Trends in Opioid Use Disorder Among Older Adults: Analyzing Medicare Data, 2013–2018

2021 ◽  
Author(s):  
Carla Shoff ◽  
Tse-Chuan Yang ◽  
Benjamin A. Shaw
Keyword(s):  
Older Adults ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Medicare Data

scholarly journals Medically Treated Opioid Overdoses Among the U.S. Elderly: Trends and Correlates

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-54
Author(s):  
Peter Treitler ◽  
Stephen Crystal ◽  
Richard Hermida ◽  
Jennifer Miles
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
The Elderly ◽  
Opioid Use Disorder ◽  
Chronic Obstructive ◽  
Medicare Beneficiaries ◽  
Older Individuals ◽  
Opioid Use ◽  
Policy And Practice ◽  
Obstructive Pulmonary Disease

Abstract High rates of opioid prescribing and comorbid medical conditions increase risk of overdose among older adults. As the US population ages and the rates of opioid use disorder (OUD) increase in the elderly population, there is a need to characterize trends and correlates of overdose in order to more effectively target policy and practice. Using a ~40% random sample of 2015-2017 Medicare beneficiaries ages 65 and older with Part D pharmacy coverage, this study examined medically treated opioid overdoses among US older adults. The sample included 13-14 million beneficiaries per year. The rate of medically treated opioid overdoses among elderly Medicare beneficiaries increased by 15% from 6 per 10,000 in 2015 to 6.9 per 10,000 in 2017. Those with overdose were disproportionately female (63%), non-Hispanic white (83%), with diagnoses of pain conditions (96%), with diagnoses of major depression (63%), and with high rates of conditions that decrease respiratory reserve such as chronic obstructive pulmonary disease. 13% had co-occurring diagnosed alcohol use disorder, 36% were diagnosed with opioid dependence or abuse, and 12% were diagnosed with hepatitis C. Older individuals with overdose represent a complex mix of risk factors; identifying those most at risk (as well as those who have very low risk, whose pain management may be compromised by overly-rigid interpretation of opioid use guidelines) is key in order to address multiple risks, balancing risk reduction with appropriate pain management.

scholarly journals Canadian Guidelines on Opioid Use Disorder Among Older Adults

2020 ◽  
Vol 23 (1) ◽  
pp. 123-134
Author(s):  
Launette M. Rieb ◽  
Zainab Samaan ◽  
Andrea D. Furlan ◽  
Kiran Rabheru ◽  
Sid Feldman ◽  
...  
Keyword(s):  
Older Adults ◽  
English Language ◽  
Oral Morphine ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Assessment And Treatment ◽  
Noncancer Pain ◽  
Health Canada

BackgroundIn Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.MethodsA systematic review of English language literature from 2008–2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method.ResultsThirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care.ConclusionThese guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.

scholarly journals Prevention, Diagnosis, and Management of Opioids, Opioid Misuse, and Opioid Use Disorder in Older Adults

2020 ◽  
Author(s):  
Andrew R. Zullo ◽  
Kristin J. Danko ◽  
Patience Moyo ◽  
Gaelen P. Adam ◽  
Melissa Riester ◽  
...  
Keyword(s):  
Older Adults ◽  
Opioid Use Disorder ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Diagnosis And Management

scholarly journals Opioid Use Disorder and Overdose in Older Adults With Breast, Colorectal, or Prostate Cancer

2020 ◽  
Author(s):  
Andrew W Roberts ◽  
Samantha Eiffert ◽  
Elizabeth M Wulff-Burchfield ◽  
Stacie B Dusetzina ◽  
Devon K Check
Keyword(s):  
Prostate Cancer ◽  
Cancer Survivors ◽  
Cancer Diagnosis ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Medicare Beneficiaries ◽  
Opioid Use ◽  
Medicare Data ◽  
End Results

