Seniors Face Barrier for Common Opioid Addiction Treatment

By Brianna Ehley of PoliticoPro
12/21/2017 09:48 AM EDT

Millions of older Americans are addicted or at high risk of becoming addicted to prescription painkillers, but Medicare doesn’t cover one of the most common treatments to wean people off opioids.

Policy experts and advocates say one of the biggest barriers to addiction treatment for seniors is Medicare’s exclusion of coverage for methadone, the oldest of the three FDA-approved medication assisted therapies treating opioid abuse.

Despite the heightened level of public attention to the opioid epidemic, advocates say there’s very little focus on the senior population. That’s even though the high prevalence of prescription opioid use among seniors, many of whom are on these medications for chronic pain, places them at high risk of abuse.

Almost one third of seniors enrolled in Medicare’s prescription drug benefit received at least one prescription opioid in 2016, and about 500,000 received “high amounts” of opioids that year, according to HHS figures. By 2020, the Substance Abuse and Mental Health Services Administration estimates, 2.7 million older Americans will abuse prescriptions drugs — nearly a 100 percent increase.

Medicare currently covers two treatments to help wean people off opioid addiction — buprenorphine, known as Suboxone, in pill form, as well as naltrexone, an injectable. They both tend to be prescribed to people with a mild to moderate substance use disorder. Experts say methadone is typically prescribed for more severe cases of addiction, and it’s very difficult to switch from it to other forms of medication assisted treatment.

Mark Parrino, the President of the American Association for Treatment of Opioid Dependence, said doctors prefer methadone as a treatment for patients who have been using opioids for longer periods of time and have built up a tolerance.

The coverage issue becomes especially tricky when people who have been receiving methadone treatment for years, covered by some private insurance plans and some states, age into Medicare at 65. At that point, they can either pay out of pocket or switch to a treatment that may be less effective.

“This is a cradle-to-grave issue. People start abusing drugs when they’re very young,” Parrino said. “I don’t think the spigot turns off when they turn 65.”

However, methadone can be prescribed to patients to treat pain under Medicare’s prescription drug benefit, known as Part D. For Medicare to cover it as an addiction treatment, it would have to be added to Medicare Part B, which pays for provider services.

“It’s kind of puzzling why physicians are allowed to prescribe addictive pain medications through Medicare but not allowed to prescribe medications to help them fight a substance use disorder on the other side of that,” said former Rep. Mary Bono, co-founder of the Collaborative for Effective Prescription Opioid Policies, during a briefing at the Capitol last month.

Rep. Richard Neal of Massachusetts, the top Democrat on the House Ways and Means Committee, recently sponsored a bill that would include methadone treatment under Medicare Part B.

“There’s a tendency to assume this crisis is concentrated among young people but it’s crept into the older population,” Neal said.

Advocates have been pushing for Neal’s measure, and one source who works in opioid policy said the bill could be part of a larger package the House Energy and Commerce Committee may take up next year. But so far, it only has Democratic support. The bill hasn’t been scored, but Neal’s office said it was drafted to be budget neutral.

The recent presidential report on opioids, which offered sweeping recommendations for battling the epidemic, made little mention of the older population. However, it did broadly recommend expanding access to medication assisted treatment.

Beyond Medicare coverage, policy experts say the health system needs to be more proactive about flagging older adults at risk of prescription drug abuse. A report from GAO earlier this year found CMS failed to identify hundreds of thousands of seniors at risk of becoming addicted to opioids. CMS had flagged 33,223 Medicare beneficiaries at high risk, while about 727,016 were actually at risk of receiving high doses of the drug, GAO said.

Kathleen Cameron of the National Council on Aging said it can be difficult to detect addiction in older people because the symptoms mimic other problems like confusion, coordination and problems with vision.

“Some older people may not even realize they have a problem,” she said. She added that seniors are at high risk of abuse because there aren’t “a lot of good alternatives to opioids.”

“We see pain a lot in this population,” Cameron. “Because we don’t have many treatments for pain, opioids are often given.”

She said integrating screening into seniors’ primary care would helpful, as well as educating doctors about how to detect prescription abuse in older Americans and educating seniors about the risks of taking these medications.

“Their needs are very different than someone in their 30s and 40s,” Cameron said.

@aatod1984
  • TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION #aatod2024

TODAY is the last day to take advantage of the discounted registration rate. #aatod2024 is the world’s premier training conference event for the treatment of #OUD.

For registration and hotel information ➡️ bit.ly/3Ue57Q6.

We look forward to seeing you in Las Vegas!
  • #aatod2024 Conference Update. Comprehensive Listing/Descriptions of Workshops, Posters, and Hot Topic Roundtable Conference Sessions are now available ➡️ http://bit.ly/3Ue57Q6.

