OCEBHA Quarterly Newsletter:
Older Adults and Opioid Use

The Oregon Center of Excellence for Behavioral Health & Aging (OCEBHA) quarterly newsletter highlights key topics related to behavioral health and aging, with special emphasis on emerging research and innovative programs that address the behavioral health needs of older adults. In this edition, we highlight some of the latest research related to older adults and opioid use.

About the Problem

Approximately one million older adults 65 years of age or older in the United States (US) are living with an opioid use disorder (OUD) (Konakanchi & Sethi, 2023). Even though adults over 55 years of age and older have lower rates of nonfatal opioid overdose emergency department visits than younger groups, the trends of opioid related deaths among adults 55 years of age and older are increasing sharply. Older adults’ unique experience of physiological, social, and psychological risk factors increase their susceptibility to the harms of opioid use. They face a combination of factors that make them especially vulnerable to the harms of opioid medications. Many people over the age of 65, about 36%, live with chronic pain. As we age, our bodies process drugs more slowly, which raises the risk of dangerous side effects like trouble breathing or accidental overdose. This is even more challenging because over 90% of older adults have at least one other chronic health problem, such as heart disease or arthritis. All of this makes it much more difficult for providers to safely manage pain and medication in this age group.

What the Research is Telling Us

In 2023, approximately 105,000 people in the United States (U.S.) died from a drug overdose, 76% of which involved opioids (National Center for Health Statistics [NCHS], 2024). While overdose death rates declined among individuals aged 54 and younger, deaths increased among adults aged 55 and older (Garnett & Miniño, 2024). Older adults 65 and older experienced the largest increase, with overdose death rates rising from 13.2 to 14.7 per 100,000. This increase reflects a longer-term trend: between 2002 and 2021, the rate of fatal drug overdoses among older adults aged 65 and older quadrupled, increasing from approximately 3.0 to 12.0 per 100,000 people (NCHS, 2024).

According to research presented at the American Society of Anesthesiologists (ASA) meeting, between 2015 and 2023, fentanyl-related opioid deaths among older adults aged 65 and older increased by more than 1,400%, highlighting the growing impact of synthetic opioids in this population. Among older adults, cocaine and methamphetamine were the most common stimulants co-involved with fentanyl in overdose deaths (ASA, 2025). Although national data indicate a general decline in total overdose deaths in 2024, attributed in part to expanded naloxone availability and increased access to treatment, older adults have not experienced the same level of benefit. Note these data have not yet gone through peer review. Overdose death rates among older age groups continued to show slight increases, even as overall overdose deaths declined (CDC, 2025).

Older Adult Opioid Demographic Trends

In 2021, approximately 12.8% of older adults aged 65 and older filled at least one outpatient opioid prescription, and 4.4% filled four or more opioid prescriptions during the year. Older women were more likely than older men to fill at least one opioid prescription (14% vs. 11%, respectively). Note that this source has not undergone peer review.

Although overdose death rates among older adults aged 65 and older remain lower than those of younger age groups, rates have increased for both men and women over time. Consistent with broader national patterns, older men experience higher opioid-related overdose death rates than older women (CDC, 2022).

Racial disparities are also evident among older adults. In 2020, non-Hispanic Black men aged 65–74 had higher drug overdose death rates than their non-Hispanic White and Hispanic counterparts (CDC, 2022). Similarly, among older women, non-Hispanic Black women aged 65–74 experienced higher overdose death rates than Hispanic and White women in 2020 (CDC 2022). Furthermore, while the U.S. saw a record 27% decline in overdose deaths in 2024, annual deaths remain higher than they were before the COVID-19 pandemic. (NCCHC 2026)

Risks, Protective Factors & Prevention Strategies

The high prevalence of chronic medical conditions and pain among older adults increases the likelihood of prescription medication use, including opioids. Chronic pain, defined as pain lasting at least three months, affects approximately 24% of all U.S. adults aged 18 and older and 36% of older adults aged 65 and older (CDC, 2024). Among this age group, 13.5% experience high-impact chronic pain, which significantly limits daily activities and quality of life.

