Older Injecting Drug Users – We’re Alive, But Will We Survive?

“Older Injecting Drug Users – We’re Alive, But Will We Survive?”

In keeping with general population trends, people who inject opioids such as heroin and morphine are also an ageing group within the Australian community. The association between drug use and death and destruction is so pronounced in the media and popular culture that it may well come as a surprise to many that people who inject drugs have a future and an old age to look forward to at all! Equally, many drug users, who did not anticipate or prepare for old age and retirement, are sometimes also surprised to find themselves still here and advancing in years. In all, the above situation has diverted attention away from older cohorts of drug users and as a result, little is known about ageing in relation to illicit drug use.
To bring greater attention to this important emerging issue the Australian Injecting & Illicit Drug Users League (AIVL) is holding a forum in Canberra and online on Friday 29 July 2011. The forum is being held as part of National Hepatitis Awareness Week 2011 and will address the health needs of older opiate users with a specific focus on hepatitis C. A panel of national experts will provide a range of perspectives on the issues of ageing, opioid use and hepatitis.
A report being launched by AIVL at the forum highlights the situation in relation to hepatitis C: “There is an extremely high rate of hepatitis C infection among people with a history of injecting drug use in Australia particularly in relation to opioid use. The virus is strongly associated with duration of injecting and prevalence can reach up to 90 per cent among groups of older opiate users. Due to the slow progression of the virus, the more severe consequences of hepatitis C typically manifest 20 to 30 years post infection. As a result, people who began injecting in their early 20’s are at a heightened risk of liver damage and conditions such as cirrhosis and liver cancer by the time they reach their 40’s and 50’s.” from “Double Jeopardy” AIVL July 2011.
Australians are living longer than ever before and the Australian Government has adopted a proactive approach to ageing’. However injecting drug user’s experience of ageing is showing itself to be different to that of their non-drug using counterparts. Although it is difficult to accurately estimate the number of opioid users of any age, there may be as many as 30,000 regular opioid users in Australia aged 40 years and over and up to 80,000 infrequent or non-dependent opioid users. Although the size of this group remains under question, their existence does not. Equally indisputable are both the specific and unmet needs of older opioid users.
Annie Madden AIVL Executive Officer explains: “At best, it would seem that opioid users in Australia will suffer the same sort of age-related complications as the general population. Having said this however, it is likely the health concerns of older opioid users will also be exacerbated by a history of injecting drug use, complications from viral hepatitis, and/or the side effects of long term pharmacotherapy treatment. Many people are long term survivors of an illicit drug using culture that has stripped them of not only their health, but their dignity and basic human rights. Far from being an issue of opioid use alone – social isolation, stigma and discrimination and poverty all play a part in the burden of disease for older opiate users.” 
The emergence of an older demographic of opioid users poses many questions, not only about how we treat our ageing population generally but how we treat older people who are suffering from entrenched prejudice and discrimination. “How we treat some of the most marginalised in our community is always a litmus test for the entire community. The best possible standards of health and being treated with basic dignity and respect should not be a privilege for some but a right for all as we age” concluded Ms Madden.