Editorial
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Sep 19, 2019; 9(5): 78-82
Published online Sep 19, 2019. doi: 10.5498/wjp.v9.i5.78
Substance use disorders among older adults: A review of randomized controlled pharmacotherapy trials
Rajesh R Tampi, Aarti Chhatlani, Hajra Ahmad, Kripa Balaram, Joel Dey, Ricardo Escobar, Thejasvi Lingamchetty
Rajesh R Tampi, Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Ohio, NH 44106, United States
Rajesh R Tampi, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44109, United States
Aarti Chhatlani, Savant Care Clinic, California, CA 90277, United States
Hajra Ahmad, Kripa Balaram, Joel Dey, Ricardo Escobar, Thejasvi Lingamchetty, Department of Psychiatry, MetroHealth, Cleveland, OH 44109, United States
Hajra Ahmad, Kripa Balaram, Joel Dey, Ricardo Escobar, Thejasvi Lingamchetty, Case Western Reserve University School of Medicine, Cleveland, OH 44109, United States
Author contributions: Ahmad H, Balaram K, Dey J, Escobar R, Lingamchetty T ,performed an analysis of existing data on the subject and wrote the paper; Chhatlani A headlined the project and edited the paper at its various stages; Tampi R provided instruction through correspondence and was the main editor of the paper.
Conflict-of-interest statement: The authors of this study have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rajesh R Tampi, MD, Chairman, Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, 1 Akron General Avenue, Cleveland, Ohio, NH 44106, United States.rajesh.tampi@gmail.com
Telephone: +1-330-3446992 Fax: +1-330-3442943
Received: April 29, 2019
Peer-review started: April 29, 2019
First decision: April 30, 2019
Revised: August 1, 2019
Accepted: August 6, 2019
Article in press: August 7, 2019
Published online: September 19, 2019
Abstract

Substance use disorders (SUDs) are a growing problem among older adults. Acamprosate, disulfiram, and naltrexone are United States Food and Drug Administration (referred to as FDA) approved for the treatment of alcohol use disorder, and buprenorphine is approved for the treatment of opiate use disorder among adults. However, the data on the use of these medications for the treatment of SUDs among older adults are unclear from randomized controlled trials (referred to as RCTs). A review of the literature indicates that there are only two RCTs that evaluated the use of pharmacologic agents for SUDs among older adults (≥ 50 years). One trial evaluated the use of naltrexone when compared to placebo for the treatment of alcohol use disorder among individuals, 50-70 years in age. The other trial evaluated the use of naltrexone or placebo as adjuncts with sertraline in the treatment of alcohol use disorder among individuals older than 55 years in age. Both trials indicated that the use of naltrexone reduced the rates of relapse among older adults with alcohol use disorder. However, we did not identify any RCTs that studied the use of buprenorphine, acamprosate, or disulfiram for SUDs among older adults. Based on available evidence, it would be safe to conclude that limited data indicate some efficacy for naltrexone in the treatment of alcohol use disorder among older adults. However, data from controlled trials on the use of other medications that are FDA approved for the treatment of SUDs among younger adults are nonexistent among older adults with SUDs.

Keywords: Older adults, Substance use, Naltrexone, Acamprosate, Disulfiram, Buprenorphine

Core tip: Substance use disorder is a growing problem among the older adult population. Unfortunately, there is very limited controlled research data on pharmacotherapy to help with this situation. Our review indicates benefits for naltrexone in the treatment of alcohol use disorder, but we were not able to find data regarding pharmacotherapy for any other substance use disorder among older adults. This review is our attempt to draw attention towards the topic of substance use disorder treatment among older adults and to encourage further research in this field.