An Ageing Methadone Population: A Challenge to Aged Persons’ Mental Health Services?

Abstract

Oral administration of methadone has been used as a treatment strategy for opiate addiction for many years. The state of Victoria, Australia, has a long-running methadone program with a large number of participants. Accordingly, a growing number of adults have utilised methadone maintenance treatment for a number of years and are now moving into older age due to advances in medical treatment and harm reduction initiatives. The objective of this review is to examine the literature pertaining to co-occurring mental illness in older methadone treatment participants and to explore the future challenges this growing cohort of ageing adults pose to aged persons’ psychiatry services. As part of a broader study into dual diagnosis in older adults, a search of the Scopus, ProQuest, and CINAHL journal databases was performed. Twenty abstracts from literature published within the previous 15 years (1999–2014) were identified that explored methadone maintenance programs and the older adults maintained on them. A number of researchers have identified the ageing methadone population to have a high degree of comorbid mental illness and psychological distress. Studies also indicate that individuals enrolled in methadone maintenance programs may engage in a degree of continual substance use, potentially leading to deleterious effects on their psychosocial function. An ageing methadone population experiencing a high degree of comorbid mental illness is likely to challenge aged persons’ psychiatry services. These services are likely to be increasingly called on to manage these individuals, particularly within Victoria where few substance use services exist for those over the age of 65. It is essential that aged persons’ psychiatry services prepare to provide care for these individuals in a responsive manner that is inclusive of both their mental health and substitution pharmacotherapy.

Factors associated with health-related quality of life in a large national sample of patients receiving opioid substitution treatment in Germany: A cross-sectional study

“…This reflects an ageing cohort of opioid users who started injecting during the heroin “epidemics” of the 1980s and 1990s and who have shaped and characterized the current European treatment systems [6, 7]. A steadily increasing age of the OST population is also observed in many other regions in the world with a longer history of OST implementation, such as New York City [8] and Australia [9]. Thus, long-term OST patients are getting older and few young people are entering OST.…”

Ageing and older people who use illicit opioids, cocaine or methamphetamine: a scoping review and literature map

“…Publications also noted the especially OAT, to better serve older adults [26,77,78]. Studies of OAT clients often investigated health-related outcomes, including the prevalence of comorbid conditions [79][80][81][82], cognitive functioning [83], infectious disease progression [78] and mortality risk [75,76], as well as the prevalence of illicit drug use among OAT clients [78,81,84,85]. Other health service sub-areas were medication and drug selling (n = 4).…”

Mobile Narcotic Treatment Programs: On the Road Again?

“…Others persist in the treatment but never wean themselves entirely off opioids. With advances in healthcare and the ability to “manage” once fatal conditions, there is an older and aging population on opioid agonist therapy who enter their geriatric years as active substance abusers [ 34 ]. This older population may be well served by mobile treatment units.…”

“…This older population may be well served by mobile treatment units. Furthermore, few programs aim at the aging substance abuser, many of whom have comorbid mental health issues that are also not frequently addressed in geriatric care [ 34 ]. There is no legally defined age limit for this service.…”