Transcript Slide 1

Deaths of older drug users
Dr. Caryl Beynon
Reader in Substance Use Epidemiology
Centre for Public Health, Liverpool John Moores University
Email: [email protected]
Web: www.cph.org.uk
Drug Treatment Programmes
Cheshire and Merseyside
Drug Treatment Programmes
Cheshire and Merseyside
98.5%
94.3%
1998
2008/09
Percentage
100
90
80
70
60
50
40
30
20
10
0
5.6%
1.5%
11 to 49
Males
50 to 74
11 to 49
Age (years)
50 to 74
Females
Drug Treatment Programmes
Cheshire and Merseyside
98.5%
94.3%
94.9%
1998
2008/09
Percentage
100
90
80
70
60
50
40
30
20
10
0
98.1%
5.6%
1.5%
11 to 49
Males
1.9%
50 to 74
11 to 49
Age (years)
5.1%
50 to 74
Females
Drug Treatment Programmes
Cheshire and Merseyside
Percentage aged 40-49 years
35
30
25
20
15
10
5
0
1996
1998
2000
2002 2004
Year
2006
2008
2010
Needle and Syringe Programmes
Merseyside
Needle and Syringe Programmes
Merseyside
Source: Inter Agency Drug Misuse Database
Needle and Syringe Programmes
Merseyside
Source: Inter Agency Drug Misuse Database
Deaths of Older Drug Users
Question 1:
Has the average age of death of drug treatment
clients changed in recent years?
Question 2:
Do older drug users and younger drug users die from
different causes?
Deaths in Treatment: Methodology
Drug treatment
agencies
(tiers 3 and 4)
Drug treatment agencies
Monitoring data
National Drug Treatment
Monitoring
System (NDTMS)
North West
Anonymous details of
people reported as dead
Names of people
reported as dead
Office of National
Statistics (ONS)
Anonymous death
details
Centre for
Public Health
Death
Acute effects of
drug use (e.g. drug
toxicity)
Non-acute effects
of drug use (e.g.
hepatitis C related
hepatocellular
carcinoma)
Not related to drug
use at all
Drug
related
deaths
Acute effects of
drug use (e.g. drug
toxicity)
Death
Non-acute effects
of drug use (e.g.
hepatitis C related
hepatocellular
carcinoma)
Not related to drug
use at all
Age at Death, Drug Treatment Clients
(North West of England)
55
Spearman’s rank correlation: P<0.01
Median age at death
50
45
40
35
30
25
20
2003/04
2004/05
2005/06
Year
2006/07
2007/08
Death
Age: less than 40
Drug related
death
Non drug
related death
Age: 40 and above
Drug related
death
Non drug
related death
Death Categorisation by Age
Under 40
40 and over
Total
DRD
Non DRD
DRD
Non DRD
2003/04
24 (35.8%)
43 (64.2%)
5 (16.7%)
25 (83.3%)
97
2004/05
26 (47.3%)
29 (52.7%)
4 (13.3%)
26 (86.7%)
85
2005/06
28 (50.0%)
28 (50.0%)
3 (6.8%)
41 (93.2%)
100
2006/07
22 (44.0%)
28 (56.0%)
21 (37.5%)
35 (62.5%)
106
2007/08
24 (51.1%)
23 (48.9%)
17 (24.6%)
52 (75.4%)
116
All years
125 (45.5%)
150 (54.5%)
51 (22.3%)
178 (77.7%)
504
Death Categorisation by Age
Under 40
40 and over
Total
DRD
Non DRD
DRD
Non DRD
2003/04
24 (35.8%)
43 (64.2%)
5 (16.7%)
25 (83.3%)
97
2004/05
26 (47.3%)
29 (52.7%)
4 (13.3%)
26 (86.7%)
85
2005/06
28 (50.0%)
28 (50.0%)
3 (6.8%)
41 (93.2%)
100
2006/07
22 (44.0%)
28 (56.0%)
21 (37.5%)
35 (62.5%)
106
2007/08
24 (51.1%)
23 (48.9%)
17 (24.6%)
52 (75.4%)
116
All years
125 (45.5%)
150 (54.5%)
51 (22.3%)
178 (77.7%)
504
Death Categorisation by Age
Under 40
40 and over
Total
DRD
Non DRD
DRD
Non DRD
2003/04
24 (35.8%)
43 (64.2%)
5 (16.7%)
25 (83.3%)
97
2004/05
26 (47.3%)
29 (52.7%)
4 (13.3%)
26 (86.7%)
85
2005/06
28 (50.0%)
28 (50.0%)
3 (6.8%)
41 (93.2%)
100
2006/07
22 (44.0%)
28 (56.0%)
21 (37.5%)
35 (62.5%)
106
2007/08
24 (51.1%)
