Disclaimer: The views, opinions, and content expressed in this presentation do not necessarily reflect the views, 

opinions, or policies of the Center for Substance Abuse Prevention (CSAP), the Substance Abuse and Mental 

Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).
Chat with Us!

In the chat pod, share with us:

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2
Improving Opioid Misuse Prevention 

Literacy Between Older Adults and Health 

Care Providers 

National Prevention Week Webinar

March 28, 2019 
Recording in Progress!

This meeting will be recorded for 

archiving purposes.

4
David Lamont Wilson 

NPW Coordinator

Public Health Analyst, Center for Substance Abuse Prevention

Substance Abuse and Mental Health Services Administration
Today’s Presenters

• Jennifer Solomon, MA, Public Health Analyst, SAMHSA

• Kathleen A. Cameron, MPH, Senior Director, Center for Healthy Aging, 

National Council on Aging

• Carol Levine, Director, Families and Health Care Project, United 

Hospital Fund

• Jane Marks, RN, MS, Associate Director, Johns Hopkins Geriatric 

Workforce Enhancement Program

6
NPW 2019

7
NPW 2019 Daily Health Themes

Monday, May 13 Prevention of Prescription & Opioid Drug 

Misuse

Tuesday, May 14 Prevention of Underage Drinking & 

Alcohol Misuse

Wednesday, May 15 Prevention of Illicit Drug Use & Youth 

Marijuana Use

Thursday, May 16 Prevention of Youth Tobacco Use

Friday, May 17 Prevention of Suicide

8
Pre·ven·tion Cham·pi·on 

Noun: a person, activity, program, or 

organization that inspires others to take 

prevention actions every day that 

change lives.

9
10

2019 NPW Planning Guide and Resource Calendar

12
Prevention Every Day

samhsa.gov/prevention-week

13
SAMHSA Behavioral Health Treatment Locator

14

https://findtreatment.samhsa.gov/
Jennifer Solomon, MA

Public Health Analyst

Center for Substance Abuse Prevention, SAMHSA
Substance Use/Misuse in Older Adults

16
• More than 80 percent of older adults use at least one prescription on a daily basis, 

with 50 percent taking five or more medications and supplements daily.1

• Nearly 16.2 million older adults over the age of 65 drank alcohol in the past month, 

with 3.4 million reporting binge alcohol use and 772,000 reporting heavy alcohol 

use.2

• SAMHSA’s TIP 26: Substance Abuse Among Older Adults estimates that a combination 

of alcohol and medication misuse affects up to 19 percent of older Americans.3

Prevalence of Substance Use/Misuse in Older Adults

1 Mattson, M., Lipari, R. N., Hays, C., & Van Horn, S. L. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services 

Administration. (2017). A day in the life of older adults: Substance use facts. Rockville, MD: Substance Abuse and Mental Health Services Administration.

2 What is the Scope of Prescription Drug Misuse, NIDA, 2015

3 Substance Abuse and Mental Health Services Administration (SAMHSA). (1998). Substance abuse among older adults: Treatment Improvement Protocol #26. 

17
Major Challenges of Our Time for Older Adults How the opioid crisis has affected older adults:

• Rates of opioid analgesic use is higher among older adults1:

• 8.1 percent for ages 40–59 

• 7.9 percent for those 60 and over

• According to CDC’s MMWR, in 2016 more than 44,000 Americans died from opioid 

overdose deaths, of which more than 7,000 were aged 55 and older.2

• NSDUH data indicate that opioid misuse increased among older adults (50+) from 

1.1 percent in 2002 to 2.0 percent in 2014, and by 2020 it’s estimated to increase to 

3.1 percent (5.7 million people).3

1 Centers for Disease Control and Prevention. (2015). National Center for Health Statistics Data Brief.

2 Centers for Disease Control and Prevention. (2019). Morbidity and Mortality Weekly Report. January 4, 2019. 

3 Substance Abuse and Mental Health Services Administration. (2017). CBHSQ Report, July 25, 2017.

18

The Opioid Crisis and Older Adults 
• One-fifth of emergency department (ED) visits involving prescription medication use 

among older adults were made by persons aged 70 or older.

