Maintenance treatment programme for opioid dependence: characteristics of 50+age group

Abstract

Purpose -The aim of this study is to explore the characteristics of a group of patients over 50 years old who are entering a substitution treatment programme for opioid dependence and to compare the characteristics of this group with those aged under 50 who are enrolled in the same substitution treatment programme.Design/methodology/approach -This is a cross sectional survey involving 92 cases in the 50 and above age group and 194 cases in the under 50 age group from community drug and alcohol services. Data were collected on demographic details, substance misuse and treatment history and progress with treatment. All the data were analysed using the Statistical Package for the Social Sciences (SPSS), version 1.1. Statistical significance between fewer than 50 and 50 þ groups were assessed using Fisher's exact test.Findings -Amongst the 92 in the group 50 years and above, 67 (average dose ¼ 63.25 mg) were on methadone maintenance (average dose ¼ 63.25 mg) and 19 (average dose ¼ 10.37 mg) on buprenorphine. In total, 11 per cent started using opiates after the age of 50. Sixty per cent used other substances out of which 31 per cent used multiple substances. Benzodiazepines, cocaine and amphetamines were the common substances of misuse. Thirty seven were infected with HCV. Comorbid rates for physical and mental illnesses were 64 per cent and 62 per cent, respectively. Nearly 86 per cent achieved good compliance with the treatment programme. Statistically higher rates of being single, lacking stable accommodation, prescription of buprenorphine, high dose prescriptions and lower rates of blood-borne viruses, physical health and mental health, past forensic history were found in the under 50 age group compared with the 50 þ age group.Practical implications -There are a considerable number of patients above the age of 50 in maintenance treatment and they differ from the less than 50 age group. Old age and substance misuse psychiatrists should be aware of the prevalence of comorbid substance misuse, physical (including blood borne viruses) and psychiatric disorders in this population. Further research is required in this neglected area and a service provision should be based on such robust research.Originality/value -This is the first study to the authors' knowledge that compares the demographic and treatment profiles of under 50 and over 50 years by age of patients in a methadone maintenance treatment programme. It clearly points to significant differences in the profiles based on age which will have implications for service provision which will have to take into account these age-related differences in particular related to physical health and social needs.

Cognition and adaptive functioning in older people attending drug and alcohol services

“…However, drug and alcohol (D&A) clients aged 50-60 years have been found to be in such poor physical and mental health (Lintzeris et al, 2015(Lintzeris et al, , 2016 that their health resembles that of people aged 70-80 years in the general population. Given this premature aging observed in D&A clients, the definition of 50+ years of age for "older" adults is therefore thought to be more appropriate (Gfroerer et al, 2003;Lofwall et al, 2005;Rosen et al, 2008;Han et al, 2009;Raja Badrakalimuthu et al, 2012;Han et al, 2015). In our recent study reporting on the health status of older (aged 50+ years) D&A clients, it was found that participants suffered from a range of health issues, including liver disease, head injury, various pain conditions, depression, and sleep problems (Lintzeris et al, 2015).…”

Health and social issues among older patients in opioid maintenance treatment in Norway

“…The number of opioid maintenance treatment patients with somatic comorbidity increased with age ( Badrakalimuthu et al, 2012 ; Haaland, Lie, Nesvåg, & Stevenson, 2015 ; Waal et al, 2014 ).…”

“…Individuals often suffer from memory loss, paranoia, changed mood or anger. Some studies illustrate that the incidence in comparison with younger OMT patients is somewhat similar (Firoz & Carlson, 2004), while others suggest higher rates of mental illness among the older group (Badrakalimuthu, Tarbuck, & Wagle, 2012). Regardless, most chronic mental illnesses do not diminish over time, but persist into older age.…”

“…The number of opioid maintenance treatment patients with somatic comorbidity increased with age (Badrakalimuthu et al, 2012;Haaland, Lie, Nesvåg, & Stevenson, 2015;Waal et al, 2014). Figure 2 shows the main somatic problems demonstrated by e-Lab: hepatitis C, cancer and liver, kidney and lung diseases.…”

Drug misuse in older people: old problems and new challenges

“…Increasing numbers of older people are presenting with drug problems (data available from the authors on request) and are on methadone maintenance treatment (Badrakalimuthu 2010).…”