23 (48.9%)
17 (24.6%)
52 (75.4%)
116
All years
125 (45.5%)
150 (54.5%)
51 (22.3%)
178 (77.7%)
504
Death Categorisation by Age
Under 40
40 and over
Total
DRD
Non DRD
DRD
Non DRD
2003/04
24 (35.8%)
43 (64.2%)
5 (16.7%)
25 (83.3%)
97
2004/05
26 (47.3%)
29 (52.7%)
4 (13.3%)
26 (86.7%)
85
2005/06
28 (50.0%)
28 (50.0%)
3 (6.8%)
41 (93.2%)
100
2006/07
22 (44.0%)
28 (56.0%)
21 (37.5%)
35 (62.5%)
106
2007/08
24 (51.1%)
23 (48.9%)
17 (24.6%)
52 (75.4%)
116
All years
125 (45.5%)
150 (54.5%)
51 (22.3%)
178 (77.7%)
504
Death Categorisation by Age
Under 40
40 and over
Total
DRD
Non DRD
DRD
Non DRD
2003/04
24 (35.8%)
43 (64.2%)
5 (16.7%)
25 (83.3%)
97
2004/05
26 (47.3%)
29 (52.7%)
4 (13.3%)
26 (86.7%)
85
2005/06
28 (50.0%)
28 (50.0%)
3 (6.8%)
41 (93.2%)
100
2006/07
22 (44.0%)
28 (56.0%)
21 (37.5%)
35 (62.5%)
106
2007/08
24 (51.1%)
23 (48.9%)
17 (24.6%)
52 (75.4%)
116
All years
125 (45.5%)
150 (54.5%)
51 (22.3%)
178 (77.7%)
504
Death Categorisation by Age
Under 40
40 and over
Total
DRD
Non DRD
DRD
Non DRD
2003/04
24 (35.8%)
43 (64.2%)
5 (16.7%)
25 (83.3%)
97
2004/05
26 (47.3%)
29 (52.7%)
4 (13.3%)
26 (86.7%)
85
2005/06
28 (50.0%)
28 (50.0%)
3 (6.8%)
41 (93.2%)
100
2006/07
22 (44.0%)
28 (56.0%)
21 (37.5%)
35 (62.5%)
106
2007/08
24 (51.1%)
23 (48.9%)
17 (24.6%)
52 (75.4%)
116
All years
125 (45.5%)
150 (54.5%)
51 (22.3%)
178 (77.7%)
504
Death Categorisation by Age
Under 40
40 and over
Total
DRD
Non DRD
DRD
Non DRD
2003/04
24 (35.8%)
43 (64.2%)
5 (16.7%)
25 (83.3%)
97
2004/05
26 (47.3%)
29 (52.7%)
4 (13.3%)
26 (86.7%)
85
2005/06
28 (50.0%)
28 (50.0%)
3 (6.8%)
41 (93.2%)
100
2006/07
22 (44.0%)
28 (56.0%)
21 (37.5%)
35 (62.5%)
106
2007/08
24 (51.1%)
23 (48.9%)
17 (24.6%)
52 (75.4%)
116
All years
125 (45.5%)
150 (54.5%)
51 (22.3%)
178 (77.7%)
504
Older drug users are significantly less
likely to die from a drug related death
(the acute effects of drug use).
Then what are older drug users dying from?
Diseases of the Liver
• Liver diseases (including alcoholic liver disease).
• Hepatitis C.
• Neoplasm of the liver (hepatitis as secondary cause).
• Not drug related?
Diseases of the Cardiovascular System
• Ischemic heart disease.
• Cerebrovascular disease.
• Stimulants are vasoconstrictors =
increased blood pressure = damage to
arterial walls = reduction in blood supply.
• Nicotine = increased blood pressure….
• Smoking = release of cholesterol into
the blood stream = atherosclerosis =
increased blood pressure….
Diseases of the Cardiovascular System
• Deep vein thrombosis.
Ageing is coupled with:
• Blood pressure changes.
• Venous value deterioration.
• Reduced regenerative
processes.
• Reduce mobility.
Respiratory Diseases
• Acute lower respiratory infections (influenza and pneumonia).
• Chronic lower respiratory diseases (chronic obstructive pulmonary
disease).
• Pneumonia (common in old and young)
• Pathogen is inhaled
• Pathogen enters via injection site
• Reduced immunity of older people.
• Chronic lower respiratory diseases (old)
• Smoking
• Harm reduction?
Deaths from Stroke
(England, 2006)
Source: British Heart Foundation (2009)
Deaths from Myocardial Infarction
(England, 1996-2004)
Source: SWEPHO(2006)
Interview Methodology
• Semi-structured interviews.
• Interview duration: up to one hour.
• Data were collected in January/February 2008.
• Interviews were taped and transcribed and analysed
thematically.
