Table 2.

Major Themes and Subthemes Summarizing the Experience of Aging with Opioid Use Disorder (OUD) Within Opioid Treatment Programs (OTPs)

Theme 1: Avoidance of medical care due to intersectional stigma Subthemes • Experienced discrimination because of their drug use • Experienced discrimination because of being on methadone or receiving care with an OTP • Experienced discrimination due to lack of housing • Experienced discrimination due to history of incarceration • Anxiety about disclosing OUD with healthcare providers, preferring to not disclose • Reliance on emergency department care • Delaying care because of stigma

Theme 2: Increasing isolation with aging and loss of family and peer groups Subthemes • Housing insecurity challenges • Loss of peer groups and family who have died and others with estrangement from family • Lack of peer social supports with age including concerns about needing a caregiver or assistance with instrumental activities of daily living (IADLs) • Loss of friends from drug overdoses • Increase loneliness after cessation of drug use and as social networks change • OTP structure (i.e., need for frequent visits) prevents other daily or social activities

Theme 3: The urgent need for integrating medical and aging-focused care with OUD treatment in the setting of increasing health and functional challenges Subthemes • Aging-related challenges: nutrition, cognitive changes, anxiety for the future, incontinence, vision, chronic pain, declining physical health, mobility, and need for assisted devices • Transportation challenges  • Reliance on emergency department care • Anxiety that methadone can affect aging and overall health and chronic disease long-term • Perception that integrated medical care with OUD treatment would be a benefit with aging and managing other chronic diseases • Lack of provider communication • Better need for mental health providers at OTPs • More information about dealing with getting older needed • Perceived need to address aging in one setting • Perceived need to stop methadone as one ages • Variable relationships with primary care providers