OBJECTIVES: To explore U.S. geriatricians' practices, beliefs, and attitudes related to opioid pain management and naloxone prescribing in older adults with serious illnesses, particularly in instances of opioid use disorder or misuse.

METHODS: A cross-sectional survey was administered anonymously via REDCap to U.S.-based geriatricians.

RESULTS: 211 responses were included in the analysis. Respondents estimated that 19.7% of patients in their panel are prescribed opioids for subacute or chronic pain. Even though 32.7% of respondents had encountered at least one opioid overdose in a patient under their care, the percentage of patients to whom they prescribe naloxone among all their patients prescribed opioids is highly variable (mean 46.8% ± SD 39.0%). Only 18.4% of respondents reported "always" taking a thorough substance use history or using a risk assessment tool when prescribing opioids. Respondents reported low confidence managing opioids in patients with a history of opioid use disorder or misuse. Most respondents (63.0%) endorsed lack of knowledge or comfort as a barrier to prescribing naloxone.

CONCLUSIONS: Geriatricians would benefit from enhanced training in safe opioid use management, especially in settings where specialty addiction services are unavailable.

CLINICAL IMPLICATIONS: U.S. geriatricians are not sufficiently prepared to manage opioids in older adults with serious illness.