Older Age Is Associated With Long-Term Retention in Buprenorphine Treatment for Opioid Use Disorder

Opioid use disorder (OUD) among older adults is a fast-growing public health problem. However, little is known about treatment outcomes among older adults in office-based buprenorphine programs. Thus, our objective was to examine how age is associated with buprenorphine treatment outcomes among adults with OUD who initiate buprenorphine treatment in primary care.

This was a retrospective cohort study of all adults with OUD who initiated buprenorphine at an office-based treatment program in the Bronx, NY between June 1, 2015 and December 31, 2017. Using cox proportional hazards analysis and logistic regression models, the primary outcome was buprenorphine treatment retention based on electronic health record (EHR) prescription orders. The main independent variable was age at initiation of buprenorphine treatment, categorized as age < 40, age 40-49, age 50-59, and age ≥ 60. Covariates included patient demographics, cannabis use at treatment intake, and history of OUD treatment with methadone.

The cohort included 239 patients of which 70 (29%) were age 50-59 and 24 (10%) were age ≥ 60. Compared to being age < 40, being age 50-59 was associated with a 27% decreased risk of treatment discontinuation (aHR of 0.63; 95% CI, 0.42-0.95) and greater odds of treatment retention at 1 year (aOR 2.23, 95% CI, 1.15-4.67) and 2 years (aOR 2.20; 95% CI, 1.03-4.74). Compared to being age < 40, being age ≥ 60 had similar, but nonsignificant findings.

In office-based buprenorphine treatment, being age 50-59 was associated with more than 25% decreased risk of treatment discontinuation and over twice the odds of long-term retention in treatment than adults age < 40. While not statistically significant, likely due to their smaller sample size, adults aged ≥ 60 had similar findings. These findings highlight the success of buprenorphine treatment for OUD once it is initiated in adults over age 50.