International agencies such as the United Nations and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have recently highlighted their concerns about increased drug use among older people.1,2 An Irish study published in the journal, Drug and Alcohol Dependence, demonstrates that the proportion of older people starting treatment for opioid use is growing, and many have used opioid drugs for a relatively long time prior to seeking treatment.3
The study analyses data from the National Drug Treatment Reporting System (NDTRS) over the 19-year period from 1996 to 2014 inclusive. The NDTRS is an epidemiological database on treated problem drug and alcohol use in Ireland. Treatment records where an individual started treatment for the first time and an opioid was the primary drug problem were selected and the data were explored using statistical techniques to assess changes over time.
A total of 18,692 individuals entered treatment for the first time for opioid use during the study period. The number of treatment admissions peaked in 2009, with numbers declining in subsequent years. Heroin was the main problem opioid across all years, accounting for 92.7% (n=17331) of all treatment entries, while methadone accounted for 2.2% (n=417), over-the-counter and other prescribed opioids accounted for 4.6% (n=852) of treatments. A small number of other opioid types were reported (0.5%, n=92), including opium and unspecified opioid drugs.
Population figures were used to calculate annual treatment incidence rates, which were analysed for trends over time. Trends in admissions fluctuated across the period and several significant trends were observed. Overall, age-adjusted treatment incidence has declined over the last 18 years. Significant downward trends were observed in age-adjusted rates for the years 1996−2004, with an annual percentage change (APC) of −7.0% (CI: −10.1 to −3.9, p=0.003), and also in the period 2009−2014 (APC=−8.6, CI: −14.6 to −2.9, p=0.012). However, in the interim years (2004−2009), the trend was upward and significant (APC=13.4, CI: 3.1−24.9, p=0.012).
The examination of incidence by age revealed a downward trend among younger age groups and an upward trend among older age groups. In early years (1996−2002), incidence was concentrated among younger age groups and became more dispersed as time passed. The largest significant downward trends were observed among 15−19-year-olds in the years 2009−2014 (APC=−25.0, CI: −36.2 to −11.9, p<0.001) and among 20−24-year-olds in the years 2010−2014 (APC=−12.9, CI: −21.5 to −3.3, p<0.001). Upward trends were detected among older age groups, and two groups were evident: (1) incidence was low in early years among those aged 25−49 years and increased by varying amounts, and (2) there was a rising incidence that did not previously exist among 50−74-year-olds. The largest significant upward trends were among 35−39-year-olds in the years 2003−2009 (APC=27.4, CI: 9.2−48.6, p=0.003), and also among 40−44-year-olds (APC=14.6, CI: 10.7−18.6, p<0.001) and 45−49-year-olds (APC=13.6, CI: 9.2−18.1, p<0.001) right across the study period.
Other key findings
Other key findings from the study included the following:
- The results show evidence of subgroups within the treatment population; those who seek treatment quickly and also those who take much longer to seek treatment. There is evidence of late-onset drug users – individuals who begin drug use later in life.
- The profile of people entering treatment for opioid use has changed; people are now older, are injecting for longer, and are taking longer to enter treatment.
- The median age commencing opioid use increased by 3 years (from age 18 to age 21 ) (U=326141.5, p<0.001).
- The median age entering treatment increased by 11 years (from age 20 to age 31) (U=145465.5, p<0.001).
- The median opioid-using duration prior to treatment increased by 5 years (from 2 to 7 years) (U=170807.5, p<0.001).
- One-half of the individuals started injecting within 1 year of first using opioids. The median time between first injecting and commencing treatment increased by 6 years for men and 2 years for women.
The study authors highlight that:
- In recent years, more and more people aged 50 years and older are entering treatment for opioid use, a trend not previously observed.
- Results show how service need has changed over the last two decades and provide an indication of future service need, which is essential for planning purposes. These findings also highlight how treatment data can be used to identify hidden groups at risk of chronic harm which may require prioritising in policy and practice.
The authors note that although drug treatment data are collected across 30 European countries, this study is the first large-scale examination of ageing and opioid use trends. The study provides evidence to underpin policy development and changes in practice. Current drug policies and treatment services are predominately focused on the needs of the known profile of younger drug users, and it is inevitable that existing services need to adapt to the ageing population. The changing composition of this group suggests a wide range of services will be required into the future and integrated approaches across addiction and healthcare services would be beneficial in identifying and treating addiction problems among ageing drug users.
2 European Monitoring Centre for Drugs and Drug Addiction (2017) Health and social responses to drug problems: a European guide. Luxembourg: Publications Office of the European Union. https://www.drugsandalcohol.ie/28040/
3 Carew AM and Comiskey C (2018) Rising incidence of ageing opioid users within the EU wide treatment demand indicator: the Irish opioid epidemic from 1996 to 2014. Drug and Alcohol Dependence, 192: 329–337. https://www.drugsandalcohol.ie/29783/