Considerations for Opioid Use Disorder in Older Adults

Abstract

To summarize current evidence regarding the epidemiology, risk factors, diagnosis, and treatment of opioid use disorder (OUD) in older adults, with emphasis on age-specific challenges related to screening, clinical presentation, pharmacologic management, and emerging treatment approaches. OUD among older adults is increasing despite declining opioid prescribing rates, with rising rates of opioid-related hospitalization and overdose mortality. Diagnosis remains challenging because age-related physiologic changes, polypharmacy, and cognitive impairment may obscure traditional manifestations of OUD. Existing screening instruments and diagnostic criteria have important limitations in elderly populations. Medications for opioid use disorder (MOUD) remain the cornerstone of treatment, with buprenorphine being favored for its safety profile and flexible formulations. Older adults represent a clinically distinct and understudied population with OUD. Current evidence supports individualized use of MOUD while accounting for comorbidities, polypharmacy, and age-related physiologic changes. Future research should prioritize geriatric-specific screening tools, diagnostic frameworks, treatment protocols, and clinical outcomes.