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Zolopa C, Høj SB, Minoyan N, Bruneau J, Makarenko I, Larney S. Ageing and older people who use illicit opioids, cocaine or methamphetamine: a scoping review and literature map. Addiction 2022; 117:2168-2188. [PMID: 35072313 PMCID: PMC9544522 DOI: 10.1111/add.15813] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
AIMS To provide an overview of research literature on ageing and older people who use illicit opioids and stimulants by documenting the conceptual frameworks used and content areas that have been investigated. METHODS We conducted a scoping review of literature relating to ageing and older people who use illicit stimulants and opioids, defining 'older' as 40 years and above. Primary studies, secondary studies and editorials were included. Searches were conducted in PubMed and Embase in July 2020 and March 2021; the Cochrane library was searched in November 2021. Charted data included methodological details, any conceptual frameworks explicitly applied by authors and the content areas that were the focus of the publication. We developed a hierarchy of content areas and mapped this to provide a visual guide to the research area. RESULTS Of the 164 publications included in this review, only 16 explicitly applied a conceptual framework. Seven core content areas were identified, with most publications contributing to multiple content areas: acknowledgement of drug use among older people (n = 64), health status (n = 129), health services (n = 109), drug use practices and patterns (n = 84), social environments (n = 74), the criminal legal system (n = 28) and quality of life (n = 15). CONCLUSIONS The literature regarding older people who use illicit drugs remains under-theorized. Conceptual frameworks are rarely applied and few have been purposely adapted to this population. Health status and health services access and use are among the most frequently researched topics in this area.
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Affiliation(s)
- Camille Zolopa
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada
| | - Stine B Høj
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Social and Preventative Medicine, School of Public Health, Université de Montréal, Montreal, Québec, Canada
| | - Julie Bruneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Iuliia Makarenko
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Sarah Larney
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada
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Abstract
Illicit drug use/misuse among older adults is understudied, although current trends point to older adults being the fastest-growing segment in the United States and other developed countries. There is a need for further insight into drug use patterns in older adults, who face their own set of socioeconomic, medical, and psychiatric problems. We reviewed the literature for data related to use/misuse of heroin and stimulants (cocaine, amphetamines, and methamphetamines) among people over the age of 40 years. We focused on prevalence rates of use/misuse of these substances, comorbidities, diagnostic challenges, screening tools, and treatment recommendations specific to the geriatric population.
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Benham DA, Rooney AS, Calvo RY, Carr MJ, Diaz JA, Sise CB, Bansal V, Sise MJ, Martin MJ. The rising tide of methamphetamine use in elderly trauma patients. Am J Surg 2021; 221:1246-1251. [PMID: 33707080 DOI: 10.1016/j.amjsurg.2021.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Methamphetamine (METH) is associated with an elevated risk of injury and the outcomes in the elderly remain unclear. We analyzed METH's impact in elderly trauma patients. METHODS Retrospective analysis (2009-2018) of trauma patients at a Level I trauma center. Elderly patients were defined as age ≥55. Substance use was identified by blood alcohol test and urine drug screen. Cox proportional hazard model was used to assess patient and injury characteristics with mortality. RESULTS Of 15,770 patient encounters with substance use testing, 5278 (34%) were elderly. Elderly METH use quadrupled over time (2%-8%; p < 0.01). Elderly METH + patients were more likely to require surgical intervention (35% vs. 17%), mechanical ventilation (15% vs. 7%), and a longer hospitalization (6.5 vs. 3.6 days) compared with elderly substance negative. Multivariate analysis showed increasing age, ventilator use, and injury severity were associated with mortality (ps < 0.01); METH was not related to mortality. CONCLUSION Substance use in elderly trauma patients increased significantly. METH use in elderly trauma patients is a risk factor for significantly greater resource utilization.
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Affiliation(s)
- Derek A Benham
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA.
| | - Alexandra S Rooney
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA.
| | - Richard Y Calvo
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA.
| | - Matthew J Carr
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA.
| | - Joseph A Diaz
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA.
| | - C Beth Sise
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA.
| | - Vishal Bansal
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA.
| | - Michael J Sise
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA.
| | - Matthew J Martin
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA.
