Drugs and Older People

In this blog we will explore the ageing population and how people who use drugs are impacted.

Over 58% of people engaged in drug and alcohol treatment services in England are over 40. The generation of the 70’s and 80’s are now in their 60s and this brings with it a set challenges for people who are still using drugs at this age, or people who have entered recovery but are facing the physical consequences of a life of drug use.

Lung damage and the risk of overdose:

Many years of inhaling substances may have led to a high prevalence of asthma and COPD in people who have smoked drugs and tobacco with high frequency for prolonged periods. Recent studies have shown that 35% of people who access drug and alcohol services for opiate use are affected by COPD.

COPD (reduced lung capacity), and other respiratory disorders, can be a heightened risk factor for overdose in people using opiate drugs. Respiratory depression can often be the cause of opiate overdose death. Research suggests that 97.2% of people who are or have been dependant on opiates are smokers. As we see the general population living to older ages this will be reflected in the population of people who use or have used drugs, and this cohort may experience a number of additional health related issues.

Liver damage and the risk of overdose:

The two main causes of liver damage in people who use drugs are viral hepatitis (predominantly hepatitis C), and excessive or dependant use of alcohol.

Hepatitis C is for the most part an asymptomatic illness and as a result can go undetected for decades. The longer a person is infected with the virus, the higher the risk of progressive liver damage such as cirrhosis, or in some cases liver cancer. Although mortality rates from hepatitis C have reduced dramatically (40% since 2015/2016) due to various hepatitis C elimination programmes headed up by NHS England, hepatitis C is still a concern for the person who may have been infected in the 1980s but has since not engaged in treatment, or in drug and alcohol services.

The more the liver is damaged the less effective it is at processing toxins and certain medicines in a person’s body. This can lead to a build-up of opiates and other respiratory depressants in a person’s body increasing the risk of a potentially fatal overdose.

Circulatory issues (ulcers, DVT, and oedema):

Groin injecting in particular has left a whole generation with severe vascular damage leading to DVT (deep vein thrombosis), lower leg ulcers and related Oedema.

Wound care and tissue management can sometimes be neglected, leaving people with prolonged episodes of pain. The management of these issues can be as simple as being regularly reviewed by a GP for compression hosiery, or moisturisers being applied to the skin of the lower legs helping to prevent compromised tissue from breaking down. Once a breakdown of tissue occurs it is imperative a leg ulcer is treated as soon as possible, a referral to local tissue viability can prevent years of extremely painful wounds.

Loss of opioid tolerance:

Loss of tolerance to substances such as opioids can be an additional factor. Many factors can lead a person to an increased risk of overdose from loss of tolerance to a compromised liver failing to process substances, and damage to the lungs.

Other health issues may mean other prescription medications are used which could impact a person’s tolerance to opioid medications leading to increased opioid overdose risks.

Blood tests:

Some people accessing phlebotomy clinics when they have had poor venous access have had negative experiences. It is essential to ensure that the person taking blood is non-judgemental, listens to the person in front of them and uses different techniques to gain access to a sample. If an individual does have a negative experience this can lead to them disengaging from services and having conditions which require treatment undiagnosed.

Social exclusion (isolation, using substances alone, and lack of social support):

As people grow older they can find their peer group gets smaller and smaller, family groups get smaller and people in friendship groups pass away or move on. Social isolation is a major factor for the ageing person, this in itself can be problematic as using alone is a key indicator in many drug related deaths. Day programs, support meetings, or residential rehabs are all options, however, joining people to their communities or accessing social prescribers are good alternatives. All of these options can add a feeling of belonging and reduce isolation by tapping people into existing recovery networks.

How do we manage those issues in the people we engage with?

For people engaged with drug and alcohol treatment services the following should be considered by keyworkers:

Build physical health needs regularly into keyworker sessions and care plans
Being aware of available resources
Provide opt-out testing for hepatitis C and other blood borne viruses
Create and maintain links with local tissue viability teams and smoking cessation services
Ensure information about the increased risk of respiratory depression/toxicity is available to people accessing drug and alcohol services
Linking to the community and social prescribers to tackle isolation
Working closely with the person’s GP
Ensure good links with professionals managing people via shared care
Supporting people to have their physical health regularly reviewed
Knowing your referral pathways
Completing further training and awareness of issues that affect older users (eg. KFX training on harm reduction and older people)
And most of all having empathy with the issues being faced by people who are getting older, who come with more complex issues, and who may be worried about their health and their future.