Letter to the Editor: Methadone and getting older
Dear Editor,
I am worried about using methadone as I get older because there are no obviously older people at my clinics. I am looking for my elders and I can’t see them.
Where are the people in their 70s, 80s and 90s? Do older people die because methadone is bad for you as you get older? Where can I find my elders if they are there? Are people more at risk of dying than the general population due to taking methadone? Do people get methadone if they need it in nursing homes? Can you overdose on methadone? Should I have naloxone in my first aid kit? Will that help? Is there anything that is dangerous to mix with my methadone that might lead to an adverse event? Are people swapping over to Buvidal… is that why I don’t see them anymore?
Yours truly,
Maali
Dear Maali,
Thanks for getting all these questions to us. You are obviously concerned, and we would like to bust a few myths for you.
Usually people on the Opioid Treatment Program (OTP) are much healthier than their peers who are still using street drugs on a daily basis. Methadone and buprenorphine are kinder to the body because they do not include unknown impurities and additives. In addition, people who stop injecting avoid associated harms like infections and viruses. People on the program often find they have healthier lifestyles as they become more financially stable, improve their relationships with their families, and achieve in the workforce. These factors all contribute to a longer and healthier life.
One of the reasons you may not be seeing older people at your public clinic is that as people reap the rewards of the program over time, they often move to accessing their dose in the private sector, moving to a private GP and chemist combination. It may be that they need to have takeaways so they can work, that they want to leave the scene behind them or that they are required to leave the public clinic to make way for people starting on the program or transferring from jail. You might also be right that some older people may have moved to Buvidal, which is an OTP option that works well for those who want to put using behind them and are sick of daily dosing.
Having said all that, recent research from UNSW found that people in NSW who have ever been prescribed methadone or buprenorphine have a life expectancy that is about 15 years less than the wider community. This finding was true for both men and women. The reasons for this reduced life expectancy are complex. Drug related deaths were a large factor in the finding with 16% of the men and 19% of the women dying from overdose or other drug-related causes. Another big factor was physical diseases (heart disease, lung disease) which may be related to the high rates of smoking in people who are prescribed treatment for opioid dependence.
However, another factor that contributes to this sad statistic is the stigma and discrimination experienced by our community. Stigma and discrimination in the health system is a factor in poor health outcomes. There is an assumption that all people who use drugs are lying about pain in order to ‘drug seek’ and that we don’t deserve proper care and treatment because our health issues stem from ‘self-abuse’. This belief can even be unconscious on the part of the health care provider. In addition, we are often shamed because we find it difficult to give blood for tests. Because we have faced a lifetime of disrespect, many older people simply stop trying to get health care because it is too stressful.
The dangers of stigma and discrimination and how power imbalances can cause people who use drugs to stop seeking the care we need are becoming well-known and well-accepted and a number of people are working to reduce stigma. We know that being treated with respect leads to better health outcomes. NUAA works on a number of projects and trainings to improve the way people who use drugs are treated.
Most older people who use drugs die from long-term conditions like heart and lung disease. Smoking tobacco is a big killer of people who use drugs. It is important for people on methadone to have their hearts checked out from time to time, and to get on the right treatment if necessary, so we aren’t dying prematurely. Liver cancer stemming from hep C has also claimed many users. This situation will shift as the new tests and treatments will see hep C gone from our community.
OTP is available in health settings like hospitals and nursing homes because it is listed as an ‘essential medicine’ by the World Health Organization. You most certainly can overdose on methadone, especially if injected or if you take more than usual or in combination with other drugs, especially additional opioids, benzos or alcohol. Naloxone reverses all opioid overdoses and you should definitely have some at home. Anyone who uses any opioids, whether they are street drugs or on prescription like the OTP or pills like OxyContin, should have naloxone and know how to avoid and recognise overdose. Knowing the risks and how to manage them will certainly help keep you alive longer.
There is no reason why people who used drugs should not live long and healthy lives. Certainly, the OTP does not cause health problems; in fact, it helps us live longer. But to live as long as we should, we need to keep trying until we find a good GP who can make sure we are getting the right tests and going on the treatments we need. You should also talk to your prescriber about your concerns.
Another place to get info is from NUAA. Call PeerLine on 1800 644 413 to ask any questions about drug use and your health. It’s also at NUAA that you can find peers of all ages. You can get involved with other people in our community at all stages of our drug use by checking out the many opportunities in this mag. For people like you who are keen to connect with our community, NUAA is your organisation.