The quantification of mortality resulting from the regular use of illicit opiates

Hulse, Gary Kenneth; English, Dallas R.; Milne, Eugene; Holman, Cheryl

doi:10.1046/j.1360-0443.1999.9422216.x

Cited by 231 publications

(135 citation statements)

References 3 publications

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“…[3][4][5][6][7][8] While mortality rates cannot be directly compared across studies without age or sex adjustment, our results appear to be consistent with other literature reports. 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.…”

Section: Discussionsupporting

confidence: 92%

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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: Discussionsupporting

confidence: 92%

“…3 Alcohol and drug dependence increase the risk of death substantially. [4][5][6][7][8] As in the general population, death in adults with substance dependence is more common in men than in women. [9][10][11] Similarly, older age is also associated with mortality in this population.…”

Section: Introductionmentioning

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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“…[1][2][3][4] Excess risk of mortality among drug users has been attributed to HIV infection, drug overdosing, and violence. [5][6][7] Fluctuations over time in the relative influence of different causes of death have also been noted.…”

Section: Introductionmentioning

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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“…As compared with those addicted to other drugs, heroin abusers still rely heavily on an i.v. route of administration that places them at greater risk for morbidity as well as premature death due to overdose (1). The neurobiological actions of opiates have been widely studied, and it appears that the rewarding effects of heroin and its psychoactive metabolites, e.g., morphine, are strongly mediated via the opioid receptor (MOR).…”

mentioning

confidence: 99%

μ Opioid receptor A118G polymorphism in association with striatal opioid neuropeptide gene expression in heroin abusers

Drakenberg¹,

Nikoshkov²,

Horváth

et al. 2006

Proc. Natl. Acad. Sci. U.S.A.

104

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Opioid receptors are critical for heroin dependence, and A118G SNP of the opioid receptor gene (OPRM1) has been linked with heroin abuse. In our population of European Caucasians (n ‫؍‬ 118), Ϸ90% of 118G allelic carriers were heroin users. Postmortem brain analyses showed the OPRM1 genotype associated with transcription, translation, and processing of the human striatal opioid neuropeptide system. Whereas down-regulation of preproenkephalin and preprodynorphin genes was evident in all heroin users, the effects were exaggerated in 118G subjects and were most prominent for preproenkephalin in the nucleus accumbens shell. Reduced opioid neuropeptide transcription was accompanied by increased dynorphin and enkephalin peptide concentrations exclusively in 118G heroin subjects, suggesting that the peptide processing is associated with the OPRM1 genotype. Abnormal gene expression related to peptide convertase and ubiquitin͞proteosome regulation was also evident in heroin users. Taken together, alterations in opioid neuropeptide systems might underlie enhanced opiate abuse vulnerability apparent in 118G individuals.drug abuse ͉ dynorphin ͉ enkephalin ͉ mRNA

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The quantification of mortality resulting from the regular use of illicit opiates

Cited by 231 publications

References 3 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

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

μ Opioid receptor A118G polymorphism in association with striatal opioid neuropeptide gene expression in heroin abusers

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