• Medications involved in ED visits made by older adults:

• 43.5 percent pain relievers 

• 31.8 percent medications for anxiety or insomnia

• 8.6 percent antidepressants 

• What happened after ED visit?

• 52.3 percent were treated and released

• 37.5 percent were admitted to the hospital

Emergency Department Visits Related to Medication Use/Misuse

Source: Substance Abuse and Mental Health Services Administration. (2010). Drug Abuse Warning Network Report.

19
SAMHSA’s Work Regarding Older Adults

• Older Adult Evidence-based Mental Health Practices Panel – June 2017

• Older Adults with SMI and the Behavioral Health Workforce – May 2018

• Older Adult Mental Health Awareness Day – May 2018 and 2019

• Aging and Disability Resource Center (ADRC) and Older Adults with Serious Mental Illnesses 

Expert Panel – August 2018

• Older Adult Peer Services Expert Panel – September 2018

• National Prevention Week Older Adults Webinar – March 2019

• Treatment Improvement Protocol: Treating Addiction in Older Adults (in progress)

SAMHSA Activities Focused on Older Adults

20
SAMHSA’s Role with the Aging Network 

Developing stronger ties with ACL and others in order to:

• Provide training and technical assistance (TTA) to improve service delivery;

• Support family caregivers;

• Improve the workforce;

• Identify evidence-based practices; and

• Provide information to the public.

SAMHSA’s Role with Administration for 

Community Living’s (ACL) Aging Network 

21
Get Connected: Linking Older Adults with Resources on

Medication, Alcohol, and Mental Health

22
23

Get Connected Toolkit

The Get Connected Toolkit helps communities:

• Build health promotion programs

• Offer prevention messages and education

• Provide screening and referral for mental health 

problems and misuse of alcohol and medications

www.samhsa.gov

“It Can Happen to Anyone: Alcohol and Medication Among Older Adults” video 

https://www.youtube.com/watch?v=FQan4-6amJk
Get Connected Toolkit Goals

24

• Educate older adults.

• Link older adults to resources.

• Help provider staff understand substance use/misuse and mental health issues.

• Increase staff competence and confidence.
Get Connected Toolkit Goals (continued) 

25

• Help organizations understand and assess how ready they are to deliver 

substance use prevention services.

• Encourage peer support. 

• Provide additional tools and resources. 
Get Connected Toolkit: Session Topics 

26

• Session One: It Can Happen to Anyone – Coping with 

Life Transitions

• Session Two: Using Medication Wisely

• Session Three: Keeping a Healthy Outlook on Life
Who Will Benefit From Using the Get Connected Toolkit

27

• Senior centers

• Adult day health services

• Nutrition programs

• State and local agencies
Who Will Benefit From Using the Get Connected Toolkit (continued) 

28

• Administration for Community Living’s Area Agencies on Aging

• Health and social services providers

• Faith-based organizations 

• Nursing homes 
Additional Resources

29
Source: Safe Use of Medicines for Older Adults, National Institutes of Health. Retrieved from https://www.nia.nih.gov/health/safe-use-medicines-older-adults

This National Institutes of Health resource provides questions older adults can ask 

their doctors about the medications they are taking. These are a sample of the 

questions:

• What is the name of the medicine and why am I taking it?

• What medical condition does this medicine treat?

• How many times a day should I take it? At what time(s)?

• If the bottle says take “4 times a day,” does that mean 4 times in 24 hours or 4 

times during the daytime?

Safe Use of Medicines for Older Adults

30
Medication Management in Older Adults

These guidelines are intended to help health 

care providers improve patient outcomes when 

providing opioid treatment, including potential 

adverse outcomes associated with the use of 

opioids to treat pain.

State Example of Prescribing Guidelines

31
Additional Actions Communities Can Take Along 

with Using the Get Connected Toolkit

32

• Participate in National Prescription Drug 

Take Back Days. 

• Share SAMHSA resources with your 

community.

