The U.S. opioid epidemic affects America’s middle aged, boomer and senior citizens in staggering numbers. Over 44% of opioid overdose deaths are in patients aged 45 to 64. When you add in the numbers for senior citizens, over half of the opioid overdose deaths in the U.S. occur in older citizens.
In 2011 approximately 15% of Medicare recipients were prescribed an opioid painkiller upon discharge from a hospital stay.
While that may be normal following surgery or an accident, approximately 42% of those same Medicare recipients were using opioid painkillers 90 days after discharge. The recommended use of an opioid medication for pain is one week or less, so those who use opioids for more than 90 days may become addicted to them.
Over-use of Opioid Painkillers Can Actually Make Pain Worse
The Baby Boomer generation (those born between 1946 and 1964) and seniors are increasingly being prescribed strong opioid painkillers. Many go on to become addicted to their painkiller medication.
A John Hopkins Medical School report says the number of Americans age 50 and older who abuse prescription drugs is projected to rise to 2.7 million in 2020. This is an increase of 190% from the 2001 figure of 910,000 people who abuse painkillers.
“Opioids are Very Addictive and Not Very Effective After 12 Weeks”
Over-use of opioid painkillers may actually make pain worse. According to a study in the journal Spine, workers who remained on opioids for more than seven days during the first six weeks after an injury were more than twice as likely to be disabled and out of work a year later. In another study in Spine, workers who received early opioid drugs in morphine equivalent amounts of more than 450 mg “were, on average, disabled 69 days longer than those who received no early opioids” and their “risk for surgery was three times greater.
In a California study, workers who received high opioid doses actually stayed out of work three times longer and experienced “delayed recovery from work-place injuries,” say other data.
Opioid Over-Prescribing for Seniors?
Approximately 10 million Medicare recipients use opioids for pain relief. Of the half million Medicare recipients in the top 5% of opioid use, 29% obtained opioid prescriptions from four or more prescribing physicians; and 31% purchased opioids from three or more pharmacies.
Medicare spends $2.7 BILLION to keep recipients on opioid painkillers; however, Medicare does NOT pay for treatment to get those who become addicted to opioids to get help for their addiction! (Write your elected officials and ask them why this is so.)
Signs of Opioid Addiction
Those who take opioids for pain do so for a reason – they have been prescribed by a physician to relieve and manage pain. Thus a physical dependence upon the medication exists until their pain is either relieved or becomes manageable.
If pain persists, the physician may choose to continue with the opioid medication for a longer period of time. For some, this is where dependence stops and abuse begins.
An individual dependent upon a pain medication takes it exactly as prescribed. This means the prescribed dosage is taken according to the frequency on the prescription label. (Every 4, 6 or 8 hours.) The individual does not attempt to get more prescriptions by seeing additional doctors, nor do they attempt to fill multiple prescriptions at more than one pharmacy. They simply get their prescription from one physician and have it filled at one pharmacy.
When Use Turns into Abuse
An individual who abuses the medication does not take it 100% as prescribed. They constantly watch the clock to see when the next dose is due. If they feel the medication is wearing off too quickly, they might take the next dose ahead of schedule.
This cycle continues until the patient runs out of medication too soon, prompting a call to the doctor for an early refill. If the doctor refuses, the individual may call another doctor for a new prescription. Or ask a family member or a friend if they have any pain medication leftover from an old prescription, or both. If such attempts do not result in obtaining more pain pills, the individual may attempt to self-medicate with alcohol until the original prescription can be refilled.
The pills are taken compulsively despite harmful consequences.
The individual appears drowsier than they do when they take the medication as prescribed.
Family relationships become strained and deteriorate.
Work or social obligations go unmet.
Inappropriate emotional responses such as angry outbursts.
Neglecting daily duties such as hygiene and eating.
Poor decision making.
Treatment for Older Adults Addicted to Opioids
While there are literally thousands of addiction treatment programs in the United States, there are only a handful that successfully treat opioid addiction due to chronic pain. Facilities that do provide such a service have physicians who are board certified in pain medicine as well as in addiction medicine.
It is vital that a multi-disciplinary team of professionals assess the client in their respective discipline (psychiatry, psychology, therapist, etc.) to formulate an effective treatment plan that manages pain while treating the addiction.
