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

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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.

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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)
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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

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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

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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

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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
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Recovery?

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