• Educate members of your community 

about how to talk to their doctors or 

other prescribers about medications.
www.SAMHSA.gov

Additional SAMHSA Resources 

33
Additional SAMHSA Resources (continued) 

34

www.SAMHSA.gov
Additional SAMHSA Resources (continued) 

35

www.SAMHSA.gov

www.SAMHSA.gov
SAMHSA Helplines and Treatment 

Locators

https://findtreatment.samhsa.gov/

https://suicidepreventionlifeline.org/

https://www.samhsa.gov/find-help/national-helpline

36

Additional SAMHSA Resources (continued) 
Jennifer Solomon, M.A.

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Prevention

Email: Jennifer.Solomon@SAMHSA.HHS.gov

SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on 

America’s communities.

www.SAMHSA.gov

1-877-SAMHSA-7 (1-877-726-4727) l 1-800-487-4889 (TDD)

Thank You

37
Kathleen A. Cameron, MPH

Senior Director

Center for Healthy Aging, National Council on Aging
Improving Opioid Misuse 

Prevention Literacy 

Between Older Adults and 

Health Care Providers 

March 28, 2019

Kathleen Cameron

Senior Director

Center for Healthy Aging

National Council on Aging
Our Mission:

Improve the lives of millions of 

older adults, especially those 

who are struggling

Our Social Impact Goal:

Improve the health and 

economic security of 10 

million older adults by 2020
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 41

NCOA’s Center for Healthy Aging

▪ Goal: Increase the quality and years of 

healthy life for older adults and adults with 

disabilities

▪ Two national resource centers funded by 

the Administration for Community Living 

• Chronic Disease Self-Management 

Education (CDSME)

• Falls Prevention 

▪ Other key areas: behavioral health, 

physical activity, immunizations, oral health
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 42

What Is Health Literacy?

Health literacy

The degree to which individuals have the capacity to obtain, process, and 

understand basic health information and services needed to make 

appropriate health decisions.

Health literacy is dependent on individual and systemic factors:

• Communication skills of patients and professionals

• Patient and professional knowledge of health topics

• Culture

• Demands of the health care and public health systems

• Demands of the situation/context

Source: Office of Disease Prevention and Health Promotion, DHHS
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 43

What Are Opioids?

Opioids are derived from opium found in the poppy plant or created 

synthetically and act by binding to specific "receptors" in the brain, 

spinal cord, and gastrointestinal tract. Opioids can change the way 

a person experiences pain.

Examples

▪ Codeine (Tylenol #3®)

▪ Oxycodone (OxyContin®, Percocet®, Percodan®)

▪ Hydrocodone (Vicodin®, Lortab®)

▪ Morphine (MS Contin®, Roxanol®)

▪ Meperidine (Demerol®)

▪ Hydromorphone (Dilaudid®)

▪ Tramadol (Ultram®)

▪ Fentanyl (Duragesic® transdermal patch)
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 44

Chronic Pain and Other Chronic Conditions Among Older Adults

▪ Chronic Pain

• 30% of older adults have chronic pain.

• Negative impact on physical, mental, sexual, and cardiovascular health, including a person’s ability to complete 

daily activities, think clearly, sleep, and manage their mood. 

• Pain leads to increased physician visits, hospital stays, medication use, and challenges with going to work and 

socialization. 

▪ Depression is highly prevalent (14–20%).

• Depression is a risk factor for substance use disorders and suicide.

• Depression is linked to pain and social isolation.

▪ 80% of older adults have at least one chronic disease.

• Nearly 2 of every 3 have multiple chronic conditions 

▪ Chronic conditions are expensive.

• 95% of health care costs for older Americans are for chronic diseases.

• Spending is escalating with the increase in chronic diseases and the aging population. 

• There are many out-of-pocket costs.

▪ Fragmented care, especially for patients with multiple chronic conditions, makes conditions difficult to 

manage.
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 45

Opioid Use Among Medicare Part D Beneficiaries

▪ 1 in 3 Medicare Part D prescription drug beneficiaries received an opioid 

prescription. 

▪ 500,000 beneficiaries received high amounts of opioids.

▪ Almost 90,000 beneficiaries were at serious risk of addiction due to being 

prescribed high amounts of opioids.

