QMJC June 2023: Disrupting the ageing cohort theory

In June 2023, colleagues from Deakin University (Australia) held a meeting of the Qualitative Methods Journal Club to discuss an article about overdose deaths among older people. In this blog, they summarise the paper’s findings and talk about whether age is a key risk factor in overdose deaths, as the dominant ‘ageing cohort theory’ would suggest.

Summary

In the 2021 article “Drug fatalities and treatment fatalism”, Fay Dennis revisits the ageing cohort theory, which is often cited to explain rises in drug-related deaths as the result of age-related complications. In the UK, where rates of heroin overdose have risen sharply in recent decades, some government officials and scholars have attributed the increase to an ageing cohort of people who use heroin with age-related health conditions that increase their risk of death from overdose. Combining insights from critical drug studies with ‘more-than-human’ approaches and a feminist ethic of care, Dennis challenges individualising explanations that posit age as a key risk factor in overdose deaths. She draws on in-depth interviews with people deemed most at risk of overdose to locate this risk, not in individual consumers, but rather in structural forces outside individual control.

Participants in Dennis’ study described encounters with drug treatment systems that left them feeling unheard, misunderstood and stigmatised, with many opting to hide their illicit drug use or leave treatment as a result. Their accounts suggest that the deaths of older people from overdose are inextricably linked to abstinence-oriented, punitive treatment systems that generate treatment despondency and a sense of fatalism among older people who have been using heroin for a long time. Dennis cautions that the sense of fatalism among older service users can all “too easily tip over into fatality” and it is therefore vital (in every sense) for treatment approaches to respond to the needs of older service users, and recognise the role of illicit drug use as a “situated mode of caring for themselves and others”. Such an approach to care stands in stark contrast to abstinence-focused treatment models that view illicit drugs as intrinsically harmful and antithetical to health. It shifts the focus and locus of responsibility for overdose deaths onto treatment systems, arguing that they are “part of a wider failure to respond to the lives of older people who use drugs”.

In disrupting the ageing cohort theory, the article draws attention to the fatalism and pathologising impulses underpinning it, arguing that such a theory risks naturalising the deaths of older people who use heroin – unfairly apportioning blame on them and obscuring the broader structural issues imbricated in overdose deaths, including prohibitionist drug policies, punitive drug treatment systems, austerity-driven funding cuts in social services, the lack of regulation affecting heroin purity, and widening health inequalities.

Discussion

Members of the group thought the article offered a careful and convincing analysis of the structural factors that shape older people’s risk of overdose. By combining rich qualitative data with concepts from feminist approaches and critical drug studies, the author was able to systematically debunk common misconceptions about older people who use heroin and, in so doing, show how, contrary to government reports and media discourse, age may actually help to protect them from overdose-related deaths. Protective factors that participants reported include changes in routes of heroin administration (from injecting to smoking), skill and experience in managing drug effects, acceptance of drug use and valuing health – all factors that are neglected by the ageing cohort theory as it equates age with increased risk.

A strength of the article was the care given to presenting the perspectives of an often-overlooked group of people who consume heroin. By centring the views of older people, the analysis exposes the ageism implicit in drug treatment systems which leave older service users feeling ignored or even punished by onerous, inflexible treatment regimes. Through its close attention to people’s stories and lived experiences, the article disrupts one-dimensional depictions of drug use and shows how narrow, exclusionary treatment metrics and an episodic care system disadvantages older clients.

Members of the group also appreciated how the author threaded the theoretical concepts through the analysis to build a sophisticated, logical argument. Some members are not familiar with the sociology of drugs literature, and they suggested that the article’s accessible, clear writing style offers a good model for qualitative researchers in different fields. In particular, we commended the author on her use of metaphor in staging the argument and teasing out particular analytic threads. For example, the application of Haraway’s string metaphor and the connections drawn between fatalism, resignation to one’s fate, and drug-related fatalities were especially productive in making the argument that overdose-related deaths are a “failure in response-ability”, contingent on drug policies, treatment practices and a wider web of historical and sociopolitical forces that far exceed the bounds of individual agency.

by Dr Kiran Pienaar, Dr Ashleigh Haw, and Dr Kyja Noack-Lundberg.

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