Older addicts cost £51m in hospital stays, report says
Drug treatment services in Scotland should be refocused to take account of the increasing number of older users, a report has said.
More than half of Scotland's 61,500 problem drug users are 35 or older.
But the report, published by the Scottish Drugs Forum (SDF), warned treatment services are "generally unprepared" to meet their needs.
The Scottish government said ensuring older drug users get the person-centred care they need was a priority.
The report said the complex and long-term care needs of older people with drug problems (OPDPs) must be taken into account by health planners as they will be the main client group for specialist services for the foreseeable future.
Emergency hospital stays
"At present services, commissioners and planners, as well as Scottish society more widely, are generally unprepared to meet the care and support needs of this older drug-using population," it warned.
"Failing to plan and invest in their care will result in an increase in the cost of meeting their needs in an unplanned, reactive way."
The report spelled out the cost to the NHS of problem drug use.
In 2012/13, people with drug problems accounted for 20,700 emergency hospital stays, costing an estimated £88.8m. Of this £50.8m was attributable to drug users aged 35 and over, according to official data.
And it said these figures are expected to increase as the proportion of people with drug problems in the older age group rises.
In 2006, OPDPs represented 34.3% of all drug users; six years later the proportion was 51.4%.
Evidence from the European Monitoring Centre on Drug and Drug Addiction (EMCDDA) suggested older drug injectors were particularly vulnerable to bacterial infection, including anthrax and botulism because many injected into muscles as they were unable, after years of abuse, to access veins.
Drugs death figures also show an increasing number of OPDPs among the fatalities.
"While deaths among under 35s have remained consistent at about 200 per year, deaths among OPDP have increased from 55 in 1996 to 513 in 2015," the report said.
"Therefore, the observed increase in deaths among OPDPs largely accounts for the rise in drug-related deaths since 1997."
Overdose death risk
Report author Dr John Budd, a GP who works at Edinburgh outreach clinic the Access Point, said the research had shown OPDPs were not being treated for all of the inevitable problems arising from their drug abuse.
"We do need a refocusing of resources. Older drug users have high rates of unplanned and emergency hospital admissions, which are hugely costly to the health service," he said.
"That resource could be used much more effectively if it were used in a preventive way through community services, primary care and social care."
He said a particular failing was that older drug users, suffering from respiratory problems such as chronic obstructive pulmonary disorder (COPD) and asthma, were not being treated for it.
"Older drug users who are in their 50s have a 15-fold increased risk of hospital admissions for respiratory problems. It's a huge problem.
"It's a risk factor for overdose death in this group, and I think all services, certainly all health services working with this population, should be able to screen for those who have respiratory difficulties and impairments and should be able to engage them in treatment for that as well as treatment for their drug use."
Three stories of drug use
Garry, 47, from Glasgow
He began smoking heroin when he was 11 and graduated into intravenous injecting. He now has deep-vein thrombosis (DVT) in his legs and an abscess in his groin. He was clean for four years, but now smokes heroin again most days on top of his methadone prescription.
Garry said: "I think the treatment services cater more for the younger ones because they want to try to nip it in the bud before it gets out of hand and they look at us as we're older, we've been using for that many years, and it's going to take a lot more work, more money, more services to try to get us to get us more help."
Laura, 35, from South Lanarkshire
She has been using heroin since she was 14, and smokes about 2gms a day. She was in a Christian rehabilitation scheme for 18 months, but relapsed. She has a 75ml daily prescription of methadone.
"It keeps you level," she said, "while you work out how to get the money for heroin." She has COPD and asthma and mental health issues.
"Sometimes in the drug services, there are young lassies and guys, maybe just out of university and they're only in their 20s, and they seem condescending. They've read about it in a book, and they're all excited. I've lived it.... I think somebody more my age or older would be better."
Martin, 40, from Glasgow
Has used heroin since he was 18, although he smoked cannabis before then. He began injecting heroin and now smokes it. He was clean for two years after being in a treatment centre for six months. He has COPD and asthma, and has recently been diagnosed with angina.
"Drug treatment centres are more suited to younger people," he said. "When I've been trying to access treatment centres they've been saying you had that chance years ago, so we're not going to offer it to you again."
The Scottish government said it welcomed the report and the insights it provides.
The Public Health and Sport minister, Aileen Campbell said she would consider its recommendations carefully.
She said: "We are committed to ensuring older drug users get the person-centred care they need and this is a current priority for the Partnership for Action on Drugs in Scotland group.
"Latest figures show that drug taking among adults is falling, and that levels of drug use among young people remains low.
"We have invested more than £630 million to tackle problem drug and alcohol use since 2008 and have a national drugs strategy to make sure recovery is a reality for individuals, families and communities."