▪ More than 6 out of every 1,000 Medicare patients are diagnosed with an 

opioid disorder, compared with 1 of every 1,000 patients covered by 

commercial insurance plans.

Source: U.S. Department of Health & Human Services Office of Inspector General. (2017). “Opioids in Medicare Part D: 

Concerns about Extreme Use and Questionable Prescribing.” HHS OIG Data Brief • July 2017 • OEI-02-17-00250.
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 46

Prescription Misuse Among Older Adults

▪ Prescription misuse is the second most common 

type of substance misuse among older adults. 

▪ At least one in four use psychoactive medications 

with abuse potential. 

▪ Up to 11% of older women misuse prescription 

drugs. 

Sources: National Institute on Drug Abuse. (2006). Misuse of Prescription Drugs. 

Simoni-Wastila, L., & Yang, H. K. (2006). Psychoactive drug abuse in older adults. The American 

Journal of Geriatric Pharmacotherapy, 4(4), 380-394.
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 47

Opioid-Related Harm to Older Adults

▪ Associated with falls and motor vehicle accidents

▪ Dependency

▪ Increases lethargy and fatigue

▪ Decreases respiration/breathing

▪ Lowers immunity 

▪ Emergency department visits 

▪ Suicide

▪ Elder abuse, which includes physical mistreatment, 

emotional abuse, financial exploitation, and neglect

▪ Death
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 48

U.S. Drug Overdose Death Rates, Per 100,000 Population, 1999–2016

Source: Hedegaard, H. et al. (2017). National Center for Health Statistics Data Brief No. 294.
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 49

Sources of Prescription Opioids Among Past-Year Non-Medical Usersa
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 50

Factors Contributing to Prescription Drug Misuse and Abuse

▪ Higher levels of prescribed medications

• Multiple chronic conditions

• Multiple prescribers

▪ Higher prevalence of stressful life events and transitions

• Parenting to “empty nesters” 

• Employment to retirement

• Changes in housing

• Bereavement 

• Diminishing physical and other abilities

• Social isolation

• Health issues/chronic disease

• Depression
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 51

The Health Literate Care Model
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 52

The Health Literate Care Model

▪ Shared decision-making: Effective dialogue helps ensure that health care 

providers understand their patients’ priorities and values — and that they clearly 

identify different treatment options, describe the risks and benefits of each in 

plain language, and involve patients in the development of a treatment plan.

▪ Teach-back method: An effective strategy for confirming that health care 

providers have explained what patients need to know in a way that the patients 

can understand. 

▪ Patient engagement: Assessing risk, building rapport, and gaining insight into 

the mental state of people with chronic pain. Effectively engaging patients 

reinforces their role on the health care team and empowers patients to play an 

active role in their pain management.
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 53

Doctor and Patient Communication

Talking Points

▪ How opioids can reduce pain during short-term use, yet there is not enough 

evidence that opioids control chronic pain effectively long term.

▪ Non-opioid treatments (such as exercise, other medications, and cognitive 

behavioral therapy) that can be effective with less harm.

▪ Importance of regular follow-up.

▪ Protecting family and friends by storing opioids in a secure, locked location and 

safely disposing of unused opioids.

▪ Precautions that can be taken to decrease risks, including checking drug 

monitoring databases, conducting urine drug testing, and prescribing naloxone if 

needed to prevent fatal overdose.
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 54

What Patients Need to Know

▪ The risks and side effects of opioid use:

• Tolerance

• Physical dependence

• Increased sensitivity to pain

• Constipation

• Nausea, vomiting, dry mouth

• Sleepiness and dizziness

• Depression

• Itching and sweating
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 55

Risks are greater with:

▪ Use of alcohol

▪ Use of certain types of 

medications. These should be 

avoided:

• Benzodiazepines

• Muscle relaxants

• Sedatives/hypnotics

• Other prescription opioids

What Patients Need to Know

Risks are greater with:

▪ History of drug misuse, 

substance use disorder, and 

overdose

▪ Mental health conditions 

(e.g., depression or anxiety)

▪ Sleep apnea

▪ Older age
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 56

Know options that don’t include opioids:

▪ Non-opioid pain relievers

▪ Other medications that are used for depression or seizure disorders

▪ Physical therapy and exercise

▪ Cognitive behavioral therapy

What Patients Need to Know
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 57

▪ Never take opioids in greater amounts or more often than prescribed. 

