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Author Topic: [UK] Old habits die hard for ageing addicts  (Read 4141 times)

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[UK] Old habits die hard for ageing addicts
« on: October 23, 2019, 12:09:36 PM »

Old habits die hard for ageing addicts

The number of older drug users is rising. But what health and care challenges do they face as they age, and is the system prepared to deal with them?

Maggie Jones receives a regular dose of methadone from her GP and dreads the thought of having to go into a care home with her dependency

Maggie Jones, 58, has used drugs for most of her life. "I worry what's going to happen as I get older and more helpless," she says. Although working and settled on a regular methadone prescription, she still feels nothing but fear when it comes to discussing her retirement.

"I know I'm lucky: I've got a great GP who will arrange things and make sure I get my methadone if I have to go into hospital. But the idea of being stuck in a bed somewhere and not having your [prescription], that's very scary.

"As for the thought of going into an old people's home, that's absolutely terrifying. Or what if you get infirm and get stuck at home and can't get to the chemist to get your prescription?

"Getting old is worrying for many people, I know that. But if you're an addict then there is this consuming fear of being powerless."

Jones (not her real name) is not alone in contemplating her dotage with a long-standing addiction. Although an early death is a reality for many addicts, methadone prescriptions and the success of harm-reduction programmes now mean that large numbers of people who began using drugs in the 1960s and 1970s are living longer.

Figures from the National Treatment Agency for Substance Misuse show that there were more than 1,300 addicts over the age of 60 in treatment in England in 2009. In 1998, just 8% of drug users were aged 40-49, but by 2006, a quarter were in this age bracket. Caryl Beynon, reader in substance use epidemiology at the centre for public health, Liverpool John Moores University, calculates that there are now around 70,000-75,000 addicts aged over 40 in the UK.

Older drug users face a grim catalogue of serious health problems as they age. "What we are seeing is that users in their 40s frequently have many of the health issues of someone in their 60s or even 70s," says Beynon. "There is also some evidence that addicts are more prone to early onset dementia."

But public services are not geared up for older addicts. Society just does not expect older people to be addicts, and drugs remain firmly linked with youth behaviour. As a result, treatment is still focused on the needs of the young, but that will need to change. "There's definitely a gap in service provision for older users," says Michael Simpson, communications officer at the charity DrugScope.

Of particular concern are the health problems facing people who have been using intravenously for many years. "I've seen horrendous injuries that have gone untreated," says Erin O'Mara, editor of Black Poppy, a magazine for heroin users, whose co-founder, Chris Drouet, died of an overdose last year, aged 60.

"There are ulcers, amputations, repeated heart problems, abscesses, breaks that aren't healed properly. Often, when people do seek help, the care they get is so lackadaisical. Many people have said to me that medical staff treat addicts like scumbags, and so they just won't go to the doctor's," O'Mara adds.

Jones agrees that health issues are worse for those still using intravenously. "Drug use takes a hefty toll: they've got Hepatitis C, HIV, bronchial problems, depression."

Reluctance to seek treatment almost cost Andrew O'Malley, 48, a recovering addict, his hand. "It was badly infected in the bone, but I felt too ashamed to get treatment. Every day I was covering it up and trying to get along," he says. "In the end I went to hospital, but I've lost most of the movement in my hand."

Older addicts also find it harder to cope with pain than elderly people who do not take drugs. "Inadequate pain relief is a real concern," says Beynon. "If someone has been on opiates for years, their tolerance will be higher and they will need higher doses to achieve an analgesic effect. But some doctors don't realise that.

"Another big problem is that as people age they inevitably need to take more medicine, particularly if they have health issues. Helping addicts to keep track of complicated regimes can be hard. They just don't remember to take their pills."

There is also mounting evidence that overdoses can be more likely as users get older – despite the false confidence many might feel after surviving decades using a particular substance.

"General problems of ageing may well make it harder to fight an overdose, putting long-standing users at greater risk," says Simpson. In particular, emphysema, bronchitis and other lung problems – smoking cigarettes as well as illegal substances is common among addicts – can result in chronic obstructive pulmonary disease, which can in turn heighten the risk of overdose.

Some addicts and those who work with them believe that the culture of methadone prescriptions has exacerbated the problem, as for decades treatment has focused on stabilising addicts, leaving many "parked up" at home.

"They just sit there waiting for the dole to turn up," says Lewis Ward, 55, a service user involvement worker in Castleford, west Yorkshire, for the social enterprise Turning Point. He was addicted to heroin for 20 years until he quit five years ago. "Although I was always working, I know how they feel. I thought I couldn't give up for years and years because I was raising a family and I couldn't afford the six-month disruption of getting clean."

Under the coalition government's drug strategy, every addict should be helped off all drugs, including methadone. But there are concerns that it will be much harder for older users to get clean than younger addicts, who have not been using drugs for as long. "We need to be really sensitive about how we do this," says O'Mara. "It's very different dealing with a 20-year-old who might have been on heroin for a short time and someone who's been an addict for 30-40 years. A lot of people are thinking: 'I'm 60. How am I going to do this?'"

She also believes that there needs to be some acknowledgment that, for some, it will be too late to change. "Most people don't want to be an addict forever. But at the same time we need to recognise that for some people they just can't live any other way. They've been on opiates their whole lives and we can't just start poking them with a stick and saying: 'Get up. Get a job.'"

Ultimately, there will come a point for many ageing addicts when they can no longer look after themselves at home, and then there is huge uncertainty about what to do.

In Rotterdam, this apprehension is being allayed. Seniorepand is a semi-private medical foundation billed as the world's first retirement home for drug users. In the Netherlands, addicts receive free healthcare and methadone, and while residents at Seniorepand are encouraged to use fewer drugs, its aim is to provide a place for them to live out their last days in dignity.

Could such a facility work in the UK? "There are no plans to introduce similar specialist facilities in England," says Paul Hayes, chief executive of the National Treatment Agency for Substance Misuse.

But representatives of the care industry remain concerned that it is not fully prepared for rising numbers of addicts and that care homes for older people cannot at present meet drug users' needs.

"[Managing people with addictions] will be an enormous challenge," says Martin Green, chief executive of the English Community Care Home Association. Care homes are not paid to look after addicts and do not have the requisite expertise to manage people with significant drug or indeed alcohol problems.

"This is an issue that will increase in prevalence and the health and social care system needs to start planning for it. The government should acknowledge this issue and re-direct some of the money currently in rehab services to care providers," says Green.

But a spokesman for the Department of Health insists the system is ready: "Before a person is admitted to a care home, the local authority social services department should assess their health and personal care needs, including any addictions, and arrange care to meet those needs that fall within its eligibility criteria."

Either way, Jones is not reassured: "Can you imagine being an addict in a regular old people's home? You wouldn't be able to move without being glared at. It would be terrible.

"With the way things are I'd rather be dependent on drugs than other people," she says.

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