Mortality Trends among Cocaine Users Treated between 1989 and 2013 in Northern Italy: Results of a Longitudinal Study

ABSTRACT

A total of 852 participants attending 11 centers for addiction treatment in north Italy following problems due to cocaine abuse between 1989 and 2013 were recruited. Two typologies were created: cocaine users (never heroin) (CU) and heroin and cocaine users (HCU). During the 38-year follow-up period, 4.8% of the whole cohort died. Over the whole period, tumors were the main causes of death; starting in 2010, suicide deaths became the first cause of death. Among CUs, most deaths were due to road accidents and suicide; among HCUs, most of the deaths were from opiate overdose and from cardio-circulatory system diseases. The excess mortality observed for all causes in either sex was 6.24; higher in females (15.03) as compared in males (6.23), higher in HCUs (9.06) as compared in CUs (5.21). The directly age-sex standardized mortality rates were 5.31 per 100, higher for females, declining after 2009 for all patients and after 2004 for HCUs. Multivariate analysis confirms the decreasing trend in the risk of death and shows a higher mortality risk for participants in the under-25 age group. Among cocaine users, special attention should be paid to the prevention of suicide deaths.

KEYWORDS:

• Cocaine
• cohort study
• mortality
• overdose
• public service dedicated to addictions
• suicide

Acknowledgments

We wish to thank Dr. Silvia Marani and Dr. Elsa Turino of the Epidemiological Monitoring Center on Addiction for their help in collecting the data. We also wish to thank the 11 Centers for Addiction Treatment of the Metropolitan Area of Bologna (Dr. Daniele Gambini, Dr. Lauretta Gianessi, Dr. Patrizia Casali, Dr. Marco Viaggi, Dr. Roberto Ragazzi, Dr. Piero De Marco, Dr. Claudio Comaschi, Dr. Giovanni Guescini, Dr. GianPiero Raschi, and Dr. Simonetta Cioni).