Emergency department data indicate a strong association between chronic medical conditions, co-occurring disorders, and an elevated risk of opioid misuse, including polysubstance use, among older adults. More than 90% of older adults aged 65 and older have at least one chronic condition, and 79% have two or more co-occur*ring conditions (CDC, 2025). Common chronic conditions in this population include hypertension, arthritis, high cholesterol, heart disease, and diabetes (CDC, 2025). Co-occurring disorders may include both physical and mental health conditions, such as mobility limitations or cognitive decline associated with depression.

Age-related physiological changes further influence prescription opioid use and overdose risk among older adults. These changes include slower drug metabolism, which can increase overdose risk, as well as a greater likelihood of respiratory depression, falls, reduced mobility, and adverse drug interactions (Substance Abuse and Mental Health Services Administration [SAMHSA], 2024). Older adults are particularly vulnerable to these physiological risks, and greater attention is needed to chronic pain management, opioid prescribing, and opioid use disorder prevention and treatment in this population (National Institute on Drug Abuse, 2020).

Caregivers (sometimes referred to as "care partners" to emphasize their collaborative role in care) should consider how intersecting physical, mental, and substance use conditions uniquely affect older adults and may influence the appropriateness of prevention and treatment strategies. For example, mobility impairments or balance difficulties may be misinterpreted as substance use, potentially delaying accurate assessment. In addition, some medications for opioid use disorder may be safer for older adults based on physiological considerations; for instance, buprenorphine carries a lower risk of respiratory depression than methadone (SAMHSA, 2024). See Table 1 for a list of risk and protective factors/prevention strategies for opioid use.

Table 1. Risk and protective factors/prevention strategies for opioid use

Risk factors
Chronic medical conditions (e.g., hypertension, arthritis, high cholesterol, heart disease, and diabetes)
Co-occurring disorders (e.g. mobility limitations or cognitive decline associated with depression)
Physiological changes (slower drug metabolism) can lead to greater likelihood of respiratory depression, falls, reduced mobility, and adverse drug interactions
Chronic pain (lasting longer than three months)
Exposure to high-potency synthetic opioids
Major life changes and social determinants (e.g., grief, retirement, social isolation, family history of substance use)

Protective factors/prevention strategies
Greater attention to chronic pain management
Consider how intersecting physical, mental, and substance use conditions uniquely affect older adults
Consider safer medication options for older adults based on physiological considerations (e.g., buprenorphine vs methadone)
Expanded availability of overdose reversal medication such as naloxone
Screening and assessment that distinguishes aging-related impairments from substance misuse
Understanding signs and symptoms of OUD, opioid intoxication, and opioid withdrawal

Table 2. Screening tools to assess opioid use

Screening Tools	Description
Opioid Risk Tool(ORT)	The Opioid Risk Tool (ORT) is a brief, self-report screening tool designed for use with adult patients in primary care settings to assess risk for opioid use among individuals prescribed opioids for treatment of chronic pain.
Drug Abuse Screening Test (DAST-10)	The Drug Abuse Screening Test (DAST-10) is a 10-item brief screening tool that can be administered by a clinician or self-administered. Each question requires a yes or no response, and the tool can be completed in less than eight minutes.
Alcohol, Smoking, and Substance Involvement Screening Tests (ASSIST)	The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) consists of eight questions to screen for all levels of problem or risky substance use in adults, including opioid use.
Current Opioid Misuse Measure - 9-item (COMM-9)	The COMM-9 is a streamlined, 9-item version of the original 17-item self-report tool designed to monitor chronic pain patients for signs of prescription opioid misuse. It evaluates behaviors from the past 30 days, such as taking more medication than prescribed or using pills to manage emotions rather than physical pain.

