Older adults with prescription opioid misuse need multidisciplinary care

Ty S. Schepis

Older adults with persistent prescription opioid misuse may require multidisciplinary care to mitigate significant mental, physical and substance use conditions, according to results of a national epidemiologic survey published in Journal of Clinical Psychiatry.

“The pattern of mental and physical health issues that older adults present with differs by their history of prescription opioid misuse,” Ty S. Schepis, PhD, of the department of psychology at Texas State University, told Healio Psychiatry. “The best case scenario is no history of past or current prescription opioid misuse, as they have the best physical and mental health; those with past (but not current) misuse have poorer mental health and greater substance use problems, while those with initiation of prescription opioid misuse in the past year have greater physical health problems. Those with both previous and current misuse have the poorest profiles overall.”

Schepis and Sean Esteban McCabe, PhD, of University of Michigan’s School of Nursing, analyzed data from the 2012 to 2013 National Epidemiologic Survey of Alcohol and Related Conditions-III, which included responses from 14,667 adults in the United States aged 50 years or older. They grouped respondents into four mutually exclusive categories — no prescription opioid misuse, prior-to-past-year misuse, past-year misuse or persistent misuse — and compared outcomes using design-based linear regression on health-related quality of life and logistic regression on substance use variables, physical health and mental health, controlling for sociodemographics, they wrote.

Schepis and McCabe found that older adults in the persistent category had the greatest impairment, including lower physical and mental health-related quality of life, as well as high rates of ED use (42.7%), any substance use disorder (37.4%) and past-year depression (17.6%). Those in the past-year category had high rates of physical health diagnoses and health care utilization. For example, 45.6% had past-year overnight hospitalization. Those with prior-to-past-year misuse had significant current psychopathology, with 13.7% having experienced past-year major depression.

“These profiles can guide treatment,” Schepis said. “In those older adults who mention using someone else’s opioid medication (a version of misuse) for the first time in the past year, attention to physical health is most crucial. For those with past or ongoing misuse, attention to mental health and substance use are key.” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.