Opioid Use Disorder and Its Treatment Among Older Adults: An Invited Commentary

Abstract

Although nonmedical and illicit use of opioids disproportionately occurs among young and middle-aged adults, opioid use disorder (OUD) and related consequences among older adults merit more attention, as highlighted by Joshi et al. 1 Joshi P Shah NK Kirane HD Medication assisted treatment for opioid use disorder in older adults: an emerging role for the geriatric psychiatrist. Am J Geriatr Psychiatry. 2019; 27: 455-457 Abstract Full Text Full Text PDF Scopus (11) Google Scholar in their article. Medications for addiction treatment (MAT), including methadone, buprenorphine, and naltrexone, are considered a cornerstone for treating OUD. Yet, MAT is underutilized because of stigma (e.g., toward persons with OUD and/or MAT itself) and structural barriers (e.g., limited insurance coverage and lack of providers), among other reasons. Joshi et al. 1 Joshi P Shah NK Kirane HD Medication assisted treatment for opioid use disorder in older adults: an emerging role for the geriatric psychiatrist. Am J Geriatr Psychiatry. 2019; 27: 455-457 Abstract Full Text Full Text PDF Scopus (11) Google Scholar do not explicitly state the inclusion criteria for their systematic review, but their finding of nine articles on methadone and none on buprenorphine or naltrexone indicates the lack of studies on MAT for OUD in older adults. The authors describe that from 2007 to 2012, MAT use was low, with only 7%–9% of adults aged 55+ years admitted to substance use disorder (SUD) treatment receiving it. 2 Chhatre S Cook R Mallik E et al. Trends in substance use admissions among older adults. BMC Health Serv Res. 2017; 17: 584 Crossref PubMed Scopus (66) Google Scholar Although alcohol remains the most common substance use problem among older adults, a recent study, also of adults 55+, found that first-time treatment admissions with heroin or prescription opioids as the primary problem substance increased 110% and 4%, respectively, from 2012 to 2015. 3 Huhn AS Strain EC Tompkins DA et al. A hidden aspect of the U.S. opioid crisis: rise in first-time treatment admissions for older adults with opioid use disorder. Drug Alcohol Depend. 2018; 193: 142-147 Google Scholar Over the same period, planned MAT increased 53% and 66%, respectively, for primary heroin and prescription opioid use. 3 Huhn AS Strain EC Tompkins DA et al. A hidden aspect of the U.S. opioid crisis: rise in first-time treatment admissions for older adults with opioid use disorder. Drug Alcohol Depend. 2018; 193: 142-147 Google Scholar