The current paper examines critically the literature on suicide rates, suicide risk factors and methods employed for suicide among heroin users, and compares these to those of the general population. Heroin users have a death rate 13 times that of their peers, and deaths among heroin users attributed to suicide range from 3-35%. Overall, heroin users are 14 times more likely than peers to die from suicide. The prevalence of attempted suicide is also many orders of magnitude greater than that of community samples. The major general population risk factors for suicide also apply to heroin users (gender, psychopathology, family dysfunction and social isolation). Heroin users, however, have extremely wide exposure to these factors. They also carry additional risks specifically associated with heroin and other drug use. Drugs as a method of suicide play a larger role in suicide among heroin users than in the general population. Heroin, however, appears to play a relatively small role in suicide among this group. Overall, suicide is a major clinical issue among heroin users. It is concluded that suicide is a major problem that treatment agencies face, and which requires targeted intervention if the rates of suicide among this group are to decline.

Suicide among heroin users: rates, risk factors and methods

Estimating mortality directly attributable to illicit drug use such as overdose death—the most tangible adverse heath effect of illicit drug use— is difficult because of variations in the quality and quantity of mortality data. As a result, it is necessary to make indirect estimates, involving estimates of the prevalence of illicit drug use. However, it is difficult to make even indirect estimates because the use of these drugs is illegal, stigma-tized and hidden. Nonetheless, efforts must be made to estimate the contribution that illicit drug use makes to the global burden of disease, because it is a pattern of behaviour that has a substantial adverse effect on the health of those who engage in it. In cohort studies of treated drug users the problematic use of illicit drugs has been associated with an increased overall rate of mortality, and with an elevated rate of a number of individual causes of death, four of which were estimated here: AIDS, overdose, suicide and trauma. Definitions of the variable of interest are difficult because of deficiencies in the data collected by countries on illicit drug use, and by disagreements over what constitutes " problematic " illicit drug use. The definition used here was long-term regular injecting use of opioids, amphetamines or cocaine. Data on the prevalence of problematic illicit drug use were derived from a range of sources that used variable methods of deriving estimates. A literature search was conducted of all studies that estimated the prevalence of problematic drug use. Available data on prevalence in countries with data were used to estimate the prevalence of problematic illicit drug use for subregions. 1 A search was also completed for cohort studies of drug users that had estimated mortality due to the four individual causes of death, and to all causes of death. Data on the number of years of follow-up were extracted from each study and a weighted average annual mortality rate was calculated for each of the four causes

Illicit drug use

To examine the impact of the AIDS epidemic on morbidity and mortality in a defined population of intravenous drug users, we analyzed overall and cause-specific death rates, AIDS incidence, and acute medical hospitalizations among patients in a long-term methadone maintenance program in New York City for the years 1984 through 1987 (midyear population for each year 828 to 891; demographic characteristics did not differ). The number of deaths while in treatment increased from 11 (13.3/1000) in 1984 to 39 (44.2/1000) in 1987. Deaths from AIDS increased from 3.6/1000 to 14.7/1000, deaths due to bacterial pneumonia/sepsis from 3.6/1000 to 13.6/1000; deaths from cirrhosis, drug overdose, trauma, and other causes remained relatively stable. AIDS incidence rose from six cases/1000 in 1984 to 20.4.1000 in 1987. Hospitalizations for AIDS, pneumonia, tuberculosis, and endocarditis/sepsis increased from 84.9/1000 in 1986 to 144.8/1000 in 1987. These data suggest that the AIDS epidemic has had a profound effect on pat...

Impact of the AIDS epidemic on morbidity and mortality among intravenous drug users in a New York City methadone maintenance program.

BACKGROUND For the past 30 years, opioids have been used to treat chronic nonmalignant pain. This study tests the following hypotheses: (1) there is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective; and (2) the main problem associated with the safety of such treatment - assessment of the risk of addiction - has been neglected. METHODS Scientometric analysis of the articles representing clinical research in this area was performed to assess (1) the quality of presented evidence (type of study); and (2) the duration of the treatment phase. The sufficiency of representation of addiction was assessed by counting the number of articles that represent (1) editorials; (2) articles in the top specialty journals; and (3) articles with titles clearly indicating that the addiction-related safety is involved (topic-in-title articles). RESULTS Not a single randomized controlled trial with opioid treatment lasting >3 months was found. All studies with a duration of opioid treatment ≥6 months (n = 16) were conducted without a proper control group. Such studies cannot provide the consistent good-quality evidence necessary for a strong clinical recommendation. There were profound differences in the number of addiction articles related specifically to chronic nonmalignant pain patients and to opioid addiction in general. An inadequate number of chronic pain-related publications were observed with all three types of counted articles: editorials, articles in the top specialty journals, and topic-in-title articles. CONCLUSION There is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective. The above identified signs indicating neglect of addiction associated with the opioid treatment of chronic nonmalignant pain were present.

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Long-term opioid treatment of chronic nonmalignant pain: unproven efficacy and neglected safety?

Objectives. We examined the relationships between substance abuse treatment, abstinence, and mortality in a sample of individuals entering treatment. We also estimated overall mortality rates and the extent to which they varied according to demographic, clinical severity, and treatment variables.Methods. We used data from a 9-year longitudinal study of 1326 adults entering substance abuse treatment on the west side of Chicago, of whom 131 died (11.0 per 1000 person-years). Baseline predictors, initial and long-term treatment response, and substance use patterns were used to predict mortality rates and time to mortality.Results. Older age, health problems, and substance use were associated with an increased risk of mortality, and higher percentages of time abstinent and longer durations of continuous abstinence were associated with a reduced risk of mortality. Treatment readmission in the first 6 months after baseline was related to an increased likelihood of abstinence, whereas readmission after 6 months ...

https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2010.197038

Surviving drug addiction: the effect of treatment and abstinence on mortality

Death rates and causes of death among opioid addicts in 52 community treatment programs in a national reporting network were compared for 3 consecutive years. The greatest proportion of patients in the base samples were male, 21 to 25 years old, black, and in MM programs. The 275 patients in the deceased sample presented essentially the same profile, with the exception that the older patients were more highly represented among the deceased. Death rates were particularly high during each year for patients over 30 years old. Over the 3 years, death rates increased for whites, addicts 21 to 25 years old, and patients in outpatient DF programs. Consistent decreases in rates each year were found for blacks, patients in the 26 to 30 age range, and patients in MM programs.

Olive Watterson

Papers

Death Rates and Causes of Death Among Opioid Addicts in Community Drug Treatment Programs During 1970–1973