Mortality and causes of death among people who inject amphetamine: A long-term follow-up cohort study from a needle exchange program in Sweden

Åhman, Ada; Jerkeman, Anna; Blomé, Marianne Alanko; Björkman, Per; Håkansson, Anders

doi:10.1016/j.drugalcdep.2018.03.053

Cited by 27 publications

(33 citation statements)

References 33 publications

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“…Details of these comparisons are provided in Supporting information, Appendix I, Table I3. The pooled all-cause SMRs were very similar: 5.71 (95% CI = 4.44-7.35) for author-reported SMRs (eight studies [45,14,15,19,24,27,30,31]), compared to our pooled allcause SMR of 6.08 (95% CI = 4.41-8.37; 23 studies). There were fewer cause-specific SMRs reported by study authors to permit robust sensitivity analyses, limiting our ability to compare findings.…”

Section: Sensitivity Analysessupporting

confidence: 60%

“…Twenty-three cohorts [14][15][16]18,19,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] (n = 115 223 participants) provided data to inform the pooled all-cause CMR. This was 1.14 per 100 py (95% CI = 0.92-1.42; Fig.…”

Section: Crude Mortality Rates Per 100 Pymentioning

confidence: 99%

“…Authors of studies of eight cohorts [14,15,19,24,27,30,31,45] reported all-cause SMRs; we imputed all-cause SMRs for a further 15 cohorts [16,[21][22][23]25,26,28,29,[32][33][34][35][36][37][38]. The pooled all-cause SMR across these 23 studies was 6.83 (95% CI = 5.27-8.84; Table 2, Fig.…”

Section: Standardized Mortality Ratios (Smrs)mentioning

confidence: 99%

“…3). There were nine studies [14][15][16]21,28,30,31,34,45] (86 942 participants) that provided all-cause SMRs separately for men (SMR = 4.68, 95% CI = 3.43-6.40) and women (SMR = 5.91, 95% CI = 3.74-9.35; see Table 2 and Supporting information, Fig. I2 in Appendix I).…”

Section: Standardized Mortality Ratios (Smrs)mentioning

confidence: 99%

“…3. Unsurprisingly, drug poisoning was the cause 13.6% [14,19,21,26] For countries included in Global Burden of Disease (GBD) regions please see www.healthdata.org/gbd/FAQ#What countries are in each region. a Studies included those that had both men and women in their cohort and reported all-cause mortality.…”

Section: Standardized Mortality Ratios (Smrs)mentioning

confidence: 99%

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Mortality among people with regular or problematic use of amphetamines: a systematic review and meta‐analysis

et al. 2019

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Background and aims Amphetamines are the second most commonly used class of illicit drugs. We aimed to produce pooled estimates of mortality risks among people with regular or dependent use of amphetamines, with a focus upon all‐cause mortality as well as specific causes of death. Design Systematic review and meta‐analysis of cohorts of people with problematic use or dependence on amphetamines with data on all‐cause or cause‐specific mortality. Setting and participants Of 4240 papers, 30 were eligible, reporting on 25 cohorts that measured all‐cause mortality, drug poisoning, suicide, accidental injuries, homicide and cardiovascular mortality. Cohorts (n = 35–74 139) were in North America, several Nordic countries and Asia Pacific. Measurement Titles/abstracts were independently screened by one reviewer and excluded those reviewed by a second reviewer. Full‐text screening was by two reviewers with discrepancies resolved via a third reviewer. We extracted data on crude mortality rates (CMR) per 100 person‐years (py), standardized mortality ratios (SMRs). We imputed SMRs where possible if not reported by study authors. We also calculated mortality relative risks. Data were pooled using random‐effects models; potential reasons for heterogeneity were explored using subgroup analyses and meta‐regressions. Findings Twenty‐three cohorts contributed data for the pooled all‐cause CMR: 1.14 per 100 py [95% confidence interval (CI) = 0.92–1.42]. Pooled cause‐specific mortality rates were: drug poisoning, 0.14 per 100 py (95% CI = 0.06–0.34); cardiovascular disease, 0.13 per 100 py (95% CI = 0.06–0.29); suicide, 0.20 per 100 py (95% CI = 0.07–0.55); accidental injury, 0.20 per 100 py (95% CI = 0.08–0.47) and homicide, 0.03 per 100 py (95% CI = 0.02–0.06). There was substantial heterogeneity for all pooled CMR estimates except homicide. The pooled all‐cause SMR was 6.83 (95% CI = 5.27–8.84). Pooled cause‐specific SMRS were: poisoning, 24.70 (95% CI = 16.67, 36.58); homicide, 11.90 (95% CI = 7.82–18.12); suicide, 12.20 (95% CI = 4.89–30.47); cardiovascular disease, 5.12 (95% CI = 3.74–7.00) and accidental injury, 5.12 (95% CI = 2.88–9.08). Conclusions People with regular or dependent amphetamine use are at elevated risk of a range of causes of mortality compared with people without regular or dependent amphetamine use.

