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

Abstract

Heroin use remains a major concern within substance use disorder (SUD) treatment provision, particularly as affected populations age. In Malta, this issue is compounded by a growing cohort of older individuals with long-term heroin use histories. Adopting a mixed methods research design, this paper investigates the physical, psychological and social challenges of ageing persons with lived experience of heroin use who are in treatment. A total of 50 participants (40 males and 10 females) completed a quantitative questionnaire, while 45 participants took part in a subsequent interview. Participants were recruited through a low-threshold state service. Quantitative data highlight high rates of overdose, unemployment, incarceration and chronic health conditions. Most participants were on long-term opioid agonist therapy, primarily methadone. In-depth interviews revealed a need for age-specific and flexible care models. Women reported unique vulnerabilities, including heightened stigma and exploitation. Many described a desire to exit the drug-using lifestyle, with long-term methadone use often seen as both stabilising and burdensome. The study calls for integrated, multidisciplinary and age and gender sensitive treatment approaches that reflect the complex biopsychosocial realities of older adults with heroin use disorder.