▪ Follow up with your primary health care provider within ___ days. 

• Work together to create a plan on how to manage your pain.

• Talk about ways to help manage your pain that don’t involve prescription opioids.

• Talk about any and all concerns and side effects. 

▪ Help prevent misuse and abuse.

• Never sell or share prescription opioids.

• Never use another person’s prescription opioids.

▪ Store prescription opioids in a secure place and out of reach of others (this may 

include visitors, children, friends, and family). 

▪ Safely dispose of unused prescription opioids: Find your community drug take-back 

program or your pharmacy mail-back program, or flush them down the toilet, 

following guidance from the Food and Drug Administration 

(www.fda.gov/Drugs/ResourcesForYou).

What Patients Need to Know
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 58

Questions to Ask Clinicians About Opioids

▪ May I have fewer pills?

▪ How should I taper off the 

medication?

▪ Where should I store my 

medication?

▪ How do I dispose of unused 

opioids?

▪ Should I have naloxone (Narcan) 

on hand?

▪ Is this medication an opioid?

▪ Is it safe to take with my other 

medications?

▪ Are there other non-opioid pain 

relievers I can take instead?

▪ Is this the lowest dose possible?
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 59

Community Evidence-Based Interventions 

▪ Substance Use Disorders

• Screening, Brief Intervention, and Referral to 

Treatment

▪ Chronic Disease Self-Management 

Education (CDSME) Programs

▪ Physical Activity and Falls Prevention 

Programs

▪ Depression

• Healthy Ideas

• PEARLS
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 60

▪ Screening quickly assesses the severity of substance use and identifies the 

appropriate level of treatment.

▪ Brief intervention focuses on increasing insight and awareness regarding 

substance use and motivation toward behavioral change.

▪ Referral to treatment provides those identified as needing more extensive 

treatment with access to specialty care.

(www.samhsa.gov/sbirt)
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 61

SBIRT

▪ Primary Goal: Reducing and preventing related health consequences, 

disease, accidents, and injuries associated with risky use.

▪ Screens for all types of substance use, not just dependencies.

▪ Provides information and assistance tailored to the individual and 

his or her needs.

▪ Intervening early with individuals at moderate risk is effective in 

reducing substance use, preventing health and other related 

consequences, and saving health care costs. 
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 62

Evidence for SBIRT

FL BRITE Project (BRief Intervention and Treatment for Elders)

▪ Results: Health educators screening solely within medical sites 

recorded fewer positive screens than those from mental health, 

substance abuse, or aging services that screened in a variety of 

community-based and health care sites. Six-month follow-ups 

revealed a significant decrease in substance use. 

▪ Conclusions: SBIRT can be extended to nonmedical services that 

serve older adults.

(Source: Schonfeld et al, AJPH 2013)
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 63

Chronic Disease Self-Management Education (CDSME) Programs

▪ CDSME model developed at Stanford University Patient Education Center.

▪ Participants gain the knowledge, skills, and necessary support to take control 

of their health and make healthy lifestyle changes.

▪ 6 workshop sessions held once a week.

▪ Each session is 2 1⁄2 hours and highly interactive.

▪ Co-facilitated by two trained leaders, one of whom has an ongoing health 

condition.

▪ Core content:

• Symptom management/social role function

• Exercises to build self-efficacy

• Goal setting and action plans 

• Problem solving to overcome challenges

• Based at the Self-Management Resource Center

https://www.selfmanagementresource.com/
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 64

Session Topics

Action Planning

Managing

Pain and Fatigue

Fitness/

Exercise

Getting a Good 

Night’s Sleep

Problem-solving Dealing with 

Difficult Emotions

Healthy Eating/Weight 

Management

Working with Health 

Professionals

Decision Making Better Breathing Communication

Medication 

Management

Rx and OTC
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 65

Healthy IDEAS Program Goals

▪ Detect and reduce the severity of depressive 

symptoms in older adults through existing 

community-based case management services. 

