Substance Use and Access to Care among Older Adults

项目摘要 由于阿片类药物中毒的增加，药物过量死亡率迅速上升， 美国的平均预期寿命已经下降。尽管美国老年人不太可能滥用 阿片类药物，自1999年以来，55至64岁的人群中药物过量的比例增加最多， 阿片类药物死亡发生在45岁及以上的人群中。2018年，80%患有阿片类药物使用障碍的美国人 (OUD)没有接受任何治疗。老年人尤其处于不利地位。2017年，只有35%的 治疗机构接受医疗保险作为支付，医疗保险本身不包括美沙酮，一种药物，往往 用于循证药物辅助治疗（MAT）。此外，由于缺乏地理上的便利， 专业治疗是一个广泛的问题，美国85%的县缺乏治疗中心， 阿片类药物治疗计划对于老年人，访问挑战可能会加剧，因为大约25 65岁以上的美国人中，有30%居住在小城镇或其他农村地区，这一比例高于2010年。 年轻的成年人。农村地区的药物滥用治疗中心也往往较少， 吸毒过量这些数据通常用于跟踪有执照的SAT中心的供应-全国SAT调查 服务（N-SSATS）-不允许缺少区分中心所必需的设施标识符 开场白和结束语以及调查无回应。这一区别很重要，因为调查无答复确实 这并不意味着附近设施（或通道）的实际数量发生了变化，而开放和关闭则发生了变化。的 这一R21的总体目标是增加对SAT设施和健康的地理可及性的理解 保险待遇的覆盖面，是否与待遇差距有关，政策如何完善 获得服务将影响老年人的长期健康结果和费用。我们的具体目标是： 目标1。使用小说跟踪和描述50岁以上老年人对SAT中心的地理访问 与健康和退休相关的心理健康和成瘾治疗跟踪库（MATTR） 研究和全国药物使用和健康调查。 目标二。确定老年人在SAT可用性方面存在的差异程度， 城乡位置和州级阿片类药物政策。 目标3。预测获得治疗机会不平等对健康轨迹和医疗保健费用的长期影响 使用微观模拟方法，未来老年人模型。 拟议中的R21是在新的许可SAT中心之间建立数据链接的必要的第一步 与其他国家代表性的调查数据库，并应用微观模拟建模， 政策努力解决晚年的OUD问题。

Project Summary The rate of drug overdose deaths has increased so rapidly due to increases in opioid-poisonings that the average life expectancy in the United States has declined. Although older Americans are less likely to misuse opioids, rates of drug overdose have increased the most among those aged 55 to 64 since 1999 and 45% of all opioid deaths are among individuals age 45 and older. In 2018, 80% of Americans with opioid use disorders (OUD) received no treatment. Older adults are particularly disadvantaged. In 2017, only 35 percent of treatment facilities accepted Medicare as payment and Medicare itself does not cover methadone, a drug often used in the evidence-based medication assisted treatment (MAT). Additionally, lack of geographic access to specialty treatment is a broad problem with 85 percent of counties in the U.S. lacking a treatment center with an opioid treatment program. For older adults, access challenges may be exacerbated as approximately 25 percent of Americans older than age 65 live in a small town or other rural area; a rate that is higher than for younger adults. Rural areas also tend to have fewer substance abuse treatment (SAT) centers and higher rates of overdose. The data typically used to track the supply of licensed SAT centers – the National Survey of SAT Services (N-SSATS) – do not allow lack facility identifiers that are necessary to distinguish between centers opening and closing and survey non-response. This distinction is important because survey non-response does not mean the actual number of facilities nearby (or access) has changed whereas openings and closings do. The overall objective of this R21 is to increase understanding of geographic access to SAT facilities and to health insurance coverage of treatment, whether it is related to disparities in treatment and how policies to improve access will affect long-term health outcomes and costs among older adults. Our specific aims are to: Aim 1. Track and characterize geographic access to SAT centers for older adults age 50+ using the novel Mental health and Addiction Treatment Tracking Repository (MATTR) linked to the Health and Retirement Study and the National Survey of Drug Use and Health. Aim 2. Determine the extent to which disparities for older adults exist in the availability of SAT based on urban-rural location and state-level opioid policies. Aim 3. Project long-term effects of disparities in access to treatment on health trajectory and healthcare costs using a microsimulation approach, the Future Elderly Model. The proposed R21 is a necessary first step to creating data linkages between the novel licensed SAT center repository with other nationally representative survey datasets and to applying microsimulation modeling to policy efforts to address OUD in later life.