title: I Didn't Get Here by Myself: An Exploration of Opioid Use Among Older People in the United Kingdom and the United States Using Visual Methods
Creators: name: McRiley, M
Publisher: name: Wiley
Year: 2023

description: Background: Older people are who use prescription opioids are living longer in the UK and the USA, and contribute to a steadily growing rate of illicit opioid and polysubstance misuse among people over 50. Anecdotal evidence suggests older people with problematic long-term opioid use issues face difficulties in accessing physical and mental health services, entering drug treatment services, maintaining safe housing, participating in employment and staying out of prison. Evidence also suggests that older people with opioid use problems remain uniquely at risk for multiple and complex health issues which combine problematic opioid use with issues of imprisonment, discrimination, housing instability, overdose, poverty, social exclusion, stigmatization and victimization. Further, there is evidence of older people with problematic long-term opioid use issues related to decades-long methadone prescriptions as stand-alone opioid treatment strategies in the UK. Opioid dependent people in the USA who would benefit from Opioid Substitution Treatment remain largely unable to access methadone and buprenorphine as treatment strategies for a range of reasons. Additional evidence suggests older people with problematic longterm opioid use issues in the UK and USA are stigmatized and denied access to healthcare and drug treatment services. Currently there exists a lack of published research exploring older people’s perspectives and experiences with problematic opioid use, obstacles to treatment and pathways to sobriety. Older long-term drug users remain an under-researched population in both the UK and USA. Aim: To explore the perspectives and experiences of older people with longterm opioid use problems and to identify the social, cultural and environmental conditions that contribute to both use and sobriety in Liverpool, UK and New Haven, Connecticut USA using visual methods. Design and Setting: A visual ethnographic study using participant-generated photography and photo-elicitation interviews among older people aged 50+, with 10+ years of experience using opioids including heroin from Liverpool, UK and New Haven, Connecticut, USA. Method: Participant-generated photo-elicitation and photo-documentation methods were used alongside participant-researcher interviews in the field over a five-week period. Participant-generated photographs and participant interviews were analyzed using a novel Modified Interpretive Engagement Framework to support both narrative and visual findings. Capitol Themes and Capitol Works, which constitute the narrative and visual findings, together articulate the similarities and differences between the two international communities. Results: A total of twenty-six people were recruited. Participants offered perspectives based on their personal photographs and lived experiences. Twenty-five participants completed exit interviews and reported a wide range of conditions that contributed to the development of long-term problematic opioid use, relapse and recovery. Thematic analysis revealed four major themes of interest: 1) adverse childhood experiences and adult traumas, 2) cyclical arrest and imprisonment, 3) housing and homelessness and 4) broken kin relationships. Themes were found to be overlapping and enmeshed issues of physical and mental health, which complicates solutions for long-term problematic opioid use in both communities. Differences between health treatment pathways, accessibility to health care services and right to health issues in Liverpool and New Haven were identified and found to result from a complex mix of long-standing policies, historical political divisions and freemarket vs universal-coverage healthcare systems.