Opioid-related deaths in Barcelona 1981-86

Mortality of HIV-positive and HIV-negative heroin abusers as a function of duration of injecting drug use

OBJECTIVE

To determine the incidence of mortality of injecting drug users as a function of the duration of injecting drugs and HIV status, and to assess how these effects vary according to age at initiation and calendar period (before and after 1992).

METHODS AND DESIGN

Cohort of 376 intravenous heroin users admitted to detoxification between February 1987 and January 1990.

SETTING

Patients referred from outpatient clinics of metropolitan Barcelona. Duration and characteristics of drug use were determined by interviews. Blood samples were collected during admission and analyzed for HIV, CD4+ cell count and different biologic parameters. Assessment of vital status and causes of death were obtained by hospital charts, death certificates, and autopsies.

RESULTS

The study population consisted of 299 men and 77 women, whose mean age at entry was 26 years, mean duration of injecting drug use before admission 6.1 years; HIV seroprevalence at entry 70.2%. By the end of the follow-up (median 5.6 years), 21.8% of individuals had died (26.6% in HIV-positive, and 10.7% in HIV-negative injecting users). Based on Kaplan-Meier estimates, 10%, 20%, and 30% of HIV negative patients died by 8.7, 11.3 and 14.3 years, respectively, after initiating injecting drugs. The corresponding survival times for the seropositives were substantially lower: 6.6, 8.5, and 11.6 years, respectively. Overall, the survival time was significantly (p < .05) decreased by 22% in HIV-positive injecting drug users. Older age at initiation of injecting drug use was significantly (p < .05) associated with mortality in HIV-positive heroin users but it showed the opposite direction among HIV-negative people. Death rates in HIV-positive patients of the same duration of drug use were similar in periods before and after 1992 (relative hazard (RH) = 0.97; 95% confidence interval: 0.58-1.61). Although not statistically significant, the hazard of death in HIV-negative injecting drug users was substantially lower after 1992 (RH = 0.59).

CONCLUSIONS

Before introduction of potent antiretroviral therapies, HIV infection further increased rates of mortality that had already been heightened by injecting drug use. Furthermore, HIV infection modifies the effect of age at initiation and eliminates the seemingly downward trend of mortality in HIV-negative people.

Opiates or cocaine: mortality from acute reactions in six major Spanish cities. State Information System on Drug Abuse (SEIT) Working Group

STUDY OBJECTIVE

To describe temporal and geographical variations in mortality from acute reactions to opiates or cocaine and the demographic and toxicological characteristics of persons who died from these in major Spanish cities between 1983 and 1991.

DESIGN

Descriptive study. Data were obtained retrospectively from pathologists' reports.

SETTING

Cities of Madrid, Barcelona, Valencia, Seville, Zaragoza, and Bilbao.

SUBJECTS

Deaths from acute reactions to opiates or cocaine were defined as those in which pathologists' reports did not indicate any other cause of death and in which evidence was found of recent consumption of these drugs.

MAIN RESULTS

The mortality rate from acute reactions to opiate/cocaine per 100,000 population in the six cities as a whole rose from 1.2 in 1983 to 8.2 in 1991. Average annual rates for the whole period ranged from 1.7 in Seville to 4.9 in Barcelona. The male/female rates ratio was 5.9:1. The mean age of persons who died rose from 25.1 years in 1983 to 28 years in 1991. In more than 90% of the cases in whom toxicological tests were undertaken opiates were detected, and the proportion in which benzodiazepines or cocaine were detected increased during the period studied.

CONCLUSIONS

Between 1983 and 1991 mortality from acute reactions to opiates/cocaine rose dramatically in major Spanish cities and significant differences in mortality between cities were found. Deaths were concentrated among men and young people. Acute drug reactions became one of the leading causes of death in persons 15-39 years of age, representing 11.1% of mortality from all causes in 1988 for this age group. Future studies should examine the relationship between the temporal and geographical variations in this type of mortality and various personal, environmental and social factors.

Natural history of parenteral drug addicts treated in a general hospital

The progress of 298 heroin addicts treated for different reasons in a general hospital from 1984 to 1987 is followed, in order to know the remission degree of parenteral drug use and mortality rates in heroin abusers, after being treated for organic diseases or undergoing quick detoxification treatment. After an average of 25 months since their first visit or admission, information was obtained in 90% of the cases, and of these, it was confirmed that 4% (11/266) had died and that 6% (15/255) were in prison. Of the remainder, reliable information was obtained from 66% (158/240), of whom 40% were no longer endovenous drug users, while 54% were still addicted to parenteral drugs. The results showed a higher percentage of remission in patients that had been admitted for organic diseases (39/65; 60%) than in those that had been treated for detoxification (30/93; 35%) (p less than 0.05).