Late- and Typical-Onset Heroin Use Among Older Adults Seeking Treatment for Opioid Use Disorder

Abstract

Objective: Analyze 10-year trends in opioid use disorder with heroin (OUD-H) among older persons and to compare those with typical-onset (age <30 years) to those with late (age 30+) onset. Design: Naturalistic observation using the most recent (2008–2017) Treatment Episode Data Set-Admissions (TEDS-A). Setting: Admission records in TEDS-A come from all public and private U.S. programs for substance use disorder treatment receiving public funding. Participants: U.S. adults aged 55 years and older entering treatment for the first time between 2008 and 2017 to treat OUD-H. Measurements: Admission trends, demographics, substance use history. Results: The number of older adults who entered treatment for OUD-H nearly tripled between 2007 and 2017. Compared to those with typical-onset (before age 30), those with late-onset heroin use were more likely to be white, female, more highly educated, and rural. Older adults with late-onset were more likely to be referred to treatment by an employer and less likely to be referred by the criminal justice system. Those with late-onset were more likely to use heroin more frequently but less likely to inject heroin than those with typical-onset. Those with typical onset were more likely to receive medication for addiction treatment than those with late-onset. Conclusion: Late-onset heroin use is increasing among older U.S. adults. Research is needed to understand the unique needs of this population better. As this population grows, geriatric psychiatrists may be increasingly called upon to provide specialized care to people with late-onset OUD-H.