Improving Substance Abuse Care for Older Adults

A recent Health Affairs article, “To Care For Older Adults With Substance Use Disorder, Create Age-Friendly Health Systems” outlines improvements for screening, treatment and coordination of care for substance use disorders among older adults.

The article notes the scope of this issue, stating that there were more than 30,000 unintentional drug overdoses among adults ages 65 and older between 1999 and 2020, representing an almost 700% increase during the time frame.

The article emphasized the importance of care coordination for older adults who often have multiple chronic conditions and may see a number of providers and take various medications to treat those conditions. The article states:

For this population, the goal should be integrated and coordinated geriatric-based care that focuses on maintaining function and managing chronic conditions, including  geriatric conditions, in coordination with substance use disorder treatment. Fragmented care for older patients on methadone, especially for patients with multiple chronic conditions who take many medications, is not age-friendly and increases the likelihood of drug-drug and drug-disease interactions, common among people living with multimorbidity. As opioid treatment programs increasingly care for an aging population, integrating other needed services (for example, medical care, psychiatric care, nursing care, physical therapy, adult day services) into existing treatment programs could mitigate social isolation and reduce hospitalization and institutionalization.

The article also promotes expanded access to buprenorphine treatment for older adults, in addition to the other two Food and Drug Administration-approved medications methadone, and naltrexone to be used when appropriate; buprenorphine may be safer for some older adults with certain chronic diseases.

Among other suggestions, the article also calls for the COVID-19 expansion in telehealth for some substance use disorder treatments to be made permanent as they can “improve access to methadone for patients with functional impairments who may be home-bound or who have difficulties with transportation.”