The aging methadone maintenance patient: Treatment adjustment, long-term success, and quality of life

Abstract

Objective: To evaluate the features and modes of adaptation to aging among Methadone Maintenance Treatment (MMT) enrollees.Setting: Beth Israel Medical Center in New York City.Participants: A sample of 156 MMT enrollees (103/66 percent males and 53/34 percent females) age 24-68 years. Twenty-nine percent of participants were aged 55 or older.Design: A cross-sectional, multivariate, correlational design.Outcome Measures: Participants were administered the MMSE, ASI, BSI, as well as measures of impulsiveness and quality of life (QOL).Results: Older adults were more likely to have had longer periods of treatment (p < 0.01), less likely to report current heroin use (p < 0.05) and overall drug use (p < 0.05), but were more likely to have a history of comorbid alcohol misuse (p < 0.01). Advanced age was also associated with less impulsiveness, hostility, paranoia, and interpersonal sensitivity (p < 0.01), more chronic medical problems (p < 0.05), greater use of medication for medical problems (p < 0.05), and more liberal take home medicine schedules (p < 0.01). However, no differences were found between older and younger participants with respect to their scores on the Overall Social Support scale (p > 0.05), the Personal Well-Being Index (p > 0.05) and the Satisfaction with Life Scale (p > 0.05), suggesting comparable levels of QOL. Furthermore, the rate of contact for older participants with medical professionals did not differ significantly from that of younger participants (p > 0.05). Only 7.1 percent of older participants reported regular contact with a primary care physician; a rate that is slightly lower than the rate in the overall population.Conclusions: The findings from the present study highlight at least two underappreciated challenges that clinicians are increasingly likely encounter in their work with the aging MMT population. These challenges are: (1) that despite numerous medical and psychiatric complaints, only a small proportion of MMT patients have regular contact with a primary care physician and the rate of contact does not appear to increase with age and (2) even with age-related declines in psychiatric comorbidity and illicit substance use, the suboptimal level of QOL that is characteristic of the MMT population as a whole does not improve with aging and length of tenure in MMT.

Changes in quality of life and its associated factors among illicit drug users in Vietnamese mountainous provinces: a 12-month follow-up study

“…This result was similar to previous work that has found age to be associated with lower-scoring on the Psychological, Social and Environmental domains [27,35,40]. A previous study examining the health status of elderly patients using MMT reported that advanced age was related to more chronic diseases, suboptimal adherence to taking medicine schedules [41]. Older patients, especially in mountainous areas -our context, have to face problems in accessing clinics because of the geographical barriers or in performing usual activities regarding physical health [23].…”

Treatment for opioid use and outcomes in older adults: a systematic literature review

“…Three studies (Firoz and Carlson, 2004;Lofwall et al, 2005;Rajaratnam et al, 2009) compared treatment outcomes among younger and older groups and found that older clients achieved better outcomes than their younger counterparts. Although the age cut-offs were not identical, differences were found in treatment retention and drug use.…”

“…At nine months post-treatment admission, the older group (age 55 years and older) had improved outcomes for drug use measures compared to the younger group (61% of older and 35% of younger patients had no positive urine-drug-screens) (Firoz and Carlson, 2004). Rajaratnam et al found that older adults (aged 55 years and older) were more likely to have longer treatment durations (p < 0.01), a history of problem alcohol use (p < 0.01), and were less likely to report current heroin (p < 0.05) and overall drug use (p < 0.05) than younger counterparts (Rajaratnam et al, 2009). Lofwall et al found several age differences when comparing groups (age 50-66 years, age 25-34 years).…”

Health and social issues among older patients in opioid maintenance treatment in Norway

“…The majority of older persons with SUD had a place to live (Haaland et al, 2015;Rajaratnam et al, 2009;Waal et al, 2014). However, 60% of participants in the Quality Assurance Project were not happy with this place.…”

“…Some studies in Europe have used 40 years of age as the cut-off point for older drug users (EMCDDA, 2010), while several American studies have used 50 years or more (Lofwall et al, 2005;Rajaratnam, Sivesind, Todman, Roane, & Seewald, 2009). In this report, based on the above aspects, the cut-off point was set at 45 years.…”