• Interviewees were recruited via drug services in
Merseyside.
Participant Characteristics
• 9 men and 1 woman.
• Age range: 54 to 61.
• 6 were single, 4 were divorced.
• Accommodation included: hostel, own home (council
house, flat or housing association bed sit), care home,
caravan.
• All were, or had been, problematic drug users.
Drug Use Initiation
• Late onset drug user.
• Adolescence or early adult years.
• Recreational use, experimentation, escape, part of the
‘hippie era’, triggered by childhood abuse or parent
dying.
• Drugs first used: alcohol, cannabis, LSD,
amphetamine, morphine hydrochloride, heroin,
speedballs (heroin and cocaine), psilocybin-containing
mushrooms.
• Late onset problematic drug use.
Current Drug Use
• Trying to use responsibly and to maintain their
health and personal safety.
“So I’ve got to be very careful, my body’s not what it was.
Occasionally I can get carried away and I’ll be feeling,
because I’m feeling young inside, I’ll be feeling young
outside, which is just not so. These days I’ve got a handle
on that. If I’ve been drinking a lot I won’t smoke. Even if
I’m not feeling too good, I’ll leave it until the alcohol’s worn
off some to make sure that I’m not going to go asleep and
not wake up.”
(man aged 61)
Physical Health
• Poor physical health.
• Chronic and life threatening conditions: circulatory
problems (deep vein thrombosis, ulcers, stroke),
respiratory problems, pneumonia, diabetes, hepatitis,
liver cirrhosis.
• Malnutrition, weight loss, obesity, impaired
mobility.
• History of accidental injury (e.g. falls) and overdose.
Physical Health: Hepatitis C
• Half had hepatitis C.
• Serious infection.
• Long asymptomatic phase.
“I’ve never really had any serious illnesses... I forgot
the hep C y’know. I’ve had no symptoms. I haven’t
been sick or anything y’know but I’ve got the virus”.
(man aged 56)
Physical Health: Vein Damage
• Problems with venous access.
“I can’t get a vein in my arm now”
(man aged 56)
• Switched to riskier practices.
“It’s harder now to inject because your veins. Your
veins sort of go y’know... I’ve been injecting in my
foot, which is stupid really, y’know. You can catch an
infection and you could end up losing your leg”.
(man aged 56)
Physical Health: Respiratory Problems
• Crack cocaine smokers.
“I get out of breath easy. I absolutely panic then”.
(man aged 52)
“It’s tender inside and when I breathe I can’t breathe
hard cos it hurts like hell”.
(man aged 58)
Mental Health
• Interviewees talked of a life using drugs as being
depressing.
“It’s a depressing life y’know. It’s not good”.
(man aged 56)
• A way to forget problems.
“That’s all we do anyway. Just take it [heroin] and just
mong for the day like and forget about your worries
and everything, got problems and you forget all that.
Things like that; it’s the reason why people take it like”.
(man aged 56)
Mental Health
• Drug use escalated, or recommenced, in times of
stress.
“You reach a point in our life, different points in your life
where you’ve got a lot of stress and the easiest thing in
the world is to say ‘oh fuck it’. And once you’ve said that,
if you’re a drug user, a drug abuser, once you’ve said
that, you’re on the rocky road to destruction again”.
(man aged 61)
Social Relationships
• All participants were single or divorced.
• Loss of relationships (family members, spouse or
partner, children, friends) common theme.
“I’ve just been left to rot on my own”.
(man aged 56)
• Death of drug-using friends was particularly common.
“In fact they’re all dead now, aren’t they, pretty well. I think
there’s about two left. And god knows how many all dead.”
(man aged 61)
Mental Health and Social Relationships
• Strong social networks very important for mental
health of older people.
• All older people experience loss of friends and
family but intensified in drug users.
“It’s made me extremely depressed in as much as the few
that were left are people I could talk to and at least there’s
consolation in company if it’s good company... [now] the
only company I could find if I wanted to would be people
who are younger and on that totally different scene, and
like I say, I have nothing in common with them...
Consequently I find myself quite lonely at times”.
(man aged 61)
Mental Health and Social Relationships
• Exacerbated by paranoia.
“You can only enjoy it [drug use] for so long, then
paranoia sets in and it does your head in”.
(man aged 61)
“I don’t like going to pubs. I always get paranoid…
Everybody’s looking at me…Drugs. Drugs do it to you”.
(man aged 58)
Conclusions
• Data suggest that each year, a growing proportion of
drug users are reaching the age of 50.
• The average age at which drug users die is increasing.
• Older drug users face new health challenges (chronic
effects of drug use).
• Deaths of older drug users are not reflected in official
drug related death figures.
• Care of older drug users will need to involve primary,
secondary and tertiary care and social services as
adjuncts to drug treatment.