Treatment of Opioid Use Disorder in the Elderly
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Geriatric Disorders (M Sajatovic and A Aftab, Section Editors)
Treatment of Opioid Use Disorder in the Elderly Christine LaGrotta Address James J Peters Bronx VA Hospital, Icahn School of Medicine at Mount Sinai, 513 West 142nd St, Unit 2, New York, NY, 10031, USA Email: [email protected]
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Geriatric Disorders Keywords Methadone I Buprenorphine I Naltrexone I Opioid I Addiction I Elderly
Abstract Purpose of Review With the increasing age of those born between 1946 and 1965, issues relating to the “baby boomer” generation are more relevant than ever. This review aims to both highlight the importance of screening for substance use disorders in the elderly (specifically in this case, opioid use disorder) and then summarize the available treatment options for this vulnerable population. Recent Findings A narrative review of the literature showed surprisingly little research on the treatment of substance use disorders, especially opioid use disorder, in the elderly. None of the three medications that are FDA approved for opioid use disorder in adults (methadone, buprenorphine, and naltrexone) is contraindicated in the elderly. All medications should be used cautiously, keeping in mind that the elderly often have more medical issues (which can include chronic pain) as well as are on multiple medications that can lead to medication interactions. Summary Because there is very limited data on treatment of opioid use disorder in later life, current treatment generally follows recommendations for the general/mixed age population. More research into the topic is needed, especially with a larger percentage of the “baby boomer” generation entering the 65+ age range.
Introduction With regard to substance use disorders, it remains a common misperception that substance use disorders, specifically opioid use disorders (OUD), have a low prevalence in the elderly compared with young and middle-aged adults. Research, for instance, has shown that the proportion of adults seeking treatment for
OUD increased 41% from 2004 to 2013, and then 53.5% from 2013 to 2015 in the midst of the US opioid crisis. [1] The Treatment Episode Data Set (TEDs) shows that between 1992 and 2005, there were increased inpatient admissions involving drugs among those aged 50 years and older. Between 1995 and 2005, treatment
Geriatric Disorders (M Sajatovic and A Aftab, Section Editors) admissions for opioid use among those aged 65 years and older increased 3.9%, from 6.6 to 10.5%, respectively. [2] According to the 2012 Treatment Episode Data Set, there were 14,230 admissions aged 65 or older to substance abuse programs. On an average day in 2012, there were 6 admissions to treatment by adults aged 65 or older for use of heroin or other opioids (Table 1). [3] In the midst of an “opioid crisis,” we must not forget about those who are arguably the most vulnerable: the elderly. This is especially relevant now, as baby boomers (people born between 1946 and 1964)
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