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Section: Sensitivity Analysessupporting

confidence: 60%

Section: Crude Mortality Rates Per 100 Pymentioning

confidence: 99%

Section: Standardized Mortality Ratios (Smrs)mentioning

confidence: 99%

Section: Standardized Mortality Ratios (Smrs)mentioning

confidence: 99%

Section: Standardized Mortality Ratios (Smrs)mentioning

confidence: 99%

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Mortality among people with regular or problematic use of amphetamines: a systematic review and meta‐analysis

et al. 2019

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Association of Pharmacological Treatments and Hospitalization and Death in Individuals With Amphetamine Use Disorders in a Swedish Nationwide Cohort of 13 965 Patients

et al. 2023

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ImportanceThere are no medications approved by authorities for the treatment of amphetamine or methamphetamine dependence, and studies investigating the effectiveness of pharmacological treatments in hard outcomes, such as hospitalization and death, are lacking.ObjectiveTo investigate the association between pharmacotherapies and hospitalization and mortality outcomes in persons with amphetamine or methamphetamine use disorder.Design, Setting, and ParticipantsThis nationwide register-based cohort study was conducted from July 2006 to December 2018 with a median (IQR) follow-up time of 3.9 (1.0-6.1) years. Data were analyzed from December 1, 2021, to May 24, 2022. All residents aged 16 to 64 years living in Sweden with a registered first-time diagnosis of amphetamine or methamphetamine use disorder and without previous diagnoses of schizophrenia or bipolar disorder were identified from nationwide registers of inpatient care, specialized outpatient care, sickness absence, and disability pension.ExposuresMedications for substance use disorders (SUDs) or for attention-deficit/hyperactive disorder, mood stabilizers, antidepressants, benzodiazepines and related drugs, and antipsychotics. Medication use vs nonuse was modeled with the PRE2DUP (from prescription drug purchases to drug use periods) method.Main Outcomes and MeasuresPrimary outcomes were hospitalization due to SUD and any hospitalization or death, which were analyzed using within-individual models by comparing use and nonuse periods of 17 specific medications or medication classes in the same individual to minimize selection bias. The secondary outcome was all-cause mortality, studied using between-individual analysis as traditional Cox models.ResultsThere were 13 965 individuals in the cohort (9671 [69.3%] male; mean [SD] age, 34.4 [13.0] years). During follow-up, 7543 individuals (54.0%) were taking antidepressants, 6101 (43.7%) benzodiazepines, 5067 (36.3%) antipsychotics, 3941 (28.2%) ADHD medications (1511 [10.8%] were taking lisdexamphetamine), 2856 (20.5%) SUD medications, and 1706 (12.2%) mood stabilizers. A total of 10 341 patients (74.0%) were hospitalized due to SUDs, 11 492 patients (82.3%) were hospitalized due to any cause or died, and 1321 patients (9.5%) died of any cause. Lisdexamphetamine was the only medication in this study that was significantly associated with a decrease in risk of 3 outcomes (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.72-0.94 for SUD hospitalization; aHR, 0.86; 95% CI, 0.78-0.95 for any hospitalization or death; aHR, 0.43; 95% CI, 0.24-0.77 for all-cause mortality). Methylphenidate use also was associated with lower all-cause mortality (aHR, 0.56; 95% CI, 0.43-0.74). Use of benzodiazepines was associated with a significantly higher risk of SUD hospitalization (aHR, 1.17; 95% CI, 1.12-1.22), any hospitalization or death (aHR, 1.20; 95% CI, 1.17-1.24), and all-cause mortality (aHR, 1.39; 95% CI, 1.20-1.60). Use of antidepressants or antipsychotics was associated with a slight increase in risk of SUD hospitalization (aHR, 1.07; 95% CI, 1.03-1.11 and aHR, 1.05; 95% CI, 1.01-1.09) as well as any hospitalization or death (aHR, 1.10; 95% CI, 1.06-1.14 and aHR, 1.06; 95% CI, 1.03-1.10, respectively).Conclusions and RelevanceIn this study, use of lisdexamphetamine was associated with improved outcomes in persons with amphetamine or methamphetamine use disorders, encouraging the conduct of randomized clinical trials. Prescription benzodiazepine use was associated with poor outcomes.

