Mortality trends among heroin users treated between 1975 and 2013 in Northern Italy: Results of a longitudinal study (2017)

The aim of this study was to examine heroin mortality trends and changes in causes of death, across time and age, in a cohort of the heroin population of treated. 5899 subjects attending twelve centers for addiction treatment (SERT) in north Italy following problems due to heroin abuse between 1975 and 2013 were recruited. This study documented elevated mortality among subjects with primary heroin abuse, with an elevated death risk in all the classes of age, declining until 2009 ad increasing starting from 2010. AIDS was the first cause of death, followed by overdose and liver-related diseases. In the course of time mortality for AIDS and for drug-related deaths has declined, whereas liver mortality and all tumors mortality have risen over time, becoming the most common causes of death by the end of the follow up. As compared with the general population, the excess mortality (SMR) observed for all causes in either sex was 13.2, higher in females (SMR=21.5) as compared with males (SMR=12.1). Higher SMRs were found in 25/34 age-group patients, with a progressive decrease in subjects with age >34years. In the course of time, among heroin users, mortality and the causes of death have changed; for SERT clients special attention should be paid to the prevention and treatment of liver-related diseases.
Highlights:
This study documented elevated mortality among subjects with primary heroin abuse, declining until 2009 ad increasing starting from 2010.
Liver mortality and all tumors mortality have risen over time, becoming the most common causes of death by the end of the follow up.
Problems emerge correlated to the aging of the users of the addiction services and to the alterations in the characteristics of the new accesses.
The rise in the excess mortality in respect to the general population is also connected to the socio-economic condition of many heroin addicts.