Opioids and the aging brain

Opioid use among older adults has risen sharply over the past two decades, driven by long-term prescriptions for chronic pain, post-surgical recovery, and palliative care, as well as by the aging of populations affected by the broader opioid epidemic. Yet the aging brain is uniquely vulnerable to these compounds. Age-related changes in pharmacokinetics, blood-brain barrier integrity, receptor density, neuroinflammation, and reserve capacity all alter how opioids act on neural circuits, and how those circuits recover, or fail to recover, after exposure. The result is a growing but fragmented body of evidence linking opioid use in later life to cognitive decline, delirium, falls, mood disturbance, sleep disruption, and accelerated neurodegeneration.Despite the scale of the problem, fundamental questions remain open. How do chronic and acute opioid exposures interact with the molecular hallmarks of brain aging, including synaptic loss, and glial dysfunction. Do opioids modify the trajectory of Alzheimer’s disease, Parkinson’s disease, or vascular cognitive impairment, and through which mechanisms? What distinguishes safe analgesia from neurotoxic exposure in older patients, and how should clinicians weigh pain control against cognitive risk? How can we better identify, treat, and support older adults living with opioid use disorder, a population often overlooked in addiction research and services?This Research Topic brings together basic, translational, clinical, and population-level work that advances our understanding of how opioids shape the aging brain and behavior. We welcome Original Research, Reviews, Mini Reviews, Systematic Reviews, Perspectives, and Methods, addressing themes including, but not limited to:o Opioid use disorder in older adults: epidemiology, neurobiological mechanisms, treatment, and recoveryo Neuroimaging, electrophysiological, and biomarker studies of opioid exposure in agingo Mechanisms of opioid action in aged neurons, glia, and neural circuitso Opioid effects on cognition, memory, executive function, and decision-making in older adultso Interactions between opioids and neurodegenerative disease pathologyo Opioid-induced delirium, sedation, and post-operative cognitive dysfunction in older patientso Chronic pain, opioid analgesia, and brain health across the lifespano Sex, gender, and socioeconomic disparities in opioid-related brain outcomes in later lifeo Non-opioid and adjunctive strategies for pain management that preserve cognitiono Policy, prescribing, and deprescribing frameworks informed by neuroscienceBy bridging molecular, systems, and clinical perspectives, this collection aims to consolidate current knowledge, surface methodological gaps, and inform safer, more effective approaches to pain and addiction care in an aging world. Topic editors: Maria Mavrikaki, Diana Marisol Abrego-Guandique, Erika Cione Source: https://www.frontiersin.org/research-topics/81083/opioids-and-the-aging-brain