The impact of drug use patterns on mortality among polysubstance users in a Canadian setting: a prospective cohort study

BMC Public Health

Evan Wood²  Julio SG Montaner²  Thomas Kerr²  Michael-John Milloy²  Huiru Dong¹  Kanna Hayashi¹  Anna Hayden¹ 

[1] British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada;Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada

关键词: Cohort study;    Vancouver;    Cocaine;    Injection drug use;    Mortality;   

Others  :  1123016
DOI  :  10.1186/1471-2458-14-1153

 received in 2014-05-08, accepted in 2014-10-09,  发布年份 2014

【 摘 要 】

Background

Illicit drug use is a well-established risk factor for morbidity and mortality. However, few studies have examined the impact of different drug use patterns on mortality among polysubstance using populations. This study aimed to identify drug-specific patterns of mortality among a cohort of polysubstance using persons who inject drugs (PWIDs).

Methods

PWIDs in Vancouver, Canada were prospectively followed between May 1996 and December 2011. Participants were linked to the provincial vital statistics database to ascertain mortality rates and causes of death. We used multivariate Cox proportional hazards regression to investigate the relationships between drug use patterns (daily alcohol use, heroin injection and non-injection use, cocaine injection, amphetamine injection and non-injection use, crack smoking and speedball injecting) and time to all-cause mortality.

Results

2330 individuals were followed for a median of 61 months (inter-quartile range: 33 – 112). In total, 466 (19.1%) individuals died for an incidence density of 3.1 (95% confidence interval [CI]: 2.8 – 3.4) deaths per 100 person-years. In multivariate analyses, after adjusting for HIV infection and other potential confounders, only daily cocaine injection remained independently associated with all-cause mortality (adjusted hazard ratio [AHR] = 1.36, 95% CI: 1.06 – 1.76).

Conclusions

Although heroin injecting is traditionally viewed as carrying the highest risk of mortality, in this setting, only daily cocaine injecting was associated with all-cause mortality. These findings highlight the urgent need to identify novel treatments and harm reduction strategies for cocaine injectors.

