Aging and heroin use: a mixed-methods study with older adults in treatment in Malta

Background Heroin use remains a major concern within substance use disorder (SUD) treatment, particularly as affected cohorts age. In Malta, a growing group of older adults with long-term heroin use histories is presenting with complex needs that strain standard treatment models.Method A mixed-methods design was used. First, 50 participants (40 males, 10 females) recruited through a low-threshold state service completed a quantitative questionnaire. Next, 45 of these participants took part in in-depth qualitative interviews to explore experiences and service needs in greater detail.Results Quantitative findings indicated high rates of overdose, unemployment, incarceration, and chronic health conditions among participants. Most were receiving long-term opioid agonist therapy, primarily methadone. Qualitative interviews highlighted the need for age-specific and flexible care models. Women reported distinct vulnerabilities, including heightened stigma and exploitation. Many participants expressed a desire to exit the drug-using lifestyle; long-term methadone was commonly described as stabilizing yet burdensome.Conclusions Older adults with heroin use disorder in Malta face intertwined physical, psychological and social challenges that are not fully met by current services. Integrated, multidisciplinary approaches that are both age- and gender-sensitive are needed to address these biopsychosocial realities, support stability and create viable pathways out of drug use.