Deaths of older Deaths of older drug users 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
Dec 25, 2015
Deaths of older drug usersDeaths of older drug users
Dr. Caryl BeynonReader in Substance Use Epidemiology
Centre for Public Health, Liverpool John Moores University
Email: [email protected]
Web: www.cph.org.uk
Drug Treatment ProgrammesDrug Treatment ProgrammesCheshire and Merseyside
Drug Treatment ProgrammesDrug Treatment ProgrammesCheshire and Merseyside
98.5%94.3%
5.6%
Drug Treatment ProgrammesDrug Treatment ProgrammesCheshire and Merseyside
98.5%94.3%
5.6%
98.1%
1.9%
94.9%
5.1%
Drug Treatment ProgrammesDrug Treatment ProgrammesCheshire and Merseyside
Needle and Syringe Programmes Needle and Syringe Programmes Merseyside
Needle and Syringe Programmes Needle and Syringe Programmes Merseyside
Source: Inter Agency Drug Misuse Database
Source: Inter Agency Drug Misuse Database
Needle and Syringe Programmes Needle and Syringe Programmes Merseyside
Deaths of Older Drug UsersDeaths 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?
Drug treatment agencies
(tiers 3 and 4)
National Drug Treatment Monitoring
System (NDTMS)North West
Monitoring data
Drug treatment agencies
Anonymous details of people reported as dead
Office of NationalStatistics (ONS)
Names of people reported as dead
Centre for Public Health
Anonymous death details
Deaths in Treatment: MethodologyDeaths in Treatment: Methodology
Drug related deaths
Spearman’s rank correlation: P<0.01
Age at Death, Drug Treatment ClientsAge at Death, Drug Treatment Clients(North West of England)
Death
Age: less than 40 Age: 40 and above
Drug related death
Non drug related death
Drug related death
Non drug related death
Under 40 40 and over
TotalDRD 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 AgeDeath Categorisation by Age
Under 40 40 and over
TotalDRD 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 AgeDeath Categorisation by Age
Under 40 40 and over
TotalDRD 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 AgeDeath Categorisation by Age
Under 40 40 and over
TotalDRD 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 AgeDeath Categorisation by Age
Under 40 40 and over
TotalDRD 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 AgeDeath Categorisation by Age
Under 40 40 and over
TotalDRD 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 AgeDeath Categorisation by Age
Under 40 40 and over
TotalDRD 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 AgeDeath Categorisation by Age
Older drug users are significantly less Older drug users are significantly less likely to die from a drug related death likely to die from a drug related death
(the acute effects of drug use).(the acute effects of drug use).
Then what are older drug users dying from?Then what are older drug users dying from?
Diseases of the LiverDiseases 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 SystemDiseases 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 SystemDiseases of the Cardiovascular System
• Deep vein thrombosis. Ageing is coupled with:
• Blood pressure changes.• Venous value deterioration.• Reduced regenerative processes.• Reduce mobility.
Respiratory DiseasesRespiratory 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 StrokeDeaths from Stroke
Source: British Heart Foundation (2009)
(England, 2006)
Deaths from Myocardial InfarctionDeaths from Myocardial Infarction
Source: SWEPHO(2006)
(England, 1996-2004)
Interview MethodologyInterview 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 CharacteristicsParticipant 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.
• 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.
Drug Use InitiationDrug Use Initiation
Current Drug UseCurrent 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)
• 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 HealthPhysical Health
Physical Health: Hepatitis CPhysical 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 DamagePhysical Health: Vein Damage
• 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”.
“I can’t get a vein in my arm now”
• Problems with venous access.
(man aged 56)
(man aged 56)
Physical Health: Respiratory ProblemsPhysical Health: Respiratory Problems
• Crack cocaine smokers.
“I get out of breath easy. I absolutely panic then”.
“It’s tender inside and when I breathe I can’t breathe hard cos it hurts like hell”.
(man aged 52)
(man aged 58)
Mental HealthMental Health
• Interviewees talked of a life using drugs as being depressing.
“It’s a depressing life y’know. It’s not good”.
• 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)
(man aged 56)
Mental HealthMental 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 RelationshipsSocial Relationships
• All participants were single or divorced.
• Loss of relationships (family members, spouse or partner, children, friends) common theme.
“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)
• Death of drug-using friends was particularly common.
“I’ve just been left to rot on my own”.(man aged 56)
Mental Health and Social RelationshipsMental 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 RelationshipsMental Health and Social Relationships
“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)
• Exacerbated by paranoia.
ConclusionsConclusions
• 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.