Transcript Meeting the health needs of older drug users

Meeting the health needs
of older drug users
Dr Muriel Simmonte
NHS Lothian
Primary Care Facilitator Team/East Lothian Locality Drug Clinic
Trainspotters?
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“Survivors” – drug users with an early
onset of drug use which has persisted for
many years
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“Late starters” – drug users who become
involved in drug use at a later age
Survivors
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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 socioeconomic disadvantage
Adverse life events – loss of friends and
family members, involvement in violence and
crime
Late starters
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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
Health issues for older drug users
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Complications of drug use – include blood
borne viruses, respiratory disease,
cardiovascular disease
Mental health and overdose risk
Age related health problems
Lifestyle and circumstances
Blood borne viruses
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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
Respiratory disease
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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
Cardiovascular disease
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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
Mental health and
overdose risk
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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.
Drug-related deaths: Scotland
Total
Under 25
25 - 34
35 - 44
45 & over
1996-2000
average
260
83
32%
108
42%
46
18%
23
9%
2004-2008
average
428
77
18%
151
35%
134
31%
67
16%
This equates to a near trebling of average annual deaths
in the 35 & over age group - from 69 (1996-2000) to
201(2004-2008)
Age related health problems
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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
Lifestyle and circumstances
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Lack of social support
Financial situation
Experience of criminal justice system
Poor engagement with mainstream health
care, especially preventative care
Meeting general health needs
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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
Meeting specific health needs
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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
Lothian NES for drug users
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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
Recovery?
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Long term treatment – positive choice or
lack of support to change?
Benefits and risks of reduction/detox
Lifestyle factors
Aspirations