The prevalence of opioid use disorder (OUD) among older Medicare beneficiaries (age 65+) has increased substantially since 2013 (Shoff et al., 2021), making it one of the fastest-growing health issues in the United States (US). Older adults face several distinct risk factors for OUD. First, older adults are more likely than younger adults to suffer from physical pain (Le Roux et al., 2016; Maree et al., 2016). Experiencing pain enhances the risk of long-term opioid use and the use of prescription opioids is positively associated with the development of OUD (Butler et al., 2016). Furthermore, life events related to the aging process can increase risk factors associated with OUD. For example, retirement and bereavement increase social exclusion, depression, and a sense of helplessness (Dufort and Samaan, 2021). These events may increase the demand for opioid treatment and thus, elevates the risk of OUD.

Previous research has suggested that disparities in OUD among older adults vary along several individual-level factors. For example, older adults who are impoverished or living with comorbidities are more vulnerable to OUD than their counterparts who are not impoverished or without comorbidities (Dufort and Samaan, 2021; Shoff et al., 2021; Wu and Blazer, 2014). In addition, female older adults tend to have a slightly higher prevalence of OUD than their male counterparts, and older adults in the young-old group (ages 65–69) are more likely to have OUD than those age 70 and over (Dufort and Samaan, 2021; Shoff et al., 2021). Moreover, compared with those without mental disorders, older adults with mental disorders (e.g., depression, anxiety, bipolar disorder, and schizophrenia) are more likely to engage in opioid and other substance use (Almeida et al., 2018; Wu and Blazer, 2014).

Residential social environment covariates, including neighborhood socioeconomic conditions and neighborhood social isolation, are associated with OUD and the ongoing opioid epidemic, net of individual-level covariates (Monnat et al., 2019; Schell et al., 2022). For example, recent studies have found drug overdose rates are positively associated with concentrated disadvantage and negatively related to residential stability within communities (Rushovich et al., 2020; Schell et al., 2022). Specific to older adults, a recent study has reported that older adults living in counties with high social isolation are more likely to be diagnosed with OUD than those in socially integrated areas (Yang et al., 2022b). More broadly, characteristics of residential social environments have also been found to be associated with older adults' health and cognitive functioning (Arcaya et al., 2016; Barnett et al., 2018; Yen et al., 2009).1 As such, it is critical to investigate how residential social environments are associated with the risk of OUD in the older population.

The coronavirus disease 2019 (COVID-19) pandemic has further complicated the risk of OUD among older adults. Specifically, the heightened risk of severe health conditions among older adults, looming shortages of medical resources, and unexpected loss of family members are likely to burden older adults with anxiety, distress, and psychiatric conditions (Pfefferbaum and North, 2020; Vahia et al., 2020). Public health measures employed to reduce the transmission of COVID-19, including physical distancing and shelter-in-place orders, have been found to increase older adults' feelings of loneliness, which in turn worsens depression, anxiety, and stress (Dahlberg, 2021; Rentscher et al., 2021).

In addition to the detrimental impact on mental health, the COVID-19 pandemic may interrupt older adults' regular doctor visits and undermine effective pain management with prescription opioids. For older adults receiving opioid treatment, care disruptions (Satre et al., 2020) may increasing chances of drug misuse. Older adults are more likely than younger adults to acquire opioids from the medical community, as opposed to other illicit sources (Cicero et al., 2014). While telehealth visits, to some extent, could offset the impact of the pandemic on healthcare service delivery, older adults are less likely than younger populations to take advantage of this service due to: lack of access to broadband, limited use of smart phones and computers, high prevalence of vision and hearing impairment, cognitive impairment, and inability to perform assessments properly (Callisaya et al., 2021; Peel et al., 2011; Pew Reseach Center, 2020). Both healthcare disruption and limited access to telehealth make it difficult to adhere to proper medication usage among older adults, including medications for opioid use disorder (MOUD) (Jones et al., 2022). Thus, they may be exposed to a heightened risk of drug misuse and OUD. As mental disorders, loneliness, and lack of proper healthcare and careful monitoring are strongly associated with dependence on opioids (Cochran et al., 2017; Dasgupta et al., 2018; Day and Rosenthal, 2019; NIDA, 2019), the risk of using non-prescribed opioids, relapse, or overdose may have increased during the pandemic.

With the onset of the pandemic, the associations between OUD and both individual and community level risk factors may be altered in two possible ways. The double jeopardy hypothesis (Barber et al., 2016; Dowd and Bengtson, 1978) suggests that older adults who were most vulnerable to OUD prior to the pandemic may have the largest increase in risk during the pandemic as they suffered the double burden of baseline risk factors and the shock of the pandemic. Explicitly, older adults living in socioeconomically disadvantaged communities are likely to become more vulnerable as their access to resources may become more limited during the pandemic, potentially widening existing disparities in OUD. By contrast, while the double jeopardy hypothesis would apply here, it is also important to consider the alternative (Strully, 2009; Wilks and Neto, 2013), where older adults with more resources before the pandemic may have demonstrated a larger increase in the risk of OUD than those with limited resources. For example, older adults living in socially integrated communities before the pandemic may have experienced a comparatively larger increase in social isolation during the pandemic compared to those living in areas that already exhibited high levels of social isolation, thereby increasing their risk of OUD to a greater extent.

The COVID-19 pandemic provides a unique opportunity to examine the associations between residential social environment and the risk of OUD because of the ways in which the pandemic has interrupted older adults' daily routines and social activities. In particular, due to the pandemic older adults have been spending more time at home or within a more limited residential area than before (Kotwal et al., 2021). As such, living in an at-risk area during the pandemic may enhance individuals' exposure to social disadvantage and increase the risk of OUD. By contrast, it is also possible that the pandemic has taken a greater toll on the social lives of older adults residing in communities with historically tight knit social networks, because more social ties could have been disrupted by the pandemic. While the pandemic poses an unprecedented shock that may have reshaped risk of OUD for older adults, little research has focused on this topic. This study aims to fill this gap by answering three questions: (1) Has the COVID-19 pandemic elevated the risk of OUD among older adults? (2) Which individual- and county-level factors are associated with the risk of OUD among older adults? (3) Do the associations between county-level social environment factors and the risk of OUD differ between the pre-pandemic and pandemic period?