A recent systematic review examining treatment for opioid use and outcomes among older adults was published in the journal, Drug and Alcohol Dependence.1 The review aim was first to identify and distil key literature on ageing among people treated for opioid use, and secondly to investigate immediate treatment outcomes such as retention and abstinence.

The review consisted of targeted databases searches, supplemented by manual grey literature searches. Only articles explicitly involving individuals who received addiction treatment for opioid use were included in the study. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 76 papers were included in the review synthesis. The study lists a number of factors why large numbers of opioid users are living longer. These include:

(1) Demographic changes and increased life expectancy in the general population, (2) ageing baby-boom and post-baby-boom cohorts (50 years-and-older age group) who experienced increasing levels of drug availability over time along with higher rates of illicit drug use during their youth, (3) developments in and improved access to healthcare, harm reduction and drug treatment services leading to increased longevity among drug users.

The authors found:

• The numbers of older drug users have been increasing internationally for the last 40 years, yet there is a dearth of literature addressing problematic drug use among older people.
• Evidence from epidemiological surveys and treatment admissions within developed countries show that people with opioid-use problems are ageing. This trend is likely to grow for the next two decades and place new demands on drug treatment services.
• There is no consensus in the literature on the definition of ‘old’, which ranges from 37 to 55, 40+, 45+, 50+, 60+, 65+, 49 to 61, 50 to 59, and 50 to 74 years of age.
• Issues relating to problem opioid use among older people have only recently been recognised and the literature calls for more attention to be given to this topic.
• Little is known about the characteristics of ageing among the opioid treatment population and there has been little discussion of appropriate treatment services for this group.
• Existing research on older adults is predominately from the United States and mainly involves alcohol and prescription medications, while existing larger-scale longitudinal studies tracking treatment and health outcomes have failed to include a significant sample of older people.
• Only a handful of studies have examined opioid treatment admissions among older adults. However, these studies are mainly small convenience samples that treat older adults as a homogenous group and/or compares them to their younger counterparts.
• Research lacks large quantitative studies explicitly examining the area and existing treatment monitoring systems are not being utilised.
• Although opioid treatment numbers are decreasing, the average age of treatment admissions is increasing.
• Current literature points to the existence of two distinct types of older opioid substance users (early and late-onset subgroups), which have yet to be studied in depth.
• Although limited, there is some evidence that older treatment clients achieve better treatment outcomes than younger counterparts, and older women achieve better treatment outcomes than men.
• The ageing opioid-using population will present many challenges for policymakers and healthcare providers who are typically accustomed to working with younger drug users.

The authors note that important issues related to the care of older people with substance use problems (medical, psychiatric, multimorbidity, cognitive decline, social isolation, mediation drug interactions, burden of medications, etc.) have been excluded due to the narrow focus of the review. However, they note that outcome measures such as employment and involvement in criminality may be less appropriate for the older population, particularly in the case of the late-onset group who are at a later stage of life and financial security.

The article highlights that much work is required to effectively prepare for and respond to the needs of older people, including developing effective prevention and treatment responses (service availability, treatment models, workforce awareness and training), developing tools to measure substance use and abuse among older adults, and providing adequate data to measure emerging problems and predict future trends.

The study concludes that ageing population who use opioids are a neglected topic within the literature, and highlights the importance of understanding their specific needs in order to prepare for and deliver appropriate care. Problematic drug use (of which opioids make up the largest proportion) had been incorrectly assumed to end as people age. The authors recommend further research using large samples to investigate subgroups in more detail. 

1    Carew AM and Comiskey C (2018) Treatment for opioid use and outcomes in older adults: a systematic literature review. Drug Alcohol Depend, 182(Suppl C): 48‒57. http://www.drugsandalcohol.ie/28129/