Ask the Expert: Benjamin Han, MD, MPH, on public health for older adults, opioid use disorder, and his 2022 Terrie Fox Wetle Rising Star Award

An internist, geriatrician, addiction medicine physician, and clinician-researcher, Dr. Han's work focuses on the intersection of chronic medical disease and substance use with a career goal to improve the health of older adults with substance use disorders. Currently, his National Institute on Drug Abuse (NIDA)-funded K23 grant aims to deliver evidence-based geriatric interventions into opioid treatment programs. A nationally recognized expert on psychoactive substance use among older adults, he has given multiple oral presentations at national meetings and his research has been showcased in national media interviews with the Today Show, NPR, CNN, and The New York Times. Dr. Han has published 57 papers in major journals including JAMA Internal Medicine, Journal of the American Geriatrics Society, and the Journal of General Internal Medicine.

Upon receiving the 2022 Wetle Award, AFAR connected with Dr. Han in this Ask the Expert Interview to gain insights from his interdisciplinary research and community-based vision.

What inspired you to pursue aging research and specifically your work in both public health and primary care?

I decided to do a geriatric medicine fellowship because I wanted to gain versatile clinical skills for caring for patients across the clinical spectrum, especially in primary care. During my fellowship, I quickly embraced the geriatric-based framework for caring for patients living with complexity and competing risks and realized the urgent need to integrate this approach into other fields that often focus on disease-specific care rather than patient-centered care. This is especially true for populations made vulnerable by systemic factors, including people living with substance use disorder. I also had a long-standing interest in addiction medicine throughout my clinical and public health training, and during my fellowship increasingly saw the need to integrate evidence-based geriatric interventions for a growing population of adults living with multiple chronic diseases receiving care in addiction medicine settings. This inspired me to pursue a career in aging research to help integrate geriatric medicine with addiction medicine.

You have been a leader in research on older adults with opioid use disorder. Do you think the medical community harbors harmful stigmas towards patients with substance use disorders and what steps can it take to reduce those stigmas? How does this stigma differ for older adults?

Yes, unfortunately, drug use and drug use treatment continue to be heavily stigmatized, including by the medical community. This is deeply harmful because there are real consequences of stigma: it prevents people from getting the help that they need and deserve. Furthermore, my qualitative research with older adults living with substance use disorders shows that this is a population that experiences multiple layers of stigma, including those related to drug use, age (ageism), functional limitations, experiencing homelessness, and being involved with the criminal legal system. For older adults, stigma often compound over time, and the related experience of discrimination occurs over decades. To address this, I believe it is important to recognize that substance use disorder is a chronic disease that is also influenced by a multitude of factors, including biological, social, and political. It does not represent a moral failing. As clinicians, we must be careful and thoughtful about how we talk to our older patients about drug use and drug use treatment, avoid stigmatizing language, and frame drug use in a health context when seeing patients in a clinical setting.

Your work reflects the importance of understanding the social determinants of healthcare. How do these determinants play a role in geriatrics and how would a socially conscious approach to aging research improve the field?

Discussions around health equity often do not include older adults when in particular, certain populations of older adults have experienced life-long discrimination, racism, and systemic injustices. These experiences over the lifespan likely affect people differently as they age. Therefore, it is critically important to recognize the role of social determinants on aging (especially accelerated aging) and the presence of multiple chronic diseases. I do think prioritizing the integration of aging research into other fields, as an example in addiction medicine, can help with this.

The Terrie Fox Wetle Rising Star Award in Health Services and Aging Research places special consideration on collaborative work with community partners. How has your experience working with community organizations informed your understanding of substance use disorders in older populations?

Working with community organizations has been a critical part of the research that I do as they are often the ones working directly with older adults with substance use disorders and attempting to help them navigate our complex healthcare system. The collaborative relationships I have with local opioid treatment programs and harm reduction organizations have been one of the highlights of my research career and helped me witness firsthand the challenges older adults with substance use disorder experience. I also want to highlight that my relationships with local health departments (especially in New York City) have been critical for me to understand on a population level the scale of what the healthcare needs are for older adults with substance use disorder and to help contribute to public health efforts to raise awareness of issues related to substance use and older adults, including overdose deaths.

Dr. Han will present his lecture, “Opioid Use Disorder Among Older Adults: Addressing Multimorbidity and Geriatric Conditions," at the Gerontological Society of America (GSA) 2022 Annual Scientific Meeting. Learn more and RSVP here.