UC San Diego

Background: Nationally, there is a sharp increase in older adults using opioids and seeking treatment for opioid use disorder (OUD). Increasing knowledge of harm reduction principles and access to harm reduction supplies and services are effective ways to reduce opioid-related harms such as overdose. However, older adults are often overlooked in harm reduction efforts in part due to stigmatizing beliefs that older adults do not use drugs. The increasing prevalence of OUD among older adults presents unique challenges in providing age-appropriate tailored harm reduction services. This dissertation aimed to assess knowledge, utilization, and ownership of harm reduction supplies and services among patients aged 55 and older in opioid treatment programs (OTPs) and explore the acceptability, feasibility, and implementation considerations of integrating tailored harm reduction interventions for this population.Methods: We conducted a sequential mixed methods approach within two OTPs across three studies. Study 1 utilized cross-sectional surveys from 75 OTP patients to assess opioid overdose knowledge, naloxone ownership, and utilization of harm reduction services. Multivariable logistic regression examined correlates of naloxone ownership. Study 2 conducted qualitative interviews with 25 OTP patients to explore acceptability and perceived barriers to accessing harm reduction services. Study 3 interviewed 15 OTP providers to evaluate the acceptability, feasibility, and appropriateness of delivering age-tailored harm reduction services. Results: In Study 1, 65% of participants owned naloxone at the time of study. However, only 9% carried naloxone and 17% had ever received overdose education. Correlates of naloxone ownership in the adjusted model included age in years and familiarity with naloxone distribution programs; opioid overdose knowledge was not significantly associated with naloxone ownership. Study 2 revealed high acceptability of harm reduction services among older adult patients, but identified barriers including intersectional stigma, logistical challenges, and lack of tailored and age-appropriate services. Study 3 found that OTP providers viewed integrating age-tailored harm reduction services as necessary and important but noted significant implementation challenges such as resource limitations, patient complexity, and sustainability. Conclusions: While naloxone ownership was moderate among older adults in OTPs, there were significant gaps in having received overdose education and naloxone carriage. Patients and providers reported high acceptability and perceived need of integrating age-appropriate harm reduction interventions but identified significant multi-level barriers to care. Our findings highlight the critical need for targeted interventions, policy changes, and implementation strategies to increase access and sustainability of age-appropriate and tailored harm reduction services for older adults in OTPs.