Mortality among drug users in Europe : New and old challenges for public health (English)

More than 6 000 drug users die of overdose each year in the European Union, and most of these deaths occur among problem drug users and involve opioids. In addition, many deaths related indirectly to drug use occur each year. To gain a clearer picture of the overall number of lives lost due to drug use in Europe, this paper builds on the results of an earlier work that looked at all-cause mortality among problem drug users. By linking data on entrants to drug treatment programmes with information from death registries, mortality cohort studies can determine death rates from all causes within the study population. The study presents data from nine European countries, including seven not previously studied using EMCDDA methodology. Among over 31 000 participants (22 % female), covering 203 000 person-years of follow-up, 2 886 deaths were recorded, 18 % among females. Overall crude mortality rate per 1 000 person-years follow-up was 14.2, but varied geographically from 3.5 to 22.7. Cause of death was reported in 71 % of all deaths, half of which was accounted for by external causes: overdose (35 %), suicide (5 %) and other external causes (10 %). Somatic causes accounted for about 45 % of the known-cause deaths: HIV/AIDS (14 %), circulatory diseases (9 %), respiratory diseases (5 %) and other somatic causes (16 %). Risk of death among problem drug users was typically 10 or more times that among their peers in the general population. The analysis shows that the deaths of problem drug users are overwhelmingly premature and preventable