Substance Use and Access to Care among Older Adults

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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.