Addict death rates during a four-year posttreatment follow-up

[Circumstances at the time of death in drug fatalities]

The circumstances in drug-related deaths were investigated in this study. The basic client sample was composed of 743 drug addicts of the opiate type who had been admitted into the institute's drug-free outpatient program from 1969 to 1982. In this program, 91 clients died during the observation period. In order to be able to judge the various backgrounds adequately, a multiply subdivided classification system was developed for the death cases. Each case was recorded in three main categories: manner of death, cause of death, and phase of addiction. This was a more elaborate procedure than those commonly used since, in general, such death cases are only subdivided into a few groups that differ little from one another. Two manners of death predominated in this sample: accidents caused by poison (62%) and suicide (25%). Within in the various causes of death, poison cases prevailed (80%) and opiate intoxication (single or combined) was predominant (60%). Concerning the phase of addiction two phases were distinguished: the actual drug addiction phase (65%) and the intramural stay in prison or a hospital (25%). There were no significant sex-related differences. Various combinations regarding the mechanism of lethal opiate intoxication of drug addicts were scrutinized, concentrating on three approaches: the lack of opiate tolerance after periods of abstinence, the synergistic effect of simultaneously taking other CNS-depressant drugs, and differences in concentration in the heroin used. Our conclusions are given from the point of view of adequate counseling for drug addicts.

Mortality of patients dependent on benzodiazepines

For patients dependent on benzodiazepines alone, or in combination with alcohol and/or other legal and illegal drugs, observed mortality rates were compared with the average population, and, in cases of isolated benzodiazepine dependence, also with a control group of non-dependent patients chosen to match each dependent not only in sex and date of birth, but also in pre-existing psychiatric illness besides dependence. For patients with an isolated benzodiazepine dependence, the mortality rate was increased, when compared with the average population, by a ratio of observed to expected numbers of deaths of about 3. However, this mortality rate did not differ from that of the control group (non-dependent patients with comparable psychiatric illnesses). For patients combining benzodiazepines with alcohol among other addictive drugs, and for patients combining benzodiazepines with illegal drugs among other addictive substances, the ratio of observed to excepted numbers of deaths was 6.2 resp. 21, thus corresponding well with other studies on mortality rates associated with alcoholism and dependence on illegal drugs. We conclude that our study does not give evidence of higher risk of early death correlated with dependence on benzodiazepines alone. However, it confirms the well-known fact of increased mortality rates in patients with psychiatric illnesses, especially with dependence on alcohol or illegal drugs.

Deaths of heroin users in a general practice population

Recent evidence suggests that heroin users in the UK are 16 times more likely to die than otherwise expected, although causes of death are varied. The present investigation examines deaths of heroin users at a large Scottish general practice over a four-year period prior to 1 July 1985. A mortality rate of 9.72 per 1000 heroin-user patients per year was observed, roughly half that previously reported, although this difference did not prove to be statistically significant. A higher proportion of the observed deaths were attributed to heroin, and fewer to the misuse of other drugs, and it is speculated that this may reflect the practice's policy of not prescribing opiates to heroin users. Factors associated with heroin-user deaths are examined and areas identified where general practitioners may help to avert some of these deaths.