Opioids: Safe for older people with arthritis?

Date Updated: 09/15/2020

Answer Section

An opioid isn't the first choice for treating chronic conditions such as arthritis. Aside from cancer pain, opioids more commonly are reserved for short-term pain relief, such as after injuries or surgeries.

When other means of relieving arthritis pain haven't helped, opioids may be prescribed. But safety and effectiveness are issues.

Opioids may not be helpful. Even when they are, people often develop a tolerance to opioid pain medications over time, so the effect of the medication may diminish after taking the same dosage for several months.

Opioids have risks that may be particularly serious for older people, including:

Sedation and mental confusion. Opioids can cause sleepiness or mental clouding, which can dramatically increase the risk of falls and fractures caused by falls.
Disordered breathing. Higher doses of opioids can result in slower or shallow breathing patterns, especially during sleep.
Heart problems. Some opioids increase the risk of heart attack or heart failure.
Constipation. Many older adults are already dealing with this problem, and opioids generally just make it worse.
Nausea. Opioids commonly cause nausea, which can make it difficult to maintain good nutrition.

An added danger for older people is that some opioids are combined with acetaminophen. Older people often take over-the-counter acetaminophen or may take other drugs containing acetaminophen for a different condition. This acetaminophen overload increases the risk of liver disease, gastrointestinal bleeding, heart failure and interactions with other drugs. Talk to your doctor about all other prescriptions and over-the-counter drugs you take before starting opioids.