MOUD in Older Adults-View Presentation

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Video Summary

The webinar focused on opioid use disorder (OUD) in older adults, highlighting that this is a growing but underrecognized public health issue. Dr. Pallavi Joshi explained that adults over 65 are a highly heterogeneous group, with varying levels of medical complexity, cognitive impairment, pain, and social support. She reviewed risk factors for substance use in later life, including retirement, bereavement, social isolation, chronic pain, psychiatric illness, and access to substances, while noting protective factors such as strong relationships, purpose, independence, and resilience.<br /><br />She emphasized that OUD in older adults is increasing due to aging baby boomers, greater life expectancy, and more permissive attitudes toward substances. Comorbidities are common, especially pain, depression, alcohol use, and other medical illnesses, making treatment more complex. The three FDA-approved medications for OUD were reviewed: methadone, buprenorphine, and naltrexone. Buprenorphine was presented as the preferred first-line option for most older adults because it is safer, can help with pain, and is easier to prescribe in office-based settings. Methadone may be appropriate for severe, refractory cases but has greater risks, including QT prolongation, sedation, and regulatory burdens. Naltrexone can be useful for abstinent patients or those with alcohol use disorder, but it is not helpful for pain and requires complete opioid abstinence before initiation.<br /><br />The discussion also covered major barriers to care, such as transportation, polypharmacy, cost, provider stigma, fragmented systems, and lack of age-specific evidence. The session concluded by stressing the need for better screening, coordinated care, and research tailored to older adults.

Keywords

opioid use disorder

older adults

buprenorphine

methadone

naltrexone

pain management

polypharmacy

substance use

geriatric care

treatment barriers