Abstract
BackgroundFew longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality. The aim of the present study was to identify predictors of increased risk of drug related death and non drug related death in substance abusers of opiates, stimulants, cannabis, sedatives/hypnotics, hallucinogens and alcohol over several decades.MethodsFollow-up study of a consecutive cohort of 561 substance abusers, admitted to a detoxification unit January 1970 to February 1978 in southern Sweden, and followed up in 2006. Demographic and clinical data, substance diagnoses and three groups of psychiatric diagnoses were identified at first admission. Causes of death were coded according to ICD-10 and classified as drug related deaths or non drug related deaths. To identify the incidence of some probable risk factors of drug related premature death, the data were subjected to a competing risks Cox regression analysis.ResultsOf 561 patients in the cohort, 11 individuals had either emigrated or could not be located, and 204/561 patients (36.4%) were deceased by 2006. The cumulative risk of drug related death increased more in the first 15 years and leveled out later on when non drug related causes of death had a similar incidence. In the final model, male gender, regular use of opiates or barbiturates at first admission, and neurosis were associated with an increased risk of drug related premature death, while cannabis use and psychosis were associated with a decreased risk. Neurosis, mainly depression and/or anxiety disorders, predicted drug related premature death while chronic psychosis and personality disorders did not. Chronic alcohol addiction was associated with increased risk of non drug related death.ConclusionsThe cohort of drug abusers had an increased risk of premature death to the age of 69. Drug related premature death was predicted by male gender, the use of opiates or barbiturates and depression and anxiety disorders at first admission. The predicted cumulative incidence of drug related death was significantly higher in opiate and barbiturate abusers over the observed period of 37 years, while stimulant abuse did not have any impact. Alcohol contributed to non drug related death.
Highlights
Few longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality
Drug abusers have an increased risk of premature mortality which is influenced by a number of factors, including types of substances used, patterns of administration, risk behavior, contracted infectious diseases, gender, age and life style
31% discontinued the detoxification treatment prematurely, 20% within the first week. These individuals went through the same admission procedure as the rest of the cohort, and their data were included in the analyses
Summary
Few longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality. Drug abusers have an increased risk of premature mortality which is influenced by a number of factors, including types of substances used, patterns of administration, risk behavior, contracted infectious diseases, gender, age and life style. Several studies of clinical samples have reported that 35-40% of all deaths in opiate users are overdoses [3,14,15,16,17,18]. A recent epidemiological study of a cohort of 100,000 substance users of amphetamine/methamphetamine and ecstasy in England and Wales 1997-2007 identified an increasing number of amphetamine deaths from 30 to 70 over this period of ten years [20]
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