Prevention, Diagnosis, and Management of Opioids, Opioid Misuse, and Opioid Use Disorder in Older Adults

Course overview

This course is based upon material published by the Agency for Healthcare Research and Quality, US Department of Health and Human Services, and is available as an open access article. Background. Opioid-related harms are increasing among older adults. Until we better understand the factors contributing to this trend, we will be unable to design and implement effective interventions to optimally manage opioid use and its potential harms among older adults. Although considerable research has been done in younger or mixed-age populations, the degree to which it is directly applicable to older adults is uncertain. Objectives. To provide a framework for understanding how to reduce adverse outcomes of opioid use among older adults, and to describe the evidence available for different factors associated with and interventions to reduce adverse outcomes related to opioid use in this population. Findings. Prior or early postoperative opioid use, or greater amounts of prescribed opioids (high number of opioid prescriptions or higher opioid dose), were consistently and strongly associated with long-term opioid use. Back pain, depression, concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs), and fibromyalgia also had consistent, but weaker, associations with long-term opioid use. Several factors were mostly associated with long-term opioid use, including benzodiazepine use, comorbidity scores, substance misuse, tobacco use, and low income. However, studies were mostly consistent that alcohol abuse and healthcare utilization were not associated with long-term opioid use. Gender, age among older adults, Black race, dementia, rural/nonurban residence, prescription of long-acting opioids, unmarried status, and use of muscle relaxants were variably associated with long-term opioid use. This course on opioid misuse among older adults is designed for social workers, professional counselors, psychologists, nurses, and substance abuse counselors, who do clinical work. This course is appropriate for beginning, intermediate and advanced level practitioners who wish to develop or increase their knowledge of older adults and opioid misuse. The course material includes a literature review of interventions. It may also be useful for licensed clinicians who require clinical continuing education courses for license renewal. The course is based on a journal article which includes research. It contains statistical analysis and data that some clinicians enjoy reading and others do not. A major benefit of reading research-based articles for continuing education is they provide practitioners with the latest findings in their field. Authors: Zullo, Danko, Moyo, Adam, Riester, Kimmel, Panagiotou, Beaudoin, Carr, and Balk. Learning Objectives: This course will provide the practitioner with detailed information regarding opioid misuse among older adults. Specifically, a professional will: Identify key terms related to opioid use Summarize factors associated with opioid-related outcomes in older adults Distinguish interventions related to opioid misuse in older adults Citation: Zullo AR, Danko KJ, Moyo P, Adam GP, Riester M, Kimmel HJ, Panagiotou OA, Beaudoin FL, Carr D, Balk EM. Prevention, Diagnosis, and Management of Opioids, Opioid Misuse, and Opioid Use Disorder in Older Adults. Technical Brief No. 37. (Prepared by the Brown Evidence-based Practice Center under Contract No. 290-2015-00002-I.) AHRQ Publication No. 21-EHC005. Rockville, MD: Agency for Healthcare Research and Quality. November 2020.