Detox services may be needed if there are complexities such as multiple addictions, serious medical and mental conditions. For example, in addition to the opioid addiction, the individual may have a drinking problem, as well as hypertension and depression. An addictionologist can determine if detox is necessary prior to residential treatment.
Residential Addiction Treatment for Best Outcomes
Residential treatment for 90 days is recommended for the best outcome. To go to treatment for 30 days and expect full recovery is unrealistic. It takes time for medications to be switched from opioids to a non-narcotic remedy. It also takes several weeks to determine if the new medication regiment is effective or not.
Addiction treatment includes therapeutic services to help the individual make cognitive and behavioral changes. In older adults the brain has lost elasticity and therefore presents more of a challenge in making necessary cognitive changes to drive recovery oriented behavior. For this reason, the treatment process normally takes longer for an older adult.
For seniors it is often necessary to continue with outpatient treatment following residential treatment. Long-term recovery requires a change from an unhealthy lifestyle to a healthy and balanced lifestyle, and to do that requires ongoing therapy and support; a continuum of care.
Effective Rehab for Boomers and Seniors
Most treatment centers treat adults age 18 and older, therefore their census is about 98% young adults between the ages of 18-29. To send a senior or older adult to such a treatment center is akin to sending them to treatment with their grandchildren: it simply does not work well.
When selecting a treatment center for an older, mature adult – who the individual will be in treatment with is a serious consideration. Some facilities may claim they have a senior or older adult track. But in most cases, this means that older individuals may be somewhat segregated from young adults.
Other facilities may be exclusively for an older population; such as one that is for adults over the age of 30 or 40. And others may be age and gender specific, which is generally a preferable choice for the patient and the family.
The treatment facility should be a state licensed inpatient or residential facility that is accredited by either The Joint Commission or CARF or both. Therapists should have a master’s level education and have a state license to provide counseling. Make sure the facility does not use non-licensed or non-graduate staff to provide counseling services. This is a practice that many unethical facilities use to save money.
A facility that specializes in opioid addiction due to chronic pain is different than a facility that simply treats opioid addiction. A physician who is board certified in pain medicine needs to be on the staff of a program that treats a chronic pain patient. Most treatment centers offer opioid addiction for non-chronic pain patients.
Who Pays for Addiction Treatment?
Medicare will not pay for substance abuse treatment, but it may pay for inpatient detoxification under Medicare Part A.
Neither Medicare Part A nor Part B pays for residential substance abuse treatment. Medicare pays for a physician, a psychologist and a licensed clinical social worker – but only if those providers participate in Medicare. It does not pay for a licensed substance abuse counselor; nor does Medicare pay a per diem rate for residential substance abuse treatment.
Not all Medicare supplements fill the gap either; so check with the insurance company that provides the supplement to see what is covered.
Commercial Insurance Addiction Coverage
Most commercial insurance plans will pay for some rehab and addiction treatment services. The type of service covered and the length of time in treatment varies from one policy to another, even within the same insurance company. Most facilities will conduct a no-obligation verification of insurance benefits for the patient beforehand so that an estimate of out-of-pocket expenses may be provided to the family. A verification of benefits by the insurance company is not a guarantee of payment by the insurance company.
Whether the patient has insurance or not, it is always the patient’s responsibility to pay for all provided treatment services. Most often that payment is required in advance.
Good, quality and professional treatment is expensive, so don’t expect insurance to cover the entire amount. A good insurance plan is one that pays about 30-50% of total addiction treatment costs.
Seeking Addiction Treatment – What to Do Next
To find a treatment facility that specializes in opioid addiction due to chronic pain for older adults, ask your primary care physician to help recommend a facility or call your insurance provider for assistance.
If you are employed your company may have an EAP (employee assistance program) that offers free and confidential services to help you find a treatment center.)
If you search the Internet, be sure the rehab facility’s staff page has a pain medicine and addiction medicine physician on staff. Board certification is highly recommended in these areas.
There are medically safe alternatives that involve non-narcotic pain relievers and effective addiction treatment. When treated by an integrated clinical team of physicians, psychologists and licensed therapists, those addicted can realize a quality of life with meaning and purpose.
About the Author
Kenneth Chance, D. Div. is the CEO and Founder of Arrowhead Lodge Recovery in Northern Arizona. Arrowhead Lodge Recovery treats men over the age of 30; our average client age is 45-65+. Our clients suffer from opioid addiction due to chronic pain, as well as co-occurring medical and mental health conditions.