An injury or surgery can be especially challenging as we get older. A fall, broken bone, joint replacement, or other medical procedure may lead to significant pain and temporarily make everyday activities more difficult. Prescription pain medications, including opioids, can provide important relief and make it easier to rest, move around, and take part in physical therapy during recovery.
However, opioids also carry a risk of dependence. This can develop gradually, sometimes before a person realizes there is a problem. As Community Outreach Coordinator at Virginia Recovery Centers (an alcohol and drug rehab in Virginia), I’ve seen firsthand how people can become dependent on prescription opioids without expecting it. Recognizing the early warning signs can help older adults and their loved ones seek help early.
Why Opioids Are Prescribed After Injuries and Surgery
Opioids are medications used to treat moderate to severe pain. Common examples include oxycodone, hydrocodone, and morphine. Doctors may prescribe them after surgery, a broken bone, a serious fall, or another painful medical condition. When used carefully and for the shortest appropriate amount of time, opioids can be an important part of recovery. They may help a person get enough rest, participate in physical therapy, and return to everyday activities.
At the same time, opioids affect the brain and nervous system. With continued use, the body can become accustomed to the medication. This can lead to tolerance or physical dependence.
Tolerance means the medication may not provide the same level of pain relief it once did. Physical dependence means the body has adapted to the medication and may experience withdrawal symptoms if the medication is suddenly reduced or stopped. Importantly, physical dependence can occur even when someone takes an opioid exactly as prescribed. Dependence is not necessarily the same thing as addiction or an opioid use disorder, but it is something that should be discussed with a healthcare provider.
Early Physical Signs of Opioid Dependence
One potential warning sign is noticing that the prescribed dose does not seem to provide relief for as long as it once did. A person may find that pain returns sooner between doses or may feel tempted to take medication more frequently or in larger amounts. Another sign can be withdrawal symptoms between doses or after reducing the medication. These may include sweating, chills, anxiety, muscle aches, restlessness, nausea, or difficulty sleeping.
Some older adults may also notice changes in their energy and daily routines. They may feel unusually tired, less alert, or unable to get through the day without their medication. These symptoms can have many possible causes, particularly in older adults, so they should not automatically be assumed to indicate dependence. However, they are worth discussing with a doctor or pharmacist.
Emotional and Psychological Warning Signs
Changes in thoughts, feelings, or behavior can also be important to recognize. For example, someone may begin thinking frequently about when they can take their next dose, counting pills carefully, or becoming increasingly worried about running out of medication. The medication may begin occupying more attention than it did earlier in the recovery process.
Another concern is using opioids for reasons other than physical pain. Someone may begin taking the medication primarily to relax, cope with stress, fall asleep, or feel emotionally better. This can be a sign that reliance on the medication is becoming more complicated. Changes in mood may also occur. A person may become more irritable, anxious, depressed, or withdrawn. Family members or close friends sometimes notice these changes before the person does.
It is important to remember that recovering from an injury can affect mood and independence, particularly for older adults. Spending more time at home or participating in fewer activities does not automatically mean there is a problem with opioid use. However, persistent isolation combined with increasing reliance on medication deserves attention.
Behavioral Changes to Watch For
Changes in how someone uses their medication may provide another important warning sign. These can include taking medication earlier or more frequently than prescribed, taking extra doses without consulting a doctor, or continuing to use opioids even after the original pain has significantly improved. Running out of medication earlier than expected can also be concerning. Someone may begin requesting refills sooner, asking for stronger medication, or visiting multiple healthcare providers to obtain additional prescriptions.
Secrecy is another potential red flag. A person may become uncomfortable discussing how much medication they are taking or become defensive when a loved one expresses concern. These behaviors do not necessarily mean someone has an opioid use disorder. There may be legitimate reasons for changing pain medication, especially when an injury or medical condition is complicated. The important thing is to discuss changes with a healthcare professional rather than making adjustments independently.
Why Opioid Dependence Can Be Difficult to Recognize
Opioid dependence can be particularly difficult to recognize when the medication was prescribed by a doctor. It is understandable to assume that a prescription medication must be safe as long as it is being used for a legitimate medical reason. However, even medications prescribed appropriately can carry risks. The likelihood of side effects and complications can also increase with age, particularly when opioids are taken along with other medications that cause drowsiness.
Dependence can also develop slowly. A person may simply feel that they still need the medication because they continue to experience pain. Over time, small changes in medication use can become a pattern. There is also no reason to feel ashamed about asking for help. Dependence is a medical concern, not a character flaw. Talking with a doctor early can help prevent a manageable problem from becoming more serious.
What to Do If You Notice These Signs
If you notice signs of possible opioid dependence in yourself or a loved one, start by talking with a healthcare provider. A doctor can review the medication, assess your pain, and determine whether changes to your treatment plan are appropriate.
Do not stop taking an opioid suddenly without medical guidance. Depending on how long you have been taking the medication and the dose, stopping suddenly can cause withdrawal symptoms. Your healthcare provider can determine whether the medication should be reduced gradually and can provide guidance on how to do so safely.
There may also be other ways to manage pain, depending on the cause. Physical therapy, appropriate exercise, non-opioid medications, behavioral approaches, and other pain-management strategies may help reduce reliance on opioids while supporting recovery. For people who develop an opioid use disorder, treatment is available. Medications such as buprenorphine and methadone can be used as part of treatment under appropriate medical supervision.
Protecting Your Health During Recovery
Recovery from a fall, injury, surgery, or other painful condition takes time. While opioids can provide short-term relief, pay attention to changes in your body, mood, and medication use. If you need more medication, think about it constantly, experience withdrawal symptoms, or use it for reasons beyond pain relief, talk with your healthcare provider. Recognizing a problem early can help protect your health, independence, and recovery.
Lauren Edwards is the Community Outreach Coordinator at Virginia Recovery Centers, a leading alcohol and drug rehab in Virginia. In her role, Lauren connects individuals and families with the center’s comprehensive addiction treatment programs, including outpatient care, medication-assisted treatment, and holistic therapies such as art and music therapy. She is dedicated to raising awareness about substance use disorders and providing compassionate support to those seeking lasting recovery, helping them navigate treatment options and access the resources they need to thrive. https://
