Abstract:Aims: To provide an overview of research literature on ageing and older people who use illicit opioids and stimulants by documenting the conceptual frameworks used and content areas that have been investigated. Methods: We conducted a scoping review of literature relating to ageing and older people who use illicit stimulants and opioids, defining 'older' as 40 years and above. Primary studies, secondary studies and editorials were included. Searches were conducted in PubMed and Embase in July 2020 and March 20… Show more
“…The majority of MOUD clinics are concentrated in big urban centers, particularly in metropolitan San Juan, which also centralizes other health infrastructures [4]. Along with economic crises, pandemics, wars, or other natural disasters, hurricanes are considered "big events" because they alter the micro and macro structures in which vulnerable populations live and make risk decisions that impact their health [5][6][7][8].…”
Background
While natural disasters like hurricanes are increasingly common, their long-term effects on people who inject drugs are not well understood. Although brief in duration, natural disasters can radically transform risk environments, increasing substance use and drug-related harms.
Methods
Based on a study of people who inject drugs (PWID) and injection risk behaviors in rural Puerto Rico, the present study uses data from two different phases of the parent study. Data for 110 participants were collected from December 2015 to January 2017, soon before Hurricane Maria landed in September 2017; the 2019 phase, in the aftermath of the hurricane, included a total of 103 participants. The present study’s main analyses used data from 66 PWID who participated in both the pre-Maria and post-Maria interviews (66 individuals measured at two time points, for a total of 132 observations), using mixed-effects binomial logistic regression to examine recent overdose experiences pre- and post-Maria. A separate descriptive analysis included all 103 participants from the 2019 interview.
Results
After Hurricane Maria, some declines in injection frequency were observed (the percentage of people reporting injecting monthly or less increased from 3.0% before Hurricane Maria to 22.7% after Hurricane Maria). However, fewer PWID reported using a new needle for most or all injections. In the pre-Maria interview, 10.6% of participants indicated they had experienced an overdose during the year of the interview and/or the calendar year prior, and this figure increased to 24.2% in the post-Maria interview. In the regression analysis, the odds of reporting an overdose during the interview year and/or calendar year prior were three times as high post-Maria, relative to pre-Maria (odds ratio 3.25, 95% confidence interval 1.06–9.97).
Conclusion
Substance use patterns, injection risk behaviors, and overdose episodes and deaths differed after Hurricane Maria, relative to before the hurricane, yet it is unclear to what extent these changes also reflect the simultaneous arrival of fentanyl. In preparation for future natural disasters, it is imperative to strengthen the health infrastructure by enhancing access and curbing barriers to syringe services programs and medications for opioid use disorder, particularly in rural or underserved locations.
“…The majority of MOUD clinics are concentrated in big urban centers, particularly in metropolitan San Juan, which also centralizes other health infrastructures [4]. Along with economic crises, pandemics, wars, or other natural disasters, hurricanes are considered "big events" because they alter the micro and macro structures in which vulnerable populations live and make risk decisions that impact their health [5][6][7][8].…”
Background
While natural disasters like hurricanes are increasingly common, their long-term effects on people who inject drugs are not well understood. Although brief in duration, natural disasters can radically transform risk environments, increasing substance use and drug-related harms.
Methods
Based on a study of people who inject drugs (PWID) and injection risk behaviors in rural Puerto Rico, the present study uses data from two different phases of the parent study. Data for 110 participants were collected from December 2015 to January 2017, soon before Hurricane Maria landed in September 2017; the 2019 phase, in the aftermath of the hurricane, included a total of 103 participants. The present study’s main analyses used data from 66 PWID who participated in both the pre-Maria and post-Maria interviews (66 individuals measured at two time points, for a total of 132 observations), using mixed-effects binomial logistic regression to examine recent overdose experiences pre- and post-Maria. A separate descriptive analysis included all 103 participants from the 2019 interview.
