Advancing Opioid Research in Older Adults

In 2018, a major research initiative was launched to address this gap. Supported through original grant funding from the National Institute on Drug Abuse (NIDA) under the National Institutes of Health (NIH), the study focused on evaluating the safety and effectiveness of opioid use in older adults, with particular attention given to dosing, duration of therapy, and the consequences of opioid tapering.

According to Yi Yang at the University of Mississippi School of Pharmacy, the principal investigator of the project, the work was motivated by a clear absence of evidence-based guidance for older adult patients.

“The original grant in 2018 was used to research the safety and effectiveness of opioid usage in older populations,” said Yang, chair and professor of Pharmacy Administration and research professor in the Research Institute of Pharmaceutical Sciences. “In 2016 the CDC issued new guidelines, but there was no evidence for patients 65 and above.”

At the time, the Centers for Disease Control and Prevention had introduced updated opioid prescribing recommendations intended to reduce misuse and overdose. However, many of those recommendations were based on studies involving younger and middle-aged adults, leaving clinicians with little research specific to older populations.

Researchers involved in the study emphasized that older adults require individualized consideration because the aging process significantly changes how medications affect the body.

“Our focus was that these populations are not simply older versions of younger patients,” Yang said.

This distinction is critical. Older adults often experience changes in kidney and liver function, increased sensitivity to medications, and multiple coexisting health conditions. Many are also prescribed numerous medications simultaneously, increasing the risk of adverse drug interactions and complications.

At the same time, chronic pain remains highly prevalent among seniors. Arthritis, neuropathy, musculoskeletal disorders, cancer-related pain, and post-surgical complications all contribute to long-term discomfort that can severely reduce mobility and quality of life.

“More than half of older populations deal with some sort of pain, which makes them significantly different from those who are younger,” Yang said.

Because of these differences, the research team sought to answer several pressing clinical questions: How safe are opioids for older adults? What dosage levels are appropriate? How long should opioids be prescribed? And what happens when patients stop taking them?

The first grant-funded study focused on examining opioid use patterns and safety outcomes in older adult populations. Researchers evaluated how opioid medications were being prescribed and whether current prescribing practices adequately reflected the medical complexities associated with aging.

As national conversations around opioid misuse intensified, the team also became interested in another emerging concern: the risks associated with abruptly discontinuing opioid therapy.

“The research investigated the safety of opioid usage and at what dosage and how long should they be used,” Yang said. “The first grant-funded research did so well that we applied for a second one that looked at what happens when suddenly stopping opioid usage.”

This second phase of research, also funded by NIH-NIDA, centered on opioid tapering strategies and the consequences of rapid discontinuation. Healthcare providers across the country had begun reducing or eliminating opioid prescriptions in response to tightening regulations and increased scrutiny surrounding opioid-related deaths. However, many clinicians and researchers worried that abrupt cessation could unintentionally harm vulnerable patients, particularly older adults.

Yang emphasized that tapering required careful evaluation because researchers already understood the potential dangers of sudden withdrawal.

“We knew that a cold turkey approach wouldn’t work,” Yang said.

The tapering study examined how gradual dose reductions might improve outcomes while minimizing withdrawal symptoms, worsening pain, or emotional distress. Researchers aimed to identify safer approaches that balanced responsible opioid stewardship with compassionate patient care.

The findings from the research initiative contributed significantly to the scientific literature surrounding pain management in older populations. According to John Bentley, professor of Pharmacy Administration, professor in the Research Institute of Pharmaceutical Sciences and director of the Center for Pharmaceutical Marketing and Management Pharmacy Administration, the project generated an extensive body of scholarly work that continues to influence ongoing discussions about opioid prescribing practices.

“This research looked at tapering opioid usage in older populations and the effects on those populations,” Bentley said. “The CDC said opioids had been over prescribed, but how much was too much, how often did tapering occur, and what are the consequences?”

To date, the research team’s work has yielded more than a dozen published manuscripts, which represent a major contribution to an area of medicine that has long lacked robust clinical evidence. The research not only provided valuable data regarding opioid safety in older adult populations, but also highlighted the importance of patient-centered approaches to pain management.

“One of the many exciting aspects of this project is that it is a truly collaborative effort among a large group of researchers,” Bentley said. “School of Pharmacy faculty members Dr. Sujith Ramachandran and Dr. Kaustuv Bhattacharya are major contributors to the team, and over the years almost 10 graduate students and several pharmacy students have joined us in our research efforts.”

As healthcare systems continue searching for solutions to the opioid epidemic, studies focused on older adults are becoming increasingly important. Older patients often face the dual challenge of managing chronic pain while remaining especially vulnerable to medication-related complications. Research such as this helps ensure that future prescribing guidelines are informed by evidence that reflects the unique realities of aging populations.

The work conducted by Yang, Bentley, and their colleagues underscores a broader shift in medicine toward individualized care. Rather than applying generalized opioid policies across all age groups, their research advocates for treatment strategies grounded in the specific needs, risks, and experiences of older adults.

Ultimately, the research represents an important step toward improving pain management while protecting patient safety, an issue that will only grow more significant as the nation’s population continues to age.