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Opioid misuse and mental health concerns in older adults

When you picture someone who misuses opioids, it’s likely not someone in their 60s, 70s or 80s. However, according to a 2022 study published in JAMA Network Open, from 1999 through 2019, 79,893 Americans age 55 and older died due to an opioid overdose. And, according to the same study, opioid use disorder in adults 65 and older more than tripled between 2013 and 2018.

A class of pain relievers also called narcotics or opiates, opioids include some familiar names, according to Harvard Women’s Health Watch. In addition to the illicit street drug heroin (often laced with fentanyl), prescription versions include morphine, hydrocodone, short-acting or long-acting oxycodone (OxyContin), tramadol, and hydromorphone (Dilaudid).

Why older adults?

According to The Opioid Public Health Emergency and Older Adults, from the Association for Community Living (ACL), older adults are among the groups affected by this problem because they often use prescription opioids to cope with painful chronic conditions, like arthritis, or procedures, such as surgery.  Like anyone else, if older adults use prescription opioids for a long time, they risk developing an opioid use disorder. Long-term opioid therapy is defined as use of opioids on most days for more than 3 months.

The ACL report states that about 40 percent of older adults report pain, compared to 30 percent of the general population. In addition, some older adults have accumulated experiences involving trauma, which can result in anxiety and depression. Furthermore, loss of loved ones and erosion of social roles can occur with age and so can disability. These challenges can make older adults, like people of all ages, prone to relying on opioids and other substances such as alcohol to ease emotional and physical pain in their daily lives.

Risk factors for substance use disorders in older adults
  • Physical risk factors for substance use disorders in older adults can include:
    • chronic pain
    • physical disabilities or reduced mobility
    • transitions in living or care situations
    • loss of loved ones
    • forced retirement or change in income
    • poor health status
    • chronic illness
    • taking a lot of medicines and supplements
  • Psychiatric risk factors include:
    • avoidance coping style
    • history of substance use disorders
    • previous or current mental illness
    • feeling socially isolated

Opioids have a stronger impact on older adults because bodily processes slow as people age.  Older adults also tend to be using multiple medications, which can interact with opioids and cause serious side effects. For example, older adults who use opioids and take an anti-anxiety medication, such as a benzodiazepine, can experience slow respiration to the point of death, depending on dosage levels. Complicating this situation is that older adults with a substance use disorder, such as an opioid use disorder, may have symptoms similar to those of depression, delirium or dementia.

Substance misuse in older adults can be missed by doctors

Unless a person tells them, their healthcare professional may not realize a patient has an alcohol or substance use problem. Other factors may hide possible problems: 

  • Having depression, memory problems or physical disability
  • Failing to consider substance use disorder in older adults
  • Mistaking symptoms for normal signs of aging, or for Alzheimer’s disease or another dementia
Signs of potential opioid misuse to watch for in older adults:
  • Increased confusion or memory problems
  • Mood changes (e.g., agitation, depression, anxiety, irritability)
  • Sleep problems (including difficulty breathing) and daytime sleepiness
  • Dizziness
  • Changes in blood pressure
  • Anemia (low blood counts)
  • Fatigue or weakness
  • Changes in liver function and other abnormal blood results
  • Poor hygiene or nutrition
  • Falls, bruises or burns
Mental health problems

More than one in four adults living with serious mental health problems also has a substance use problem. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), mental health problems and substance use disorders sometimes occur together. This is because:

  • Certain substances can cause people with an addiction to experience one or more symptoms of a mental health problem.
  • Mental health problems can sometimes lead to alcohol or drug use, as some people with a mental health problem may misuse these substances as a form of self-medication.
  • Mental health and substance use disorders share some underlying causes, including changes in brain composition, genetic vulnerabilities and early exposure to stress or trauma.
Where to get help

Suicide and Crisis Prevention Lifeline
The 988 Suicide & Crisis Lifeline, previously known as the National Suicide Prevention Lifeline, offers 24/7 call, text and chat access to trained crisis counselors who can help people experiencing suicidal, substance use and/or mental health crisis, or any other kind of emotional distress. People can also call, text or chat 988 if they are worried about a loved one who may need crisis support.

Treatment for Mental and Substance Abuse Disorders
Millions of Americans have mental and substance use disorders. These resources are available to help you find treatment options.

  • Call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline at 1-800-662-HELP (4357) for free, confidential, 24/7, 365-day-a-year treatment referral and information service for individuals and families facing mental and/or substance use disorders.
  • Visit FindTreatment.gov, a confidential and anonymous resource for persons seeking treatment for mental and substance use disorders in the United States and its territories.
Resources and information related to substance misuse and mental health disorders

Sources: Association for Community Living, Center for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, Ohio Department of Mental Health and Addiction Services, Health in Aging Foundation, National Institutes of Health

This page and all marketing and communications efforts connected to it were made possible by Grant 5H79TI085753-02 from the Substance Abuse and Mental Health Services Administration (SAMHSA). Their contents are solely the responsibility of the authors and do not necessarily represent the official views of SAMHSA.

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