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

Selwyn, Peter A.; Hartel, Diana; Wasserman, William; Drucker, Ernest

doi:10.2105/ajph.79.10.1358

Cited by 124 publications

(42 citation statements)

References 30 publications

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“…5 Morbidity and mortality are high, 6,7 and the medical and psychological consequences are familiar to all. 8,9 Sustained substance use can result in damage to the brain.…”

Section: -mentioning

confidence: 99%

Problems with Inpatient Drug users in Jeddah

Iqbal

2001

Annals of Saudi Medicine

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Background:To identify problems associated with the treatment of inpatient drug users in Jeddah, and suggest ways of improving the delivery of health care service to these drug users. Subjects and Methods: Three hundred and two subjects with substance dependence who were admitted to the Voluntary Detoxification Unit of Al Amal Hospital, Jeddah, between January and April 1997 (inclusive) were studied. A data gathering form was designed to collect relevant information. Outcome was recorded after discharge or transfer from the unit. Results: Over half the subjects were single, unemployed, without high school education and came to the hospital unaccompanied. About 68.21% used heroin and 21.52% used alcohol. About 87.86% were intravenous drug users (IVDUs) and 54.69% started injecting from the outset. Just under half of the subjects were from outside Jeddah. There were regional variations in the choice of abused drugs. Most inpatients were on their first or second admission. The vast majority of subjects were readmitted within a year of discharge, and 44.70% gave no specific reason for their hospitalization. Unaided abstinence was reported by 42.71% and post-treatment abstinence by 57.52%. On admission, 57.14% expressed no desire to complete the program. About 54.63% were discharged after receiving medical detoxification, and 7.61% went on to have drug rehabilitation. Conclusion:The main finding of the study was that very few drug users were committed to completing the treatment program. There is a need to review the related factors that may be responsible for this situation. Changes have to be made to improve compliance and increase retention of the inpatient program. Contractual and probationary treatment of drug users should be initiated. Current restrictions on admissions have to be eased. There should also be a decentralization and development of local services, as well as a reappraisal of addiction services.

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“…5 Morbidity and mortality are high, 6,7 and the medical and psychological consequences are familiar to all. 8,9 Sustained substance use can result in damage to the brain.…”

Section: -mentioning

confidence: 99%

Problems with Inpatient Drug users in Jeddah

Iqbal

2001

Annals of Saudi Medicine

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“…Common nonnatural causes of death are overdose, suicide, violence, and accidents. [4][5][6] The HIV epidemic has contributed greatly to increased mortality in this population, [7][8][9][10] but in most countries, overdose is the leading cause of death among drug users. 11 Methadone is widely used for detoxification, but it is also used as maintenance treatment to prevent withdrawal symptoms.…”

mentioning

confidence: 99%

The impact of harm-reduction-based methadone treatment on mortality among heroin users

Langendam

Brussel²,

Coutinho³

et al. 2001

Am J Public Health

127

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OBJECTIVES: The purpose of this study was to investigate the impact of harm-reduction-based methadone programs on mortality among heroin users. METHODS: A prospective cohort investigation was conducted among 827 participants in the Amsterdam Cohort Study. Poisson regression was used to identify methadone maintenance treatment characteristics (dosage, frequency of program attendance, and type of program) that are significantly and independently associated with mortality due to natural causes and overdose. RESULTS: From 1985 to 1996, 89 participants died of natural causes, and 31 died as a result of an overdose. After adjustment for HIV and underweight status, there was an increase in natural-cause mortality among subjects who left methadone treatment (relative risk [RR] = 2.38, 95% confidence interval [CI] = 1.28, 4.55). Leaving treatment was also related to higher overdose mortality, but only among injection drug users (RR = 4.55, 95% CI = 1.89, 10.00). CONCLUSIONS: Harm-reduction-based methadone treatment, in which the use of illicit drugs is tolerated, is strongly related to decreased mortality from natural causes and from overdoses. Provision of methadone in itself, together with social-medical care, appears more important than the actual methadone dosage.

