MOUD in Older Adults-View Presentation Slides

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This presentation, “MOUD in Older Adults,” by geriatric psychiatrist Dr. Pallavi Joshi, reviews the growing need to address opioid use disorder (OUD) in aging populations and how to manage medications for opioid use disorder (MOUD) in older adults.<br /><br />The talk defines older adults as typically age 65 and older, while noting that some studies include people as young as 40 or 50. It highlights that the older adult population is increasing rapidly, especially among Baby Boomers with greater lifetime exposure to substances. Risk factors for OUD in later life include retirement, loss of a spouse, chronic pain, psychiatric illness, cognitive decline, social isolation, and economic stress. Protective factors include social support, independence, good medical care, and a sense of purpose.<br /><br />The presentation emphasizes that OUD in older adults is rising, yet remains understudied and undertreated. Comorbid pain, depression, medical illness, and other substance use disorders are common and complicate care. It reviews the three FDA-approved MOUD options: methadone, buprenorphine, and naltrexone.<br /><br />Methadone can be effective for severe, refractory OUD but requires opioid treatment program enrollment and close monitoring due to risks such as QT prolongation, sedation, constipation, and drug interactions. Buprenorphine is often preferred for most patients because it has a lower overdose risk, can be prescribed in office-based settings, and may help with pain, though it still requires careful induction and monitoring. Naltrexone is useful for patients who are already abstinent and want a non-opioid option, but it is not appropriate for those needing opioid pain treatment.<br /><br />The presentation also discusses major systemic barriers, including limited provider training, lack of age-specific guidelines, logistical challenges, insurance and facility restrictions, and social isolation. It concludes that older adults with OUD often have complex medical and psychiatric needs, and that more research, better screening, and integrated care models are needed to improve outcomes.
Keywords
older adults
opioid use disorder
MOUD
methadone
buprenorphine
naltrexone
geriatric psychiatry
chronic pain
substance use disorder
integrated care