The quantification of mortality resulting from the regular use of illicit opiates

UNLABELLED: AIMS/DESIGN: Estimates of mortality associated with illicit opiate use provide useful information to those directing and monitoring local, national and international policies and programmes. Most studies investigating the association have, however, been small with imprecise estimates of increased mortality. The current study combines data from a number of international studies in a meta-analysis to estimate more precisely mortality associated with illicit opiate use. Because HIV infection among injecting drug users differs dramatically between countries and localities, we excluded studies where AIDS was a major contributor to mortality. Studies were included only where AIDS-specific mortality accounted for less than 2% of total mortality. FINDINGS: Our results show a mortality rate for people regularly using illicit opiates, which is more than 13 times greater than that observed for the general community. It is estimated that 9.4% of total mortality in Australians aged 15-39 years of age can be attributed to regular use of illicit opiates. Application of this aetiological fraction to Australian mortality data for 1992 indicate that approximately 401 male and 161 female deaths occurred as a result of opiate use. This represents some 15,429 and 6261 person-years of life lost (to age 70) for males and females, respectively. CONCLUSIONS: The mortality rate for illicit opiate users is approximately 13 times greater than for the general population. The large number of years of life lost is reflective of the relatively young population (15-39 years of age) in which opiate-related mortality occurs. Relative risk estimates can also be applied to data on the prevalence of illicit opiate use in other countries to produce locally based aetiological fractions and estimates of person-years of life lost.