National record linkage study of mortality for a large cohort of opioid users ascertained by drug treatment or criminal justice sources in England, 2005–2009

doi:10.1016/j.drugalcdep.2014.09.782

Drug and Alcohol Dependence

Volume 146, 1 January 2015, Pages 17-23

https://doi.org/10.1016/j.drugalcdep.2014.09.782 Get rights and content

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Highlights

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Opioid user mortality is almost 6 times higher than in the general population.
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Mortality is elevated for a range of diseases and for homicide and suicide.
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Excess mortality persists into old age and for some causes is exacerbated.
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Drug-related poisoning (DRP) accounts for just under a half of opioid user deaths.
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Young female DRP mortality is lower than male but the difference narrows with age.

Abstract

Background

Globally, opioid drug use is an important cause of premature mortality. In many countries, opioid using populations are ageing. The current study investigates mortality in a large cohort of opioid users; with a focus on testing whether excess mortality changes with age.

Methods

198,247 opioid users in England were identified from drug treatment and criminal justice sources (April, 2005 to March, 2009) and linked to mortality records. Mortality rates and standardised mortality ratios (SMRs) were calculated by age-group and gender.

Results

There were 3974 deaths from all causes (SMR 5.7, 95% Confidence Interval: 5.5 to 5.9). Drug-related poisonings (1715) accounted for 43% of deaths. Relative to gender-and-age-appropriate expectation, mortality was elevated for a range of major causes including: infectious, respiratory, circulatory, liver disease, suicide, and homicide. Drug-related poisoning mortality risk continued to increase beyond 45 years and there were age-related increases in SMRs for specific causes of death (infectious, cancer, liver cirrhosis, and homicide). A gender by age-group interaction revealed that whilst men have a greater drug-related poisoning mortality risk than women at younger ages, the difference narrows with increasing age.

Conclusion

Opioid users’ excess mortality persists into old age and for some causes is exacerbated. This study highlights the importance of managing the complex health needs of older opioid users.

Keywords

Mortality

Opioid use

Addiction epidemiology

Drug related poisoning mortality

Ageing opioid users

Cited by (0)

¹: NDEC, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, UK, M13 9PL.

²: MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.

³: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.