Unnatural causes of death among drug addicts in Stockholm: an analysis of health care and autopsy records

Trends in mortality from external causes in the Republic of Seychelles between 1989 and 2018

Data on injury-related mortality are scarce in the African region. Mortality from external causes in the Seychelles was assessed, where all deaths are medically certified and the population is regularly enumerated. The four fields for underlying causes of death recorded were reviewed in the national vital statistics register. The age-standardised mortality rates were estimated (per 100,000 person-years) from external causes in 1989–1998, 1999–2008, and 2009–2018. Mortality rates per 100,000 person-years from external causes were 4–5 times higher among males than females, and decreased among males over the three 10-year periods (127.5, 101.4, 97.1) but not among females (26.9, 23.1, 26.9). The contribution of external causes to total mortality did not change markedly over time (males 11.6%, females 4.3% in 1989–2018). Apart from external deaths from undetermined causes (males 14.6, females 2.4) and “other unintentional injuries” (males 14.1, females 8.0), the leading external causes of death in 2009–2018 were drowning (25.9), road traffic injuries (18.0) and suicide (10.4) among males; and road traffic injuries (4.6), drowning (3.4) and poisoning (2.6) among females. Mortality from broad categories of external causes did not change consistently over time but rates of road traffic injuries increased among males. External causes contributed approximately 1 in 10 deaths among males and 1 in 20 among females, with no marked change in cause-specific rates over time, except for road traffic injuries. These findings emphasise the need for programs and policies in various sectors to address this large, but mostly avoidable health burden.

Accident rates for drug-dependent patients in treatment for substance dependence: a pilot trial

OBJECTIVES

To analyze accident rates among drug-dependent patients before and after treatment for substance dependence.

METHODS

Self-reported lifetime data and data from the year prior to the start of treatment were analyzed from a cohort including 53 drug-dependent patients, 48 men and 5 women, who had started treatment for substance dependence in an outpatient treatment center in Valladolid, Spain. We also obtained prospective information about treatment dropout and accident rates in the 3-month follow-up period after the start of drug-dependency treatment.

RESULTS

Twenty-two percent of drug-dependent patients had an accident in the year prior to starting treatment, and 64.2 percent had an accident in his or her lifetime. Road traffic accidents were the most frequent, with 11.3 percent of patients reporting at least one in the prior year and 45.3 percent reporting at least one road traffic accident in his or her lifetime. Furthermore, drug-dependent patients were frequently under the influence of drugs when driving (13.2%), as well as when performing dangerous activities at work (11.3%), at home (9.4%), and during sporting activities (5.7%) in the year prior to starting treatment. Of the 30 patients who were still undergoing treatment after 3 months, 2 had had accidents during this period (6.6%), one occurring at work and the other at home.

CONCLUSIONS

Accident involvement, and especially involvement in road traffic accidents, was common among drug-dependent patients. Many accidents occurred in the year prior to treatment initiation. Furthermore, drug-dependent patients often undertook risky activities while under the influence of drugs. There is a need to implement accident prevention strategies, especially strategies that target road traffic accidents, in treatment programs for drug-dependent patients.

Causes and manners of death among users of heroin, methadone, amphetamine, and cannabis in relation to postmortem chemical tests for illegal drugs

A 12-year medicolegal investigation of deceased illegal drug users (ILDU) in Stockholm, Sweden, classified on the basis of postmortem chemical tests, showed noticeable variations in causes and manners of death as well as in the distribution of suicide methods. This study offers objective information about connection between the postmortem findings of illegal drugs and the causes and manners of death of their users. However, further studies, comparing prevalence of drug use in general population and at the postmortem tests, are needed for more detailed elucidation of this connection.

Cause-specific excess mortality in siblings of patients co-infected with HIV and hepatitis C virus

Background

Co-infection with hepatitis C in HIV-infected individuals is associated with 3- to 4-fold higher mortality among these patients' siblings, compared with siblings of mono-infected HIV-patients or population controls. This indicates that risk factors shared by family members partially account for the excess mortality of HIV/HCV-co-infected patients. We aimed to explore the causes of death contributing to the excess sibling mortality.

Methodology and Principal Findings

We retrieved causes of death from the Danish National Registry of Deaths and estimated cause-specific excess mortality rates (EMR) for siblings of HIV/HCV-co-infected individuals (n = 436) and siblings of HIV mono-infected individuals (n = 1837) compared with siblings of population controls (n = 281,221). Siblings of HIV/HCV-co-infected individuals had an all-cause EMR of 3.03 (95% CI, 1.56–4.50) per 1,000 person-years, compared with siblings of matched population controls. Substance abuse-related deaths contributed most to the elevated mortality among siblings [EMR = 2.25 (1.09–3.40)] followed by unnatural deaths [EMR = 0.67 (−0.05–1.39)]. No siblings of HIV/HCV co-infected patients had a liver-related diagnosis as underlying cause of death. Siblings of HIV-mono-infected individuals had an all-cause EMR of 0.60 (0.16–1.05) compared with siblings of controls. This modest excess mortality was due to deaths from an unknown cause [EMR = 0.28 (0.07–0.48)], deaths from substance abuse [EMR = 0.19 (−0.04–0.43)], and unnatural deaths [EMR = 0.18 (−0.06–0.42)].

