Meeting the health needs of older drug users

1. Meeting the health needs of older drug users Dr Muriel Simmonte NHS Lothian Primary Care Facilitator Team/East Lothian Locality Drug Clinic

2. Trainspotters? • “Survivors” – drug users with an early onset of drug use which has persisted for many years • “Late starters” – drug users who become involved in drug use at a later age

3. Survivors • More likely to have been in long term maintenance treatment • Higher incidence of chronic illness related to their drug use including Hepatitis C and HIV • Health consequences of long term socio-economic disadvantage • Adverse life events – loss of friends and family members, involvement in violence and crime

4. Late starters • Often related to stressful life events • Previous drug misuse • Older people more likely to be prescribed medication including psychoactive medication and analgesia • Misuse of prescription drugs and OTC medication

5. Health issues for older drug users • Complications of drug use – include blood borne viruses, respiratory disease, cardiovascular disease • Mental health and overdose risk • Age related health problems • Lifestyle and circumstances

6. Blood borne viruses • Cumulative risk of hepatitis B and C • Undiagnosed hepatitis C - past injectors • Untreated hepatitis C – previously declined, not offered, overlooked • Additive affect of alcohol on hepatic function • HIV infection +/- antiviral treatment • Sexual transmission – risk of complacency when no perceived contraceptive needs

7. Respiratory disease • COPD, emphysema and lung cancer risk associated with chronic smoking – tobacco and cannabis • Exacerbation of asthma with inhaled drugs • Lung damage associated with drug inhalation eg cocaine • Opportunistic infections in HIV positive patients including PCP

8. Cardiovascular disease • Increased risk associated with smoking, diet, alcohol • Coronary artery spasm, tachycardia and arrhythmias with cocaine and other stimulants • Chronic venous and/or arterial damage secondary to injecting • Valvular heart disease

9. Mental health and overdose risk • Association between mental health problems and drug use • Increasing impact of bereavement, social isolation, anxiety • Memory problems and cognitive impairment • Increased and increasing risk of drug-related deaths in over 35 age group.

10. Drug-related deaths: Scotland This equates to a near trebling of average annual deaths in the 35 & over age group - from 69 (1996-2000) to 201(2004-2008)

11. Age related health problems • Increase in diseases associated with older age: hypertension, IHD, diabetes, COPD • Interaction between medical treatments and substitute or illicit drugs • Changes in metabolism and tolerance to drugs and alcohol • Increased likelihood of chronic painful conditions – back pain, arthritis and headache

12. Lifestyle and circumstances • Lack of social support • Financial situation • Experience of criminal justice system • Poor engagement with mainstream health care, especially preventative care

13. Meeting general health needs • Awareness of care providers to health needs beyond drug-related care • Promoting engagement of drug users in preventive health care e.g. screening, immunisation • Pain control issues in drug users: may require specialist services and non pharmacological interventions • Awareness of circumstances linked to development of drug dependence in older patients

14. Meeting specific health needs • Appropriate adjustment in treatment to reflect metabolic changes • BBV prevention, testing and treatment needs • Care of chronic illnesses related to drug use • Co-morbidity – cognitive impairment, anxiety, depression

15. Lothian NES for drug users • Aprox. 4,000 patients • 54% age 35 or over • 25% age 40 or over • 1% age 60 or over Patients attending Primary Care: potential for engagement regarding other health issues

16. Recovery? • Long term treatment – positive choice or lack of support to change? • Benefits and risks of reduction/detox • Lifestyle factors • Aspirations