Opioid Misuse Among Older Adults- Prevalence, Correlates and Implications for Social Work Practice

Background and Purpose:
The opioid crisis remains a major public health concern in the United States, yet older adults (aged 65 and older) are frequently overlooked in research and intervention efforts. This population faces unique vulnerabilities, including chronic pain, polypharmacy, and increased healthcare utilization, which may elevate risk for opioid misuse and related harms. Additionally, misuse is often underrecognized due to provider bias and the misattribution of symptoms to aging or comorbid conditions. Existing research has largely focused on younger populations, limiting understanding of opioid-related risks in later life. The purpose of this study is to estimate the prevalence of opioid misuse among older adults and examine demographic, health, and psychosocial correlates associated with increased risk.

Methods:
This study employed a quantitative, cross-sectional design using the combined 2021–2024 National Survey on Drug Use and Health (NSDUH) public use data file (N = 232,441). Respondents aged 65 and older were identified using the recoded age variable (AGE3 = 11). The primary outcome was past-year opioid misuse, defined as misuse of prescription pain relievers. Independent variables included sociodemographic characteristics, self-reported health status, mental health indicators (e.g., depression), and functional limitations. Analyses accounted for the complex survey design using person-level weights (ANALWT2_C4), strata (VESTR_C), and primary sampling units (VEREP). Weighted descriptive statistics were used to estimate prevalence, and multivariable logistic regression models were used to examine associations between opioid misuse and key predictors.

Results:
Approximately 1.5% of adults aged 65 and older reported past-year opioid misuse. Older adults reporting fair or poor health had higher odds of misuse (OR = 2.12, p < .001), as did those with depressive symptoms (OR = 1.78, p < .01). Functional limitations, including difficulty with mobility and daily activities, were associated with increased likelihood of misuse (OR = 1.43, p < .05). Lower-income individuals had significantly higher odds of misuse compared to higher-income counterparts (OR = 1.69, p < .05).

Conclusions and Implications:
Although prevalence is relatively low, opioid misuse among older adults represents a meaningful and underrecognized public health concern shaped by both health and social determinants. Findings highlight the need for age-responsive screening and intervention strategies that address chronic health conditions, mental health, and functional limitations. Social workers are uniquely positioned to identify at-risk individuals, provide integrated care, and advocate for accessible, geriatric-informed substance use services. Policy efforts should prioritize expanding interdisciplinary approaches to pain management and behavioral health care for older adults. Future research should examine longitudinal patterns and evaluate targeted interventions for this population.