Policy and practice briefingsOlder people with problematic opioid use

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Issues

People over the age of 40 make up an increasing share of those with an opioid problem in Europe. This is reflected in the increasing age of those in drug treatment and those dying of opioid overdoses.

In this group of older opioid users, the physical ageing process may be accelerated by the cumulative effects of polydrug use, overdose and infections over many years. Older people with opioid problems have higher rates of degenerative disorders, circulatory and respiratory problems, pneumonia, breathlessness, diabetes, hepatitis and liver cirrhosis than their peers and younger people who use drugs. They may also be more susceptible to infection, overdose and suicide.

In addition, their social networks may be reduced because of premature death and stigma, which can further increase social exclusion and isolation from families. The stigma and shame of still using drugs may also act as a barrier to help-seeking.

Response options

The types of responses needed for this group include:

  • Drug treatment services tailored to the needs of older people need to provide multidisciplinary care to address their medical and psychological needs as well as their social isolation.
  • Improved access to, and uptake of, hepatitis C antiviral therapies.
  • Specialised nursing homes for long-term residential care of ageing drug users.
  • Awareness-raising and training of health and social care staff dealing with elderly people about how to respond to the needs of older people with drug problems to ensure appropriate care and avoid stigmatisation.
  • Appropriate physical health care, including dental health services
  • Advocacy support to increase self-esteem, acceptance and positive feelings about the future, with peer-led approaches likely to be particularly appropriate.

European picture

  • Planning of services to meet the future health and social care needs of this growing cohort of older drug users in Europe is needed.
  • This may require having age-specialised care services that host social activities and events, and provide regular peer and volunteer support.
  • An integrated, multidisciplinary approach is needed with interagency partnerships and referral between specialised and mainstream health and social services to address the needs of older opioid users.

Summary of the available evidence

The evidence base in this area is very limited and more evaluation of innovative interventions is needed. However, some pointers can be gleaned from a few studies:

  • A pilot study in the United Kingdom showed that older drug users could be recruited into a gym-based exercise scheme but multiple social challenges reduced their ability to participate.
  • Men’s shed programmes in Australia, Canada, Ireland and the United Kingdom have encouraged older men to develop a sense of identity, self-esteem and value by learning new skills, developing social networks and engaging with communities.
  • Specialised nursing homes for older people with drug problems who are not able to care for themselves exist in Denmark, Germany and the Netherlands. In the United States, the Geriatric Addiction Program was developed to meet the needs of older adults with substance misuse problems. The community-based programme provides in-home substance use intervention, assessment and linkage to services for older adults. There is a need for evaluation of these approaches to identify models for the provision of geriatric care need to be developed appropriate for different groups and contexts.

Implications for policy and practice

The implications for future development of responses for this group include:

Basics

  • Key issues for service providers are managing comorbidity, chronic health conditions, overdose deaths, early ageing, loneliness and isolation. These needs can be met by modifying or restructuring services and developing specialist services that address both health and social care needs.
  • Clear communication channels and referral pathways need to be in place between drug services and mainstream health and social care services.

Opportunities

  • Investment in workforce development for staff involved in generic elderly care, in order to improve their understanding of the needs of older people with drug problems, could improve the management of physical and mental health problems in this group.
  • Developing protocols for managing pain in people who are opioid-dependent for use in pain and palliative care clinics would assist the provision of high quality care in these settings.

Gaps

  • Screening tools and outcome measures need to be developed that are appropriate for older people with long-standing substance misuse and associated health and social problems.
  • There is a need to identify promising interventions and models of care to address the health and social problems experienced by the growing cohort of older people with opioid problems and to evaluate them to identify and share best practice.

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