Supporting the Safe Use of Prescription Opioids Among Older Adults

ADvancing States is a membership association that represents the designated aging, disability and long-term service and support agencies in states, territories and the District of Columbia. Formerly known as the National Association of States United for Aging and Disabilities (NASUAD), the organization supports states through a wide range of activities, which includes engaging Congress and the federal government to improve policy; providing outreach and education to states and partners; and working directly with the state agencies to help them improve the services and supports that they oversee.

To learn more about how ADvancing states engages leaders in the senior space on policy and program development related to the opioid abuse crisis, Allied Against Opioid Abuse (AAOA) interviewed Damon Terzaghi, Senior Director of Long-Term Services and Supports (LTSS) Policy at ADvancing States.

 

AAOA: How does the opioid epidemic impact older Americans?

Damon Terzaghi: Although much of the discussion around the opioid crisis focuses on working-age adults, it’s important to consider how older Americans are being impacted. For instance, one key and often overlooked component is the increase in utilization and abuse among older Americans. According to the Agency for Healthcare Research and Quality, opioid related hospitalizations for individuals aged 65 and over increased by more than one-third between 2010–2015 and emergency department visits for this age group increased by 74 percent during the same period.

As the nation seeks to reduce opioid dependency, we must consider the challenges that arise when parsing out appropriate pain management strategies for older adults with chronic conditions versus improper and unsafe prescribing patterns. These issues require ongoing research and engagement across the research and development, medical and social services fields.


AAOA:
How is ADvancing States engaged to help address the opioid epidemic?

Damon Terzaghi: As part of our ongoing survey of state agencies, we are tracking trends in abuse, neglect and exploitation around the country. Our series of state surveys has tracked these events, and the increase in cases is truly alarming. Anecdotal feedback from state leaders indicates that they believe there is a strong correlation between many of these cases and prescription opioid abuse — by the individual, their caregiver and/or their family members. However, agencies are struggling to collect tangible data on these issues, and this could be an area for future exploration.

Additionally, our network provides significant support to family caregivers who are caring for a loved one. One recent trend is the growth in older adults caring for their grandchildren (or, in some cases, great-grandchildren) which is partially driven by opioid-related addictions or death of a parent. This issue has been highlighted in recent hearings on the reauthorization of the Older Americans Act in the House and the Senate, seeking more flexibility to serve grandparents under the National Family Caregiver Support program.


AAOA:
Why did ADvancing States join Allied Against Opioid Abuse?

Damon Terzaghi: ADvancing States recognizes that we are not experts in identifying, treating and preventing opioid abuse and dependency, but that these issues are extremely important for our members and the people we serve. A core part of effective health and human service delivery involves coordinating with experts to ensure that the most effective and up-to-date information is available to the team that supports the individual. AAOA helps provide our states with information, research and access to expertise on these important issues, and we are happy to share AAOA resources via our weekly newsletter.

We also recognize that safe storage and disposal is another important part of curbing opioid abuse. Many older adults may have legitimate opioid prescriptions, which are likely to continue to exist at that individual’s residence. However, theft of opioids by caregivers and families is a pervasive problem across the country. AAOA resources can help the aging and disability network educate their providers and the individuals they serve about ways to prevent this from occurring.


AAOA:
Last year, your organization conducted a survey that asked state agencies about their partnership efforts on substance abuse issues. How are you seeing agencies work together at the state-level to address the opioid crisis?

Damon Terzaghi: One of the key roles of aging and disability organizations involves convening experts in a wide range of topics and helping translate their expertise to the needs of older adults and individuals with disabilities. Sometimes this collaboration can be as simple as providing resources, such as fact sheets, directories for safe disposal locations, or tip sheets identifying signs of abuse, to the entities that deliver services to the participants. Other times it can involve combining funding sources from multiple programs to host trainings for service professionals, or to establish educational campaigns for the general public. Lastly, sometimes it is simply important to remind those in charge of policy and programs that older adults have unique needs and challenges.


AAOA:
Where are the gaps in knowledge for older adults, people with disabilities and their caregivers when it comes to safe storage and disposal of prescription opioids? What more can state agencies do to integrate educational efforts into their long-term services and supports systems?

Damon Terzaghi: According to a survey of over 200 service providers done by our partners at the National Council on Aging, 80 percent of respondents indicated that their clients did not have knowledge of safe alternatives to opioids nor of proper ways to store and dispose of their existing prescriptions. Given how much energy has been expended at a national level to increase information and awareness of these trends, it is concerning to see these types of gaps in understanding and knowledge at the local level.

From our perspective, there is often a language gap when those individuals steeped in policy and technical issues try to engage with broader populations. Crafting messages that actually resonate with people and help them understand how they are affected is a challenge across a wide range of government supports and services.

For long-term services and support systems, it will be important to work with the touchpoints that already serve individuals in the community — such as area agencies on aging, senior centers, Medicaid case managers, and congregate or home-delivered meal providers. This involves tailored information that explains why it’s important to the participants they serve, what signs to look for and where to go for help if an issue arises.

Answers have been edited for brevity and clarity.