Understanding the Problem
The U.S. opioid epidemic affects America’s middle aged and senior citizens in staggering numbers. In 2011 approximately 15% of Medicare recipients were prescribed an opioid painkiller upon discharge from a hospital stay, and approximately 42% of those same Medicare recipients were using opioid painkillers 90 days after discharge, and at 90 days abuse an addiction are highly likely.
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 an increase of 190% from the 2001 figure of 910,000 people who abuse painkillers.
Medicare spends $2.7 BILLION to keep recipients on opioid painkillers; however, Medicare does NOT pay for substance abuse (SUD) treatment necessary to get those who become addicted to opioids off of them! (Medicare only pays for inpatient hospital care, not long term residential SUD treatment.)
Signs of Opioid Addiction
Most seniors take opioids for pain do so because it’s been prescribed by their physician to relieve and manage pain. Thus a physical dependence upon the medication exists until their pain is either relieved or becomes manageable. Individuals dependent upon a pain med takes it exactly as prescribed – the prescribed dosage is taken according to the frequency on the prescription label. The individual does not seek 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.
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 they run 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.
Addiction follows abuse. Here are some signs to look for:
• 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 Adults Addicted to Opioids
Effective treatment for opioid addiction due to chronic pain should be done at a licensed residential rehab for at least 90 days for the best outcome. 30 day treatment programs do not allow sufficient time for detox and then the cognitive therapy and training required to overcome opioid addiction. Also, the doctor will change the patient’s medication regimen from opioids to a non-narcotic remedy, which usually takes several weeks to determine if the new medication regiment is effective or not.
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 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.
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 to such a treatment center is akin to sending them to treatment with their grandchildren – it simply does not work well. Some facilities may claim a senior or older adult track which means that those individuals may be 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, a practice that many unethical facilities use to save money.
Neither Medicare Part A nor Part B pays for residential substance abuse treatment. It pays for a physician, a psychologist and a licensed clinical social worker on an outpatient basis only if those providers participate in Medicare. It does not pay for a licensed substance abuse counselor nor does it pay a per diem rate for residential substance abuse treatment. And not all Medicare supplements fill the gap either, so check with the insurance company that provides the supplement to see what is covered.
Treatment fees are the responsibility of the patient, or their financial guarantor. There are some Medicare supplement plans that will pay what Medicare does not. One should call their supplement provider before calling a drug rehab.
Addiction to prescription opioid-based prescription painkillers by older, mature adults is a growing problem. Millions of senior Americans are addicted and without help it becomes deadly. 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, one may realize a quality of life with meaning and purpose.
About the Author
Kenneth Chance, D. Div. is the Founder of Arrowhead Lodge Recovery in Northern Arizona. Arrowhead Lodge Recovery treats senior citizens, who suffer from opioid addiction due to chronic pain, as well as co-occurring medical and mental health conditions. For more information contact Arrowhead Lodge at 1-888-654-2800 or visit our website at www.arrowheadlodgerecovery.com.