We demonstrate that a range of treatments for heroin dependence reduces overdose mortality risk. However, the considerable excess mortality risk in the month following treatment indicates the need for greater health education of drug users and implementation of relapse and overdose death prevention programmes. Further investigation is needed to measure and weigh the potential benefits and harms of short-term therapies for opiate use.

Cohort mortality studies, especially in combination with estimates of prevalence, provide useful insights into the impact of opiate use on mortality across European countries and emphasize how preventing overall and drug-related deaths among opiate users can significantly improve the health of the population.

BackgroundThis multicenter study is aimed at estimating changes in the effect of high temperatures on elderly mortality before and after the 2003 heat waves and following the introduction of heat prevention activities.MethodsA total of sixteen cities were included in the study. City-specific relationships between maximum apparent temperature (MAT) and elderly daily mortality before (1998–2002) and after (2006–2010) intervention were modelled through non-linear distributed lag models and estimates were combined using a random effect meta-analysis. We estimated the percentage change in daily mortality for 3°C variations in MAT above the 25th percentile of the June city-specific 1998–2002 distribution.A time-varying analysis was carried out to describe intra-seasonal variations in the two periods.ResultsWe observed a reduction in high temperatures’ effect post intervention; the greatest reduction was for increases in temperature from 9°C to 12°C above the 25th percentile, with a decrease from +36.7% to +13.3%. A weak effect was observed for temperatures up to 3°C above the 25th percentile only after. Changes were month-specific with a reduction in August and an increase in May, June and September in 2006–2010.ConclusionsA change in the temperature-mortality relationship was observed, attributable to variations in temperature distributions during summer and to the introduction of adaptation measures. The reduction in the effect of high temperature suggests that prevention programs can mitigate the impact. An effect of lower temperature remains, indicating a relevant impact of temperature at the beginning of summer when the population has not yet adapted and intervention activities are not fully operational.

AIDS mortality among drug addicts began to decrease earlier than expected; the decrease was particularly significant in the period 1993-94 for both sexes. Afterwards a continuous but slight decrease was observed among males only. Even though overdose mortality has also decreased slightly in recent years, we still observe high mortality levels for both overdose and all other causes. These findings suggest that interventions directed specifically towards the reduction of baseline mortality are still needed.

BackgroundFew studies have identified specific factors that increase mortality during heat waves. This study investigated socio-demographic characteristics and pre-existing medical conditions as effect modifiers of the risk of dying during heat waves in a cohort of elderly residents in Rome.MethodsA cohort of 651,195 residents aged 65 yrs or older was followed from 2005 to 2007. During summer, heat wave days were defined according to month-specific thresholds of maximum apparent temperature. The adjusted relative risk of dying during heat waves was estimated using a Poisson regression model including all the considered covariates. Risk differences were also calculated. All analyses were run separately for the 65-74 and 75+ age groups.ResultsIn the 65-74 age group the risk of dying during heat waves was higher among unmarried subjects and those with a previous hospitalization for chronic pulmonary disease or psychiatric disorders. In the 75+ age group, women, and unmarried subjects were more susceptible to heat. Furthermore, a higher susceptibility to heat among those with previous hospitalization for diabetes, diseases of the central nervous system (CNS), psychiatric disorders and cerebrovascular diseases resulted from risk differences.DiscussionResults showed a higher susceptibility to heat among those older than seventy-five years, females and unmarried. Pre-existing health conditions play a different role among the two considered age groups. Moreover, compared with previous studies the pattern of susceptibility factors have slightly changed over time. For the purposes of public health programmes, susceptibility should be considered as time, space and population specific.