In a demographic shift, older adults now comprise an increasing proportion of those receiving methadone maintenance treatment (MMT) for opioid use disorder. A study of MMT recipients in New York City suggests that 13% of the population is over 60 years of age. Adults ages 50-59 are among the largest age demographic, evidence that the number of older adults receiving MMT will continue to increase. Because medical comorbidities, cognitive impairment, and neurobehavioral changes often accumulate with age, older adults on MMT become increasingly vulnerable. The cost of MMT and logistical considerations also pose challenges to continued care. Together, these issues warrant a reconsideration of emerging concerns and health policies related to use of MMT in this growing and understudied population. Given the changing health care system and the opioid epidemic, the need for evidence-based guidelines and supportive policies that consider the unique treatment needs of older populations is especially relevant.