A hidden aspect of the U.S. opioid crisis: Rise in first-time treatment admissions for older adults with opioid use disorder

Abstract

Background: Older adults with opioid use disorder (OUD) are a medically complex population. The current study evaluated trends in older adults seeking treatment for OUD, with a focus on primary heroin versus prescription opioid use. This study also compared older adults with OUD to the younger OUD population on demographics and drug use behaviors.

Methods: Publicly available data from state-certified addiction treatment centers were collected via the Treatment Episode Data Set - Admissions (TEDS-A) between 2004-2015. This study utilized Joinpoint Regression to conduct a cross-sectional, longitudinal analysis of trends in first-time treatment admissions for OUD in adults 55 and older (older adults; n = 400,421) versus adults under the age of 55 (n = 7,795,839). Given the rapid increase in older adults seeking treatment for OUD between 2013-2015, secondary outcomes include changes in demographics and drug use between 2012 (as a baseline year) and 2015.

Results: The proportion of older adults seeking treatment for OUD rose steadily between 2004-2013 (41.2% increase; p-trend = 0.046), then rapidly between 2013-2015 (53.5% increase; p-trend = 0.009). The proportion of older adults with primary heroin use more than doubled between 2012-2015 (p < 0.001); these individuals were increasingly male (p < 0.001), African American (p < 0.001), and using via the intranasal route of administration (p < 0.001).

Conclusions: There has been a recent surge in older adults seeking treatment for OUD, particularly those with primary heroin use. Specialized treatment options for this population are critically needed, and capacity for tailored elder care OUD treatments will need to increase if these trends continue.

Keywords: Heroin; Older adults; Opioid use disorder; Prescription opioids; Treatment; Trend analysis.

Conflict of interest statement

Conflict of Interest Statement

Author DAT has received medication supplies from Indivior for an investigator initiated study, was site PI for a clinical trial sponsored by Alkermes, and is on a scientific advisory board for Alkermes. Author ECS has served as a consultant or served on advisory boards for Analgesic Solutions, Indivior, The Oak Group, Egalet Pharmaceuticals, Caron, Innocoll, and Pinney Associates, and has received research funding through his university from Alkermes. All opinions expressed and implied in this paper are solely those of the authors and do not represent or reflect the views of the Johns Hopkins University or the Johns Hopkins Health System. Authors ASH and KED report no conflicts.

Copyright © 2018 Elsevier B.V. All rights reserved.

Figures

Figure 1.

Trends in first-time treatment admissions for primary opioid use among adults 55 and older versus adults under 55 who present to State-certified addiction treatment facilities. Lines represent joinpoint regression analyses for significantly different trends within groups, across time. OUD = opioid use disorder.

Figure 2.

Left: percent of older adults (55 and older) presenting to treatment for the first time with opioid use disorder using heroin as their primary drug of choice. Right: percent of older adults presenting to treatment for the first time with opioid use disorder using prescription opioids as their primary drug of choice. Both graphs show the relative proportion (in black) of older adults where opioid maintenance therapy (OMT) was planned as part of treatment for opioid use disorder (OUD). RX = prescription.

Figure 3.

Number of older adults presenting to treatment for the first time for opioid use disorder using heroin as their primary drug of choice. Lines represent the primary heroin route of administration. Years are restricted to the most recent surge in OUD treatment among older adults (2013-2015; see Figure 1) and include 2012 as a baseline comparator. The line marked “Other” encompasses oral, smoked, or any “other” route of administration as defined by the Treatment Episode Data Set.