Do we need special programs for aging drug users?

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1 High risk drug use and drug treatment in Europe 2014 EMCDDA event: Continuity and Change Lisbon, September 2014 Do we need special programs for aging drug users? Andrej Kastelic EUROPAD General Secretary SEEA net President Center for Treatment of Drug Addiction Psychiatric Clinic Ljubljana Ljubljana, Slovenia

2 Traditionally drug use is associated with young population. People do not mature out of drug use. Baby boom population reaching the age of

3 Demographic changes and trend in heroin consumption with increasing epidemia from 70s peaking in 80s in Western Europe, 80s and 90s in Southern Europe and 90s and 2000s in Eastern Europe and central Asia.

4 ,7 23,9 23,5 23, ,2 23,1 22,3 22,2 21, ,1 22,2 22, ,4 28,4 28,7 26,8 27,37 26,1 20 Avarage age Year

5 40,00 Average age 35,00 30,00 25,00 29,65 29,09 27,58 27,80 25,21 24,30 30,69 28,76 26,22 30,79 29,17 26,99 32,18 29,74 27,37 32,81 31,10 28,40 33,77 32,63 28,36 34,37 32,18 28,74 20, Year New enterance Not 1st time enterance more tha 1 year in the prog.

6 Duration of addiction desease 25,00 20,00 15,00 10,00 5,00 0,

7 Duration of treatment in MAT

8 Time from the beginning of drug use to initiation of treatment

9 Delež Leto PONOVNI CZOPD PRVI CZOPD PONOVNI IVZ PRVI IVZ

10 Number of patients, treated in 2007 and 2012 who were ever convicted (45%) % % ne % % 85 62,5% 37,5% da 0 metadon buprenorfin sr-morfin sr-morfin; 50; 7% buprenorfin; 122; 17% sr-morfin; 30; 5% buprenorfin; 85; 14% metadon; 559; 76% metadon; 494; 81%

11 Drug users age over 40 years represent in some European countries more than 50% of new admissions (including recurring admissions) in opioid substitution treatment (OST) and more than 60% in OST are over this age.

12 Relapse rate in treatment is 60-80% with death rate much higher among those who stop treatment many clients continue or interrupt and restart MAT that lead to increase of older clients. Abstinence raise during older patients is generally higher than in younger adults.

13 Limited research data, stigma, discrimination and shame about substance use increase reluctance to see professional care. Multiple somatic and mental health comorbidities complicate diagnosis treatment.

14 Older drug users are vulnerable population with needs for specific interventions and services. Specialized services are rear and the needs try to be addressed trough existing facilities by individually tailored interventions that should covered needs beyond those solely related to drug use.

15 Aging related changes of brain and other physiological alterations together with often prescribed medication and drugs may lead to elevation of drug/medications serum levels and more pronounced effects, interactions, side effects including severe toxicity. In OST services more care should be taken about choice of medication, dosage, means of administration, take home dosages, pain treatment, patronage community care

16 Methadone More drug interactions (QTC) methadone with other medications. Side effects consider as result of drug use. Slower inductione and tapering the medications.

17 The age related possible deterioration of the immune system leads to decline in the immune response. Physiological alterations may lead to elevation of drug serum levels and more pronounced effects. Drug use is a risk factor for earlier and more serious diabetes, neurological disorders, cardio vascular diseases, liver cirrhosis, and cancer.

18 Overdose can be more likely as users get older despite the false confidence many might feel after surviving decades with using different substances. High levels of smoking (not only tobacco but cocaine, heroine, cannabis, ) respiratory complications. Emphysema, bronchitis, chronic obstructive pulmonary disease heighten the risk of overdose.

19 More and complex psychological and psychiatric disorders: anxiety, dementia, loneliness, that are exacerbated trough stressful life events and there are more suicides in this population. Elderly are prone to more injuries and accidents and risk of death specially when using simultaneously alcohol or benzodiazepines. Dental deteriorations.

20 Low socio-economic status Lack of family support Employment Housing Transportation Leisure activities Pain management opio phobia (underprescribing of necessary medications: fear of side effects, overdosing, iatrogenic drug addiction, misuse and diversion)

21 Staff training and awareness should be raised between special services and general care providers-general practitioners. Special skills of nursing staff should be available trained and motivated to work with older adults helping to learn and maintain leaving skills and monitor medicine use. Individual and group based approaches (in incarceration custodial settings, as well) using supportive, nonconfrontational approaches, building self esteem. Case management/communities linked and outreach including 24 hours supervised services. Use of age appropriate pace and content.

22 HR services Palliative care Group homes Old people s home There is some evidence that drug users are more prone to early onset of dementia.

23 Worries about getting old need help staying alone not able to sleep without financial resources

24 Society dose not expect older people to use drugs gap in service provision Care homes are not paid to look after drug users and do not have expertise to manage people with significant drug and alcohol problems. With the way the things are, I would rather be dependent on drugs than other people.

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