Death and survival in a cohort of heroin addicts from London clinics: a 22‐year follow‐up study

Abstract

Data are presented on the 43 people who died over a 22-year follow-up period of a cohort of 128 heroin addicts drawn in 1969 from the newly opened London clinics. The main causes of death were drug-related, with 18 deaths specifically determined as due to overdose, of which the great majority were among people being prescribed opiates at the time. The mortality rate was a mean of 1.84% annually, and the excess mortality ratio was 11.9. This excess was highest at the beginning and varied over the period of study, appearing higher at the opening of the clinics and again in the mid-1980s. No sex differences in mortality rates were demonstrated but the excess mortality was concentrated at younger ages. No prediction of the 85 survivors could be made on the basis of length of heroin use prior to study intake, nor on age at intake.

Observed Patterns of Illicit Opiate Overdose Deaths in Chicago, 1999–2003

“…Our findings support the acknowledged link between age and the likelihood of OD death 1,12,13,15 in the U.S. and other wealthy societies. Chicago_s mean age of death-39 years-resonates with the findings.…”

“…Although OD incidence varies across settings, annual mortality rates among untreated opiate addicts range from 1 to 2% with higher mortality incidence in some populations. [12][13][14][15][16] International OD death rates among opiate users range from six to 20 times greater than the norm for their drug-free peers, with accidental OD accounting for up to 45% of their deaths. 17,18 Intravenous heroin use-as opposed to less lethal routes of administration such as intranasal ingestion-accounts for the vast majority of opiate-related ODs.…”

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

“…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.…”

“…9,15,16 Much of the mortality research including people with substance dependence has focused on injection drug users, primarily of heroin. 15,17,18 This is likely because of the high prevalence of overdose, among other serious medical consequences, and the concomitant risk of death. 4 More than two-thirds of illicit drug users in an Australian study reported nonfatal drug overdose in their lifetime, 17 and a substantial proportion of the excess mortality in drug users is because of drug overdose.…”

The Relationship Between Depressive Symptoms and Nonfatal Overdose Among a Sample of Drug Users in Baltimore, Maryland

“…5 Although depressive symptoms are strong predictors of suicide and attempted suicide, 6,7 most drug overdoses do not appear to be suicide attempts. [8][9][10] It has been hypothesized that some individuals use illicit drugs to selfmedicate for dysphoria and other mental conditions. 11 Depressed drug users are more likely to use more of their drug to alleviate their symptoms and improve their mood.…”