Use of Medications for Opioid Use Disorder in Older Adults

Introduction: The American population diagnosed with opioid use disorder is growing, particularly those aged ≥65 years. Less than 30% of opioid use disorder patients receive medication for opioid use disorder, and even fewer older adults. Methods: Using 20% national Medicare data, beneficiaries aged over 65 years diagnosed with opioid use disorder in 2017–2022 were selected to assess the trend and types of medication for opioid use disorder use, including methadone, buprenorphine, or naltrexone. In the 2022 cohort (n=69,380), a multivariable logistic regression model was constructed to examine the factors associated with use of medication for opioid use disorder. Analyses were performed in 2024. Results: Use of medications for opioid use disorder among older adults increased from 4.8% in 2017 to 7.5% in 2019 and 15.0% in 2022. The larger increase coincided with implementation of a new Medicare payment policy covering methadone for opioid use disorder. About 79% of opioid use disorder patients had chronic pain and arthritis; 50% had anemia, depression, or anxiety. Males, Black patients, Hispanic patients, older patients, and rural residents had lower odds of receiving medication for opioid use disorder. Enrollees with dual coverage from Medicaid had higher odds of receiving medication for opioid use disorder. Patients with alcohol or tobacco use disorders, anxiety, depression, hypothyroidism, or liver disease were more likely to receive medication for opioid use disorder; conversely, those with non-Alzheimer's dementia, cancer, chronic kidney disease, stroke, chronic pain, or arthritis were less likely to receive medication for opioid use disorder. Conclusions: The rate of medication for opioid use disorder use was low in older adults. The disparity in medication for opioid use disorder use underscores the need for improved access to comprehensive opioid treatment programs and increased medication for opioid use disorder coverage. Additional studies of treatment patterns are also warranted.