The Graying of the Opioid Epidemic

Sharon O'Day
November 29, 2017
Medicare Part B

Opioids are prescribed at a high level to seniors. Yet, painkillers affect older adults differently than younger adults. According to the Center for Medicare and Medicaid Services (CMS), an opioid use disorder has been diagnosed in six in every 1,000 Medicare beneficiaries. Meanwhile, study results published in Health Affairs in 2016 showed a markedly increased risk of hospitalization due to opioid overdose in Medicare beneficiaries who used opioids for 90 days or more. While the focus of opioid abuse treatment has been adults under age 40, seniors are also at risk of becoming addicted to opioids.

How Medication Effects Differ for Adults Aged 65 and Older

Older Americans are frequently more sensitive to a medication’s effect on brain chemistry than younger adults. Since drug absorption may be delayed in people aged 65 and older, its effect may not be as quickly apparent to the person ingesting the drug (per an article). Consequently, older adults may self-medicate with a higher-than-prescribed opioid dose in an effort to more quickly eliminate pain—leading to a confused mental state plus “slip and fall” accidents, as well as the risk of overdose.

The Making of an Opioid Crisis in Seniors

Nearly one-third of all Medicare patients were prescribed opioids to relieve pain by their doctors in 2015 (according to report by AARP). This report also noted that 2.7 million people over age 50 in the US were found to have abused painkillers in that same year. Additionally, the hospitalization rate for adults over age 65 due to opioid abuse has increased five-fold over the past 20 years.

Three of the main healthcare circumstances in which seniors are prescribed opioids for an extended period are as follows:

  • Post-surgery after a hip or knee replacement;
  • Following diagnosis of a broken bone (i.e., due to an accident);
  • When arthritis in the spine has become disabling

Caregivers of addicted people who are 65 years of age (or older) may be less apt to recognize signs of opioid addiction due to the high incidence of disabling back and joint pain—necessitating pain-relief to maintain quality of life—in adults in the senior age demographic. Therefore, intervention by a medical provider to taper the older addicted patient off opioids may not occur until the addiction is very entrenched.

Purdue Pharma’s OxyContin was approved by the Food and Drug Administration (FDA) in 1995. Subsequently, an aggressive marketing campaign commenced in 1996 to promote OxyContin’s use. Physician-aimed advertising reassured medical providers that oxycodone-containing drugs were not addictive, and doctors across the US began prescribing opioids to their patients suffering from arthritic pain on a long-term basis. The vicious cycle for these patients was that withdrawal symptoms were commonly experienced after taking opioids for more than one week, and one symptom of opioid withdrawal is a feeling of increased pain.

In this way, millions of older adults have become physically addicted to oxycodone, while also experiencing decreased pain relief over time from their medication. Indeed, study findings published in 2016 in Clinics in Geriatric Medicine found that 6-9% of community-dwelling older adults used opioids on a regular basis to treat chronic (non-cancer) pain.

How Opioids Cause Addiction

Opioids attach to receptors in the brain, and then block the transmission of pain signals. For anyone who has experienced chronic arthritic pain, the fast-acting relief can be life-changing in a positive way. However, tolerance to the prescribed drug—as also found in heroin addiction—often develops in people taking opioid painkillers.

This tolerance leads to the need for a progressively higher dose to experience the same level of pain relief. In addicted individuals, an addiction-related behavior of “doctor-shopping” often occurs to acquire new (and increased) opioid prescriptions. Likewise, addicted patients often lie to their doctors about the actual amount of the opioid medication taken on a daily basis.

How Bad Is the Crisis Among Seniors?

The Office of the Inspector General of the US Department of Health and Human Services (DHHS) reported that one third of the 43 million seniors covered by Original Medicare (Part D) filled at least one opioid prescription in 2016. Ten percent received opioids for at least six months—and Medicare paid nearly $4.1 billion for 79.4 million opioid prescriptions.

While the total number of prescriptions written annually can be calculated, it is impossible to know exactly how many seniors are experiencing an opioid addiction. Symptoms are often confused by relatives and caregivers for dementia and/or depression. Moreover, clinicians may ignore the warning signs—especially in nursing homes.

Six Signs of Painkiller Tolerance in the Elderly

Despite public awareness of the dangers of chronic opioid ingestion, opioid-containing medications remain widely prescribed following the common surgeries experienced in later life. Six signs that an older loved one may be developing an opioid painkiller addiction are:

  • An increasingly groggy or sedated affect;
  • Changes in sleeping or eating patterns (e.g., sleeping far more hours than normal);
  • Withdrawal from usual activities and people;
  • Increased anxiety and depression;
  • Self-medicating with higher doses of opioids than prescribed;
  • More frequent requests for prescription refills of the opioid medication

What To Do If You Suspect Misuse of Opioids

Do you suspect that an older family member is misusing opioids? If so, it is a good idea to accompany that person to a medical provider’s office to discuss the problem. A drug treatment program may be necessary—or a physician-supervised plan for weaning your loved one away from opioid dependency.

Will Medicare Cover Treatment for Opioid Abuse?

The following conditions have to be met for Medicare to cover inpatient (or outpatient) treatment for opioid abuse:

  1. The services are received from a Medicare-participating provider or facility.
  2. The services are designated by a healthcare provider (e.g., physician) as medically necessary.
  3. The treatment plan is established by a healthcare provider.

Original Medicare (Part A) will pay a portion of the cost of inpatient care if the Medicare beneficiary is hospitalized for substance abuse treatment (including an inpatient stay in a rehab facility). The website presents the following as the current “out-of-pocket” costs that will accrue (unless the hospitalized beneficiary has purchased a Medigap plan covering these “out-of-pocket” costs):

  • $1,316 deductible for each benefit period ($1,340 in 2018).
  • Days 1–60: $0 coinsurance for each benefit period ($0 in 2018).
  • Days 61–90: $329 coinsurance per day of each benefit period ($335 in 2018).
  • Days 91 and beyond: $658 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over the beneficiary’s lifetime) ($670 in 2018).
  • Beyond lifetime reserve days: all costs (all costs in 2018).

Original Medicare (Part B) will pay a portion of the Medicare beneficiary’s outpatient substance abuse treatment services (i.e., treatment received in a hospital’s outpatient clinic, or some other outpatient treatment center).

Summary of Original Medicare’s Substance Abuse-Related Treatment Coverage

Medicare’s overall covered services related to substance abuse treatment include (but are not limited to) the following:

  • Psychotherapy;
  • Patient education regarding diagnosis and treatment;
  • Post-hospitalization follow-up;
  • Prescription drugs administered during a hospital stay or injected at a doctor’s office;
  • Outpatient prescription drugs covered under Medicare’s Part D (optional prescription drug coverage)

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