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Detection of drugs and hepatitis C virus in used syringes from a needle exchange in Gothenburg, Sweden

Bergström,

Andersson,

Larsson

2023

Drug Testing and Analysis

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People who inject drugs (PWID) are exposed to serious health risks such as lethal overdoses, addiction and infections. The patterns of drug use and the prevalence of hepatitis C virus (HCV) infection vary greatly between and even within countries. Data on drugs used for injection are important to inform PWID of risks and adapt healthcare. This study aimed to determine which substances are injected in Gothenburg, Sweden, and estimate the risk of HCV transmission. A total of 150 syringes handed in at the needle and syringe exchange program (NEP) in Gothenburg over a week in November 2021 were analysed for drug content using liquid chromatography coupled with high‐resolution mass spectrometry. Using a dose‐adjusted comparison, the main drug(s) injected was distinguished from the impurities in the syringes containing several drugs. HCV RNA was quantified by real‐time PCR in an additional set of 150 syringes. Drugs were detected in >99% of analysed syringes, and the most common drugs were amphetamine (81%), followed by buprenorphine (8.0%), heroin (6.7%) and alprazolam (4.6%). Less common findings were testosterone (2.7%), methylphenidate (2.0%), MDMA (0.7%), trenbolone (0.7%) and zopiclone (0.7%). Eleven syringes (7.3%) contained more than one drug. HCV RNA was detected in 13% of the syringes, and one in 10 contained enough to potentially transmit an infection. This study underlines the importance of access to NEPs for PWID to reduce the risks associated with drug injection.

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Mortality and causes of death among people who inject amphetamine: A long-term follow-up cohort study from a needle exchange program in Sweden

Abstract: People injecting amphetamine as a primary drug were found to have significantly elevated mortality compared with the general population, with high rates of both external and somatic causes of death.

Cited by 27 publications

References 33 publications

Mortality among people with regular or problematic use of amphetamines: a systematic review and meta‐analysis

Mortality among people with regular or problematic use of amphetamines: a systematic review and meta‐analysis

Association of Pharmacological Treatments and Hospitalization and Death in Individuals With Amphetamine Use Disorders in a Swedish Nationwide Cohort of 13 965 Patients

Detection of drugs and hepatitis C virus in used syringes from a needle exchange in Gothenburg, Sweden

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Mortality and causes of death among people who inject amphetamine: A long-term follow-up cohort study from a needle exchange program in Sweden

Abstract: People injecting amphetamine as a primary drug were found to have significantly elevated mortality compared with the general population, with high rates of both external and somatic causes of death.

Cited by 27 publications

References 33 publications

Mortality among people with regular or problematic use of amphetamines: a systematic review and meta‐analysis

Mortality among people with regular or problematic use of amphetamines: a systematic review and meta‐analysis

Association of Pharmacological Treatments and Hospitalization and Death in Individuals With Amphetamine Use Disorders in a Swedish Nationwide Cohort of 13 965 Patients

Detection of drugs and hepatitis C virus in used syringes from a needle exchange in Gothenburg, Sweden

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Association of Pharmacological Treatments and Hospitalization and Death in Individuals With Amphetamine Use Disorders in a Swedish Nationwide Cohort of 13 965 Patients