First, let’s get the bad news out of the way. The opioid dependence and addiction problems that were surging before the COVID-19 pandemic may have only become worse. The Centers for Disease Control and Prevention estimates that about 90,000 people died of drug overdose deaths during the 12-month period ending September 2020, and local reports from all over the country indicate that the numbers have likely gone up substantially since then.

Older adults can be just as vulnerable to opioid dependence as younger people. That was true before the pandemic too. One 2019 study found that between 2006 and 2014, the number of people age 65 and older admitted to the emergency room for opioid misuse increased by 220%.

“Older patients often have multiple medical conditions that may be causing chronic pain, and that can increase opioid dependence risk,” says Tiffany Bell, M.D., medical director for the Recovery Village Columbus Drug and Alcohol Rehab. The facility is part of the Advanced Recovery Systems network, which has locations across the United States. “It could be that opioids are being overprescribed, but there are other possible factors, like chronic usage driven by less social support, more serious withdrawal symptoms, and increasing pain levels.”

But there’s good news to report here too. Treatment options are expanding, and more awareness about the issue could help with prevention. Whether you’re struggling with opioid dependence or you just want to take steps to protect yourself, here’s what the experts say you should know.

Medications may help break the cycle of opioid dependence

The best-known medications that help break the grip of opioids are methadone, naltrexone, and buprenorphine, says Michael Gordon, M.D., medical director at The Berman Center, a recovery treatment center in Atlanta.

The medications work in different ways: Naltrexone blocks the activation of opioid receptors, which prevents the drug from producing rewarding effects. Methadone slowly activates opioid receptors without providing feelings of euphoria. And buprenorphine binds to opioid receptors but only partially activates them. Like methadone, it can reduce cravings and withdrawal symptoms in a person with an opioid use disorder, but it does so without producing euphoria.

All three medications can be very effective, but they tend to be underused, according to the National Institute on Drug Abuse.

Slowly tapering off opioids works, but you need supervision

Older adults may experience more dangerous withdrawal symptoms when stepping away from opioids, says Dr. Bell. That's one reason you should never try to go cold turkey on your own. If you do, you could increase the risk of an elevated heart rate, depression, respiratory issues, or cognitive impairment, says Dr. Bell.

“You need to be very careful when you’re reducing opioid dependence, especially if you’re on multiple medications,” she says. Working with your doctor to reduce your opioid dose is the better approach. They can help you scale down slowly to avoid withdrawal effects.

Dr. Gordon adds that recovery centers may also help, since there are many that assist with opioid use disorder and addiction.

Addressing mental health may boost physical wellness

Although much attention is put on how chronic pain can lead to opioid use disorder, the relationship actually runs in both directions, says Dr. Gordon. Research indicates that opioid usage increases pain sensitivity, so the more you take, the worse your pain will be when you stop. As a result, you keep taking more, often upping your dosage.

It’s a dangerous cycle. As the pain intensifies, it can lead to increased anxiety and stress about how the medication isn’t working as well, Dr. Gordon says. That can worsen health issues like back pain and migraines, which can lead to even more overuse of pain medications.

“Addressing mental health is both a prevention strategy and a treatment option,” Dr. Gordon says. “It keeps your pain from becoming worse, in both early and later stages.”

Reducing your reliance on opioids can reduce your sensitivity to pain. But getting there may require help. If you think you may suffer from anxiety or depression, talk to your doctor or a therapist.

Insurance may cover alternative therapies for opioid dependence

Medicare covers some chiropractic care and acupuncture, which you might want to consider either as an alternative therapy to medication or a complement to it, says Mary Gay, PhD, evening program director at Georgia-based recovery center The Summit Wellness Group.

Physical therapy and massage can also be particularly useful for reducing pain, she adds, potentially reducing the need for opioids.

Medicare Part B also covers opioid use disorder treatment. The service includes medication, counseling, and therapy, which can be performed in a telehealth setting as well as in-person.

Boosting overall wellness with healthy strategies like exercise, stress reduction, quality sleep, and good nutrition can also contribute to the effort to manage pain and avoid opioid use. For example, a study published earlier this year found that people with a vitamin D deficiency may have a higher risk of opioid dependency. So filling your nutritional gaps can be helpful.

The first step is being honest

Dependence can be hard to see, especially if a trusted doctor prescribed your medication in the first place and no one has raised concerns about refills. But Dr. Gordon says there are signs you may have an issue. The two big ones to watch for are:

• The thought of discontinuing opioids makes you feel anxious or panicked.
• You start rejecting any non-opioid pain treatment your doctor recommends.

For example, you may be dismissive of physical therapy despite chronic back pain, or you may refuse to even try switching to a nonnarcotic medication because you’re convinced it won’t work.

“Older people who take opioids may have been on them for years, and they take them as prescribed, so they don’t think dependence is a possibility,” explains Dr. Gordon. “If you feel fearful of stopping, though, that tends to be an indication that you should be looking at this from a possible dependence perspective.”

His advice is to talk with your doctor about that concern ASAP — that way you can come up with a plan about how to move forward.