By Barbara Goodheart, ELS
They’ve been called a “growing and understudied population”—people who need treatment, yet find it hard to obtain or to pay for. So, many do without it. And, as time passes, they become increasingly vulnerable to physical and mental challenges.
Who are they? They’re older adults who have opioid use disorders (OUDs).
Recommendations from medical and government sources on what to do to help them—evidence-based guidelines, supportive policies, even general suggestions on making treatment available to this group—are sorely lacking.
Until very recently, this was the case with another demographic group—adolescents with OUDs. When we wrote about adolescents in our August/September newsletter, that situation was changing for the better. In fact, we found so many recommendations about making drug therapy available to this group that we couldn’t include all of them.
The Elderly and OUDs—Today and Tomorrow
An article by Brandi Cotton, PhD, and colleagues, in ps.psychiatryonline.org (citation below) depicts the current situation with elderly people in New York City, and postulates how the picture is likely to change. The age group 50 to 59 years is among the most populated in New York, and about 13% of the population is older than age 60. Some older New Yorkers have been in methadone maintenance treatment (MMT) since the mid-seventies.
These factors, along with the medical problems and coexisting conditions that typically accompany aging, will continue to make older people increasingly vulnerable to OUDs—not only in New York City, but across the country—and will increase the need for MMT.
Age-Related Medical and Financial Issues
Aging often makes patients more susceptible to the side effects of MMT, and may also bring some degree of cognitive decline. Patients may find it difficult to continue to adhere to MMT’s federal regulations and requirements, such as the need for on-site visits.
Costs are another issue. Transitioning to Medicare usually means higher expenses, because Medicare currently doesn’t pay for methadone when it’s used to treat OUDs. Nor do nursing homes, other long-term facilities, and home health agencies generally cover methadone for treating OUDs.
The very thought of becoming old and being opioid-dependent makes many patients anxious, the authors note; yet patients lack good options. They’re also anxious about discontinuing methadone treatment, or cross-tapering to buprenorphine or naltrexone—with “potential rebound pain, opiate withdrawal, and the prospect of relapse.”
The authors stress that as the government considers changing funding mechanisms, “providing access to MMT and addressing the unique treatment needs of older adults should be considered.” So far, the authors note, the needs of the elderly receiving MMT “have received minimal attention.”
The proportion of older patients receiving MMT is expected to rise. The authors believe it’s important to develop clinical guidelines to help providers and patients decide whether to taper or to discontinue MMT, and if to discontinue, when to switch to an alternative, and whether the taper should be slow or quick.
If continuing MMT is deemed the best clinical choice, it’s important to ensure that structural supports are in place for administering MMT under long-term care, or in skilled-nursing facilities.
Cotton BP, Bryson WC, Bruce ML. Methadone maintenance treatment for older adults: Cost and logistical considerations. ps.psychiatryonline.org. doi: 10.1176/appi.ps.201700137.
Bill White’s Blog: Challenges Older Adults Face During Recovery
A search for additional recommendations turned up little—until we found an interesting November 7 post by William L. White on the blog he co-authors with Randall Webber: http://www.williamwhitepapers.com/blog/2017/11/recovery-challenges-among-older-adults-bill-white-and-randall-webber.html.
|William (Bill) White, MA, Emeritus Senior Research Consultant with Chestnut Health Systems in Illinois, has a Master’s degree in Addiction Studies. Active in the field since 1969, he’s the award-winning author or co-author of more than 400 articles, research reports, monographs, and book chapters, and 20 books.
Randall Webber, MPH, a consultant and trainer at JRW Behavioral Health Services, is a faculty member at the Behavioral Services Center CADC School in Skokie, Illinois.
Bill White’s November 7 blog on older adults discusses several vulnerabilities that can disrupt the stability of long-term recovery in this age group—but then he turns optimistic about the future.
Vulnerabilities That Can Disrupt Long-Term Recovery
Listed below are the four root causes of vulnerabilities Bill White discusses in his blog. These underlying causes are responsible when adults develop problems related to drug or alcohol use in later life. They may also cause recurrences after patients have spent years in recovery—when recurrences may be fatal.
- Physiological factors. Age-related changes in the way the body metabolizes drugs and alcohol can cause drug interactions and troublesome symptoms. The onset of pain and sleep disturbances may lead patients to self-medication. This can make matters worse, for multiple medications can intensify the effects of drugs and alcohol for older people. On the other hand, if patients must discontinue important medications taken to support their recovery, problems related to drug or alcohol use are likely to recur.
- Emotional factors. Depression or anxiety are among common responses to losses—the loss of one’s own functional capabilities; the loss of friends and family members, because of death or relocation; a lack of meaningful activities; and a possible decline in one’s standard of living. These situations and others can eventually lead to self-medication with drugs or alcohol.
- Social factors. Social networks are disrupted when family members, friends, or sponsors relocate, retire, or die. New social groups—such as retirement communities—may favor heavy drug or alcohol use.
- Spiritual factors. Some people who lose connection with religion as they grow older drift into substance use or other forms of risk-taking. Some aging adults, Bill White notes, “fearing they are running out of time, commence risk-taking behavior similar to that seen in adolescence.” Some people feel they’ve fallen far short of their goals, and simply give up, “until some event or new relationship rekindles a zest for living.
Despite having written about these vulnerabilities, Bill White strikes an optimistic note as he closes his blog.
In an eloquent closing paragraph, he lists some advantages of aging that help enhance resilience and the quality of personal and family life in long-term recovery:
. . . Changes in lifestyle that improve physical and emotional health. A shift in focus from doing to being. Acceptance of imperfection and limitation. Letting go of past resentments. Seeking forgiveness and forgiving. Deepening gratitude for one’s blessings. More meaningful personal and family relationships. Discovering previously hidden resources within and beyond the self. The gift of time for pleasurable pursuits and quiet reflection.
A Hopeful Outlook for the Older Generation
Bill White writes that most older adults, including those in recovery, do manage to maintain their health and meet the challenges of the final stage of life, but that they need “specialized, developmentally appropriate prevention, early intervention, treatment, and recovery support services.” He expects to see remarkable breakthroughs aimed at the special circumstances and needs of older adults.