Opioid Use Disorder

Opioid use disorder (OUD) is a significant public health burden with the highest rates of prevalence in the United States. Adverse events from prescription and recreational opioid use have significantly increased in the last two decades, including the rate of both fatal and nonfatal opioid overdoses. OUD is a chronic, relapsing disorder affecting all age-groups and requiring pharmacological and non-pharmacological treatments and interventions. The use of medication assisted therapy (MAT) to aid in the treatment and recovery of OUD is statistically beneficial for sustained remission. Multiple forms of MAT are available and approved for treatment of OUD including opioid agonists (methadone), partial opioid agonists (buprenorphine), combination of partial agonists and antagonists, and antagonists (naltrexone) in oral, sublingual, and injectable forms. Non-pharmacological interventions include psychotherapeutic approaches to recovery which can be facilitated in inpatient rehabilitation units, outpatient rehabilitation facilities, intensive outpatient programs (IOP), as well as community-based programs such as Narcotics Anonymous (NA). In this chapter, we review the epidemiology, risk factors, assessment, and evidence-based treatment algorithms for opioid use disorder, giving special consideration to its effects on and treatment options for the geriatric population.