By Jessica Hall
Fewer than 40% of Medicare beneficiaries with opioid-use disorders receive proper care, study finds
In 2022, 52,000 Medicare beneficiaries experienced an opioid overdose, according to the Centers for Disease Control and Prevention.
No one expects Grandma to have a drug addiction – but it’s more common than you may think.
Older adults have seen the largest increase in drug overdoses of any age group as doctors prescribe opioids for chronic pain without creating plans for weaning patients off the medication and without keeping an eye out for signs of abuse, experts said.
In 2023, 6.4 million Medicare beneficiaries had a substance-use disorder, including alcohol-use disorders and other drug disorders. Of these, 1.9 million had an opioid-use disorder, according to the National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration.
From 2022 to 2023, people 65 and older saw an 11.4% increase in drug-overdose rates, the largest increase of any age group, according to the Centers for Disease Control and Prevention. In 2022, 52,000 Medicare beneficiaries experienced an opioid overdose.
“Many older adults’ opioid abuse flies under the radar. Providers often don’t ask seniors about overusing or abuse,” said Olivera Bogunovic-Sotelo, an assistant professor of psychiatry at Harvard Medical School and an expert on addiction. “Providers are doing better about screening for alcohol usage and alcohol addiction, but there’s not the same scrutiny of opioid abuse. They may see [a patient’s] opioid prescription, but they’re not asking, ‘Are you overusing opioids?’ And from the patient’s perspective, they think the doctor prescribed it, so they can use it. There isn’t as much caution around it as there should be.”
Read: Older adults are drinking more. Could that pose a public-health risk?
A new study published in the journal Health Affairs found that fewer than 40% of Medicare beneficiaries with opioid-use disorders received the proper care under standard quality measures. Medicare Advantage performed worse than traditional Medicare on six of the eight measures. Medicare also performed worse than Medicaid on all three quality measures available for comparison.
The quality measures included such things as treatment initiation and engagement; follow-up seven days after an emergency department visit for opioid-use disorder; and follow-up 30 days after an emergency department visit or after hospitalization for opioid-use disorder.
The share of the Medicare population receiving care for opioid-use disorders ranged from a low of 11% for starting treatment to a high of 38% for hospital follow-up within 30 days, the study found.
The Centers for Medicare & Medicaid Services declined to comment.
“Older adults are being overprescribed. Everyone is being overprescribed, but with older adults, there may be other medications at play and less awareness of the issue of abuse or misuse,” said Faika Zanjani, a professor of gerontology and an associate dean of research at Virginia Commonwealth University. “There’s also a problem of doctors not talking to each other and not coordinating care. And something will be overlooked.”
Older adults metabolize medication more slowly, so opioids linger much longer in their system, Bogunovic-Sotelo said. That can affect how they feel and how other medications in their body interact, she said.
The difficult of treating chronic pain
“Many older adults struggle with chronic pain,” Bogunovic-Sotelo said, noting that 80% have arthritis. “Some get opioid prescriptions to handle pain. This may interfere with other medications they’re on.”
She added: “An older adult may have too many medications that aren’t being managed properly.”
Providers, friends and family members may mistakenly attribute symptoms of opioid-use disorders – such as being unsteady or forgetful – to underlying chronic conditions rather than drug misuse, said Amanda Krisher, associate director of behavioral health at the National Council on Aging’s Center for Healthy Aging.
Isolation can also make it more challenging to spot potential signs of abuse among older people, Krisher said.
Read: There aren’t enough doctors to care for older people, and it’s only going to get worse
Zanjani noted that another problem is a lack of specialists in the medical treatment of older adults.
Doctors also don’t spend enough time talking to patients about overuse of opioids, experts said.
“There’s not a lot of time spent on addiction prevention at all. It’s only treating after the fact. Older adults should have prescription reviews happening at well visits, but it’s not happening,” Zanjani said.
“If someone’s in pain, there’s no hesitancy in prescribing for pain. But talking about exercise, yoga or weight loss? No. The easiest route is prescribing. Medication is the easier button to push. It’s the norm. De-prescribing and exercise every day needs to be the norm, but it’s not,” she said.
Zanjani said that the process of getting a patient off a medication can be challenging. “De-prescribing increases people’s lifespans, but that’s not happening,” she said.
“Providers are not looking for abuse. They’re not looking for signs of it. They’re not talking about it. Those conversations aren’t happening at all with patients. And the older generation really trusts their doctor. My doctor prescribed it, so it must be OK – that’s the attitude. There’s a risk of self-escalating, of self-medicating. There’s not critical questioning happening on either side,” Zanjani said.
Ageism affects care
Ageism also plays a role, Zanjani said. “Addiction screenings don’t happen with seniors. The assumption is made that because they’re older adults, they won’t be abusing. But the rates keep increasing,” she said.
Krisher said there’s a common misconception in the medical community that older adults don’t overuse substances, but she noted that the “current generation of older adults came of age in the era of drugs, sex and rock and roll. They are not averse to using drugs or alcohol.”
Bogunovic-Sotelo agreed that ageism plays a role.
“People don’t expect [older adults] to misuse or abuse opioids, and they tend to think the symptoms of overuse are related to aging rather than the drug use itself,” she said.
Another sign of ageism is that medical providers may think it’s too late to intervene when an older person shows signs of addiction, Krisher said.
“Doctors may approach the situation [thinking] that the person is going to die anyway, so why bother treating the opioid-use disorder? But everyone deserves that chance,” Krisher said.
-Jessica Hall
This content was created by MarketWatch, which is operated by Dow Jones & Co. MarketWatch is published independently from Dow Jones Newswires and The Wall Street Journal.
(END) Dow Jones Newswires
09-11-25 1215ET
Copyright (c) 2025 Dow Jones & Company, Inc.