When Dr. Benjamin Han, a geriatrician and addiction medicine specialist at the School of Medicine at the University of California, San Diego, meets with new patients, he goes beyond the typical health issues that older adults face. In addition to chronic conditions, functional ability, and medication use, he also asks about their use of tobacco, alcohol, cannabis, and other nonprescription drugs. Dr. Han understands that patients may be hesitant to disclose their substance use, so he approaches the topic in a health context. He explains to them the physiological changes that occur as we age and how those changes can make older adults more sensitive to substances. By framing the conversation in this way, Dr. Han is able to uncover important information about his patients’ substance use habits.
For example, he has uncovered cases where patients complaining of insomnia were actually using stimulants, like methamphetamines, to stay awake. He has also come across patients who were prescribed opioids for chronic pain but ran into trouble when they were prescribed additional medications, like gabapentin, which interacted negatively with the opioids.
Dr. Han has seen firsthand the detrimental effects of substance use on older adults. Some of his patients have experienced exacerbated heart problems, liver disease, and cognitive impairment due to substance use. Unfortunately, despite his best efforts, some have even overdosed and died. In the past, substance use among older adults received limited attention compared to younger, working-age individuals affected by the opioid epidemic. However, as baby boomers reach the age of 65 and qualify for Medicare, substance use disorders among older adults have increased significantly.
A study on opioid use disorder in Medicare enrollees over the age of 65 showed a threefold increase in just five years, from 4.6 cases per 1,000 in 2013 to 15.7 cases per 1,000 in 2018. The true rate of the disorder may be even higher due to underreporting resulting from the stigma surrounding drug use. Fatal overdoses among seniors have also quadrupled from 2002 to 2021. This includes intentional overdoses, such as suicides, as well as accidental overdoses due to drug interactions and errors.
It’s important to note that most substance use disorders among older adults involve prescribed medications rather than illegal drugs. This is a significant concern considering that most Medicare beneficiaries take multiple medications, increasing the likelihood of confusion and potential overdose. In fact, the complexity of medication regimens is a contributing factor to overdoses among older adults.
While the absolute number of drug overdose deaths among seniors may still be relatively low, the rate of increase is alarming. It’s crucial to address this issue proactively to prevent further harm. Substance use disorders among older adults can have severe health consequences, including falls and accidents, accelerated cognitive decline, cancers, and various organ diseases.
Moreover, older Medicare beneficiaries with substance use disorders are more likely to experience psychological distress and have suicidal thoughts compared to those without such disorders. Despite this, very few seniors receive treatment for their addiction, and many face barriers to seeking help. Stigma concerns, logistical barriers, and affordability issues all contribute to the lack of treatment among older adults.
Medicare coverage itself presents obstacles as well. While there have been some improvements, such as coverage for substance use screening and opioid treatment programs, more intensive treatment options, like residential treatment, are not covered. Medicare Advantage plans can be even more restrictive, with limited provider networks and prior authorization requirements.
Although progress is being made, the lack of access to treatment continues to contribute to overdoses and deaths. Additionally, doctors who may not be accustomed to diagnosing substance abuse in older adults may overlook the risks. It’s essential for both healthcare providers and older adults themselves to recognize the vulnerabilities associated with substance use in this age group.
In conclusion, addressing substance use disorders among older adults is crucial as the population ages and the rates of substance use continue to rise. By improving access to treatment, increasing awareness among healthcare providers, and destigmatizing substance use, we can better support and protect older adults from the detrimental effects of addiction.
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