Opioid Use Disorder in Older Adults: a Narrative Review.

Purpose of the Review: The review synthesizes current literature on the epidemiology, treatment outcomes, and co-occurring conditions of opioid use disorder (OUD) in older adults, framed through the OUD cascade of care model. Recent Findings: The prevalence of OUD among older adults has risen significantly, with Medicare data showing an increase from 4.6 to 15.7 per 1,000 beneficiaries between 2013 and 2018. Hospitalizations and overdose deaths have also escalated, particularly among racially minoritized groups. Despite policy changes expanding access to medications for OUD, including the removal of the X-Waiver and Medicare's coverage of opioid treatment programs, treatment rates remain low, and disparities are present based on geographic location, race, ethnicity, and gender. Studies indicate that buprenorphine and methadone significantly reduce mortality risk, yet optimal dosing and delivery models for older adults remain underexplored. Additionally, older adults with OUD experience high rates of comorbidities, including cardiovascular disease, psychiatric conditions, and chronic pain, further complicating the initiation and maintenance of medications for OUD. Summary: Older adults with OUD are growing and while treatment is increasing, research and best practices on age-friendly approaches to screening, treatment, and harm reduction remain unknown. The growing burden of OUD in this population underscores the urgent need for research on tailored interventions, particularly regarding medications for OUD initiation, polypharmacy management, and care delivery models that accommodate mobility and cognitive impairments. Expanding harm reduction strategies and integrating OUD treatment into general medical settings can enhance access and improve outcomes for older adults.