Treatment for opioid use and outcomes in older adults: a systematic literature review

Abstract

A B S T R A C TBackground: Historically, issues relating to problem substance use among older people have received little attention, and have only recently been recognised. Methods: A literature review of relevant material was conducted in November 2015 to assess current outcome research among older adults treated for opioid dependence. Multiple electronic databases were searched and results were supplemented by grey literature, library and online searches, and relevant references within selected articles. Retrieved articles were assessed for relevance against the inclusion and exclusion criteria. Results were reviewed to identify major findings and recommendations. Results: A total of 76 titles were included in the review. Most research conducted on older adults involves alcohol and prescription medications. Older drug users are growing in number and have a unique profile, with many presenting for treatment for the first time aged 50-70 years. Findings reveal (1) opioid treatment numbers are decreasing, however the average age of treatment admissions is increasing, (2) there is no consensus on what old is (3) two distinct types of older opioid substance users exist (early/late onset), (4) older clients achieve better treatment outcomes than younger counterparts, and (5) older women achieve better treatment outcomes than men. Conclusions: Findings suggest that little is known about treatment outcomes among older people. Problematic drug use (of which opioids make up the largest proportion) had been incorrectly assumed to end as patients age. Defining an age limit for 'older' is important. Addiction and healthcare services must anticipate and prepare for increased demand by this group.

Framing Science: How Opioid Research Is Presented in Online News Media

“…These findings align with research exploring the news media's framing of health and science issues, which has previously documented the prevalence of the valid science frame relative to the uncertain and controversial frames (Antilla, 2005;Ruhrmann et al, 2015;Guenther et al, 2019) as well as a general tendency for journalists to minimize uncertainty when reporting on science (e.g., Dumas-Mallet et al, 2018;Ponce de Leon et al, 2019) and uncritically report messages found in peer-reviewed journal articles (Bubela and Caulfield, 2004;Caulfield, 2004). Our study demonstrates that such practices prevail despite the politicized nature of the opioid crisis and the evolving research into new drug treatments and prevention measures (Bell et al, 2018;Carew and Comiskey, 2018;Crist et al, 2018;Koller et al, 2019;Volkow et al, 2019). While the opioid crisis itself remains controversial among Americans and Canadians (Angus Reid Institute, 2018; Blendon and Benson, 2018), our results suggest that scholarly publications surrounding the crisis do not-at least from the perspective of the nine major news outlets analyzed in this study.…”

Increasing Rates of Opioid Misuse Among Older Adults Visiting Emergency Departments

“…Further, given that those identified in the ED with opioid misuse tend to be the young-old, but present with twice as many chronic conditions on average, as well as with higher rates of coexisting mental health needs, effort to target interventions specifically toward this age group is needed. Importantly, because managing symptoms of withdrawal and other complications of opioid misuse are more challenging in the face of certain diagnoses, including hypertension, chronic obstructive pulmonary disorders, and heart failure (Carew & Comiskey, 2018), all of which were leading complications in this study, additional age-specific data are needed to guide interventions and treatment.…”

“…This paucity exists despite older adults’ higher use of prescription opioids (Frenk, Porter, & Paulozzi, 2016), evidence of increasing misuse (SAMHSA, 2017), and risk associated with long-term use (Solomon et al, 2010). Moreover, the effort to understand the scope of the problem among older adults has been further limited by inconsistent definitions used in the extant literature, with age categories labeled, “older adults,” defined as 45+, 50+, 55+, and 60+ (Carew & Comiskey, 2018). Given differences in access and need of health care services associated with age, inconsistent definitions impede policy understanding, as well as basic knowledge about the impact of the crisis on older adults.…”

A Multidimensional Latent Class Analysis of Harmful Alcohol Use Among Older Adults: Subtypes Within the Swedish Addiction Severity Index Registry

“…Although an early death is common for individuals with substance use disorders (SUD), aging baby boomers, increased availability of treatment for alcohol and drug use disorders and medications for alcohol and opioid use disorders, changes in patterns of use, access to health care and services such as harm-reduction programs mean that, compared to earlier cohorts, individuals with SUD are living longer ( 7 18 3 Beynon, 2009; Han et al, 2009; Arndt et al, 2011; Carew and Comiskey, 2018 ). Given this trend, the number of older adults with substance use problems is growing ( 50 Sorocco and Ferrell, 2006; Kuerbis et al, 2014 ).…”