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Heroin Addiction and Related Clinical Problems: 2007, 09, 3 (pages: 41 - 50)

Mortality Among Opiate Abusers in Stockholm: A Longitudinal Study

Stenbacka M., Leifman A., Romelsjö A.

Summary: Background. Earlier studies have shown that opiate abuse is associated with an increased risk of developing a negative lifestyle, and also with high mortality and morbidity in young people. Many studies on mortality among drug users are based on clinical samples with short follow-up periods. In this study we were able to follow a more general cohort of opiate abusers with reference to mortality and morbidity during a 37-year follow-up period. The aims were to analyse mortality in a large cohort of opiate abusers during a follow-up period as long as 37 years. Material and methods: The study is based on a cohort of opiate abusers selected in Stockholm in 1967. They were recruited by using a case finding method, with data based on reports from authorities, hospitals, prisons, schools, and so on. A total of 817 people (647 men and 170 women) reported opiate abuse alone (Op) or in combination, either with central stimulants (Op+Cs) or alcohol (Op+Alc). The cohort was followed up in the Cause of Death and Inpatient-care Registers, until 2003 and 2004, respectively. Results. A total of 477 (58.4%) opiate abusers (392 men and 85 women) died during the follow-up period. The average age of death was higher for the men in the cohort (48.1 years) than for the women (42.9 years). The average age at death in Stockholm County was 71.7 for men and 76.3 for women in 1967 and 77.8 and 82.3 in 2003. Irrespective of drug use (Op, Op + Cs and Op+Alcohol use), a common cause of death among the youngest (15-34 years) was accidents (41%, 35%, and 11%) followed by suicide. After adjusting to take account of age and gender in the general population in Stockholm County, the standard mortality ratio (SMR) among the whole group was 4.38 (95% CI 4.0-4.78); it was 5.79 (95%CI 4.56-7.02) for the women and 3.45(95% CI 3.11-3.79) for the men. Conclusion. The female addicts were at a considerably higher mortality risk than the men and at death they were younger. Accidents and suicide, especially among young people, are two causes of death which might have been prevented. This is crucial in supplying information useful to preventive efforts.