A 33-Year Follow-up of Narcotics Addicts

Hser, Yih‐Ing; Hoffman, Valerie; Grella, Christine E.; Anglin, M. Douglas

doi:10.1001/archpsyc.58.5.503

Cited by 737 publications

(554 citation statements)

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“…39 While poisoning accounted for 40.9% of deaths in our study, it was the cause of 22% of the deaths in a 33-year study of heroin users. 40 A longitudinal intervention study of mortality after drug treatment found the same three leading causes of death: poisoning, trauma, and medical illness. 37 Heroin as primary drug of choice is a major focus in the addiction mortality literature because of the high risk of overdose and infectious disease associated with its use.…”

Section: Discussionmentioning

confidence: 99%

“…37 Heroin as primary drug of choice is a major focus in the addiction mortality literature because of the high risk of overdose and infectious disease associated with its use. 4,15,17,18,40,41 Homelessness is another predictor of risk of death for substance-dependent people. [19][20][21] Of note, any homelessness was not a significant risk factor in our analyses.…”

Section: Discussionmentioning

confidence: 99%

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Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

Saitz

Gaeta²,

Cheng³

et al. 2007

J Urban Health

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The objective of this analysis was to assess the mortality rate and risk factors in adults, with substance dependence, who are not receiving primary medical care (PC). Date and cause of death were identified using the National Death Index data and death certificates for 470 adults without PC over a period of almost 4 years after detailed clinical assessment after detoxification. Factors associated with risk of mortality were determined using stepwise Cox proportional hazards models. Subjects were 76% male, 47% homeless, and 47% with chronic medical illness; 40% reported alcohol, 27% heroin, and 33% cocaine as substance of choice. Median age was 35. During a period of up to 4 years, 27 (6%) subjects died. Median age at death was 39. Causes included: poisoning by any substance (40.9% of deaths), trauma (13%), cardiovascular disease (13.6%), and exposure to cold (9.1%). The age adjusted mortality rate was 4.4 times that of the general population in the same city. Among these individuals without PC in a detoxification unit, risk factors associated with death were the following: drug of choice [heroin: hazard ratio (HR) 6.9 (95% confidence interval (CI) 1.6-31.1]; alcohol: HR 3.7 (95% CI 0.79-16.9) compared to cocaine); past suicide attempt (HR 2.1, 95% CI 0.96-4.5); persistent homelessness (HR 2.4, 95% CI 1.1-5.3); and history of any chronic medical illness (HR 2.1, 95% CI 0.93-4.7). Receipt of primary care was not significantly associated with death (HR 0.85, 95% CI 0.34-2.1). Risk of mortality is high in patients with addictions and risk factors identifiable when these patients seek help from the health care system (i.e., for detoxification) may help identify those at highest risk for whom interventions could be targeted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

Saitz

Gaeta²,

Cheng³

et al. 2007

J Urban Health

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“…There is no accepted definition of ‘injecting risk’, with studies showing high rates of relapse after 1 year but reducing substantially after more than 5 years 40, 41. By including all individuals who reported ever injecting, it is conceivable that we have included some who have ceased injecting, which would lead to an overestimate.…”

Section: Discussionmentioning

confidence: 99%

Problem drug use prevalence estimation revisited: heterogeneity in capture–recapture and the role of external evidence