【 授权许可】

   
2014 Hayden et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Hulse GK, English DR, Milne E, Holman CD: The quantification of mortality resulting from the regular use of illicit opiates. Addiction 1999, 94(2):221-229.
• [2]Coffin PO, Galea S, Ahern J, Leon AC, Vlahov D, Tardiff K: Opiates, cocaine and alcohol combinations in accidental drug overdose deaths in New York City, 1990–98. Addiction 2003, 98(6):739-747.
• [3]Stoove MA, Dietze PM, Aitken CK, Jolley D: Mortality among injecting drug users in Melbourne: a 16-year follow-up of the Victorian Injecting Cohort Study (VICS). Drug Alcohol Depend 2008, 96(3):281-285.
• [4]Degenhardt L, Singleton J, Calabria B, McLaren J, Kerr T, Mehta S, Kirk G, Hall WD: Mortality among cocaine users: a systematic review of cohort studies. Drug Alcohol Depend 2011, 113(2–3):88-95.
• [5]Degenhardt L, Bucello C, Mathers B, Briegleb C, Ali H, Hickman M, McLaren J: Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies. Addiction 2011, 106(1):32-51.
• [6]Singleton J, Degenhardt L, Hall W, Zabransky T: Mortality among amphetamine users: a systematic review of cohort studies. Drug Alcohol Depend 2009, 105(1–2):1-8.
• [7]Davidson PJ, McLean RL, Kral AH, Gleghorn AA, Edlin BR, Moss AR: Fatal heroin-related overdose in San Francisco, 1997–2000: a case for targeted intervention. J Urban Health 2003, 80(2):261-273.
• [8]Mathers BM, Degenhardt L, Bucello C, Lemon J, Wiessing L, Hickman M: Mortality among people who inject drugs: a systematic review and meta-analysis. Bull World Health Organ 2013, 91(2):102-123.
• [9]Warner-Smith M, Darke S, Day C: Morbidity associated with non-fatal heroin overdose. Addiction 2002, 97(8):963-967.
• [10]Hickman M, Carnwath Z, Madden P, Farrell M, Rooney C, Ashcroft R, Judd A, Stimson G: Drug-related mortality and fatal overdose risk: pilot cohort study of heroin users recruited from specialist drug treatment sites in London. J Urban Health 2003, 80(2):274-287.
• [11]Arendt M, Munk-Jorgensen P, Sher L, Jensen SO: Mortality following treatment for cannabis use disorders: predictors and causes. J Subst Abuse Treat 2013, 44(4):400-406.
• [12]Tyndall MW, Craib KJ, Currie S, Li K, O’Shaughnessy MV, Schechter MT: Impact of HIV infection on mortality in a cohort of injection drug users. J Acquir Immune Defic Syndr 2001, 28(4):351-357.
• [13]Merrall EL, Bird SM, Hutchinson SJ: Mortality of those who attended drug services in Scotland 1996–2006: record-linkage study. Int J Drug Policy 2012, 23(1):24-32.
• [14]Bartu A, Freeman NC, Gawthorne GS, Codde JP, Holman CD: Mortality in a cohort of opiate and amphetamine users in Perth, Western Australia. Addiction 2004, 99(1):53-60.
• [15]Kaye S, Darke S: Non-fatal cocaine overdose among injecting and non-injecting cocaine users in Sydney, Australia. Addiction 2004, 99(10):1315-1322.
• [16]Barrio G, Molist G, de la Fuente L, Fernandez F, Guitart A, Bravo MJ, Brugal MT: Mortality in a cohort of young primary cocaine users: controlling the effect of the riskiest drug-use behaviors. Addict Behav 2013, 38(3):1601-1604.
• [17]Dias AC, Araujo MR, Dunn J, Sesso RC, de Castro V, Laranjeira R: Mortality rate among crack/cocaine-dependent patients: a 12-year prospective cohort study conducted in Brazil. J Subst Abuse Treat 2011, 41(3):273-278.
• [18]Maas B, Fairbairn N, Kerr T, Li K, Montaner JS, Wood E: Neighborhood and HIV infection among IDU: place of residence independently predicts HIV infection among a cohort of injection drug users. Health Place 2007, 13(2):432-439.
• [19]Wood EKT: What do you do when you hit rock bottom? Responding to drugs in the city of Vancouver. Int J Drug Policy 2006, 17(2):55-60.
• [20]Tyndall MW, Currie S, Spittal P, Li K, Wood E, O’Shaughnessy MV, Schechter MT: Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. Aids 2003, 17(6):887-893.
• [21]Werb D, Debeck K, Kerr T, Li K, Montaner J, Wood E: Modelling crack cocaine use trends over 10 years in a Canadian setting. Drug Alcohol Rev 2010, 29(3):271-277.
