It is well known that how we live our lives has a profound effect on how well we age and our wellbeing in later life. It is not just a case of what we do when we reach our sixties. I often wonder what young people are doing to their hearing when the sound at rock concerts can be palpably felt on the body; when exceedingly loud music is pumped directly into the ears through headphones. Let’s hope that advances in hearing aid technology keep up – both in efficacy and affordability. But that may be sour grapes on the part of an ageing kill-joy and, anyhow, it is not what I want to talk about in this and the following blog. I want to start with illicit drug use.
For those who can remember that far back in drug use history – in the 60s the fashion was LSD, in the 70s (and ongoing) cannabis, in the 80s and 90s Ecstasy, then “party pills” and now methamphetamine/P. This is not an exhaustive list, but it illustrates that we have had significant levels of illegal substance use for many decades.
Some sources suggest that at one stage New Zealand had the highest per capita rate of heroin use in the world and we may now top the world for marijuana use. A 2015 Global Drug Study found that, in the previous 12 months, more Kiwi respondents had smoked pot (32.5 percent) than tobacco (30.1 percent).
So the length of time that this smorgasbord of drugs has been around means that users are now reaching their fifties and beyond. A report from the Royal College of Psychiatrists (RCP) in the UK in March of this year concluded that the proportion of older people with substance misuse is rising more rapidly than can be explained by the rise in the proportion of older people in the UK. And the “baby boomer” population, who are all now aged over 50 is at the highest risk of rising substance misuse in the older population. These are the people who may have participated in and enjoyed the successive fashions for illicit drugs, which I mentioned at the beginning, so they could be exhibiting cumulative effects in the same way that earlier tobacco smoking can have long-lasting consequences. The RCP further conclude that the misuse of illicit drugs such as cannabis and amphetamines and prescription painkillers is a growing public health problem. And substance misuse in older people is associated with reduced life expectancy and accelerated ageing, which is further compounded by socio-economic deprivation and chronic mental and physical health problems.
The older heroin addict
The RCP reports that drug treatment services in the UK have increasing numbers of patients who are being maintained on opioid substitution treatment (to counter heroin addiction) into their 50s and beyond. It was once believed that illicit drug users ‘matured’ out of their drug use, but there is evidence that older heroin users do not reduce their use as they age. Older people with a history of heroin dependence have poorer physical health and social functioning than their non-dependent peers and show high levels of depression, PTSD, anxiety, arthritis and hypertension, not to mention liver disease, through hepatitis C infection.
This may be an extreme result, but many years of illicit drug use may leave older people with poor physical health, reduced mobility and limited social support. Death rates in older people with substance misuse are higher than in the general older population.
This situation results in increased demands on a variety of services such as older people’s mental health, primary and social care, acute hospital services and help from the voluntary sector, not to mention criminal justice for continuing users. Often staff in these settings have little specialist knowledge of how to deal with the older people involved. Older people, with ongoing problems related to drug use have distinctive and varied needs, requiring diverse responses from services. Hearing their voices and encouraging close links between health and social care services, as well as family and carers, will be needed.
It may also be difficult to place ageing drug users in mainstream residential care. Some countries (e.g. Denmark, Germany, Netherlands) have developed specialised nursing homes and accommodation services for this group, but there are concerns that this process may introduce stigmatisation and increase social exclusion.
But then there are the legal drugs – alcohol, prescription and over-the-counter remedies. How much of a problem are they in our ageing society? Next time……
 Royal College of Psychiatrists (2018) Our Invisible Addicts, 2nd edition.
College Report CR211, London. The report also involved the Royal College of
General Practitioners and the British Geriatrics Society. It follows on an earlier report published in 2011.