et al. 2015

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Background and AimsCapture–recapture (CRC) analysis is recommended for estimating the prevalence of problem drug use or people who inject drugs (PWID). We aim to demonstrate how naive application of CRC can lead to highly misleading results, and to suggest how the problems might be overcome.MethodsWe present a case study of estimating the prevalence of PWID in Bristol, UK, applying CRC to lists in contact with three services. We assess: (i) sensitivity of results to different versions of the dominant (treatment) list: specifically, to inclusion of non‐incident cases and of those who were referred directly from one of the other services; (ii) the impact of accounting for a novel covariate, housing instability; and (iii) consistency of CRC estimates with drug‐related mortality data. We then incorporate formally the drug‐related mortality data and lower bounds for prevalence alongside the CRC into a single coherent model.ResultsFive of 11 models fitted the full data equally well but generated widely varying prevalence estimates, from 2740 [95% confidence interval (CI) = 2670, 2840] to 6890 (95% CI = 3740, 17680). Results were highly sensitive to inclusion of non‐incident cases, demonstrating the presence of considerable heterogeneity, and were sensitive to a lesser extent to inclusion of direct referrals. A reduced data set including only incident cases and excluding referrals could be fitted by simpler models, and led to much greater consistency in estimates. Accounting for housing stability improved model fit considerably more than did the standard covariates of age and gender. External data provided validation of results and aided model selection, generating a final estimate of the number of PWID in Bristol in 2011 of 2770 [95% credible interval (Cr‐I) = 2570, 3110] or 0.9% (95% Cr‐I = 0.9, 1.0%) of the population aged 15–64 years.ConclusionsSteps can be taken to reduce bias in capture–recapture analysis, including: careful consideration of data sources, reduction of lists to less heterogeneous subsamples, use of covariates and formal incorporation of external data.

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“…The use of heroin among high school seniors in the United States has also increased (Monitoring the Future Study, 2000). Many heroin-dependent individuals also abuse cocaine, marijuana, and alcohol (Hser et al, 2001). These substance abusers are at risk for many medical problems, including collapsed veins, endocarditis, abscesses, cellulitis, hepatitis, pneumonia, lymphadenopathy, spongiform leukoencephalopathy, and HIV/AIDS (Ben Diane et al, 2000;Hser et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

“…Many heroin-dependent individuals also abuse cocaine, marijuana, and alcohol (Hser et al, 2001). These substance abusers are at risk for many medical problems, including collapsed veins, endocarditis, abscesses, cellulitis, hepatitis, pneumonia, lymphadenopathy, spongiform leukoencephalopathy, and HIV/AIDS (Ben Diane et al, 2000;Hser et al, 2001). Treatment approaches such as methadone, l-a acetomethadol, and buprenorphine, which are useful in reducing heroin use and in keeping patients in treatment programs (O'Connor and Fiellin, 2000;Johnson et al, 2000), might reduce health risks in these patients.…”

Section: Introductionmentioning

confidence: 99%

Methadone Treatment Induces Attenuation of Cerebrovascular Deficits Associated with the Prolonged Abuse of Cocaine and Heroin

Herning

Better

Tate

et al. 2002

Neuropsychopharmacol

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Opiate replacement therapy has been useful in reducing heroin use and in keeping patients in treatment programs. However, neuropsychological and neurophysiological effects of this treatment regimen have not been evaluated systematically. To determine whether methadone treatment reduces the magnitude of cerebral blood flow alternations in polysubstance (heroin and cocaine) abusers, we compared blood flow parameters in control subjects (n ¼ 26), polysubstance abusers (n ¼ 28) maintained on methadone for 24 weeks, and polysubstance abusers (n ¼ 22) who were not seeking treatment. Blood flow velocity was recorded from the anterior and middle cerebral arteries using transcranial Doppler sonography on an outpatient visit. The pulsatility index, a measure of cerebrovascular resistance, was significantly (po0.05) increased in both groups of polysubstance abusers compared to control subjects. Increased pulsatility in the two groups of substance abusers suggests constriction of the small cortical arteries. Nevertheless, the methadonemaintained polysubstance abusers had significantly lower pulsatility values than the nontreatment substance-abusing group. These findings suggest that maintenance on methadone might have significant beneficial neurovascular effects on this population of patients.

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A 33-Year Follow-up of Narcotics Addicts

Abstract: While the number of deaths increased steadily over time, heroin use patterns were remarkably stable for the group as a whole. For some, heroin addiction has been a lifelong condition associated with severe health and social consequences.

Cited by 737 publications

References 10 publications

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

Problem drug use prevalence estimation revisited: heterogeneity in capture–recapture and the role of external evidence

Methadone Treatment Induces Attenuation of Cerebrovascular Deficits Associated with the Prolonged Abuse of Cocaine and Heroin

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