title: Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment.
abstract: OBJECTIVE
  To examine survival and long term cessation of injecting in a cohort of drug users and to assess the influence of opiate substitution treatment on these outcomes.
  
  
  METHODS
  Prospective open cohort study.
  
  
  METHODS
  A single primary care facility in Edinburgh.
  
  
  METHODS
  794 patients with a history of injecting drug use presenting between 1980 and 2007; 655 (82%) were followed up by interview or linkage to primary care records and mortality register, or both, and contributed 10,390 person years at risk; 557 (85%) had received opiate substitution treatment.
  
  
  METHODS
  Duration of injecting: years from first injection to long term cessation, defined as last injection before period of five years of non-injecting; mortality before cessation; overall survival.
  
  
  RESULTS
  In the entire cohort 277 participants achieved long term cessation of injecting, and 228 died. Half of the survivors had poor health related quality of life. Median duration from first injection to death was 24 years for participants with HIV and 41 years for those without HIV. For each additional year of opiate substitution treatment the hazard of death before long term cessation fell 13% (95% confidence interval 17% to 9%) after adjustment for HIV, sex, calendar period, age at first injection, and history of prison and overdose. Conversely exposure to opiate substitution treatment was inversely related to the chances of achieving long term cessation.
  
  
  CONCLUSIONS
  Opiate substitution treatment in injecting drug users in primary care reduces this risk of mortality, with survival benefits increasing with cumulative exposure to treatment. Treatment does not reduce the overall duration of injecting.
authors.affiliation: Department of Social Medicine, University of Bristol, Bristol BS8 2PS.
authors.forename: Jo
authors.initials: J
authors.lastname: Kimber
authors.forename: Lorraine
authors.initials: L
authors.lastname: Copeland
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.forename: John
authors.initials: J
authors.lastname: Macleod
authors.forename: James
authors.initials: J
authors.lastname: McKenzie
authors.forename: Daniela
authors.initials: D
authors.lastname: De Angelis
authors.forename: James Roy
authors.initials: JR
authors.lastname: Robertson
mesh_terms: D000328:Adult; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000401:mortality; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000401:mortality / Q000534:rehabilitation*; D011379:Prognosis; D015819:Substance Abuse, Intravenous / Q000401:mortality / Q000534:rehabilitation*; D055815:Young Adult
chemical_list: D009294:Narcotics; D008691:Methadone