Conclusions

HCV co-infection among HIV-infected patients was a strong marker for family-related mortality due to substance abuse and other unnatural causes. To reduce morbidity and mortality in HIV/HCV-co-infected patients, the advances in antiviral treatment of HCV should be accompanied by continued focus on interventions targeted at substance abuse-related risk factors.

Causes of death among crack cocaine users

OBJECTIVE: The study accompanied 131 crack-cocaine users over a 5-year period, and examined mortality patterns, as well as the causes of death among them. METHOD: All patients admitted to a detoxification unit in Sao Paulo between 1992 and 1994 were interviewed during two follow-up periods: 1995-1996 and 1998-1999. RESULTS: After 5 years, 124 patients were localized (95%). By the study endpoint (1999), 23 patients (17.6%) had died. Homicide was the most prevalent cause of death (n = 13). Almost one third of the deaths were due to the HIV infection, especially among those with a history of intravenous drug use. Less than 10% died from overdose. CONCLUSIONS: The study suggests that the mortality risk among crack cocaine users is greater than that seen in the general population, being homicide and AIDS the most common causes of death among such individuals.

Recent life problems and non-fatal overdose among heroin users entering treatment

AIMS

To investigate the role of recent life problems in non-fatal overdose among heroin users entering various drug treatment settings.

DESIGN

Cross-sectional data from a longitudinal study investigating drug treatment effectiveness.

SETTING

Five prison drug treatment services, three residential rehabilitation units, three residential detoxification units and 21 community drug treatment services located in rural, urban and inner-city areas of Scotland.

PARTICIPANTS

Of a total of 793 primary heroin users commencing drug treatment during 2001-02, 337 (42.5%) were prison drug service clients; 91 (11.5%) were residential rehabilitation clients; 97 (12.2%) were residential detoxification clients; and 268 (33.8%) were community drug treatment clients.

MEASUREMENTS

Univariate and stepwise multivariate logistic regression analyses examined associations between overdosing in the 90 days prior to treatment entry and basic demographic characteristics, recent drug use and recent life problems.

FINDINGS

Ninety-one study participants (11.5%) reported at least one overdose and 19 (2.4%) reported more than one overdose in the 90 days prior to treatment entry. A chi2 test revealed no significant difference in rates of recent overdosing between the four treatment settings (P = 0.650). Recent drug use and recent life problems-but not demographic characteristics-were associated independently with recent overdosing. However, recent life problems were not associated independently with recent overdosing among clients entering prison, clients entering residential rehabilitation or with multiple recent overdosing.

CONCLUSIONS

Associations between recent life problems and recent overdose were evident, but varied by treatment setting. Treatment providers should identify and address heroin users' life problems as part of a broad strategy of overdose prevention.

Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies

BACKGROUND

This study updated and expanded upon Harris and Barraclough's empirical review [Harris, E.C., Barraclough, B., 1997. Suicide as an outcome for mental disorders. A meta-analysis, Br. J. Psychiatry 170, 205-228] of retrospective and prospective cohort studies of alcohol and drug use disorders and suicide.

METHOD

Studies presenting data on alcohol and drug use disorders and suicide originally identified by Harris and Barraclough were used in this study. To find additional studies, (1) the location of English language reports on MEDLINE (1994-2002) were identified with the search terms 'substance-disorders' with 'mortality' and 'follow-up', (2) read throughs were conducted of four prominent alcohol and drug specialty journals from 1966 through 2002, and (3) the reference sections of studies that met criteria were searched for additional reports. This strategy yielded 42 new studies meeting eligibility criteria.

RESULTS

The estimated standardized mortality ratios (SMR; 95% confidence interval) for suicide were as follows: alcohol use disorder (979; 95% CI 898-1065; p < 0.001), opioid use disorder (1351; 95% CI 1047-1715; p < 0.001), intravenous drug use (1373; 95% CI 1029-1796; p < 0.001), mixed drug use (1685; 95% CI 1473-1920; p < 0.001), heavy drinking (351; 95% CI 251-478; p < 0.001). SMR estimates stratified by sex were also calculated.

CONCLUSIONS

Additional studies on the association of suicide and mixed drug use, heavy drinking, and alcohol use disorders in women augmented the findings of Harris and Barraclough, along with a novel estimate for intravenous drug use, a byproduct of intensive research on HIV in the past decade. There is a large empirical literature on alcohol use disorders and suicide and a moderate literature on suicide and opioid use disorders and IV drug use. There remains limited prospective data on the association of suicide and other drug use disorders (e.g., cocaine, cannabis).