Substitution therapy service provision into older age.

Abstract

Sir—Rotherham is a deprived former steel and mining town in South Yorkshire, UK, with a population of 250 000 and not surprisingly has a large number of heroin-dependent individuals. We expect an 100% increase in patients entering treatment in the 10 years up to 2008. It is a key objective of the government's policy on drugs to engage drug users in treatment [1] and this is reflected in the higher year-on-year targets for patients entering treatment in Rotherham. The increasing numbers entering and being maintained on treatment have a worrying implication for already stretched drug treatment services, and many patients remain on methadone for many years. Longer-term or maintenance treatment with oral methadone or buprenorphine is an essential component of the British National Treatment Agencies strategy [2]. Rotherham figures show increases in numbers entering treatment in line with government targets, but also a number of older users. On our case-load we have seven patients aged over 50, the oldest being 57, on long-term substitution therapies, 14 aged between 45 and 49 and 29 aged 40–44 years, with increasing numbers in the younger age groups. Soon there will be a cohort of patients in substitution therapies aged over 60. Currently the Rotherham Community Drug Team, in line with most statutory treatment services, are funded to provide a service for patients on substitution therapies aged up to 65. When patients on substitution therapies reach this milestone who will take over their care? Will this be GPs, old-age psychiatrists or will drug services be funded to provide this service? I believe future service provision needs to be addressed now if we are to ensure we are not victims of our own success. My window of observation relates to one clinical service in the United Kingdom, but I believe that the question raised is a wider one.