Primary health care and other social issues for older people who inject drugs
Australian Government data have established that chronic non-communicable diseases are now responsible for around 80% of the total burden of disease in Australia and it is estimated that by 2020 they will account for almost 75% of all deaths . Concurrent ageing and drug use (licit and illicit) create a discrete set of unique and, as yet, not fully understood problems for older people.
There is an absence of research about the long-term health and social outcomes for older Australians who use licit and illicit drugs. The number of older people who have never sought treatment for their drug use is largely unknown and there remains limited knowledge of the health implications of long term use especially of opiates.
Recently I worked with a local primary health care service in Melbourne established to provide health care specifically for people who inject drugs to audit their use of services by older people with a history of drug injecting. We concentrated on the use of the service by people aged over 50 and this revealed an enormous amount of information about the reasons for attendance and the health issues with which many of them are living. The average age of the 66 people attending was 54 (range 50-68 years). One third of the people attending were female, a similar proportion to the number of females who appear in most research with PWID in Australia.
The on-going use of alcohol and illicit drugs was common with one in five of people presenting with problematic alcohol consumption as a major concern. Heroin was noted as the primary illicit drug people were using. Almost one in five people presented to the service reporting problems using a combination of drugs.
Older people with a history of drug injecting and living with hepatitis C are for the first time named as a priority population in the Australian National Hepatitis C Strategy (2014-2017) . Determining the health needs of people with hepatitis C as they age is an important public health issue given the Australian population is ageing as a whole and as older people with chronic HCV are at increased risk of developing liver disease.
Almost two-thirds of those included in the audit had recent blood borne virus testing conducted and over half were hepatitis C positive. More than two-thirds were being regularly monitored and ten people were being 'worked up' for hepatitis C treatment. Alternative models of care to the tertiary hospital liver clinics means that hepatitis C treatment will become more regularly provided successfully in primary care settings .
Opiate Substitution Treatment
More than 10,000 people aged over 50 are now prescribed opiate substitution treatment and this represents over 20% of people on OST. Almost two-thirds of people attending this service were currently being dosed with pharmacotherapy by a local chemist most commonly it was methadone. Interestingly almost half the people aged over 50 using this primary health care service were also seeing another GP even if only for OST prescriptions.
Legal Issues and other social issues
One-third of clients reported a legal issue as part of their access to the service. Legal issues were also commonly reported both drug related and non-drug related. Almost one quarter of those being seen at the service had a history of incarceration. There are a range of issues for older prisoners, especially those with a history of drug injecting, that require further investigation .
Unstable housing is an on-going and ever present issue for people on fixed statutory incomes. This issue was highlighted for almost 20% of people in the audit and a small number required extensive and intensive housing support from workers in the health care team. This has been noted as problematic for older women and warrants further work .
1. Australian Institute of Heath and Welfare, Australia's Health 2014. 2014, AIHW: Canberra.
2. Commonwealth of Australia, Fourth National Hepatitis C Strategy 2014-2017. 2014: Canberra
3. Newman, A.I., et al., Treatment of chronic hepatitis C infection among current and former injection drug users within a multidisciplinary treatment model at a community health centre. Canadian Journal of Gastroenterology, 2013. 27(4): p. 217-223.
4. Waldbrook, N., Formerly Homeless, Older Women's Experiences with Health, Housing, and Aging. Journal of Women & Aging, 2013. 25(4): p. 337-357.
5. Trotter, C. and S. Baidawi, Older prisoners: Challenges for inmates and prison management. Australian & New Zealand Journal of Criminology, 2015. 48(2): p. 200-218.