▪ Reach underserved populations.

▪ Train agency staff to deliver an evidence-based 

intervention for depression to older adults. 

▪ Improve linkage between community aging service 

providers and health/mental health professionals.

▪ For more information: http://healthyideasprograms.org/
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 66

Core Program Components

▪ Step 1: Screening

▪ Step 2: Education

▪ Step 3: Referral & Linkage

▪ Step 4: Behavioral Activation

• Empowering older adults to manage their depressive symptoms by engaging 

in meaningful, positive activities.

▪ Step 5: Re-assessment with ongoing case-management 
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 67

Benefits to Clients

▪ Reduction in severity of depressive symptoms

▪ Reduction of self-reported pain

▪ Increased knowledge of how to get help for 

depression 

▪ Increased level of activity

▪ Increased knowledge of how to manage 

depressive symptoms
Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging 68

Kathleen Cameron

Senior Director

Center for Healthy Aging

National Council on Aging

kathleen.cameron@ncoa.org

571-527-3996
Carol Levine

Director

Families and Health Care Project, United Hospital Fund
Health Literacy and Pain Management:

Family Caregivers as Partners 

Carol Levine

Director, Families and Health Care Project

United Hospital Fund

SAMHSA Webinar on Improving Opioid Misuse Prevention 

Literacy Between Older Adults and Health Care Providers

March 28, 2019
United Hospital Fund works to build a 

more effective health care system for 

every New Yorker. An independent, 

nonprofit organization, we analyze public 

policy to inform decision-makers, find 

common ground among diverse 

stakeholders, and develop and support 

innovative programs that improve the 

quality, accessibility, affordability, and 

experience of patient care.

www.uhfnyc.org

Created by UHF, Next Step in Care is designed 

to change health care practice by routinely 

identifying, acknowledging, training, and 

supporting family caregivers, especially at 

times of transitions in care. It provides 

practical advice and easy-to-use guides for 

both health care providers and family 

caregivers that focus on transitions between 

hospitals, rehabilitation facilities, nursing 

homes, and home. While New York is the 

primary focus of UHF and Next Step in Care’s 

work, the impact and relevance are national 

and even international.

www.nextstepincare.org

71
Importance of Health Literacy

in Pain Management 

• Health care today is complex and challenging. 

• Understanding multiple medications is essential for best possible patient 

outcomes.

• Pain medications present particular challenges.

• Worry about misuse may prevent patients from getting appropriate pain 

relief.

• There is a difference between short-term and chronic pain management.

• Prevalent misunderstandings and myths interfere with appropriate 

decision-making. 

• Stigma pervades culture, including health care settings.

72
Health Literacy Is Hard to Achieve

• Obtaining, processing, and understanding basic health information and 

services is a high standard for patients and family caregivers. 

• People need to understand insurance, bureaucratic language, and 

institutional arrangements, not just medical terminology and 

prescription orders.

• Understanding “services” may be harder than understanding “basic 

health information.”

• Health literacy is particularly important for drug treatment options, 

which are limited, especially in rural areas.

73
What a Caregiver Expects From 

the Health Care System

74
What a Caregiver Actually Experiences

75
Family Caregivers as Partners in Care

• 43 million Americans are family caregivers (including family 

members, friends, neighbors) who provide personal care, do 

household tasks, and undertake medical/nursing tasks such as 

managing multiple medications, wound care, and monitoring 

machines.

• Caregiver worry about pain medications (too much? too little?) is a 

major source of caregiver stress.

• Caregivers accompany patient to doctor visits, ED visits, and 

hospital stays, yet they may not be included in medication 

reconciliation and decision-making. 

• Caregivers may have more accurate information about a patient’s 

drug use than patient. 

• Caregivers may get inconsistent or incomplete information.

76
Before Learning New Information, 

Have to Unlearn Misinformation

Common myths:

• Taking pain drugs always leads to addiction.

• If a doctor prescribed it, it must be good for me.

• I don’t have to keep track of my medications because they are all “in the 

system.” 

• Medication-assisted treatment is just substituting one drug for another.

