Association between routes of drug administration and all-cause mortality among drug users

Abstract

Mortality among drug users based upon routes of administration (ROA) is less studied. We examined deaths by ROA, and association between ROA and all-cause deaths. Data of 2766 primary users of opiates and stimulants who sought treatment in Helsinki, Finland, from 1997 to 2008 were linked to the national cause-of-death register. Cox regression models were used to compute adjusted hazard ratios (aHRs) for all-cause deaths, with 95% confidence intervals (CIs). There were statistically significant differences in all-cause deaths by ROA reported at baseline interview (p = 0.012): 12.7% (n = 251/1976) among intravenous (IV) drug users, 11.5% (n = 27/235) among oral users, 7.9% (n = 12/152) among smokers, 6.9% (n = 19/276) among snorters, and 16.5% (n = 21/127) among those with unspecified ROA. IV users died more from accidental overdose relative to other specified routes (p = 0.036). All nine HIV and all three hepatitis C deaths occurred among IV users. The hazard for all-cause death was lower among smokers compared to IV users (aHR: 0.52 (95%CI: 0.28–0.97) after adjusting for gender, homelessness, drug use behaviours, and psychiatric comorbidities present at baseline. Deaths occurred in all groups: drug users in general need to be educated that no route of drug administration is harmless. Preventive and intervention measures should target all ROA.

Keywords:

• Cohort study
• mortality
• risk factors
• routes of administration
• substance abuse

Funding

Funding was received from the Academy of Finland, grant number 118584, and the Finnish Cultural Foundation (Central Fund).

Additional information

Funding

Funding was received from the Academy of Finland, grant number 118584, and the Finnish Cultural Foundation (Central Fund).