Chasing the Pendulum: The Past, Present, and Future of Opioids and Older Adults

The management of pain in older adults has been profoundly shaped by shifting attitudes toward acute and chronic opioid therapy. Historically, opioids have been recognized as highly effective for acute and cancer-related pain, but their use in chronic non-cancer pain, especially among older adults, remains controversial due to concerns about addiction, safety, and efficacy. Over recent decades, increased opioid prescribing has coincided with a dramatic rise in opioid misuse, addiction, and overdose deaths, prompting renewed scrutiny of prescribing practices and regulatory responses. This article traces the historical "pendulum" of opioid policy and practice, examines the unique challenges faced by older adults-including heightened vulnerability to adverse effects and polypharmacy-and highlights the ongoing debate between ensuring adequate pain relief and minimizing harm. It also explores best practices and emerging approaches, such as patient-centered care and the integration of non-opioid therapies, and calls for a balanced, evidence-based framework that addresses both the legitimate needs of older adults in pain and the societal imperative to reduce opioid-related harms.