The overdose crisis is not just a story about young people. It’s increasingly about our parents and grandparents. Between 2000 and 2020, deaths among adults over 55 rose more than tenfold, nearly 9,000%. According to the Centers for Disease Control and Prevention (CDC), in 2022 alone, nearly 6,700 people aged 65 and older died from drug overdoses, most involving prescription opioids, benzodiazepines or alcohol.
These aren't just statistics; they represent people who live full lives, care for others and deserve better from our health system. Many face untreated pain, overprescribing, social isolation and a system unprepared to support their recovery. Many older adults fall into this crisis through iatrogenic addiction — dependence caused by a physician's well-meaning prescription for chronic pain or anxiety. Adding to this, the use of multiple medications increases the risk of dangerous drug interactions, accounting for a disproportionate number of fatal overdoses in this age group.
At the center of this challenge is Medicare, the primary source of health coverage for older Americans. While it pays for detox and limited outpatient care, its structure still reflects an outdated, crisis-response model: treating addiction as a short-term medical issue rather than a chronic, manageable condition.
Outdated and restrictive coverage limits pose major obstacles to substance use treatment for Medicare beneficiaries. Medicare fails to cover the full spectrum of services, providers and treatment settings needed for effective care. As a result, many beneficiaries receive little to no treatment until their condition worsens and requires hospitalization. Too often, older adults are referred to residential treatment programs that lack qualified staff, standardized practices or measurable outcomes. Research presented at the 2024 American Public Health Association conference found that many such facilities operate without credentialed professionals or oversight, leading to poor outcomes and wasted dollars. Older adults also face unique barriers: stigma, limited screening by primary care providers and complex medication interactions. These challenges demand smarter policies that focus on prevention, integration and accountability; not the expansion of unregulated care.
We believe good policy starts with evidence and compassion. Real Medicare reform can save lives when it is focused on three proven solutions:
1. Integrate Behavioral Health into Primary Care.
For most older adults, primary care is their first and often only point of contact with the health system. Embedding substance use screening and treatment into these visits ensures early detection and reduces hospitalizations. The Collaborative Care Model, tested within Medicare, has shown significant reductions in substance use and improved mental health outcomes. This approach works and can be scaled nationally.
In addition to integration, focusing on policies which increase overall coverage and parity for Medicare Advantage plans should be enforced.
2. Eliminate Cost Sharing for Medications for Opioid Use Disorder (MOUD).
Methadone and buprenorphine are the most effective treatments for opioid use disorder, yet Medicare’s copays, particularly those incurred under the Part D structure, often prevent adherence. Congressional cuts threaten to make the State Opioid Response (SOR) grants that subsidize these medications in many communities vanish, leaving seniors with difficult financial choices. Studies show that when cost-sharing is removed, treatment retention improves by 40% and overdose deaths decline.
3. Expand and Standardize Crisis and Community-Based Services.
Older adults in crisis shouldn’t end up in emergency rooms or unregulated facilities. This challenge is particularly acute in rural areas, which have seen higher age-adjusted overdose death rates than urban areas since 2015. Given the widespread closure of rural hospitals and limited specialty mental health providers (often termed "treatment deserts"), relying solely on facility-based care is a non-starter.
Medicare can instead cover mobile crisis teams and short-term stabilization units, which are scalable, community-based solutions that connect people to ongoing treatment. For residential care, policy must demand accountability, as outlined in proposals like the Residential Recovery for Seniors Act, which calls for standardized residential services that are medically necessary, patient-centered and clinically appropriate. For example, the Certified Community Behavioral Health Clinic (CCBHC) model, supported by SAMHSA, is demonstrating success in rural areas by requiring around the clock crisis services and integrating a broad range of care, significantly reducing emergency department use. These types of models reduce hospitalizations and overdoses while ensuring care is close to home, a vital consideration where travel distances often pose a significant barrier to consistent treatment adherence for seniors.
Together, these reforms reflect the need for data-driven, human-centered policy. Expanding access without accountability risks repeating past mistakes. Instead, we must invest in what works; integrated care, prevention and oversight that protects both patients and public funds.
The rise in overdose deaths among older Americans is not an inevitable part of aging. It’s a preventable failure of fragmented care. Medicare has the authority and responsibility to change this. With reforms rooted in evidence and empathy, we can help older adults live longer, healthier and with the dignity they deserve.
To learn more about our OPI’s mission to advance policy solutions that save lives and end the U.S. overdose crisis, visit our program page.