Abstract Background Despite high rates of opioid therapy, evidence about the risk of preventable opioid harms among cancer survivors is underdeveloped. Our objective was to estimate the odds of opioid use disorder (OUD) and overdose following breast, colorectal, or prostate cancer diagnosis among Medicare beneficiaries. Methods We conducted a retrospective cohort study using 2007-2014 Surveillance, Epidemiology, and End Results-Medicare data for cancer survivors with a first cancer diagnosis of stage 0-III breast, colorectal, or prostate cancer at age 66-89 years between 2008 and 2013. Cancer survivors were matched to up to 2 noncancer controls on age, sex, and Surveillance, Epidemiology, and End Results region. Using Firth logistic regression, we estimated adjusted 1-year odds of OUD or nonfatal opioid overdose associated with a cancer diagnosis. We also estimated adjusted odds of OUD and overdose separately and by cancer stage, prior opioid use, and follow-up time. Results Among 69 889 cancer survivors and 125 007 controls, the unadjusted rates of OUD or nonfatal overdose were 25.2, 27.1, 38.9, and 12.4 events per 10 000 patients in the noncancer, breast, colorectal, and prostate samples, respectively. There was no association between cancer and OUD. Colorectal survivors had 2.3 times higher odds of opioid overdose compared with matched controls (adjusted odds ratio = 2.33, 95% confidence interval  = 1.49 to 3.67). Additionally, overdose risk was greater in those with more advanced disease, no prior opioid use, and preexisting mental health conditions. Conclusions Opioid overdose was a rare, but statistically significant, outcome following stage II-III colorectal cancer diagnosis, particularly among previously opioid-naïve patients. These patients may require heightened screening and intervention to prevent inadvertent adverse opioid harms.

scholarly journals Opioid Use Disorder Among Hospitalized Older Adults: Prevalence, Characteristics, and Discharge Status

2020 ◽  
Vol 21 (4) ◽  
pp. 557-559 ◽  
Author(s):  
Andrew R. Zullo ◽  
Patience Moyo ◽  
Eric Jutkowitz ◽  
Wenhan Zhang ◽  
Kali S. Thomas
Keyword(s):  
Older Adults ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Discharge Status ◽  
Hospitalized Older Adults

scholarly journals Medically Assisted Treatment of Opioid Use Disorder Among Elderly and Non-Elderly Medicare Beneficiaries

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-54
Author(s):  
Jennifer Miles ◽  
Stephen Crystal ◽  
Peter Treitler ◽  
Richard Hermida
Keyword(s):  
Older Adults ◽  
Addiction Treatment ◽  
Elderly Population ◽  
Ethnic Disparities ◽  
The Elderly ◽  
Opioid Use Disorder ◽  
Close Monitoring ◽  
Medicare Beneficiaries ◽  
Opioid Use ◽  
Racial Ethnic

Abstract Although medication for addiction treatment (MAT) is known to be the most effective treatment for opioid use disorder (OUD), these medications are widely underutilized, especially among older adults and racial/ethnic minorities. Of the three main MAT modalities, Medicare covered buprenorphine and naltrexone in 2017; methadone was not covered until 2020. We examined MAT prescribing among elderly compared with non-elderly Medicare beneficiaries. Our sample was drawn from a ~40% random sample of 2017 Medicare beneficiaries with Part D coverage and was comprised of elderly beneficiaries (age 65+) with OUD (N=112,314) or who experienced opioid poisoning (N=9,657), and non-elderly Medicare beneficiaries (the Medicare disability population, age 0-64) with OUD (N=161,423) or opioid poisoning (N=13,591). MAT was underutilized in both Medicare populations, but especially in the elderly population. Of elderly beneficiaries with OUD, 5.1% and 0.8% were prescribed buprenorphine and naltrexone, respectively, compared to 15.5% and 2.3% among non-elderly. Among elderly beneficiaries with opioid poisoning, 3.1% and 0.8% were prescribed buprenorphine and naltrexone, respectively, compared to 10.1% and 3.2% in the non-elderly population. Sharp racial/ethnic disparities were identified within each age group. These findings highlight the need to expand access to MAT for Medicare beneficiaries, particularly older adults among whom underutilization is pronounced. Several recent Medicare policy changes have sought to address this issue, but continuing efforts and close monitoring are warranted in an effort to dramatically increase rates of treatment for elderly with opioid use disorder.

