Trends in Opioid Use Disorder Among Older Adults: Analyzing Medicare Data, 2013-2018

Abstract

Introduction: Opioid use disorder has grown rapidly over the years and is a public health crisis in the U.S. Although opioid use disorder is widely studied, relatively little is known about it among older adults. The goal of this study is to gain a better understanding of opioid use disorder among older Medicare beneficiaries over time and across several sociodemographic dimensions.

Methods: Data from the 2013-2018 Centers for Medicare & Medicaid Services Master Beneficiary Summary Files were analyzed in 2020 to examine the trends in opioid use disorder prevalence among Fee-for-Service Medicare beneficiaries aged ≥65 years. Utilizing the overarching opioid use disorder flag, trends in opioid use disorder prevalence were examined for the following sociodemographic dimensions: age, sex, race/ethnicity, and dual eligibility status (i.e., enrolled in both Medicare and Medicaid owing to low income). Chi-square tests were used to compare opioid use disorder prevalence across groups.

Results: Since 2013, estimated rates of opioid use disorder among older adults have increased by >3-fold overall in the U.S. Estimated opioid use disorder is more prevalent among the young-old (i.e., ages 65-69 years) beneficiaries than among other older adults, and dually eligible beneficiaries have consistently shared a heavier burden of opioid use disorder than Medicare-only beneficiaries. Regarding race/ethnicity, Blacks and American Indians/Alaskan Natives are more vulnerable to opioid use disorder than other groups.

Conclusions: The descriptive trends between 2013 and 2018 indicate that estimated opioid use disorder prevalence has increased greatly over the study period in all sociodemographic subgroups of older adults, highlighting an urgent challenge for public health professionals and gerontologists.

Figure 1.

Estimated opioid use disorder prevalence per 1,000 Medicare beneficiaries by age and dual eligibility status, 2013–2018. Note: All differences are statistically significant (p≤0.001).

Figure 2.

Estimated opioid use disorder prevalence per 1,000 Medicare beneficiaries by sex and dual eligibility status, 2013–2018. Note: All differences are statistically significant (p≤0.001).

Figure 3.

Estimated opioid use disorder prevalence per 1,000 Medicare beneficiaries by race and dual eligibility status, 2013–2018. Note: All differences are statistically significant (p≤0.001) with the exception of Asian/Pacific Islander in 2013.