(224) Use of medications for opioid use disorder in older adults

Background: American population diagnosed with opioid use disorder (OUD) is growing, with those aged ≥ 65 comprising a fast growing segment of this population. OUD in older adults increased > 3.5 times from 2013 to 2019, with about 1 million older adults with OUD. Less than 30% of OUD patients receive medication for OUD (MOUD), with an even lower use rate in older adults.

Objectives: To examine trends and characteristics of MOUD use in older adults.

Methods: A 20% sample of Medicare enrollees aged 65+ diagnosed with OUD in 2017-2021 was selected. Study outcome was use of MOUD: methadone, buprenorphine, and naltrexone. Patient characteristics included age, sex, race/ethnicity, original entitlement, dual Medicaid coverage, and rural/urban residence. Patient comorbidity included physical health conditions (hypothyroidism, anemia, atrial fibrillation, cancer, chronic kidney disease-CKD, chronic obstructive pulmonary disease, diabetes, chronic pain, heart failure, hyperlipidemia, hypertension, ischemic heart disease, liver disease, peripheral vascular disease, arthritis, and stroke), mental health conditions (Alzheimer’s disease/related dementia-ADRD, anxiety, depression), and other substance use (alcohol and tobacco). A multivariable logistic regression model was built to examine patient characteristics and comorbidity associated with MOUD use.

Results: MOUD use increased from 4.8% in 2017, 7.5% in 2019, to 14.0% in 2021. The larger increase coincided with implementation of a new Medicare payment policy that covered methadone for OUD. Among 69,799 patients in 2021, about 75% had chronic pain and arthritis; about 50% had CKD, ischemic heart disease, and anxiety. Females, Blacks, older patients, and rural area residents had lower odds of receiving MOUD. Enrollees with dual coverage from Medicaid had higher odds of receiving MOUD. Patients with alcohol use, tobacco use, anxiety, depression, hypothyroidism, and liver disease were more likely to receive MOUD; conversely, those diagnosed with ADRD, cancer, CKD, hyperlipidemia, or stroke were about 20-30% less likely to receive MOUD. Patients with chronic pain and arthritis were 55% and 36% less likely to receive MOUD.

Conclusions: MOUD use varied by patient subgroups, with lower odds of use in patients with ADRD, cancer, CKD, and stroke, suggesting prescriber concerns about potential MOUD toxicity/adverse drug interactions in certain comorbidity. OUD patients with chronic pain or arthritis on long-term opioid prescription had the lowest odds of receiving MOUD, suggesting a need for safe and effective interventions for OUD and chronic pain. Future studies are needed to guide policy changes aimed at narrowing race, sex, and rural-urban disparity in MOUD use.