The workshop committee is pleased to present a dynamic workshop lineup that includes extremely rich and diverse educational content for all disciplines. You will hear from experts who will share the latest research and developments relating to opioid use disorders and treatment. The workshop lineup will include state of the art information on diverse areas of focus such as patient care and best practices, building community partnerships and collaborations, public policy and regulatory changes, workforce development, quality assurance, and financial reimbursement. There will be workshops that focus on emerging treatment trends and developments such as the fentanyl epidemic, mobile opioid treatment programs, regulatory changes, expansion of treatment services in rural areas, integrating treatment with the corrections systems, and integrating harm reduction initiatives. For those newer to the field or those who want a refresher on the basics, we have once again included a “Foundations” track which will include selections on the fundamentals of medication assisted treatment.

The conference will continue to be the world’s premier training and education event for the treatment of opioid use disorders.  We hope to see you in Las Vegas!
  • Patient access to OTPs saves lives every day.

AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. 

Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
  • Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. 

“Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA 

Read More ➡️ bit.ly/3tKb1gy
  • Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
  • Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. 

Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. 

Register ➡️ bit.ly/461CkkG
  • Final Opportunity to Submit Proposals for the #aatod2024 Conference. The submission window will close tonight at 12am ET.

To submit a proposal, please follow the on-screen instructions, bit.ly/3KxQSzU. For questions or additional information regarding the Call for Presentations, please send an email to meetings@aatod.org or call 856-423-3091.

We look forward to receiving your submissions and hope to see you at the conference for what will be the premier conference on the treatment of opioid use disorders in 2024! #morethanmedicine #programnotapill #opioids #OUD #OpioidUseDisorder #submitproposal
  • Today is the Final Day to Submit Proposals for the #aatod2024 conference, 9/21 ➡️ bit.ly/3KxQSzU

The Workshop Committee encourages you to submit proposals on innovative initiatives to enhance patient outcomes, improve program development and administration, promote integration across the continuum of care, and the development of collaborations with organizations outside of the traditional opioid treatment system.

Conference Objectives:
1️⃣Conduct a comprehensive review of the latest evidence addressing the opioid epidemic and its implications for patients, clinicians, administrators, and policy makers by identifying the most effective interventions.
2️⃣Discuss peer to peer approaches in treating opioid use disorder in an effort to improve patient outcomes in health systems, organizations, and communities.
3️⃣Evaluate the gaps in current services for opioid use disorder and develop recommendations to improve the delivery of multidisciplinary care in various populations based upon evidence-based practices.
4️⃣Disseminate a comprehensive plan of innovative services designed to treat emerging needs of patients with opioid use disorder and improve patient outcomes by providing examples of effective methods and how to implement them.
5️⃣Identify effective referral pathways to other health services offering treatment for conditions associated with opioid use disorder addiction and/or recovery by developing partnerships within the community.
  • We are pleased to announce that the deadline for submitting presentations for the #aatod2024 Conference has been extended to Thursday, September 21, 2023.

We encourage all interested parties to take advantage of this opportunity and submit their proposals as soon as possible. We look forward to receiving your proposals and to seeing you in Las Vegas in 2024. 

https://conta.cc/3PiV5ck
  • August 31st is International Overdose Awareness Day 
💜 #IOAD2023 
💜 #NaloxoneSavesLives 
💜 #EndOverdoseNow

Please contact your State Opioid Treatment Authority for locations in your community that distribute naloxone kits —> bit.ly/3qVPOPz. 

 Full Video 🎥 bit.ly/3ElzdYD
TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION #aatod2024

TODAY is the last day to take advantage of the discounted registration rate. #aatod2024 is the world’s premier training conference event for the treatment of #OUD.

For registration and hotel information ➡️ bit.ly/3Ue57Q6.

We look forward to seeing you in Las Vegas!
TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION #aatod2024 TODAY is the last day to take advantage of the discounted registration rate. #aatod2024 is the world’s premier training conference event for the treatment of #OUD. For registration and hotel information ➡️ bit.ly/3Ue57Q6. We look forward to seeing you in Las Vegas!
3 weeks ago
View on Instagram |
1/10
#aatod2024 Conference Update. Comprehensive Listing/Descriptions of Workshops, Posters, and Hot Topic Roundtable Conference Sessions are now available ➡️ http://bit.ly/3Ue57Q6.

The workshop committee is pleased to present a dynamic workshop lineup that includes extremely rich and diverse educational content for all disciplines. You will hear from experts who will share the latest research and developments relating to opioid use disorders and treatment. The workshop lineup will include state of the art information on diverse areas of focus such as patient care and best practices, building community partnerships and collaborations, public policy and regulatory changes, workforce development, quality assurance, and financial reimbursement. There will be workshops that focus on emerging treatment trends and developments such as the fentanyl epidemic, mobile opioid treatment programs, regulatory changes, expansion of treatment services in rural areas, integrating treatment with the corrections systems, and integrating harm reduction initiatives. For those newer to the field or those who want a refresher on the basics, we have once again included a “Foundations” track which will include selections on the fundamentals of medication assisted treatment.