• People who use illegal drugs are weak and do not deserve costly treatment.

• Treatment for substance abuse doesn’t work.

77
Enhancing Health Literacy 

About Pain Management

• Start discussions early, not while in crisis.

• Consider all medications and whether some can be dropped.

• Use simple definitions of types of drugs and how they differ.

• Explain how drugs affect the brain. 

• Avoid demeaning and judgmental terms (not just with 

patients but also with colleagues). 

• Remember to dispel myths. 

• Involve family caregiver(s) at every stage.

• Listen to their concerns.

• Answer questions and repeat information as often as needed.

• Use teach-back to ensure comprehension—patient/caregiver 

tells what routine to follow using their own words.

78
Medication Reconciliation

and Management

Medication Management is how one ensures for any medications given

• the right patient 

• the right drug 

• the right dose

• the right route

• the right time

79

Medication reconciliation: the process of creating the most accurate list possible of all medications (RX and OTC) a patient is taking 

and comparing that list to admission, transfer, and/or discharge orders, with the goal of preventing adverse medical events. 

Source: IHI
Points to Discuss with Patient and Caregiver

• Why is this pain medication being prescribed?

• What are the benefits? And the risks?

• Are there alternatives to this drug?

• Are there non-drug alternatives to controlling pain?

• How long should I take the medication?

• What kind of side effects should I watch out for?

• How should I keep the medication safe from children who live with me or visit?

• How should I dispose of the leftover pills?

80
The Four Habits Approach to Effective 

Communication

1. Invest in the beginning—develop trust.

2. Elicit the patient’s and family caregiver’s 

perspective—listen.

3. Demonstrate empathy—words and body language.

4. Invest in the end—summarize and review next steps

Source: Frankel, R., Stein, T., & Krupat, E. (2003). The Four Habits Approach to Effective Clinical Communication. Clinician-Patient 

Communication series, The Permanente Medical Group. 

81
Thank you

Carol Levine

clevine@uhfnyc.org

United Hospital Fund’s Next Step in Care website

www.nextstepincare.org

Suzanne C. Brundage and Carol Levine, “The Ripple Effect: The Impact of the 

Opioid Epidemic on Children and Families,” available at: 

https://uhfnyc.org/publications/publication/ripple-effect-opioid-epidemicchildren-and-families/

82
Jane Marks, RN, MS

Associate Director

Johns Hopkins Geriatric Workforce Enhancement Program

83
Community Outreach 

Jane Marks, RN, MS

Associate Director

Johns Hopkins Geriatric Workforce Enhancement 

Program
JHGWEP

• Supported by the Health Resources and Services Administration 

(HRSA) of the U.S. Department of Health and Human Services 

(HHS) under grant number UIQHP28710, Johns Hopkins 

Geriatric Workforce Enhancement Program. This information or 

content and conclusions are those of the author and should not 

be construed as the official position or policy of, nor should any 

endorsements be inferred by HRSA, HHS or the U.S. 

Government.

85
Objective

• To discuss community outreach and education 

through faith-based communities regarding the opioid 

crisis.

86
Partners

• Brown Memorial Church

• Johns Hopkins Bayview Medical Center

– Healthy Community Partnership

– Community Outreach

– Addiction Medicine Faculty

• Baltimore City Health Department

• Living Well Center

• Mental Health Association of Maryland

87
Brown Memorial Church

88
Two Faith Communities - Baltimore City

89
First Panel Session

• Addiction

• Breaking the Stigma

• Depression

• Pain Management

– Partner with your health care team

– Alternatives to pain management

* Physical Therapy 

*Chronic Pain Management

90
Panel (con’t)

• Storing Medications safely

• How to dispose unused medications

• Role of Faith Based Communities 

91
Resources

• Handouts 

– Opioid Use Disorder

– Addiction

92
Second Session

• Baltimore City Health Department

– Naloxone

– Resources for treatment

• Mental Health Association of 

Maryland

93
One Thousand Love Letters

- Artist-Peter Bruun

94
Resources

95
Questions & Discussion

Please use the chat feature to 

share your questions and 

thoughts with us.

96
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