Grandma may not be the first suspect when painkillers vanish from the medicine cabinet.

But many elderly Americans are fighting often-hidden battles with prescription drug abuse, a Florida addiction specialist cautioned Thursday in Pittsburgh. John Dyben suggested nearly 2.9 million older adults nationwide may face the problem, a figure that fits into federal estimates on overall substance abuse among those at least 60 years old.

“The reality is that it’s happening a lot,” said Mr. Dyben, director of older adult treatment services at the Hanley Center in West Palm Beach. The facility is among few residential programs in the United States that specialize in substance abuse care for the elderly, whose addictions can worsen pre-existing health conditions, he said.

Mr. Dyben delivered the warning to about 350 people at the Sheraton Pittsburgh Hotel at Station Square, where a two-day conference on the opioid crisis is being held. Cleveland-based Vendome Healthcare Media pulled together the event, whose attendees include a cross-section of counselors, therapists and doctors from across the area. Speakers on Thursday put an emphasis on strategies for slashing overuse of narcotics. More than 14,000 people died in 2014 from overdoses involving prescription forms of the drugs, such as oxycodone and hydrocodone, according to the Centers for Disease Control and Prevention.

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Recovery ”programs aren’t as friendly as we think they are,” said Peter F. Luongo, executive director at the Downtown-based Institute for Research, Education and Training in Addictions. He said specialists should give a sense of hope to recovering addicts, who can face deadly relapses once when they leave treatment.

Likewise, the help shouldn’t follow a ”cookie-cutter” model that supplies identical care to each patient, said Thomas M. Baier, a senior executive director at JEVS Human Services in Philadelphia. He said care can “be whatever it needs to be” — as long as it works.

“We’re talking about human beings here,” said Mr. Baier, who oversees methadone clinics. “There are too, too many variables.”

As for older patients, Mr. Dyben said conversational approaches to screening can help health care workers identify those with substance abuse problems. Nearly 12 million Medicare beneficiaries received at least one prescription for an opioid painkiller last year, according to a federal report released this week.

Adam Smeltz: asmeltz@post-gazette.com, 412-263-2625.. The Associated Press contributed.