Recent Australian data, outlined in a British Medical Journal editorial and published by The Conversation, Substance misuse in older people, shows rates of alcohol and drug use are actually decreasing among younger age groups, while increasing dramatically in people over the age of 50.
Not only is there a rise in the proportion of older people who regularly drink at risky levels, there are also more older people using cannabis.
While the editorial has attracted considerable global interest, Burnet’s Program Director, Behaviours and Health Risks, Professor Paul Dietze and Burnet Senior Fellow, Dr Peter Higgs are also shining the light on the issues facing older people who inject drugs (PWID).
Their evidence-based response “Older drug injectors require attention too” has also been published online by the BMJ and an edited version is reproduced below.
Find out more about research underway in Burnet’s Healthy Ageing Program and Behaviours and Health Risks Program.
Older drug injectors require attention too
Rao and Roche note the number of people aged over 50 using substances problematically is increasing across a range of settings globally. The proportion of older people who inject drugs (PWID) also appears to be increasing, at least in the developed world.
Many PWID commenced their injecting careers in the drug epidemics of the 1980s and 1990s and continue to use substances (including injecting) today. Research on the health needs of older PWID, particularly those who continue to use opioids in North America, and the United Kingdom shows how little we understand of the life trajectories of ageing and drug use.
This cohort has already established lifestyle and health trajectories that will carry them into their old age over the next two decades, the management of which has emerged as an increasingly important public health problem.
For example, some symptoms such as changes in blood pressure, changes in moods or memory impairment may only manifest in older age and the lives of older PWID are likely to be characterised by considerable levels of morbidity not experienced by other older people without a drug injecting history.
A range of barriers to accessing health care for PWID have been identified, including stigma and discrimination, health workers’ lack of confidentiality, service models that are unacceptable or inaccessible, cultural differences in approaches to managing health problems, economic disadvantage and competing priorities. Recent research has also highlighted that PWID often do not seek health care or delay accessing it.
Australian surveillance data suggest there is a large, ageing cohort of (predominantly) opioid injectors in Australia. Similarly, national opiate substitution treatment (OST) data show that, of the more than 48,500 people receiving OST, 22 percent were aged over 50. It is also largely unknown what impact continuing to inject has on the life course of older people.
Issues of stigma mean that relatively few older adults with injecting histories seek on-going primary health care, despite many having regular contact with pharmacies, and alcohol and other drug specialists.
Primary care and other healthcare services may provide a valuable opportunity to screen for any potential health problems associated with either opioid use or ageing, the burden of which may be due to issues directly related to on-going injecting drug use.
There is a need to understand and design services for this population that includes key features such as low-threshold and client-centred. There is still much to understand in relation to the impact of OST on people who have been using it for decades especially in relation to cardiovascular disease and the high rates of smoking in this population.
As PWID get older their presentations to primary care for a broad range of chronic health problems will likely increase. Therefore, the sooner we can address these range of issues the less likely they are to end up in tertiary health settings.