Opportunities to Innovate Health Policy and Practice to Improve Opioid Use Disorder Care for Older Adults Across the Care Continuum.

Abstract

Older adults with opioid use disorder (OUD) are a growing population with high levels of multimorbidity and social complexity. While treatment gaps for OUD exist across the lifespan, older adults face specific barriers to diagnosis, treatment, and harm reduction services. Current care models are often poorly equipped to address medical and social complexity or provide integrated care, and the geriatric workforce has traditionally had little training on managing OUD and other substance use disorders. There are also specific payment and insurance coverage gaps that may disproportionately impact older adults, including limited service coverage and poor reimbursement for integrated care and wraparound services. To address these gaps, there are opportunities to shape policy and redesign systems to improve access and quality of care. We must continue to adapt our care models to provide integrated treatment that is age-friendly, appropriate, and acceptable to older adults with OUD. Maintaining and expanding insurance coverage-including preserving Medicaid access, expanding Medicare coverage, and improving reimbursement within the care continuum-is a critical lever to ensuring older adults receive accessible, high-quality OUD care. There are also opportunities to improve workforce training and support across acute, postacute, and outpatient care settings. Methadone reform is another important area that could disproportionately improve care for older adults and those with multimorbidity. Finally, tailoring low-barrier, telehealth, and other nontraditional OUD care models to serve older adults is an important but underexplored area. By leveraging policy strategies to promote the incorporation of age-friendly care within the addiction space, clinicians and policymakers can promote access and bolster the quality of addiction care across the continuum.