Results
After Hurricane Maria, some declines in injection frequency were observed (the percentage of people reporting injecting monthly or less increased from 3.0% before Hurricane Maria to 22.7% after Hurricane Maria). However, fewer PWID reported using a new needle for most or all injections. In the pre-Maria interview, 10.6% of participants indicated they had experienced an overdose during the year of the interview and/or the calendar year prior, and this figure increased to 24.2% in the post-Maria interview. In the regression analysis, the odds of reporting an overdose during the interview year and/or calendar year prior were three times as high post-Maria, relative to pre-Maria (odds ratio 3.25, 95% confidence interval 1.06–9.97).
Conclusion
Substance use patterns, injection risk behaviors, and overdose episodes and deaths differed after Hurricane Maria, relative to before the hurricane, yet it is unclear to what extent these changes also reflect the simultaneous arrival of fentanyl. In preparation for future natural disasters, it is imperative to strengthen the health infrastructure by enhancing access and curbing barriers to syringe services programs and medications for opioid use disorder, particularly in rural or underserved locations.
“…Despite the rapidly increasing literature concerning older adults’ drug use, there is less research on the subject among prison populations ( 5 , 12 ). In a recent scoping review on older adults who use illicit opioids, cocaine, or methamphetamine ( 13 ), out of 164 papers included in the review, only 15 mentioned participants’ incarceration as part of the study, often referring to incarceration history only when describing the study population or when distinguishing between comparison groups. Similarly, another review by Maschi and Dasarathy ( 14 ) concluded that there was a significant unexplored research and practice gap in the literature concerning justice-involved older adults with respect to the prevalence of mental health disorders including drug abuse and other addictions.…”
Section: Introductionmentioning
confidence: 99%
“…Which substances are used? ( 13 , 23 ), the experiences of IOAs who use drugs have received less attention. These experiences were addressed mainly anecdotally, as part of a wider exploration of older adults’ experience of incarceration, or as part of a study of individuals’ substance use experience in prison, when some of the participants happened to be older adults.…”
BackgroundThe prevalence of drug abuse among older adults has grown over the last decade. Despite the expanding development of a body of research dedicated to studying this phenomenon, drug abuse by incarcerated older adults has been marginalized. Thus, the aim of the present study was to explore drug abuse patterns in the lives of incarcerated older adults.MethodSemi-structured interviews were conducted with 28 incarcerated older adults, and an interpretive analysis was used to analyze the participants’ narratives.FindingsFour themes emerged: (1) Growing up around drugs; (2) Prison onset; (3) Professionals, and (4) Lifelong substance abuse.ConclusionThe study findings reveal a unique typology of drug-related themes in the lives of incarcerated older adults. This typology sheds light on the interplay between aging, drug use, and incarceration and the way these three socially marginalized positions may intersect.
“… Trauma is a key factor in conceptual models that link aging to opioid and stimulant use disorders. Early‐life trauma can be a driving factor in people who use opioids and stimulants throughout their life, and later‐life trauma might explain why some individuals develop new onset opioid and/or stimulant use disorders as older adults .The scoping review by Zolopa and colleagues highlights that the majority of research on opioid and/or stimulant use in older adults is gleaned from medical records or national surveys to assess clinical correlates and trends in older adults seeking treatment over time [1–3]. While these studies are informative and necessary, Zolopa et al .…”
mentioning
confidence: 99%
“…The scoping review by Zolopa and colleagues highlights that the majority of research on opioid and/or stimulant use in older adults is gleaned from medical records or national surveys to assess clinical correlates and trends in older adults seeking treatment over time [1][2][3]. While these studies are informative and necessary, Zolopa et al [3] note that very few studies apply conceptual frameworks that seek to explain why older individuals might have opioid use disorder (OUD) and/or stimulant use disorder (StimUD) that persists throughout the life-span (sometimes termed 'drug use careers') [4], and why some older individuals develop OUD/StimUD later in life. Trauma and adverse experiences might be core factors among conceptual models of substance use that give context to, and provide a mechanistic basis for, understanding substance use in older adults.…”
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