Opioid use disorder (OUD) affects people from different age brackets. More recently, a rise in substance abuse issues among seniors has taken the spotlight. Older adults are not only uniquely vulnerable to potential OUD, but they also require special consideration when diagnosing an OUD and accessing care. Below, we explain the challenges of opioid addiction in the elderly.
The rise in elderly drug addiction
The body of evidence speaking to a rising prevalence of OUD among seniors has been growing. One study examining OUD in Medicare-receiving individuals aged 65 and older showed a threefold jump in cases in five years. Additionally, researchers suggest that the real numbers may be higher due to underreporting.
Opioid-related overdose fatalities among seniors are likewise on the rise, quadrupling from 2002 to 2021. Although the rates of OUD mortality are lower among the elderly than for other age groups, these figures still point to a marked increase. In 2000, the death rate for people aged 65 and older was 2.4 deaths per 100,000 standard population. In 2020, the number increased to 8.8 deaths per 100,000 standard population.
The National Council on Aging (NCOA) did its own research into OUD among seniors through a survey of community-based organizations across 40 U.S. states and Puerto Rico. Overall, seven in ten of the organizations they surveyed reported spending more time dealing with opioid-related issues than in the past.
What makes seniors vulnerable to OUD?
Part of what makes diagnosing and treating OUD in seniors so challenging is the fact that drug addiction among the elderly often involves legally prescribed medication, not illicit drugs. Older adults who take many medications may be at particular risk of mixing opioids with other medicines, resulting in a dangerous, even fatal, interaction. Essentially, the more medications a person takes, the higher the risk of accidentally ingesting the wrong medicine.
On top of that, older individuals may suffer from certain issues that make them more susceptible to potential substance abuse. For example, chronic pain is frequently managed with opioids (although non-pharmaceutical treatments are increasingly being explored in light of the rise in OUD).
According to some estimates, the prevalence of chronic pain among the elderly may range from 25 to 85%. Such legitimate ailments may lead to a legitimate prescription—which, unfortunately, can lead to OUD without proper care. Doctor-written prescriptions are still a major factor in opioid misuse.
Such correlations may help explain the rise in opioid addiction in the elderly in part. However, they aren't the only cause. Researchers also highlight social stigma as a problem. Healthcare professionals suggest that seniors may face greater barriers when it comes to communicating about opioid dependency. This lack of open communication can also impede diagnosis, which is a critical first step to getting help.
Unique challenges faced by seniors seeking OUD treatment
The stigma around OUD is one hurdle seniors may face in getting help. However, it's not the only challenge. Healthcare professionals also flag logistical hurdles. Seniors may be less mobile, for example, which can impede their ability to access care. For a senior who doesn't drive, finding transportation to get treatment can be tricky, especially if they live in a rural area.
There are also the costs that come with treatment. Seniors may be on a limited income when they retire, and Medicare may not cover all of the costs. With that in mind, things are looking up. Since 2020, Medicare has covered opioid treatment programs. In the future, coverage is expected to expand to include a more comprehensive variety of healthcare providers and treatment options, including intensive outpatient treatment.
Medicare also covers substance use screening, which can be a valuable first step in diagnosis and subsequent care. In its survey, the NCOA flagged a lack of screening opportunities as one concern. This is linked to an overall lack of awareness surrounding the prevalence of elderly drug addiction.
Challenges for senior caregivers
Experts suggest that a first step in combating opioid addiction in the elderly is raising awareness among caregivers and older adults alike. Improved health literacy can enhance understanding regarding the appropriate use of opioids—for example, to treat chronic pain. Knowledge of non-pharmacological treatment options can also be a helpful countermeasure.
Awareness of the risks of prescription opioid addiction, in particular, is especially important, since senior OUD is often linked to legally prescribed medications. For example, any senior taking opioids should be monitored regularly by a qualified healthcare professional. The professional can then gather patient feedback, adjust dosages as needed, and determine if and when treatment can be stopped.
Senior caregivers can also be trained to recognize risk factors for potential opioid misuse. Misuse could mean taking another person's prescription drugs, taking a larger dose than prescribed, or administering the medication through a different method than prescribed. Common risk factors include past or current substance abuse, familial substance abuse, stress, unemployment, poverty, and a history of depression or anxiety.
In general, strong communication between patients, caregivers, and healthcare professionals is a must. This can help reduce the risk of OUD in the first place—and, in the event of OUD, increases the likelihood of affected individuals being diagnosed and offered the care they need.
As awareness about OUD in the elderly grows, so too are treatment options. By offering medications for addiction treatment (MAT) online, Ophelia helps to address certain barriers to OUD treatment, such as mobility challenges. Through Ophelia, eligible patients can receive a Suboxone prescription (important safety information) at their local pharmacy and then get the ongoing mental health support they need online.
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