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Opioid Use Disorder in Older Adults: a Narrative Review.
Jarratt D Pytell1,2, Mariah L Robertson3,4, Benjamin H Han5
1Department of Medicine, University of Colorado School of Medicine, Mail Stop B180, 12631 E. 17 th Ave, Aurora, CO 80045, USA.
Current Geriatrics Reports
|May 26, 2025
Summary
Opioid use disorder (OUD) is increasing in older adults, but treatment rates are low, especially for marginalized groups. More research is needed on age-friendly OUD care and harm reduction strategies.
Area of Science:
- Gerontology
- Public Health
- Pharmacology
Background:
- The prevalence of opioid use disorder (OUD) among older adults has significantly increased, evidenced by a rise in Medicare beneficiaries from 4.6 to 15.7 per 1,000 between 2013 and 2018.
- Hospitalizations and overdose deaths related to OUD have also escalated in this demographic, disproportionately affecting racially minoritized populations.
Purpose of the Study:
- To synthesize current literature on the epidemiology, treatment outcomes, and co-occurring conditions of opioid use disorder (OUD) in older adults.
- To frame the understanding of OUD in older adults through the lens of the OUD cascade of care model.
Main Methods:
- Literature synthesis and review of current research on OUD in older adults.
- Analysis of epidemiological data, treatment outcomes, and comorbidity patterns.
- Examination of the OUD cascade of care model in the context of aging.
Main Results:
- Despite policy advancements, treatment rates for OUD in older adults remain low, with significant disparities based on geography, race, ethnicity, and gender.
- Medications for opioid use disorder, such as buprenorphine and methadone, are effective in reducing mortality risk, but optimal dosing and delivery for older adults require further investigation.
- Older adults with OUD frequently present with comorbidities like cardiovascular disease, psychiatric conditions, and chronic pain, complicating treatment initiation and maintenance.
Conclusions:
- There is an urgent need for research into age-friendly screening, treatment, and harm reduction approaches for older adults with OUD.
- Tailored interventions are crucial, focusing on medication management, polypharmacy, and adaptable care delivery models for those with mobility or cognitive impairments.
- Integrating OUD treatment into general medical settings and expanding harm reduction strategies can improve access and outcomes for this growing population.
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