Opioid Use Disorder Treatment in Seniors Shows Disparities

TOPLINE:

The use of medication for opioid use disorder (MOUD) in older adults has increased over the years, yet disparities persist across patient subgroups, with men, Black and Hispanic individuals, rural area residents, and those with comorbidities such as chronic pain and arthritis being less likely to receive treatment.

METHODOLOGY:

• Researchers examined the characteristics of the use of MOUD among adults aged > 65 years diagnosed with OUD from 2017 to 2022 who were identified using national Medicare data.
• A total of 69,380 patients with OUD (60.7% women; 85.8% White individuals) were included in 2022.
• Patient characteristics such as age, sex, race or ethnicity, original entitlement (disability or old age), dual Medicaid coverage, and rural or urban area residence were considered.
• Comorbidities included conditions such as chronic kidney disease, cancer, ischemic heart disease, chronic pain, arthritis, depression, anxiety, diabetes, obesity, and substance use disorders.
• The outcome assessed was the use of MOUD, including methadone, buprenorphine, or naltrexone, with a multivariable logistic regression model used to examine patient characteristics and comorbidities associated with the use of medication.

TAKEAWAY:

• The use of MOUD among older adults increased from 4.8% in 2017 to 15.0% in 2022, while the prevalence of OUD remained stable at 1.4%.
• The odds of receiving MOUD were lower for men, Black and Hispanic individuals, those with disability entitlement, those who were rural area residents, and older patients, with the odds being lowest for those aged ≥ 85 years (adjusted odds ratio [aOR], 0.19; 95% CI, 0.17-0.21). Patients with dual Medicaid-Medicare coverage had higher odds of receiving the medication (aOR, 1.83; 95% CI, 1.73-1.93).
• Patients with tobacco use disorder, anxiety, or hypothyroidism had higher odds of receiving the medication, with the odds being highest for those with alcohol use disorder (aOR, 1.33; 95% CI, 1.23-1.45) and depressive disorders (aOR, 1.30; 95% CI, 1.24-1.37).
• Patients with non-Alzheimer’s dementia, cancer, chronic kidney disease, or stroke were less likely to receive the medication, and those with chronic pain or arthritis had a 56% and 39% lower likelihood, respectively, of receiving the medication.

IN PRACTICE:

“Disparities in MOUD prescribing by subpopulations of older adults underscore the need for policy changes that improve access to comprehensive opioid treatment programs and increase MOUD coverage,” the authors wrote.

SOURCE:

This study was led by Yong-Fang Kuo, PhD, of the School of Public and Population Health at the University of Texas Medical Branch in Galveston, Texas. It was published online on January 30, 2025, in the American Journal of Preventive Medicine.

LIMITATIONS:

This study did not consider the duration of diagnosis of OUD or the timing of medication initiation or continuation. Social determinants of health were not assessed for their impact on the use of medication. This study focused on prescriptions filled rather than the actual use of medication. Moreover, the effects of psychosocial treatments on the initiation of and adherence to MOUD were not examined.

DISCLOSURES:

This study was supported by grants from the National Institute on Drug Abuse. Two authors disclosed receiving grants from the same organization. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.