Introduction: Opioid use disorder is highly prevalent and treatment is becoming more complex with the emergence of fentanyl. Methadone is a highly effective medication and full agonist of the opioid receptor allowing treatment of patients with high opioid tolerance. The proportion of adults over 65 is increasing and will rise to 77 million by 2034. In geriatric populations up to 50% of Medicare recipients take at least five medications a day. This polypharmacy and physiologic changes of metabolism puts this population at a higher risk of adverse events. In this study, we aim to determine the current practice of methadone treatment of older adults to address gaps of care within the geriatric community.
Methods: In order to determine current medical practice around the care of older adults (³ 65 years old) in Opioid Treatment Programs (OTPs) who provide methadone as a medication for opioid use disorders (MOUD), phone calls were made to 21 certified centers throughout New Mexico. Survey inquiry included instigators of dose changes and monitoring protocols for older adults in addition to standard annual history, physical, and electrocardiogram. For an in-depth analysis of a patient population taking methadone, a retrospective chart review of patients at the University of New Mexico (UNM) OTP called the Addiction and Substance Abuse Program (ASAP) was performed.
Results: Of these 335 adults on methadone, 13% (n=44) were ³ 65 years old with a maximum methadone of 200 mg, 75% of whom qualified for ³ 2 weeks of take-home doses compared to only 45% of patients < 65.
Discussion: Older adults face unique risk factors with methadone treatment due to polypharmacy, metabolic changes, and comorbidities. To address both the chronic condition of OUD effectively and acknowledge the unique biology of the aging population, further guidance is imperative.
Dankoscik, M E.; S H. Patel; A Viszolay; E W. Green; C Smith; and V Jacobsohn. "Guidance on Methadone for Opioid Use Disorder in Older Adults: Current Practices." (2023). https://digitalrepository.unm.edu/hsc-bbhrd/94
Poster presented at the Brain & Behavioral Health Research Day 2023
1st Place Poster prize for Population Health.