If older pain patients take Opiodis, research shows it can dramatically alter their lives, and not necessarily for the better. The first line of treatment should be non-opioid based, in many cases. KevinMD.com posted a great blog about it, written by Steven Reznick, MD.
A 2010 research paper in the Archives of Internal Medicine looked at 12,840 Medicare patients with an average age of 80 who had used opioids, traditional anti-inflammatory drugs, or a class of non narcotic prescription painkillers like Celebrex. Their findings included:
- opioid users were more than four times more likely to suffer a fall with a fracture than non-opioid users
- deaths from any cause were 87% more likely in opioid users.
- cardiovascular complications including heart attacks, strokes, and cardiac death were 77% higher in opioid users than in users of NSAIDS.
And yet, the United States has reportedly seen a 32% increase in the use of opioids among patients 65 and older since 2007, in part due to reports form groups like the American Geriatrics Society, who with some of their members have received financial support from drug manufacturers. Also from the Reznick article:
George Lundberg, MD and Maria Sullivan, MD of Columbia University presented a sane and reasonable approach to pain pill management in MedPage Today. They suggested that non-narcotic pain products be tried initially. They encouraged doctors and nurses to discuss the side effects of narcotics with patients including constipation, sedation, addiction, and overdose and with long term use the risk of hyperalgesia and sexual dysfunction.
They noted the high abuse potential of short acting opioids such as Dilaudid (hydromorphone) and Vicodin (hydrocodone/acetaminophen) and pointed out that these drugs may be good for short term initial pain relief but not chronic use. They reviewed the pharmacology of methadone and pointed out that it is responsible for far too many overdoses due to its basic metabolism and mechanism of action. They suggested never using it in patients who have not taken opioid narcotics regularly.