Drug-related mortality and its impact on adult mortality in eight European countries

Bargagli, Anna Maria; Hickman, Matthew; Davoli, Marina; Perucci, Carlo A.; Schifano, Patrizia; Buster, Marcel; Brugal, M. Teresa; Vicente, Julián

doi:10.1093/eurpub/cki168

Cited by 153 publications

(121 citation statements)

References 24 publications

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“…6 Because direct estimates of mortality among people with refractory opioid dependence in methadone maintenance treatment were not available, we used alternative estimates for the methadone and relapse states in the sensitivity analyses. 35,36 HIV seroconversion The probability of HIV seroconversion was a function of treatment status, frequency of heroin injection, and unprotected sexual contact. 37,38 Seroconversion could occur at any stage in the model and was independent of transitioning between states of treatment, relapse and abstinence.…”

Section: E318mentioning

confidence: 99%

Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment

Nosyk

Guh

Bansback

et al. 2012

CMAJ

115

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Section: E318mentioning

confidence: 99%

Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment

Nosyk

Guh

Bansback

et al. 2012

CMAJ

115

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“…It is well documented that there is a high mortality rate among drug users, and that death by overdose is common cause of death in that group (Clausen et al, 2008;Darke and Degenhardt, 2007;Davoli et al, 2007;Bargagli et al, 2006;Johnson et al, 2005;Gossop et al, 2002). Actually, deaths from opiate overdose comprise the vast majority of all drugrelated deaths (Strang et al, 2008;Darke and Zador, 1996).…”

Section: Introductionmentioning

confidence: 99%

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Ravndal

Amundsen²

2010

Drug and Alcohol Dependence

106

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Background:Drug users who are leaving/completing inpatient medication-free treatment may, like drug users released from prison, have an elevated risk of dying from fatal overdoses. This is mainly explained by their low drug tolerance. Methods:Two hundred and seventy-six drug users who had been admitted to eleven inpatient facilities in Norway, were followed prospectively after discharge from treatment during an eight year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). The following instruments were used: EuropASI, SCL-25 and MCMI-II.Information on deaths and causes of death were obtained from the National Death Register. Results:A total of 36 deaths were registered after discharge from treatment during the observation period, of which 24 were classified as overdose deaths. During the first 4 weeks after discharge six persons died, yielding an unadjusted excess mortality of 15.7 (rate ratio) in this period (CI 5.3-38.3). All were dropouts and all deaths were classified as opiate overdoses.There was no significant association between time in index treatment and mortality after discharge, nor did any background characteristics correlate significantly with elevated mortality shortly after discharge. Conclusions:The elevated risk of dying from overdose within the first four weeks of leaving medicationfree inpatient treatment is so dramatic that preventive measures should be taken. More studies from similar inpatient programmes are needed in order to obtain systematic knowledge about determinants of overdose deaths shortly after leaving treatment, and possible preventive measures..

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“…There have been a few, mainly city-based, studies in Europe [13], but the mortality patterns can be changing substantially and quickly [14][15][16][17] and large-scale cohort studies are needed in different European countries that can provide comparable information about overdose risk. Interpreting mortality statistics and trends in drug use is complex, and unlikely to lead to any firm conclusions without information on overdose risk.…”

Section: Europe: What Do the Data Tell Us?mentioning

confidence: 99%

Trends in overdose deaths from drug misuse in Europe: what do the data tell us?

et al. 2008

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Europe: what do the data tell us?During the 1990s the number of drug-related deaths (acute poisonings) in the United Kingdom increased rapidly. Between 1993 and 2000 the number of deaths doubled from 864 to 1662 [1,2], precipitating the recognition that reducing drug misuse deaths was a public health priority [3]. The UK Advisory Council on the Misuse of Drugs recommended the creation of a new surveillance indicator to follow overdose trends, which was incorporated into the government's drugs strategy. A target was set to reduce deaths related to drug misuse by 20% by 2004 compared to a 1999 baseline [4]. As more than three-quarters of drug-related poisonings in the United Kingdom are opiate-related, expanding drug treatment options, especially methadone maintenance for problem opiate users, was seen as a critical overdose prevention measure [5]. UK and European indicators of drug-related deaths include deaths certified as due to drug use or misuse and include acute poisonings (overdose deaths) based on routine mortality statistics; the indicators exclude other deaths that may have been caused directly or indirectly by drug use but which cannot be attributed readily to drug use within routine statistics (such as infections, other injuries or chronic diseases) [1].Early signs were very encouraging. Between 2001 and 2004, the government investment in specialist drug treatment doubled to over £250 million annually [6]. The volume of methadone prescriptions increased markedly, and there was a drop in the estimated number of deaths per 1000 patient-years treated with methadone [7]. The number of drug misuse deaths fell from 2001, and by 2003 the reduction in drug-related deaths had almost reached the target. However, in 2004 and 2005 there were sharp increases in drug misuse deaths, due largely to heroin overdose, meaning the government's target was not met [8,9].The European context is presented in Fig. 1, which compares trends in overdose deaths in selected European countries with similar population sizes [10]. The figure shows drug misuse deaths per million population from 1993 to 2005 for England and Wales, Italy, Germany and Spain (Madrid, Barcelona, Valencia, Bilbao, Seville and Zaragoza only) based on routine mortality statistics. The drug-poisoning mortality rate in these six Spanish cities probably overestimates the rate for Spain overall, but is likely to provide an accurate representation of trends over time.By 2004/05 the drug misuse mortality rates in England and Wales was one of the highest in Europe. However, case definition and data extraction from mortality statistics varies between countries despite there being a common European definition [11], which may explain, in part, the difference in the size of the mortality rates between countries. There have been no changes in the compilation of statistics over time. More illuminating, therefore, and a salutary reminder to policy makers in England and Wales, is the difference in trends over time. In none of the other selected European countries did the ove...

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Drug-related mortality and its impact on adult mortality in eight European countries

Cited by 153 publications

References 24 publications

Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment

Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Trends in overdose deaths from drug misuse in Europe: what do the data tell us?

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