• [22]Fairbairn N, Kerr T, Buxton JA, Li K, Montaner JS, Wood E: Increasing use and associated harms of crystal methamphetamine injection in a Canadian setting. Drug Alcohol Depend 2007, 88(2–3):313-316.
• [23]Wood E, Montaner JS, Li K, Barney L, Tyndall MW, Kerr T: Rate of methadone use among Aboriginal opioid injection drug users. CMAJ 2007, 177(1):37-40.
• [24]Strathdee SA, Palepu A, Cornelisse PG, Yip B, O’Shaughnessy MV, Montaner JS, Schechter MT, Hogg RS: Barriers to use of free antiretroviral therapy in injection drug users. JAMA 1998, 280(6):547-549.
• [25]Milloy MJ, Kerr T, Buxton J, Rhodes T, Krusi A, Guillemi S, Hogg R, Montaner J, Wood E: Social and environmental predictors of plasma HIV RNA rebound among injection drug users treated with antiretroviral therapy. J Acquir Immune Defic Syndr 2012, 59(4):393-399.
• [26]Spittal PM, Craib KJ, Wood E, Laliberte N, Li K, Tyndall MW, O’Shaughnessy MV, Schechter MT: Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. CMAJ 2002, 166(7):894-899.
• [27]Craib KJ, Spittal PM, Wood E, Laliberte N, Hogg RS, Li K, Heath K, Tyndall MW, O’Shaughnessy MV, Schechter MT: Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver. CMAJ 2003, 168(1):19-24.
• [28]Arendt M, Munk-Jorgensen P, Sher L, Jensen SO: Mortality among individuals with cannabis, cocaine, amphetamine, MDMA, and opioid use disorders: a nationwide follow-up study of Danish substance users in treatment. Drug Alcohol Depend 2011, 114(2–3):134-139.
• [29]Fugelstad A, Annell A, Rajs J, Agren G: Mortality and causes and manner of death among drug addicts in Stockholm during the period 1981–1992. Acta Psychiatr Scand 1997, 96(3):169-175.
• [30]White JM, Irvine RJ: Mechanisms of fatal opioid overdose. Addiction 1999, 94(7):961-972.
• [31]DeBeck K, Kerr T, Li K, Fischer B, Buxton J, Montaner J, Wood E: Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs. CMAJ 2009, 181(9):585-589.
• [32]Marshall BD, Wood E: Putting risk compensation to rest: reframing the relationship between risk behavior and antiretroviral therapy among injection drug users. AIDS 2012, 26(18):2405-2407.
• [33]Marshall BD, Milloy MJ, Wood E, Montaner JS, Kerr T: Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. Lancet 2011, 377(9775):1429-1437.
• [34]Kerr T, Tyndall M, Li K, Montaner J, Wood E: Safer injection facility use and syringe sharing in injection drug users. Lancet 2005, 366(9482):316-318.
• [35]Wood E, Tyndall MW, Montaner JS, Kerr T: Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. CMAJ 2006, 175(11):1399-1404.
• [36]Wood E, Tyndall MW, Zhang R, Stoltz JA, Lai C, Montaner JS, Kerr T: Attendance at supervised injecting facilities and use of detoxification services. N Engl J Med 2006, 354(23):2512-2514.
• [37]Debeck KKT, Bird L, Zhang R, Marsh D, Tyndall M, Montaner J, Wood E: Injection drug use cessation and use of North America’s first medically supervised safer injecting facility. Drug Alcohol Depend 2011, 113(2–3):172-176.
• [38]de Lima MS, de Oliveira Soares BG, Reisser AA, Farrell M: Pharmacological treatment of cocaine dependence: a systematic review. Addiction 2002, 97(8):931-949.
• [39]Castells X, Casas M, Perez-Mana C, Roncero C, Vidal X, Capella D: Efficacy of psychostimulant drugs for cocaine dependence. Cochrane Database Syst Rev 2010., 2CD007380
• [40]Johnson BA-DN, Wang X, Penberthy K, Javors M, Seneviratne C: Topiramate for the treatment of cocaine addiction a randomized clinical trial. JAMA Psychiatry 2013, 70(12):1338-1346.
• [41]Silverman K, Wong CJ, Needham M, Diemer KN, Knealing T, Crone-Todd D, Fingerhood M, Nuzzo P, Kolodner K: A randomized trial of employment-based reinforcement of cocaine abstinence in injection drug users. J Appl Behav Anal 2007, 40(3):387-410.
• [42]Weatherby NR NL, Cesari H, Booth R, McCoy CB, Watters JK, Williams M, Chitwood DD: Validity of self-reported drug use among injection drug users and crack cocaine users recruited through street outreach. Eval Program Plann 1994, 17(4):347-355.
• [43]Darke S: Self-report among injecting drug users: a review. Drug Alcohol Depend 1998, 51(3):253-263. discussion 267–258