Exploring the biopsychosocial needs of ageing persons with a heroin use disorder in treatment in Malta : implications for policy, service provision and research

Abstract

This mixed-methods study investigates the complex and interconnected physical, psychological, and social needs of ageing individuals receiving treatment for heroin use disorder in Malta. Against the backdrop of an ageing population and an increasingly older cohort of persons with lived experience of heroin use, the research aims to explore their experiences and needs, assess perceived service adequacy, and provide recommendations for improving treatment models and support systems. Quantitative data from 50 participants aged 40 and above, collected at Malta’s Substance Misuse Outpatient Treatment Unit (SMOPU), reveals a population of persons with lived experience of heroin use facing multiple vulnerabilities. The majority had experienced overdose, long-term unemployment, and a history of incarceration. Chronic pain, digestive issues, and co-occurring mental health conditions such as depression and anxiety were common. Most participants were enrolled in long-term opioid agonist therapy, with methadone being the most widely used medication. Qualitative interviews with 45 participants revealed nuanced insights into daily struggles, service engagement, and aspirations for the future. While the SMOPU was often praised as a “one-stop shop,” concerns emerged about overcrowding, stigma, and unmet psychological and social needs. Many older individuals found traditional residential treatment programmes to be unsuitable and expressed a desire for age-specific, flexible models of care. Dual diagnosis, homelessness, financial hardship, and legal challenges were recurring themes. Women reported distinct vulnerabilities, including greater exposure to exploitation, stigma, and barriers to care. Participants frequently described feelings of exhaustion with the drug-using lifestyle, which in many cases motivated desistance. However, long-term methadone use was viewed ambivalently, valued for its stabilising effect, but also experienced as a burdensome dependency. The report concludes with a call for integrated, multidisciplinary, and age-sensitive services that reflect the biopsychosocial realities of older adults who use heroin and are in treatment. Key recommendations include the expansion of wraparound support at the SMOPU, decentralised methadone access, tailored mental health interventions, and gender-responsive programming. This study provides timely insights into an under-researched population and offers practical directions for enhancing the quality, accessibility, and person-centredness of addiction services in Malta.