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The aim of this study is to explore the characteristics of a group of patients over 50 years old who are entering a substitution treatment programme for opioid dependence and to compare the characteristics of this group with those aged under 50 who are enrolled in the same substitution treatment programme.

This is a cross sectional survey involving 92 cases in the 50 and above age group and 194 cases in the under 50 age group from community drug and alcohol services. Data were collected on demographic details, substance misuse and treatment history and progress with treatment. All the data were analysed using the Statistical Package for the Social Sciences (SPSS), version 1.1. Statistical significance between fewer than 50 and 50+ groups were assessed using Fisher's exact test.

Amongst the 92 in the group 50 years and above, 67 (average dose=63.25 mg) were on methadone maintenance (average dose=63.25 mg) and 19 (average dose=10.37 mg) on buprenorphine. In total, 11 per cent started using opiates after the age of 50. Sixty per cent used other substances out of which 31 per cent used multiple substances. Benzodiazepines, cocaine and amphetamines were the common substances of misuse. Thirty seven were infected with HCV. Comorbid rates for physical and mental illnesses were 64 per cent and 62 per cent, respectively. Nearly 86 per cent achieved good compliance with the treatment programme. Statistically higher rates of being single, lacking stable accommodation, prescription of buprenorphine, high dose prescriptions and lower rates of blood‐borne viruses, physical health and mental health, past forensic history were found in the under 50 age group compared with the 50+ age group.

There are a considerable number of patients above the age of 50 in maintenance treatment and they differ from the less than 50 age group. Old age and substance misuse psychiatrists should be aware of the prevalence of comorbid substance misuse, physical (including blood borne viruses) and psychiatric disorders in this population. Further research is required in this neglected area and a service provision should be based on such robust research.

This is the first study to the authors' knowledge that compares the demographic and treatment profiles of under 50 and over 50 years by age of patients in a methadone maintenance treatment programme. It clearly points to significant differences in the profiles based on age which will have implications for service provision which will have to take into account these age‐related differences in particular related to physical health and social needs.