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“…La aparición del SIDA contribuyó en gran medida al incremento de la mortalidad entre ADVP [5][6][7][8] . La mayoría de los estudios sobre relaciones entre drogodependencia de opiáceos y mortalidad se realizan sobre grupos de individuos numéricamente limitados, y por ello muchas de las estimaciones del aumento de la mortalidad por uso ilegal de opiáceos no están avaladas científicamente.…”

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Causas principales de muerte entre 2.708 heroinómanos del noreste italiano (1985-1998)

et al. 2002

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RESUMENObjetivos. Establecer las causas de la muerte acaecidas entre 1985 y 1998 en un numeroso grupo de usuarios de droga por vía intravenosa (ADVP)] acogidos en 36 Servicios Públicos para Toxicomanías (Ser T) del noroeste italiano.Métodos. Estudio realizado sobre datos recogidos en los archivos de los Ser. T y del Registro Municipal de cada una de las ULSS estudiadas.Individuos implicados. Todos los ADVP que hayan pasado por lo menos una vez por uno de los 36 Ser.T. incluidos en el estudio.Resultados. El estudio analizó las causas de la muerte de 2708 individuos. La primera causa de muerte es la sobredosis (37%), seguida del SIDA (32.5%) y de los accidentes de tráfico (9.4%). El porcentaje de muertes causadas por el SIDA aumentó progresivamente, pasando de un 2.7% en 1985 a un 42.2% en 1996, reduciéndose después al 16.9% en 1998. El porcentaje de fallecimientos por sobredosis se mantuvo prácticamente constante durante todo el tiempo. La edad media de la muerte aumentó, pasando de 26 años a mediados de los años 80 a 34 años en 1998. La tasa de mortalidad entre ADVP es 13 veces mayor que en el conjunto de la población (95%, CI 11.3-14.6). En el conjunto de la población el porcentaje de fallecimientos en edades comprendidas entre los 15 y los 34 años atribuida al uso de opiáceos era en 1991 (año del último censo) del 16%. La prevalencia del VIH no resultó estadísticamente significativa en las causas de muerte por suicidio o sobredosis.Conclusiones. Se comprobó que la tasa de mortalidad era 13 veces superior a la de la población general. Se demostró la importancia del sexo femenino y el drop out de los tratamientos (al margen del tipo de tratamiento en cuestión) como factores de riesgo de sobredosis. La paulatina disminución de muertes por SIDA destaca la importancia de los tratamientos preventivos y terapéuticos adecuados contra la infección de VHC. Las medidas que se adopten en el campo de las drogodependencias, tanto en el ámbito de la política como en la investigación y la formación, deben tener presente el dramáticamente elevado porcentaje de individuos que mueren por consumo de heroína. Participants: All IDUs who had sought medical care at least once in the PCDUs during the study period.Findings: Of 2708 deaths, overdose was found to be the major cause (37%), followed by AIDS (32.5%) and road accidents (9.4%). The percentage of deaths due to AIDS increased steadily from 2.7% in 1985 to 42.2% in 1996, and then decreased to 16.9% in 1998. Deaths due to overdose remained almost constant. The average age of death per year rose from 26 in the mid eighties to 34 in 1998. The mortality rate among IDUs proved much higher compared to the general population of the same age (13-fold, 95% CI 11.3-14.6). The proportion of all deaths attributable to regular use of illegal opiates in the 15-34 age group in the general population in 1991 was 16%. HIV prevalence was not a significant factor in suicides and deaths by overdose.Conclusions: The mortality rate was 13 times greater than in the general population. To be female and...

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

Abstract: 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,

Cited by 124 publications

References 30 publications

Problems with Inpatient Drug users in Jeddah

Problems with Inpatient Drug users in Jeddah

The impact of harm-reduction-based methadone treatment on mortality among heroin users

Causas principales de muerte entre 2.708 heroinómanos del noreste italiano (1985-1998)

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