Substance Use - Opioids

In general there are two populations that develop opioid use disorder – those with longstanding use since teens or twenties, and those that develop it later in life after prescription exposure for pain. In 2015, older adults in Canada were the age group with the highest prevalence of hospitalization due to opioid overdose.

• People over 50 years old accounted for 39% of deaths from Substance Use Disorders in 2015, according to the World Health Organization. Of those deaths in older adults (65+) approximately 75% were linked to the use of opioids.
• To reduce the risk of developing OUD, prescriptions should be the lowest effect dose of the least potent immediate release opioid for three days or less and rarely seven days or more.
• Non-opioid and non-pharmacological strategies are preferable to opioids.
• When treating older adults with OUD, buprenorphine-naloxone should be considered first-line for withdrawal management and opioid maintenance treatment. Methadone is an alternative. For select patients, either slow-release oral morphine or opioid antagonist treatment with naltrexone may be used.
• Behavioural techniques, particularly contingency management, can be offered (but not required) in conjunction with pharmacological management of OUD in older adults.