Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Substance Use Disorders in Later Life


Substance use disorders in older adults often go undiagnosed because screening is frequently overlooked. Key to supporting patients to make a change is developing rapport and trust.

Ms. B is a 72 year-old woman who lives alone in a senior high rise building. She has a history of chronic pain in her hips and knees. Her previous provider will no longer prescribe oxycodone because for the past two months her thirty day script ran out after two weeks.


Tearful and fearful that providers won’t help her, she admits that she often takes oxycodone when she is upset. After spending a great deal of time building rapport and making sure she knew my goal was to work with her, I explained I would not prescribe her oxycodone.


She was open to undoing isolation, treating mood, and trying buprenorphine, at a twice daily dose, as a treatment for opioid use disorder and pain. Almost immediately after the switch in medication, she became physically more active, no longer dwelling on when her next dose of pain meds would be and how much she had left. Ms. B remained on low dose buprenorphine. Her pain improved, as did her quality of life.


Substance use disorders in older adults often go undiagnosed as screening is frequently overlooked. Retirement and living alone further the risk of harm. Our recent paper in the NEJM reviews the current trends and research related to prevalence, detection, and management of substance use disorders in later life. We also aim to raise awareness of harms from even low amounts of alcohol intake, as well as the risk of opioids in older adults. Key to impacting patients to make a change is the ability to develop rapport and trust with patients.