Among other solutions, educational campaigns along with expanding access to residential rehab programs to Medicare beneficiaries could mitigate the growing trend of drug overdose deaths in seniors, experts said during a hearing
of the Senate Special Committee on Aging on Thursday.
Overdose deaths among seniors quadrupled from 2002 to 2021, said Keith Humphreys, PhD, of Stanford University School of Medicine in Palo Alto, California, citing a research letter he co-authored in JAMA Psychiatry.
Looking at the broader picture, one in approximately 370 deaths among older adults was the result of intentional or unintentional overdose, a rate lower than that of the working age population, he noted. Still, the fourfold increase is troubling, and early CDC data have indicated a 14% uptick in deaths among this population.
"So, the problem seems to be getting worse," he said.
While one in eight of these overdose deaths was intentional, the primary driver of these trends are "unintentional deaths in illicit markets," typically involving cocaine, methamphetamine, and especially fentanyl, Humphreys explained.
In his written testimony, Humphreys said that potential reasons for this increase in overdose deaths included a rise in pharmaceutical products broadly -- approximately 54% of seniors take four or more prescription drugs, and in some cases, neither the senior nor their physician are aware of the adverse interactions of these medications.
Furthermore, as people age, their bodies' ability to "metabolize and tolerate" drugs changes, raising their risk of overdose, as well as other problems such as falls, he noted.
He also pointed out that different generations "carry substance patterns with them through their lives." The teenagers and young adults who attended Woodstock are now Medicare beneficiaries. As these Baby Boomers move into retirement, clinicians should expect more drug use among older Americans.
Witnesses, including Humphreys, acknowledged that Congress has begun to tackle this issue. In 2018, Congress passed the SUPPORT Act, which gave Medicare beneficiaries access to community-based clinics that provide methadone treatment. And in the Consolidated Appropriations Act of 2023, Congress authorized Medicare to cover mental health counselors and intensive outpatient treatment.
As Deborah Steinberg, JD, senior health policy attorney for the Legal Action Center based in Washington, D.C., pointed out, the Centers for Medicare & Medicaid Services also recently increased Medicare reimbursement rates for certain addiction and mental health services, including office-based substance use disorder treatment, to help boost provider participation.
Still, there's more work to be done, witnesses said.
For example, Humphreys noted, Congress could build on the SUPPORT Act reforms by also making residential treatment programs Medicare eligible.
It could also extend protections of the 2008 Mental Health Parity and Addiction Equity Act -- a bill that required insurers' benefits for mental health and substance use to be comparable to all other medical benefits -- which have been afforded to employees of small, medium, and large companies; those on the state exchanges; and most Medicaid enrollees, to include seniors, who are currently excluded.
"Remarkably, the Medicare program, the standard setter for other types of insurance, is not subject to this critical civil rights law," with certain exceptions, Steinberg said.
This lack of parity pushes the cost burden onto patients, clinicians, and states and to the Medicare Hospital Insurance Trust Fund when conditions are left untreated, she added. "We recommend Congress apply the Parity Act to all parts of Medicare."
Humphreys noted that the Parity Act currently does not apply to Part A of Medicare -- inpatient hospital care, skilled nursing facility care, and other services -- or to "fast-growing" Medicare Advantage plans.
"Giving everyone in Medicare the same parity protections that almost every other American enjoys would increase access both to the care of substance use disorder, as well as the mental health problems that often co-occur with them," he said.
James Carroll, JD, former director of the White House Office of National Drug Control Policy, also noted that while there are educational campaigns highlighting the dangers of synthetic drugs and fentanyl-laced fake pills for children and teenagers, "our seniors need to receive this message too: 'One pill can kill.'"
Finally, William Stauffer, executive director of the Pennsylvania Recovery Organizations Alliance and a person in recovery, said that it's important to look at the COVID pandemic and its relationship to the problem of loneliness.
"A lot of aging adults in recovery, they're looking for purpose ... If we did something like create an older adult recovery community corp to pair older adults in recovery to others who need help, we'll be saving a lot of lives. Even those who are in the helping roles. Because we all want hope, purpose, and connection," Stauffer said.
https://www.medpagetoday.com/publichealthpolicy/washington-watch/107876
