A prospective study of mortality among drug misusers during a 4‐year period after seeking treatment

Gossop, Michael; Stewart, Duncan; Treacy, Samantha; Marsden, John

doi:10.1046/j.1360-0443.2002.00079.x

Cited by 270 publications

(243 citation statements)

References 47 publications

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“…Only three of the deceased were females. This harmonises with other studies, showing that males have a significantly higher risk of death Gossop et al, 2002;Ødegård et al, 2007;Clausen et al, 2007).…”

Section: Discussionsupporting

confidence: 92%

“…It is well documented that there is a high mortality rate among drug users, and that death by overdose is common cause of death in that group (Clausen et al, 2008;Darke and Degenhardt, 2007;Davoli et al, 2007;Bargagli et al, 2006;Johnson et al, 2005;Gossop et al, 2002). Actually, deaths from opiate overdose comprise the vast majority of all drugrelated deaths (Strang et al, 2008;Darke and Zador, 1996).…”

Section: Introductionmentioning

confidence: 99%

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Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Ravndal

Amundsen²

2010

Drug and Alcohol Dependence

109

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Background:Drug users who are leaving/completing inpatient medication-free treatment may, like drug users released from prison, have an elevated risk of dying from fatal overdoses. This is mainly explained by their low drug tolerance. Methods:Two hundred and seventy-six drug users who had been admitted to eleven inpatient facilities in Norway, were followed prospectively after discharge from treatment during an eight year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). The following instruments were used: EuropASI, SCL-25 and MCMI-II.Information on deaths and causes of death were obtained from the National Death Register. Results:A total of 36 deaths were registered after discharge from treatment during the observation period, of which 24 were classified as overdose deaths. During the first 4 weeks after discharge six persons died, yielding an unadjusted excess mortality of 15.7 (rate ratio) in this period (CI 5.3-38.3). All were dropouts and all deaths were classified as opiate overdoses.There was no significant association between time in index treatment and mortality after discharge, nor did any background characteristics correlate significantly with elevated mortality shortly after discharge. Conclusions:The elevated risk of dying from overdose within the first four weeks of leaving medicationfree inpatient treatment is so dramatic that preventive measures should be taken. More studies from similar inpatient programmes are needed in order to obtain systematic knowledge about determinants of overdose deaths shortly after leaving treatment, and possible preventive measures..

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Ravndal

Amundsen²

2010

Drug and Alcohol Dependence

109

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“…A prospective study of mortality among drug users after treatment showed an equally high mortality rate (1.2%), which was six times higher than that for a general, agematched population. 37 A prospective study of mortality after alcohol and drug abuse treatment showed a higher mortality of 2.38% per year, three times that expected in male veterans. 38 Moos et al reported that mortality in treated alcoholdependent patients was two to five times higher than age-and sex-matched comparison groups.…”

Section: Discussionmentioning

confidence: 94%

“…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. 4,15,17,18,40,41 Homelessness is another predictor of risk of death for substance-dependent people.…”

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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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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“…35,45,46 The covariates found to be significantly associated with time to death in the Cox proportional hazards regression analysis-age, education, HIV infection, social isolation-are also consistent with other studies of mortality. [47][48][49] Even though we cannot rule out that other unmeasured individual-level factors could account for the cross-site difference, higher-level factors such as access and availability of services might also be exerting an important influence. For example, the catchment area where the NY cohort was recruited had five methadone programs with multiple clinics where HIV care was directly offered.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Mortality Among Puerto Rican Injection Drug Users in East Harlem, New York, and Bayamon, Puerto Rico

Colón¹,

Deren

Robles³

et al. 2006

J Urban Health

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A prospective study of mortality among drug misusers during a 4‐year period after seeking treatment

Cited by 270 publications

References 47 publications

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

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

A Comparative Study of Mortality Among Puerto Rican Injection Drug Users in East Harlem, New York, and Bayamon, Puerto Rico

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