Prescribing Opioids to Older Adults: A Guide to Choosing and Switching Among Them

Marc Ginsburg, RN, MScN, NP; Shawna Silver, MD, PEng; Hershl Berman, MD, FRCPC


Geriatrics and Aging. 2009;12(1):48-52. 

In This Article

Abstract and Introduction


The use of opioid medications and converting among them in the older adult population can often be challenging. Physiological changes in older adults may affect metabolism and cognitive abilities. Due to renally cleared metabolites, some opioids, such as morphine, should be used with caution among older adults. Others, such as meperidine, should never be used at all. When prescribing or changing opioids, the choice of the correct formulation, appropriate counselling, and close follow-up are essential for optimal pain management and in order to prevent adverse outcomes.


The treatment of pain in the older adult population can present significant challenges. Older adults may have a number of chronic conditions. Some of these may affect which drugs they can use, and others may require medications that may put these patients at a higher risk for drug-drug interactions. Age-related changes in physiology, such as renal function, may limit which drugs can be prescribed. Cognitive, language, and hearing obstacles are important considerations as well.

Inappropriate prescription and ineffective pain management are common.[1] Because pain control is poorly taught in training, many physicians are reluctant to prescribe opioids in sufficiently high doses, for fear of causing harm.[2] Inappropriate medication use in older adults has also been linked to a growing number of adverse drug reactions and to excess health care utilization.[3]

The purpose of this article is to familiarize the reader with commonly used opioids and how they can be applied in the older population. Special attention is given to selecting the appropriate drug in this particular group of patients, and how to convert from one opioid to another.


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