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Guo ML, Buch S. Neuroinflammation & pre-mature aging in the context of chronic HIV infection and drug abuse: Role of dysregulated autophagy. Brain Res 2019; 1724:146446. [PMID: 31521638 DOI: 10.1016/j.brainres.2019.146446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/29/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022]
Abstract
In the era of combined antiretroviral therapy (cART), HIV-1 infection has transformed from adeath sentenceto a manageable, chronic disease. Although the lifeexpectancy of HIV+ individuals is comparable to that of the uninfectedsubjects paradoxically, there is increased prevalence ofage-associatedcomorbidities such asatherosclerosis, diabetes, osteoporosis & neurological deficits in the context of HIV infection. Drug abuse is a commoncomorbidityofHIV infection andis often associated withincreased neurological complications. Chronic neuroinflammation (abnormal microglial and astrocyte activation) and neuronal synaptodendritic injury are the features of CNS pathology observed inHIV (+) individualsthat are takingcART & that abuse drugs. Neuroinflammation is thedrivingforceunderlying prematureaging associated with HIV (+) infection, cART and drugs of abuse. Autophagy is a highly conserved process critical for maintaining cellular homeostasis. Dysregulated autophagyhas been shown to be linked with abnormal immune responses & aging. Recent emerging evidence implicatesthe role ofHIV/HIV proteins, cART, & abused drugsin disrupting theautophagy process in brain cells such as microglia, astrocytes, and neurons. It can thus be envisioned that co-exposure of CNS cells to HIV proteins, cART and/or abused drugs couldhavesynergistic effects on theautophagy process, thereby leading to exaggerated microglial/astrocyte activation, ultimately, promotingthe aging process. Restoration of autophagic functioncould thusprovide an alternative therapeuticstrategy formitigating neuroinflammation & ameliorating the premature aging process. The current review aims to unravel the role of dysregulated autophagy in the context of single or co-exposure of microglia, astrocytes, and neurons to HIV/HIV proteins, drugs of abuse &/or cART and will also discuss the pathways involved in dysregulated autophagy-mediated neuroinflammation.
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Affiliation(s)
- Ming-Lei Guo
- Department of Pharmacology and Experimental Neuroscience, 985880 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Shilpa Buch
- Department of Pharmacology and Experimental Neuroscience, 985880 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198, USA.
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Abstract
Alcohol and drug use problems among older individuals are a growing public health concern. However, few treatments have been developed for this population, despite an emerging body of literature suggesting that older substance users are more likely to benefit from interventions tailored to meet their specific needs. In particular, older adults with a history of substance abuse have expressed a preference for treatments that focus on financial problems, physical health, and mobility issues, and make attempts to prescriptively involve supportive others in treatment. To address these needs, we developed a modified version of Family Behavior Therapy (FBT) for older individuals with substance use problems that involves participation from significant others and covers skills that are relevant to an older clientele. This modified form of FBT is illustrated through the case of Jack-a 55-year-old man with a longstanding addiction to methamphetamine. After completing 16 sessions, Jack's alcohol and drug use was substantially reduced, and he reported strong confidence in his ability to resist substance use in the future. Despite this promising first case, further work is needed to fully examine the efficacy of this modified version of FBT for older individuals with substance use problems.
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Tam CHL, Kwok SI, Lo TW, Lam SHP, Lee GKW. Hidden Drug Abuse in Hong Kong: From Social Acquaintance to Social Isolation. Front Psychiatry 2018; 9:457. [PMID: 30319464 PMCID: PMC6167475 DOI: 10.3389/fpsyt.2018.00457] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/03/2018] [Indexed: 11/13/2022] Open
Abstract
The present paper examines the issue of hidden drug abuse in Hong Kong. Although official statistics show that the reported number of drug-abuse cases has been in decline in recent years, it has been reported that drug abusers tend to hide themselves at home to take drugs; thus, they are not discovered easily by the law enforcement and social control agents who report drug abuse cases to the Central Registry of Drug Abuse, resulting in the decrease in the reported number of drug-abuse cases. This "dark figure" phenomenon is a reflection of the official figure and reporting behavior, not the actual situation of drug abuse in Hong Kong. Through in-depth interviews of 30 ex-drug addicts, the majority of them started drug taking in early youth, the present paper identifies five stages of drug taking from social acquaintance to social isolation. It argues that although drug taking among abusers is a kind of social activity in their initial stage of drug use, they become socially isolated when their drug use is prolonged. Several reasons are identified, including users' easy accessibility to drugs and changes in the popularity of drugs and use of drug equipment. Most importantly, the hidden process is triggered and aggravated by numerous negative drug effects, such as decline in physical health, weak physical appearance leading to self-perceived discrimination, co-occurrence of psychiatric symptoms of increased anxiety and suspicion, and decline of trust among peers due to prolonged drug abuse. Possible solutions associated with clinical interventions, legislative policies, and law-enforcement operations are proposed.
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Affiliation(s)
- Cherry Hau-Lin Tam
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | | | - T Wing Lo
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Sally Hing-Po Lam
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Gabriel Kwun-Wa Lee
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
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