Addressing the Opioid Crisis Among Older Americans

Video Transcript

Bradley D. Stein

Director, Opioid Policy, Tools, and Information Center (OPTIC); Senior Physician Policy Researcher, RAND Corporation

Thank you for inviting me to share insights on combating the opioid crisis, which is increasingly impacting older Americans. The toll of the crisis extends far beyond fatal overdoses. It affects millions of Americans, not just older adults fighting to maintain their own recovery, but also those spending their life savings to pay for adult children's addiction treatment or raising their children's children. Today, I will focus on what escalating rates of opioid use disorder among older adults imply for health care, how upstream strategies of better chronic pain management can help prevent opioid misuse, and the social toll of grandparents raising grandchildren due to parental addition.

Opioid use disorder rates have tripled among Medicare beneficiaries over the last decade. The rapid increase poses significant challenges to our health care system, which is not adequately prepared to address the unique needs of this population. Primary care providers, the clinicians at the heart of treating our older adults, often lack training or confidence in managing opioid use disorder. Meanwhile, few addiction specialists are equipped to handle the complex medical needs of older patients with conditions like dementia. This mismatch leaves many older adults with opioid use disorder without adequate care. Only with concentrated efforts and federal investments will the clinical workforce caring for the elderly be prepared to efficiently and effectively treat individuals with opioid use disorder and disorders like dementia.

Efforts to reduce opioid prescribing have curbed misuse, but many individuals with chronic pain don't receive non-opioid treatments, leaving many without adequate pain management options. Expanding access to non-opioid pain management is essential to address this gap and can help prevent new opioid use disorder cases. Congress can help by considering incorporating non-opioid therapies for chronic pain in value-based insurance designs to enhance affordability and ensure that these services are fully covered by Medicare. It can also possibly consider expanding existing loan forgiveness programs, such as Rural Health Grants or the National Health Services Corps, to include providers trained in these non-medication therapies to ensure we have an adequate workforce in the future.

Finally, the opioid crisis has far-reaching social consequences for older Americans beyond their own health needs. An estimated 2.6 million grandparents are raising grandchildren, often becoming informal caregivers when parents struggle with addition or succumb to overdose. Doing so often until significant emotional and financial burdens as grandparents working to keep their family together, delay retirement, or take on new expenses like housing or child care. Congress can help support these families by expanding access to respite care and affordable child care through programs like Head Start or alongside the Child Abuse Prevention and Treatment Act (CAPTA) reauthorization. It can seek to ensure grandparent caregivers have access to benefits such as health insurance for the children in Kinship Navigator programs, whether they participate in the formal child welfare system or not. And it's important that we support the development of educational resources tailored specifically for grandparents stepping up to raise children affected by parental substance use disorders.

There's no single solution to the opioid crisis, but health care reforms, improving non-opioid chronic pain management, and better supporting families affected by addiction, like so many of the patients I treat, will help keep families together and ensure that our health care system is better prepared to meet the diverse needs of older Americans.