Opiate Use Among the Elderly

[hppygr8ful, ASN, RN, EMT-I]

I am seeing a number of elderly patients in assisted living situations who seem to take a lot of opiates. One patient who couldn't weigh more than 120 pounds was 85 and wearing a Fentanyl Patch - getting Morphine Sulphate 15 mg routine every 6 hours plus MS Contin every 12 hours routine wit Norco for breakthrough pain. She's perfectly delightful, alert and oriented and not driving anywhere but are Dr's really being responsible practitioners? I know pain management is a science but this just seems like a lot to me? What do you all think?

[heron, ASN, RN]

I think you're paying too much attention to numbers and not enough to the resident. If she's alert, oriented and comfortable enough to be "perfectly delightful" then it seems to me that her pain regimen is right on target.

[hppygr8ful, ASN, RN, EMT-I]

I actually don't mind it - I was just a little surprised

[heron, ASN, RN]

Long term opioids can reach some pretty impressive dosages, for sure. Luckily, the amount required to overdose rises with tolerance. Seems like your lady is doing well, so I would consider her practitioner pretty competent.

Personally, I think pain is actually under-treated in the elderly, especially those with advanced dementia. Add that to the haphazard way we assess pain and prescribe opioids as the only solution to the problem and I agree that there's issues that need addressing.