FAST FACTS: Safety Precautions for Opioid Use

Older adults are at higher risk of medication-induced side effects from opioid use due to normal changes related to aging. Having two or more diseases or medical conditions make older adults more at risk for adverse effects. Side effects of common pain treatments can be a deterrent to good pain control, especially with older adults who are physically vulnerable. It is extremely important to communicate with your family member’s healthcare provider to monitor opioid use and follow all safety precautions.

Key Principles

• Because older adults are more sensitive to medication side effects, monitoring for and preventing issues is important.
• When prescribing opioids, your family member’s healthcare providers should start at a lower dose and adjust the dose based on patient’s response and reported side effects.
• Due to adverse effects, the following medications should be used with caution and should be discussed with the provider: codeine, meperidine, NSAIDs (e.g. ibuprofen, naproxen).
• Be cautious with use of combination medications that include acetaminophen (i.e. Tylenol) as the amount of acetaminophen can add up and be dangerous if over the recommended total daily limit of 4 grams.
• Report all medications that include acetaminophen to the provider.
• Because constipation is a common opioid-induced side effect in older adults, when an opioid treatment is started for your family member a routine laxative should also be prescribed. The dose of laxative should be increased as the dose of opioid is increased.
• Tolerance is the body's normal response to continued exposure to a medication and can result in a reduction of the side effect over time. Such tolerance can develop to most opioid side effects except constipation.

Overview of Common Opioid Side Effects

• Constipation, nausea, dizziness, and urinary retention.
• Higher risk of falls and fractures when taking opioids.
• Increased of delirium
• Prolonged side effects should be reported to your family member’s health care provider for further medication management

What Else You Should Do

• Write down and share information about your family member’s pain with their healthcare provider
• Use a Pain Diary to note important information useful to the healthcare provider
• Encourage your family member to try a non-drug treatment and document the impact on their pain in their Pain Diary

References:

1. William D. Dhey, M.L. (2014). Naloxegol for Opioid-Induced constipation in Patients with Noncancer Pain, N Engl J Med.
2. Rogers E, Mehta S, Shengelia R, Reid MC. Four strategies for managing opioid-induced side effects in older adults. Clin Geriatr. 2013:21.
3. Argoff C, Brenna J, Camilleri M, Davies A, Fudin J. Consensus Recommendations on Initiating Prescription Therapies for Opioid-Induced Constipation. Pain Medicine, Volume 16, Issue 12, December 2015, Pages 2324-2337.
4. Safety Considerations when using opioids for older adults. Jennifer Pruskowski PharmD, Rollin Wright MD, Neal Sprissler PharmD, Mamta Bhatnagar MD. Palliative Care Network of Wisconsin, accessed 12/17/2020.

Used with permission of K. Herr, PI, Cancer Pain in Elders: Promoting EBP's in Hospices; NCI Grant R01CA115363; Adapted from AHRQ Grant RO1 HS 10482; M. Titler; PI; Revised 5/1/21.