Challenges of Long-Term Opioid Prescription in Geriatric Pain Management: A Case Report of Oxycodone Dependence and Withdrawal-Associated Delirium

A 66-year-old patient was admitted to our geriatric psychiatry unit with opioid- and polypharmacy-associated delirium with withdrawal features. Further evaluation revealed a history of chronic pain of unclear etiology, likely related to polyneuropathy, for which he had been maintained on long-term oxycodone therapy. He was found to be severely intoxicated and demonstrated clear signs of opioid dependence. Detoxification was initiated but was complicated by increased use of as-needed medications, and despite significant side effects, the patient insisted on continuing opioid treatment. This case is presented not merely as an individual prescribing failure, but as an illustration of a system-level breakdown in opioid stewardship. In this example, long-term opioid therapy in an older adult continued without sufficient reassessment of benefit, harm or psychological drivers of pain. Psychiatric comorbidities are often under-recognized, and alternative pain management approaches are seldom provided, raising questions about the rationale for prolonged opioid prescribing in this population. The case underscores the risks of long-term opioid therapy in geriatric patients and the urgent need for improved opioid stewardship and multimodal pain management strategies. Patients with prescription opioid dependence frequently present with psychiatric comorbidities that are insufficiently addressed. Alternative pain treatment concepts are often not offered. Long-term opioid treatment for chronic pain represents a frequent therapeutic challenge due to significant adverse effects.