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Background: Opioid maintenance treatment (OMT) secures a low mortality in a vulnerable population and is often a lifelong treatment. One would therefore expect an increasing prevalence of OMT among the elderly. This article describes a study with three elements; a literature review, an investigation of occurrence and an exploration of elderly patients’ needs and experiences. Material and methods: PsycINFO, Ovid Medline and Embase were searched with reference words for opioid maintenance and age. Norway has a national cohort study of patients in OMT describing recruitment, retention in treatment, age and mortality. A prognosis of numbers in treatment older than 50 and 60 years were extrapolated based on probabilistic premises. Finally, a qualitative interview study of OMT patients in two municipalities near Oslo was performed. Five OMT patients aged between 58 and 64 years were interviewed with open questions on thoughts, needs and experiences. Findings: The review points to an increasing population with psychiatric and somatic comorbidities and diverse needs. Their opinions and experiences seem largely unexplored. The population estimates indicate that Norway by 2018 will have between 3084 and 3567 individuals older than 50 years and between 201 and 302 individuals older than 60 years in OMT. The qualitative study demonstrated that the elderly OMT patient typically attributes their being alive to OMT. It is a life with a high prevalence of ailments and diseases. Their somatic diseases are mostly adequately treated by their GP, but they feel left alone with a high level of mental problems and loneliness. They miss follow-up from the OMT and social services and are not met on existential thoughts and sorrow for their life. A wish to end OMT during their lifetime is noteworthy. This would necessitate a close collaboration with the OMT services and support from a social network. Conclusions: The study points to insufficient knowledge of and strategies to meet an increasing number of individuals with composite problems in OMT. The numbers will remain too small to warrant specially designed local projects, but large enough to necessitate awareness and competencies in the ordinary municipal health and social services.