The intersection of aging, pain, and opioid use disorder: a retrospective chart review from an outpatient opioid treatment clinic.

Abstract

Introduction: Older adults represent a growing proportion of individuals with opioid use disorder (OUD) and adults 55 + are significantly more likely to experience a fatal overdose. This exploratory pilot study examined age-related differences in health and treatment characteristics among patients in outpatient opioid treatment to assess whether older adults show distinct patterns compared to younger patients, providing insight into this growing population.

Methods: This retrospective chart review analyzed data from 79 patients (ages 23-70) seeking care at a low-threshold outpatient opioid treatment clinic. Data were extracted from electronic health records and included demographics, substance use, diagnoses, current pain, depression, quality of life, and treatment characteristics. Associations between age and clinical variables were analyzed using correlational, logistic regression, and repeated-measures ANCOVA methods.

Results: Older age was predictive of past pain-related diagnoses and older adults (55+) longer histories of illicit opioid use (mean = 30 years) and tobacco smoking (mean = 43 years) compared to younger adults. While polysubstance use was more common among younger patients, fentanyl use was high across all ages (∼65%). Older adults received higher methadone doses and remained in treatment longer. Despite greater chronic exposure to opioids, age was not significantly associated with depression or quality of life scores at intake.

Conclusions: Findings from this pilot study reveal age-related patterns in substance use, pain history, and treatment engagement among patients with OUD. The data suggest that older adults may face unique risks related to cumulative opioid exposure, while also demonstrating potential protective factors such as treatment retention. Integrated, age-responsive approaches are urgently needed to address the complex needs of this growing population.