The conference will continue to be the world’s premier training and education event for the treatment of opioid use disorders.  We hope to see you in Las Vegas!
#aatod2024 Conference Update. Comprehensive Listing/Descriptions of Workshops, Posters, and Hot Topic Roundtable Conference Sessions are now available ➡️ http://bit.ly/3Ue57Q6. The workshop committee is pleased to present a dynamic workshop lineup that includes extremely rich and diverse educational content for all disciplines. You will hear from experts who will share the latest research and developments relating to opioid use disorders and treatment. The workshop lineup will include state of the art information on diverse areas of focus such as patient care and best practices, building community partnerships and collaborations, public policy and regulatory changes, workforce development, quality assurance, and financial reimbursement. There will be workshops that focus on emerging treatment trends and developments such as the fentanyl epidemic, mobile opioid treatment programs, regulatory changes, expansion of treatment services in rural areas, integrating treatment with the corrections systems, and integrating harm reduction initiatives. For those newer to the field or those who want a refresher on the basics, we have once again included a “Foundations” track which will include selections on the fundamentals of medication assisted treatment. The conference will continue to be the world’s premier training and education event for the treatment of opioid use disorders. We hope to see you in Las Vegas!
4 weeks ago
View on Instagram |
2/10
Patient access to OTPs saves lives every day.

AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. 

Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
Patient access to OTPs saves lives every day. AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
3 months ago
View on Instagram |
3/10
Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. 

“Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA 

Read More ➡️ bit.ly/3tKb1gy
Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. “Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA Read More ➡️ bit.ly/3tKb1gy
4 months ago
View on Instagram |
4/10
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery. Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1 For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
5 months ago
View on Instagram |
5/10
Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. 

Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. 

Register ➡️ bit.ly/461CkkG
Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. Register ➡️ bit.ly/461CkkG
5 months ago
View on Instagram |
6/10
Final Opportunity to Submit Proposals for the #aatod2024 Conference. The submission window will close tonight at 12am ET. To submit a proposal, please follow the on-screen instructions, bit.ly/3KxQSzU. For questions or additional information regarding the Call for Presentations, please send an email to meetings@aatod.org or call 856-423-3091. We look forward to receiving your submissions and hope to see you at the conference for what will be the premier conference on the treatment of opioid use disorders in 2024! #morethanmedicine #programnotapill #opioids #OUD #OpioidUseDisorder #submitproposal
5 months ago
View on Instagram |
7/10
Today is the Final Day to Submit Proposals for the #aatod2024 conference, 9/21 ➡️ bit.ly/3KxQSzU The Workshop Committee encourages you to submit proposals on innovative initiatives to enhance patient outcomes, improve program development and administration, promote integration across the continuum of care, and the development of collaborations with organizations outside of the traditional opioid treatment system. Conference Objectives: 1️⃣Conduct a comprehensive review of the latest evidence addressing the opioid epidemic and its implications for patients, clinicians, administrators, and policy makers by identifying the most effective interventions. 2️⃣Discuss peer to peer approaches in treating opioid use disorder in an effort to improve patient outcomes in health systems, organizations, and communities. 3️⃣Evaluate the gaps in current services for opioid use disorder and develop recommendations to improve the delivery of multidisciplinary care in various populations based upon evidence-based practices. 4️⃣Disseminate a comprehensive plan of innovative services designed to treat emerging needs of patients with opioid use disorder and improve patient outcomes by providing examples of effective methods and how to implement them. 5️⃣Identify effective referral pathways to other health services offering treatment for conditions associated with opioid use disorder addiction and/or recovery by developing partnerships within the community.
5 months ago
View on Instagram |
8/10
We are pleased to announce that the deadline for submitting presentations for the #aatod2024 Conference has been extended to Thursday, September 21, 2023. We encourage all interested parties to take advantage of this opportunity and submit their proposals as soon as possible. We look forward to receiving your proposals and to seeing you in Las Vegas in 2024. https://conta.cc/3PiV5ck
5 months ago
View on Instagram |
9/10
August 31st is International Overdose Awareness Day 💜 #IOAD2023 💜 #NaloxoneSavesLives 💜 #EndOverdoseNow Please contact your State Opioid Treatment Authority for locations in your community that distribute naloxone kits —> bit.ly/3qVPOPz. Full Video 🎥 bit.ly/3ElzdYD
6 months ago
View on Instagram |
10/10

Announcing groundbreaking updates: HHS/SAMHSA's new regulations mark a significant step forward for opioid treatment programs. Fostering enhanced accessibility, flexibility and patient dignity. Gratitude to @@AATOD1984 for their pivotal role in this progress. #OpioidTreatment

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