Treatment Approaches for Opioid Use Disorders in Late Life

Abstract

The use of opioids and opioid-related deaths in the USA has risen to epidemic proportions. Until recently, the impact of this public health crisis in older adults has not been adequately emphasized. This paper reviews the extant literature for the management of opioid use disorder (OUD) in older adults, with a focus on both pharmacologic and non-pharmacologic interventions for OUD in older adults. Opioid prescriptions for older adults have dramatically increased since the 1990s. OUD in older adults is under recognized and under treated in clinical settings. Once identified, appropriate treatments for OUD should be offered to older adults. These include a combination of psychosocial and pharmacologic approaches. Pharmacologic treatments include antagonist and agonist therapies. Antagonist agents, such as naloxone for acute overdoses and naltrexone for maintenance treatment, and agonists, such as buprenorphine and methadone, have been used. Psychosocial treatments include motivational interviewing (MI) and motivational enhancement treatment (MET) approaches, as well as family support and community resource linkage. In order to optimally address OUD in older adults, a multi-dimensional approach involving pharmacotherapy in combination with psychosocial treatments is recommended. Directions for future research include studies aimed at evaluating the efficacy of such treatments specifically in older adults including those with chronic pain and other comorbidities for which opioid use presents both benefits and challenges.