Table 3. Interventions to address opioid use

Interventions	Description
Provider Education on Geriatric Prescribing	Targeted training for MDs, DOs, and NPs focused on best practice guides for opioid dosage in older populations. This education emphasizes age-related physiological changes, such as slower metabolism, to prevent accidental overdose and respiratory depression. These are often topics covered in trainings provided by OCEBHA. For example, the 2023 elimination of the federal "X-waiver," which now allows more healthcare providers to prescribe buprenorphine without special authorization. (NCCHC 2026)
Chronic Pain Self-Management	The Chronic Pain Self-Management Program is an interactive group workshop for individuals living with chronic pain, including arthritis, back pain, headaches, and pelvic pain. Participants learn practical strategies to manage pain and related challenges such as fatigue, sleep difficulties, emotions, and communication with others. Core skills include action planning, problem-solving, and informed decision-making to support day-to-day self-management.
Older Adult Health Literacy Initiatives	Programs designed to increase the health literacy of older adults regarding the specific risks opioids pose to their age group. These initiatives help patients understand how chronic conditions and other medications can interact dangerously with opioids.
Oregon Pain Management Resources (OHA & OPG)	Specialized resources including the Oregon Health Authority (OHA) OPMC Pain Education Courses and Oregon Pain Guidance (OPG). These provide evidence-based tools and clinical guidelines tailored for both patients and clinicians navigating the complexities of pain management in Oregon.
Opioid Prevention for Aging & Longevity (OPAL)	The O.P.A.L. Program is providing older adults 65 years and older and their care partner(s) an opportunity to learn more about opioid pain medications, non-opioid pain medications and integrative medicine therapies like Tai Chi, Yoga, mindfulness meditation and other therapies for the management of chronic pain.
Wellness Initiative for Senior Education WISE	The Wellness Initiative for Senior Education (WISE) Program celebrates healthy aging and educates older adults on a variety of topics including safe medication use, the aging process, communicating effectively with healthcare providers, and strategies for making healthy lifestyle choices. WISE facilitators are trained by New Jersey Prevention Network (NJPN) and engage participants in interactive and informative lessons.
Cognitive Behavioral Therapy (CBT)	CBT is the primary behavioral health intervention for identifying the activations that lead to opioid use, and for older adults, the focus shifts toward managing the intersection of physical pain and emotional distress. Therapists often adapt CBT to use a slower pace and shorter sessions to account for potential cognitive fatigue. Rather than just focusing on drug use, the therapy focuses on coping skills training for chronic pain (such as relaxation and pacing activities) and managing "the grief of aging," including the loss of friends, health, or career identity.
Medication Assisted Treatment	The FDA has approved three medications for treating opioid use: methadone, buprenorphine and naltrexone. Methadone and buprenorphine work by reducing cravings and preventing withdrawal. Naltrexone works by blocking the effects of opioids in the body.
Narcotics Anonymous (NA)	Narcotics Anonymous (NA) is a nonprofit, peer-led recovery fellowship for people who want to stop using drugs, including opioids. NA follows a 12-step model and is free, voluntary, and anonymous. Meetings are held worldwide and are open to anyone with a desire to stop using drugs—no diagnosis, referral, or insurance required.
SMART Recovery	SMART Recovery is a science-based, self-empowering alternative to 12-step programs that uses Cognitive Behavioral Therapy (CBT) to help older adults manage opioid addiction. The program builds motivation, teaches coping skills, and supports healthy thinking, making it well-suited for prescription misuse in older adults. It offers a flexible, respectful, evidence-based path to recovery, often alongside medical care for chronic pain or other conditions.

Table 4. Generic medication names

Generic Name	Common Brand Names
Hydrocodone	Vicodin, Norco, Lortab
Oxycodone	Percocet, OxyContin, Roxicodone
Morphine	MS Contin, Kadian, Arymo ER
Codeine	Tylenol #3 or #4 (Tylenol with Codeine)
Fentanyl	Duragesic (patch), Subsys (spray)
Hydromorphone	Dilaudid, Exalgo
Buprenorphine	Belbuca, Butrans (patch)
Tramadol	Ultram, ConZip

Conclusion

Addressing the opioid crisis among older adults means moving beyond generic solutions and focusing on what this population truly needs. Older adults deal with specific physical changes, unique social situations, and real barriers to care, all of which raise their risk of behavioral health needs. To make a real difference, interventions must recognize these realities and offer strategies designed with older adults in mind.

To tackle opioid use among older adults, healthcare providers should use prevention and screening tools that fit this age group, such as the Opioid Risk Tool (ORT) and DAST-10, to obtain an accurate picture of risk in primary care. Alongside these tools, programs such as OPAL and WISE offer valuable education about safe medication use and therapies that respect the aging process. When choosing treatment, it is also important to consider older adults’ specific health needs; for example, buprenorphine is often a better choice than methadone because it poses less risk of breathing problems in this population.

Finally, outreach efforts need to directly address the serious racial disparities in overdose deaths, especially among non-Hispanic Black men and women ages 65 to 74. By combining thoughtful pain management, strong social support, and proven screening tools, care teams can help make life safer for the roughly one million older adults living with opioid use disorder today.