Are opioids OK for people living with dementia? New research out of AAIC shows that dementia combined with this addictive class of painkillers can cause risk of death to skyrocket. Patients and loved ones will need to weigh the risks versus the benefits.
One in three people with dementia develop chronic pain. When over-the-counter medications like Aspirin or Aleve aren’t enough, doctors may prescribe opioids: a class of notoriously addictive class of painkillers that includes fentanyl, oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and others. But are they safe for people living with dementia? New research presented at the Alzheimer’s Association International Conference finds they have even higher risks than for cognitively healthy individuals. In fact, adults with dementia are eleven times more likely to die within the first two weeks of taking opioids. After the first two weeks, people with dementia still have a six-times-higher chance of dying.
“The use of strong opioids has increased considerably over the past decade among older people with dementia,” study lead Christina Jensen-Dahm at Copenhagen University Hospital said in a press release. “Our study shows the importance of careful evaluation of risk and benefits to the patient when considering initiating opioid therapy among elderly individuals with dementia.”
The researchers looked at 75,471 adults in Denmark over the age of 65 diagnosed with dementia between 2008 and 2019. More than two in five people in the study were prescribed opioids. Over the course of 180 days, the participants taking opioids were four times more likely to die. Stronger opioids — like morphine, oxycodone, hydromorphone, and fentanyl — increased the risk of death by more than a factor of six over those six months. Nearly two thirds of people with dementia using fentanyl patches died within that time period.
In dementia, opioids may do more harm than good
For patients with dementia, experts say the should work with their doctor to weigh the risks versus the benefits of taking opioids for pain. It’s a decision that needs to be made case by case. In the case of chronic pain, their harms may well outweigh the benefits, according to Jensen-Damn.
“Opioids are known to have significant side-effects including sedation, confusion, respiratory depression and falls,” she said.
The researchers weren’t able to determine just why opioids increase the risk of death for people living with dementia, however.
“Opioids should generally be used for the shortest possible time as they carry significant risk,” Jensen-Damn told Being Patient. “If a patient with dementia is on an opioid it makes sense for the caregiver to discuss risk and benefits with their doctor. In some cases, the patients are in severe pain and clearly benefit from opioid therapy and in this case opioid would be indicated as discontinuation could lead to worsening of quality of life.”
Opioids aren’t the first class of drugs shown to increase the risk of mortality in individuals with dementia. Atypical antipsychotics prescribed for treating individuals with dementia who have hallucinations or aggression double the risk of death. These findings lead to changes in clinical guidance and practice that decreased how often these drugs are prescribed in nursing homes.
Are opioids OK for someone living with dementia?
Neurologist Nicole Purcell at the Alzheimer’s Association added that if doctors are going to prescribe strong, addictive, and risky painkillers like opioids to anyone, including people living with dementia, this should be a carefully thought-through decision in which the risks and benefits are assessed, and the response to the drugs is monitored.
“Pain should not go undiagnosed or untreated, in particular in people living with dementia who may not be able to effectively articulate the location and severity of the pain,” Purcell said. “Decisions about prescribing pain medication should be thought through carefully, and, if used, there needs to be careful monitoring of the patient.”
UPDATE 18 July 1:10 p.m. ET: The headline of this article was updated for clarity. New context about what drugs fall into the category of opioids was added to the first paragraph. A disclaimer that taking opioids for pain is a subjective choice best made by the patient and/or their loved ones and doctor was added, to help counter the worst-case-scenario media coverage of this study.