Mortality among older adults with opioid use disorders in the Veteran's Health Administration, 2000–2011

• We examined mortality in older (>50 years) adults with opioid use disorders.
• Drug-related and traumatic mortality rates among older adults with OUD did not decline with age, and were augmented by chronic disease deaths.
• Health care for this group requires interventions to address opioid-related mortality risk, as well as general geriatric care.

BackgroundThe population of people with opioid use disorders (OUD) is aging. There has been little research on the effects of aging on mortality rates and causes of death in this group. We aimed to compare mortality in older (≥50 years of age) adults with OUD to that in younger (<50 years) adults with OUD and older adults with no history of OUD. We also examined risk factors for specific causes of death in older adults with OUD.MethodsUsing data from the Veteran's Health Administration National Patient Care Database (2000–2011), we compared all-cause and cause-specific mortality rates in older adults with OUD to those in younger adults with OUD and older adults without OUD. We then generated a Cox regression model with specific causes of death treated as competing risks.ResultsOlder adults with OUD were more likely to die from any cause than younger adults with OUD. The drug-related mortality rate did not decline with age. HIV-related and liver-related deaths were higher among older OUD compared to same-age peers without OUD. There were very few clinically important predictors of specific causes of death.ConclusionConsiderable drug-related mortality in people with OUD suggests a need for greater access to overdose prevention and opioid substitution therapy across the lifespan. Elevated risk of liver-related death in older adults may be addressed through antiviral therapy for hepatitis C virus infection. There is an urgent need to explore models of care that address the complex health needs of older adults with OUD.