For the past 26 years, I have worked in the addiction sector in Dublin watching the landscape of substance use evolve. While much attention is given to young people and new drug trends, there is a growing, overlooked and underserved group, older drug users; this trend is being seen across Europe. Individuals in their late 40s who have used substances for decades. Their needs are unique and complex, and their voices are often unheard.
While for some of us in our late 50s, early 60s, the challenges of ageing are eased by strong social network, easy access to healthcare, and stable accommodation. For older drug users, the challenges are met with further blocks, barriers and discrimination; they are magnified by decades of substance use, societal judgement, isolation and alienation.
Older drug users in Dublin are a very diverse group, but many of whom are now facing the physical and mental toll of long-term drug use compounded by the usual ageing-related health issues. It is acknowledged that long-term drug use accelerates the ageing process; older drug users often experience chronic conditions such as liver cirrhosis, diabetes, circulatory and respiratory problems, and cognitive decline at an earlier age from the general population. Many also live with undiagnosed or poorly managed mental health disorders. Easy access to integrated care – where addiction services work side-by-side with primary care – is key to the well-being of this group.
Aside from health complications, older drug users may face other compounding issues such as social isolation, housing instability and financial vulnerability. If you do not live in a secure, stable environment, it is difficult to maintain recovery and address long-term physical and mental health needs. Many emergency accommodations – Hostels, Bed & Breakfast accommodation, and Family Hubs - do not have the resources to meet the complex needs of this group such as mobility issues and dual diagnosis. Their remit is primarily to provide food and shelter and signpost their residents to other more specialised services.
Older drug users face many blocks and barriers to access adequate support. Aside from stigma and shame that can prevent individuals seeking help, many addiction services are not designed or adapted to work with an older cohort. Older drug users may feel alienated from day programmes dominated by a younger cohort or perhaps may find that their specific health challenges are not addressed such as chronic pain management or bereavement support.
There is an absence in Dublin of age-specific interventions. For example, older users may respond well to slower-paced therapy with a focus on life review and legacy work. Harm reduction services should also be more accessible, welcoming and less intimidating for older drug users – often easy targets to younger drug users.
So, what are the solutions? What can be done in a sector already fully stretched, with staff and volunteers trying to meet the needs of every individual presenting?
We need more integrated age-inclusive services where addiction, mental health and primary care services work side-by-side. Organisations need to develop age-specific services for older users such as the following initiatives:
- Peer Support Groups where older users could share experiences and strategies in a safe environment
- Specialised Housing First Programmes that would provide stable, drug-use friendly accommodation for older users
- Chronic Pain Management Programmes that would offer alternatives to opioids for pain management such as acupuncture, non-opioid medications and physical therapy
- Geriatric-Specific Screening that would incorporate substance use screening into geriatric assessments,
Staff in the social care sector and primary care sector should also receive training on the unique needs of older drug users; investing in training would lead to better care, improved health outcomes and a more skilled and empathic workforce.
As healthcare professionals, we need to start recognising the intersection of ageing and addiction. We need to ensure services are fully resourced and equipped to meet the needs of older users.
In 2025, out of 662 service users engaging with Chrysalis, 131 users were between the age of 50 to 65 which represented roughly a fifth of the total number, and only 29 individuals were between the age of 18 to 25. The rest were between the ages of 26 to 50.
My questions to my peers are, ‘are we really doing enough for older users?’, ‘are older users receiving appropriate care?’.
Passerose Mantoy
Passerose Mantoy is the CEO of Chrysalis Community Drug Project, a community-based drug and alcohol service operating in Dublin’s North Inner City. Her training and qualifications are in the areas of counselling, supervision, leadership and community development.
Passerose has worked in addiction services for the last 25 years; the first ten years as addiction practitioner, and fifteen years as CEO of Chrysalis CDP. She is an accredited addiction counsellor and clinical supervisor. She believes in a person-centred and trauma informed approach, the voice and choice of the service user being central to the model of care of Chrysalis.
As CEO of Chrysalis, she has publicly commented on the deteriorating situation in Dublin’s North Inner City e.g. rising complexity in addiction cases, and the need for compassionate, comprehensive support for individuals seeking help.
Passerose has a particular interest in Public Health and Engaged Research.
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