scholarly journals Medication Improves Age Disparities in Six-Month Treatment Retention for Opioid Use Disorder

2020 ◽  
Author(s):  
Carrie M. Mintz ◽  
Ned J. Presnall ◽  
John M. Sahrmann ◽  
Jacob T. Borodovsky ◽  
Paul E.A. Glaser ◽  
...  
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Age Groups ◽  
Opioid Use Disorder ◽  
Treatment Retention ◽  
Opioid Use ◽  
Medication Treatment ◽  
Psychosocial Services ◽  
Treatment Type ◽  
Age Disparities

AbstractBackground and AimsAdolescents with opioid use disorder (OUD) are an understudied and vulnerable population. We examined the association between age and six-month treatment retention, and whether any such association was moderated by medication treatment.MethodsIn this retrospective cohort study, we used an insurance database with OUD treatment claims from 2006-2016. We examined 261,356 OUD treatment episodes in three age groups: adolescents (ages 12-17), young adults (18-25) and older adults (26-64). We used logistic regression to estimate prevalence of six-month retention before and after stratification by treatment type (buprenorphine, naltrexone, or psychosocial services only). Insurance differences (commercial vs Medicaid) in medication treatment prevalence were also assessed.ResultsAdolescents were far less likely to be retained compared to adults (17.6%; 95% CI 16.5-18.7% for adolescents; 25.1%; 95% CI 24.7-25.4% for young adults; 33.3%; 95% CI 33.0-33.5% for older adults). This disparity was markedly reduced after adjusting for treatment type. For all ages, buprenorphine was more strongly associated with retention than naltrexone or psychosocial services. Adolescents who received buprenorphine were more than four times as likely to be retained in treatment (44.5%, 95% CI 40.6-49.0) compared to those who received psychosocial services (9.7%, 95% CI 8.8-10.8). Persons with commercial insurance were more likely to receive medication than those with Medicaid (73.3% vs 36.4%, χ2 =57,870.6, (p<.001).ConclusionsAge disparities in six-month treatment retention are strongly related to age disparities in medication treatment. Results point to need for improved implementation of medication treatment for persons with OUD, regardless of age or insurance status.

scholarly journals BARRIERS TO CARE FOR OLDER ADULTS IN MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S141-S141
Author(s):  
Alexis A Bender ◽  
Maggi N Robert ◽  
Nathan S Quan ◽  
Emma M Klein ◽  
Molly M Perkins
Keyword(s):  
Older Adults ◽  
Opioid Use Disorder ◽  
Health Conditions ◽  
Treatment Programs ◽  
Opioid Use ◽  
Care Needs ◽  
Negative Experiences ◽  
Medication Assisted Treatment ◽  
Treatment Staff ◽  
Age Related

Abstract Over the last decade, the number of older adults (people over the age of 50) who misuse opioids doubled and continues to increase. People over the age of 50 also represent one of the fastest growing groups entering into and sustaining medication assisted treatment (MAT) (i.e., methadone and buprenorphine) for opioid use disorder (OUD). Despite increasing awareness of this growing at-risk population, significant knowledge gaps regarding their support and care needs persist. To begin to address these gaps, we conducted interviews with 20 treatment staff, focus groups with 18 patients and surveys with 100 patients over the age of 50 at eight diverse Opioid Treatment Programs (OTPs) participating in a 1-year pilot study (Bender, PI) funded by the Georgia Clinical and Translation Science Alliance supported by the National Center Advancing Translational Sciences. Patients in this study do not always disclose their use of MAT to non-OTP providers. When they do, participants reported numerous negative experiences with non-OTP providers, including perceived discrimination, stigma, and misunderstanding by providers about MAT. These negative experiences potentially contribute to an over reliance on OTP providers to manage age-related health conditions (e.g., COPD, hypertension). Providers report minimal training about aging and varied levels of confidence to manage these conditions. We present the experiences of patients and providers with suggestions for improving care coordination. We conclude with recommendations to improve communication among providers working with older adults in recovery from OUD.

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