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35th AM (2025) - Poster Session
Managing Long-Term Methadone Use in Older Adults A ...
Managing Long-Term Methadone Use in Older Adults A Case-Based Discussion of Clinical and Ethical Challenges
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This presentation addresses the clinical and ethical challenges of managing long-term methadone treatment in older adults with opioid use disorder (OUD), illustrated through a case vignette of a 71-year-old man on methadone maintenance therapy (MMT) for over 30 years. As the population of older adults on methadone increases—roughly 13% of NYC recipients are age 60+ and OUD rates in older Medicare beneficiaries are rising—the complexities associated with aging, such as frailty, cognitive decline, mobility issues, polypharmacy, and multimorbidity, heighten risks like overdose, falls, QTc prolongation, and sedation.<br /><br />The case highlights a patient who experienced progressive mobility decline, frequent falls, delirium, and self-neglect while living independently, refusing offers for safer housing. These factors rendered take-home methadone unsafe, but daily clinic visits posed fall risk due to impaired mobility. Ethical dilemmas included balancing patient autonomy against safety, deciding on methadone dosing during acute delirium, and determining when providers should intervene in housing matters.<br /><br />Key lessons emphasize the importance of routine cognitive assessments, geriatric-specific research on methadone pharmacokinetics, best practices for transitioning to buprenorphine, and clinical frameworks tailored for older adults. Buprenorphine is considered preferable in some geriatric cases to reduce risks of sedation, delirium, and overdose, though patients may resist switching due to fears of withdrawal or destabilization. In the presented case, a gradual methadone taper with transition to buprenorphine was implemented, ultimately leading to patient satisfaction.<br /><br />The discussion underscores the need for patient-centered, multidisciplinary collaboration involving addiction specialists, geriatricians, and social services to address safety, autonomy, and clinical outcomes in aging OUD populations receiving methadone. However, current evidence and clinical guidelines remain limited, signaling an urgent call for further geriatric-focused research and policy development.
Keywords
methadone maintenance therapy
opioid use disorder
older adults
geriatric pharmacokinetics
buprenorphine transition
polypharmacy risks
patient autonomy
ethical dilemmas
mobility decline
multidisciplinary care
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