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

Abstract

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..

Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths

“…We also identified other localizations of mortality in time and context. In addition to the clustering after prison release, we identified preliminary evidence of a similar clustering at the end of in-patient detoxification [13], an observation subsequently confirmed in larger studies [14,15]. With colleagues Matt Hickman and Rosie Cornish from Bristol, we also analysed data from the large General Practice Research Database (GPRD), looking over a 15-year period at the extent to which mortality data had a relationship to the initiation, continuation or termination of methadone or buprenorphine prescription.…”

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

“…(The finding of increased risk up to four weeks post prison release was subsequently quantified as 1 in 200 prisoners with history of heroin use dying from opioid overdose in the first two weeks post-release and was replicated internationally (Merrall et al, 2010). Similar but less intense concentrations of overdose deaths were subsequently also observed among patients completing in-patient detoxification (Strang et al, 2003), residential rehabilitation (Davoli et al, 2007), and hospital/residential treatment (Merrall et al, 2013;Ravndal and Amundsen, 2010)). …”

Últimos desarrollos en los implantes y las inyecciones depot de naltrexona; el jovencito de la escalera se está haciendo mayor

“…This situation carries a high risk of OOD. Ravndal and Amundsen found a 15-fold increase in the Standard Mortality Rate in the first four weeks after discharge, 43 all due to OOD. Most deaths could have been prevented by the use of a GMI.…”