substance use disorder.

You can prepare yourself and your household for a possible opioid emergency. It might be uncomfortable to imagine yourself or your older parent having an overdose reaction, but think of learning to recognize the sign of overdose and having the life-saving medication Narcan on hand as similar to other emergency techniques like learning to recognize when someone is choking or having a well-stocked first aid kit.

Add Narcan to your first aid kit

Naloxone, often known as Narcan, is now available over the counter in many pharmacies, or a clinician who prescribes opioids may also prescribe naloxone. Naloxone is an easy to use, affordable nasal spray that works quickly. If you give naloxone to someone who is not having an opioid overdose, it doesn’t harm them. If they are having an overdose, it can save a life.

The signs of opioid overdose are easy to recognize for those who know what they are. Signs include seeming tired or sleepy, cold and clammy skin, small and pin-point pupils and slow or no breathing.

Act fast if you think someone is having an overdose. Too much of an opioid can slow or stop breathing, which is a life-threatening emergency. Call 911 and give the person naloxone by spraying it in their nostrils. Even our wonderful emergency responders here in Spokane need some time to arrive in an emergency. With naloxone now available over the counter, it’s possible for you to help with an opioid overdose while waiting for the emergency responders to arrive.

Washington state has a “good Samaritan” law that protects people who are trying to help someone who is having an overdose, allowing regular people to give naloxone without legal liability. The law also limits liability for people reporting an overdose and those experiencing one, so don’t hesitate even if the drugs taken aren’t a prescription or were taken by someone other than the patient with the prescription.

I commonly hear from patients: “I’ve been taking this for years and have never had a problem!” That assumption is often far off the mark though. Taking opioids over a longer period can lead to tolerance of the medication, meaning you feel less of an effect now than with the original dose. That leads people to sometimes want to increase the dose, either with a prescription or without, but more medication can mean increased risk and side effects.

Particularly troubling for some older adults, opioids can cause memory loss and confusion. Opioids may also stay in the body longer if you have kidney issues, causing greater side effects. Research evidence indicates a link between opioids and kidney disease as well as decreased testosterone levels. Additionally, many older adults take other sedating medications (such as common sleep aids, allergy medications or anxiety medications) or have sleep apnea or lung problems. Combining opioids with other medications or taking them when these or other medical problems are present increases the risk of fatal overdose.

If you or someone you care for have been taking opioids for a longer period, whether problems are obvious or not, it’s useful to check in with your prescribing clinician at your next appointment or send a message asking if the opioid medication is still the best approach for the issues for whichg they were prescribed.

Substance use disorder in older adults is often not diagnosed and so often not treated

Many of us have it in our minds that seniors aren’t in danger of dependence and addiction, but like anyone, older adults can misuse medications and face substance use disorders. A recent study found that as much as 35% of people over the age of 50 with an opioid prescription for chronic paid reported that they misused their medication.

For older adults, substance use disorder often isn’t acknowledged or recognized. When people are retired or have fewer responsibilities outside of their homes, it can be easier to mask or hide the signs of chronic opioid addiction. In some cases, symptoms of substance use disorder including loss of control, social or health consequences of use, risky use, or craving, can be mistaken for other medical conditions that are more common among older adults including unsteadiness, confusion and depression. Increasing tolerance, acceptance of increased medication use, fear of debilitating pain and weakened community ties can all add to risks of substance use at any age. Recognizing the issue is the first step to a healthier approach.

Treatment for opioid use disorder is available and it is effective. Clinicians will often recommend a collaborative approach that supports the patient’s needs in substance use disorder treatment and also addresses pain management to care for the issues that initially warranted the prescription.

We’re seeing a crisis in opioid use overall: More than 109,000 people in the U.S. died from overdosing on opioids in 2023. While opioids can be useful and effective in some situations, there are many other ways to treat chronic pain successfully other than relying on these medications. If you do opt to take opioid pain medications or are a care taker or loved one to someone who does, you should learn to recognize the signs of substance use disorder, have over the counter naloxone nasal spray on hand, and know what to do in an overdose emergency.

David Ward is a family physician at Kaiser Permanente in Spokane.