Mortality among injection drug users identified as "out of treatment".

McAnulty, Jeremy; Tesselaar, Helen; Fleming, David W.

doi:10.2105/ajph.85.1.119

Cited by 18 publications

(7 citation statements)

References 11 publications

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“…Estimates use the incidence of HCV from the general model with 2.5% antibody loss per year and assume an 85% drop in incidence between 1989 and 1994. reasons unrelated to the infection, because HCV infection is associated with risk factors such as blood transfusion and intravenous drug use which are, themselves, associated with increased mortality. [21][22][23][24] Our assumption about age-specific incidence implies that, in each age group, the number of cases of symptomatic hepatitis C is proportional to the number of new HCV infections. This may not necessarily be the case.…”

Section: Discussionmentioning

confidence: 99%

The past incidence of hepatitis C virus infection: Implications for the future burden of chronic liver disease in the United States

et al. 2000

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Because chronic liver disease may develop many years after acute hepatitis C virus (HCV) infection, the past incidence of acute infections is a major determinant of the future burden of HCV-associated complications. We estimated past incidence of acute HCV infection using national seroprevalence data and relative age-specific incidence data from a sentinel counties surveillance system. Projections of the future prevalence of HCV-infected patients were derived from models that included an 85% drop in HCV infection incidence as observed for reported cases in the early 1990s. The models showed a large increase in the incidence of HCV infections from the late 1960s to the early 1980s. The degree of increase was dependent on the assumed rate of antibody loss; a model with 2.5% annual antibody loss showed annual incidence increasing from 45,000 infections (95% confidence interval [95% CI]: 0-110,000) in the early 1960s to 380,000 infections (95% CI: 250,000 to 500,000) in the 1980s. Projections showed that although the prevalence of HCV infection may be declining currently because of the decline in incidence in the 1990s, the number of persons infected for H20 years could increase substantially before peaking in Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States and causes approximately 15% of all reported episodes of acute viral hepatitis. 1,2 Injection drug use and high-risk sexual activity are the most frequently identified risk factors associated with acute disease. Blood transfusion was a major risk factor for acquiring HCV infection before donor screening for human immunodeficiency virus infection, and surrogate marker testing for non-A, non-B hepatitis began in the mid-1980s, followed by screening for antibody to HCV (anti-HCV) in 1990. Young adults (ages 20 to 35 years) are at highest risk for acute infection, having an incidence 6 times higher than that of persons over 40 years 1 (Centers for Disease Control and Prevention [CDC], unpublished data).The most significant feature of HCV infection is the high rate of chronic infection and chronic hepatitis, which in the long term can lead to cirrhosis. 3 It is unknown how many of the nearly 4 million persons infected in the United States 2 will ultimately develop these complications.Direct determination of the incidence of new infections is impractical because most acute HCV infections are asymptomatic 4,5 and clinical disease is greatly under-reported. 6 In the past, the incidence of HCV infection has been estimated by adjusting the number of reported cases to account for under-reporting and for asymptomatic infections. An alternative method is to model incidence from prevalence data using ''catalytic modeling. '' 7,8 PATIENTS AND METHODSData Sources. The third National Health and Nutrition Examination Survey (NHANES III) was a cross-sectional national survey conducted from 1988 to 1994 that provided nationally representative prevalence estimates for a variety of health measures and conditions. 9 A total of...

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Section: Discussionmentioning

confidence: 99%

The past incidence of hepatitis C virus infection: Implications for the future burden of chronic liver disease in the United States

et al. 2000

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“…It has been reported that as many as 30% to 60% of methadone-related deaths are due to persons not prescribed the drug (55,162). Evidence suggests that excess mortality among out-oftreatment users is at least similar to that reported for those in treatment (163,164). In Italy (Rome) there was a higher risk in those who left treatment compared to those in MMT, especially when subjects had been out of treatment > 2 weeks (13).…”

Section: Methadone Treatmentmentioning

confidence: 98%

Characterization of Methadone Overdose: Clinical Considerations and the Scientific Evidence

Wolff¹

2002

Therapeutic Drug Monitoring

106

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Overdosing with methadone is a growing phenomenon in Britain and other countries due to the increase in prescription and the availability of this compound. Little is known of the circumstances surrounding methadone death due to some extent to the difficulty of defining drug-related death and also the difficulty of collecting clinical and biographical data in a predominantly illegal and marginal milieu. However, the evidence points to highest risk at night (to this end manifestations of its toxicity often go unrecognized) in those whose usual tolerance has been reduced and occurring some considerable time after ingestion. Further investigations are needed to elucidate fully the mechanism and spectrum of methadone overdose. Death from methadone is eminently preventable more so because of the long-term nature of the clinical sequelae. Indeed the key issue with methadone that sets it apart from other opioids is its potential for delayed toxicity. Consequently steps should be taken to disseminate the salient facts to all those who come into contact with the drug.

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“…It is likely that this will be underestimated since few cohort studies report mortality rates from all forms of trauma and it is difficult to calculate valid aetiologic fractions for these causes due to the fact that many trauma deaths in drug users may not be recognised as being related to drug use. Nonetheless, rates of traumatic injury are also high in this group with estimates of mortality attributed to this cause ranging from 0.16% per annum [44] to 0.37% [50] with a weighted average of 0.26% per annum.…”

Section: Traumamentioning

confidence: 94%

“…The particular limitations of the cohort studies that are most relevant to this project are, firstly, that these studies were conducted exclusively in developed countries (principally the USA and European countries). Secondly, with one exception [44] these studies drew their samples from people receiving treatment for drug-related problems. Finally, the majority of cohort studies were conducted in the pre-AIDS era.…”

Section: Quantification Of Riskmentioning

confidence: 99%

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Challenges and Approaches to Estimating Mortality Attributable to the Use of Selected Illicit Drugs

et al. 2001

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A number of unique challenges are faced when attempting to estimate mortality attributable to illicit drugs. The hidden nature of illicit drug use creates difficulties in quantifying the prevalence of such use; identifying adverse health effects associated with exposure, and calculating the risk of these effects. The use of cohort studies of drug users allows the identification of causes of mortality associated with drug use and the determination of the risk of these causes. This risk estimate can then be used in conjunction with estimates of the prevalence of drug use to extrapolate the burden of mortality. We identify a number of such studies and present some solutions to the major challenges faced when attempting to estimate the global burden of mortality attributable to illicit drug use.

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Mortality among injection drug users identified as "out of treatment".

Cited by 18 publications

References 11 publications

The past incidence of hepatitis C virus infection: Implications for the future burden of chronic liver disease in the United States

The past incidence of hepatitis C virus infection: Implications for the future burden of chronic liver disease in the United States

Characterization of Methadone Overdose: Clinical Considerations and the Scientific Evidence

Challenges and Approaches to Estimating Mortality Attributable to the Use of Selected Illicit Drugs

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