Home > The needs of people who use drugs and are aged 40+ years

Dillon, Lucy (2022) The needs of people who use drugs and are aged 40+ years. Drugnet Ireland, Issue 81, Spring 2022, pp. 21-22.

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People who use drugs (PWUD) and are aged 40 years or over experience particular challenges as a cohort. These include social isolation and exclusion as well as poorer physical and mental health outcomes.1 The Ballyfermot Local Drug and Alcohol Task Force (BLDATF) commissioned a study on the needs of this cohort in their area of Dublin. Entitled It’s like we’re the forgotten...: an exploration of the issues affecting older people in Ballyfermot who are experiencing problematic drug and alcohol use, it was published in March 2021.1

Study context and aims

Both Ireland’s national drugs strategy and that of the European Union (EU) recognise the necessity of improving the response to the needs of older PWUD.2,3 The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) notes that while this cohort is not a homogenous one, many of them began using heroin in the 1980s and 1990s and are now at high risk of a variety of serious conditions and will need health and social care interventions in the future.4 With this in mind and recognising a need in the local area, BLDATF agreed three aims for their research:

  • To help build a supportive environment for older drug and alcohol users in the Ballyfermot community in partnership with key stakeholders
  • To research the needs of older drug and alcohol users in the community
  • To make recommendations on the development and strengthening of appropriate supports in partnership with other stakeholders. 


The research took a mixed methods approach. Interviews and focus groups were carried out with service providers and PWUD in this older age cohort. A limited literature review was carried out and data analysed from the Health Research Board’s (HRB) National Drug Treatment Reporting System (NDTRS) and the Health Service Executive’s (HSE) Central Treatment List for methadone maintenance. Most of this work was carried out before the onset of the Covid-19 pandemic, but a survey of community and statutory service providers was added to the research brief to explore the impact of the pandemic and Government restrictions on the services and service users. 


Barriers to accessing services

The study identified barriers that PWUD faced when accessing services. Some related to service users’ having ‘entrenched behaviours resulting from lifelong experience of serious disadvantage to a variety of structural issues which made it more difficult for this group to access services easily and receive effective care in the setting best suited to their needs’ (p. 22).1 These barriers included:

  • Service users often did not trust or had a poor relationship with service providers. This translated into a reluctance to engage with services and poor attendance at appointments.
  • Service users would prefer to be more discreet in their attendance at the methadone treatment clinic. The entrance to the Ballyfermot treatment clinic was described as being in a ‘highly visible location’, prohibiting discreet attendance at the service. Users did not like other members of their community being able to see them queuing for or entering the service. This was perceived to be stigmatising.
  • Linked to the previous finding, people on methadone maintenance felt particularly stigmatised by the wider community. This stigma impacts on their lives by ‘perpetuating shame and isolation’ (p. 23).1
  • Service providers and users reported an unconscious bias on the part of some health and social care professionals, which impacted the way in which they interact with clients. They have a negative bias towards older PWUD, in particular those on methadone maintenance, which affects their ability to be non-judgemental and deliver a quality service.
  • A recurring theme among community and statutory service providers was a lack of accurate information and knowledge among providers and users about the services available to older PWUD. There were also gaps in service providers’ knowledge of the roles of various professionals in the system and how referral systems worked. This prevented PWUD from accessing the right services and experiencing continuity of care, for example.
  • There was agreement across both statutory and community service providers that there was a lack of joined-up working in Ballyfermot drug and alcohol services. It was perceived that there were ‘too many different voices working in the sector and that this caused confusion and inefficiencies’ (p. 26).1 This was linked to a perception that given the confusion among services, users sometimes attended multiple projects at the same time. This resulted in duplication of resources and clients lacking a clear progression pathway. 

Additional services

Service users and providers identified services that they would like to see in Ballyfermot, including:

  • A multipurpose day centre where PWUD can interact socially, access services, and be signposted to other interventions was top of the list. The space would provide a ‘hub in which people could access health and social care services in, including preventative health care and screening services’ (p. 31).1
  • A space in which people who were on methadone maintenance could stabilise and reduce their ‘double dosing’ (p. 32)1 where they took their methadone dose and additional drugs.
  • Improved access to HSE services for those experiencing dual diagnosis. PWUD wanted access to addiction and mental health services at the same time rather than ‘falling between the gaps’ (p. 32).1
  • Peer mentoring in the community-based services.
  • Extended hours for those services that are already established in Ballyfermot.

A bus service to provide lifts back to the city centre for those who are accessing services in the Ballyfermot area but have hostel accommodation in the city centre. While the ideal solution would be that they could be housed in Ballyfermot, in the meantime the bus service would reduce their vulnerability and support their access to services. 

Concluding comment

The report provides BLDATF with a set of recommendations covering a range of themes, including the barriers to accessing supports; how programmes in the area could better meet the needs of older PWUD; how interagency and joint working practices could be improved; and what resources are required to improve the physical and mental health for this age cohort. While these findings are targeted at BLDATF, they are likely to be of interest to those working in other task force areas.

1  Deane A (2021) It’s like we’re the forgotten...: an exploration of the issues affecting older people in Ballyfermot who are experiencing problematic drug and alcohol use. Dublin: Ballyfermot Local Drug and Alcohol Task Force. https://www.drugsandalcohol.ie/35208/

2  Department of Health (2017) Reducing Harm, Supporting Recovery: a health-led response to drug and alcohol use in Ireland 2017–2025. Dublin: Department of Health. https://www.drugsandalcohol.ie/27603/

3  Council of the European Union (2020) EU drugs strategy 2021–2025. Brussels: Council of the European Union. https://www.drugsandalcohol.ie/33750/

4  European Monitoring Centre for Drugs and Drug Addiction (2017) Health and social responses to drug problems: a European guide. Luxembourg: Publications Office of the European Union. https://www.drugsandalcohol.ie/28040/

Item Type
Publication Type
Irish-related, Open Access, Article
Drug Type
All substances
Intervention Type
Screening / Assessment
Issue Title
Issue 81, Spring 2022
May 2022
Page Range
pp. 21-22
Health Research Board
Issue 81, Spring 2022

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