Addiction. 2025 Dec 24. doi: 10.1111/add.70306. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: Persons who inject drugs (PWID) experience a high burden of early-onset frailty, primarily due to multifactorial causes such as infections (human immunodeficiency virus [HIV], hepatitis C virus [HCV]), substance use, and polypharmacy. Methadone, although an effective treatment for opioid use disorder, has demonstrated toxicity across several body systems that may impact or accelerate the aging process. Therefore, the purpose of this analysis was to determine the association of methadone use with frailty and physical function among PWID.
DESIGN: This study performed a retrospective analysis from the AIDS Linked to IntraVenous Experience (ALIVE) longitudinal cohort between 2005 and 2020, using multivariable mixed effect logistic regression, adjusting for demographics, body mass index, substance use, HIV, and comorbidities.
SETTING: Baltimore, Maryland, United States.
PARTICIPANTS: Adult participants (≥18 years) were recruited into the ALIVE cohort if they reported a history of or current injection drug use. Our study included 2153 participants with 13 909 person-years of follow-up.
MEASUREMENTS: Methadone usage, whether prescribed or non-medical, was self-reported by participants during study follow-up. The primary outcome measurement was frailty as defined by the Fried frailty phenotype. Physical function was measured using grip strength and 4-m gait speed.
FINDINGS: At baseline, 883 were currently using methadone. Median age was 48 (interquartile range: 42, 53) years; 81% were Black, 34% female, 80% had incomes <$5000, and 31% were living with HIV. Methadone use was associated with 25% higher odds of frailty (95% confidence interval [CI]: 1.09, 1.43). This difference suggested that the odds of frailty among individuals using methadone at age 50 were comparable to those not using methadone at age 54. Methadone use was associated with lower average grip strength [-0.71 kg (95% CI: -0.94, -0.48)], but not slower gait speed.
CONCLUSIONS: Among persons who inject drugs, those using methadone appear to be more likely to experience frailty at an earlier age compared with those not using methadone. Early screening for frailty and other geriatric conditions may be warranted among individuals with active methadone use in this population.
PMID:41437797 | DOI:10.1111/add.70306