(2) Characteristics of new methadone use among older adults

Background: : Methadone is an FDA approved medication that, when taken as prescribed, can be a safe and effective method to treat opioid use disorder and pain. It is important for prescribers to be aware of current research and account for known risks, like overdose, falls, cognitive and psychomotor impairments, and drug interactions, when prescribing methadone to those aged 65 years and older. However, there is a paucity of recent research that describes the characteristics of methadone use among older adults.

Objective: : To describe demographic and clinical characteristics of new methadone users aged 65 years and older.

Methods: : This retrospective cohort analysis used pharmacy and medical claims data from the Humana Healthcare Research database to identify new users of methadone between 1/1/2022 –12/31/2024. The cohort included members continuously enrolled in a Medicare Advantage prescription drug (MAPD) plan 12-months prior (baseline) to the first methadone claim during the study period (index), without a methadone prescription during baseline. Demographic characteristics (age, sex, race, population density, eligibility for Medicaid or Part D, low-income subsidy, original reason for Medicare) and prescribing provider were measured at index. Clinical characteristics (health risk estimates, comorbidities, medication use) were measured during baseline. Hospice use and mortality were measured in the 90 days post index.

Results: : We examined 3,321 MAPD members newly initiated on methadone. Average age was 65.9 years. Half were female (49.7%), 80.3% were white, 76.2% resided in a non-rural area, 50.5% were dually eligible for Medicaid or Part D low-income subsidy, and 68.1% were initially eligible for Medicare through disability. Mean (SD) Elixhauser condition count was 5.5 (3.3) and Rx-Risk score was 8.1 (3.4). Most patients (84.5%) were on opioid treatment prior to initiating methadone. Common prescribing specialties were primary care (34.8%), pain management (30.1%), and hospice/palliative care (16.2%). Baseline cancer diagnosis was observed in 39.3% of patients; drug abuse diagnosis (26.1%) was also common. Within 90 days of their first methadone prescription, 12.0% used hospice care, and 19.9% were deceased.

Conclusions: : Methadone use was generally rare in this MAPD population. Patients initiated on methadone reflect a complex presentation that often-included social risk factors, history of disability, cancer diagnosis, and/or history of substance abuse. Further research should examine factors and health outcomes associated with methadone initiation in the primary care setting.

Sponsorship:: CWSPC, HHR