Mortality in heroin-assisted treatment in Switzerland 1994-2000.
BACKGROUND
A major goal of heroin-assisted treatment in Switzerland has been to reduce the drug-related mortality of heroin users. Therefore, a continuous monitoring of deaths under treatment is essential.


OBJECTIVE
To assess mortality of participants in heroin-assisted treatment in Switzerland over a 7-year period from 1994 to 2000, and to compare this mortality to the general population and to other populations of opioid users, as reported in the literature.


METHODS
Estimation of person years under heroin-assisted treatment from the complete case registry of heroin-assisted treatment in Switzerland. Estimation of standardized mortality ratios comparing the population in treatment to the Swiss population (standardized to the year 2000).


RESULTS
Over the 7-year period, the crude death rate of patients in heroin-assisted treatment, and including one month after discharge from treatment, was 1% per year. The standardized mortality ratio for the entire observation period was 9.7 (95% C.I. 7.3-12.8), with females having higher standardized mortality ratios (SMR 17.2) than males (SMR 8.4). There was no clear time trend.


CONCLUSIONS
Mortality in heroin-assisted treatment was low compared to the mortality rate of Swiss opioid users 1990s (estimated to be between 2.5 and 3%). It was also low compared to mortality rates of opioid users in other maintenance treatments in other countries as reported in the literature. The SMR was also lower than that reported in the only meta-analysis in the literature: 13.2 (95% C.I. 12.3-14.1). The low mortality rate is all the more noteworthy as heroin-assisted treatment in Switzerland included only refractory opioid addicts with existing severe somatic and/or mental problems.


BACKGROUND
No conflicts of interest declared.
Rehm
Jürgen
J
Addiction Research Institute, Konradstr. 32, CH 8031 Zurich, Switzerland. jtrehm@aol.com
Frick
Ulrich
U
Hartwig
Christina
C
Gutzwiller
Felix
F
Gschwend
Patrick
P
Uchtenhagen
Ambros
A
D002423:Cause of Death; D005260:Female; D003932:Heroin / Q000627:therapeutic use*; D006556:Heroin Dependence / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use*; D012737:Sex Factors; D016320:Substance Abuse Treatment Centers; D013557:Switzerland / Q000453:epidemiology
D009294:Narcotics; D003932:Heroin; D008691:Methadone