Mortality among individuals with cannabis, cocaine, amphetamine, MDMA, and opioid use disorders: a nationwide follow-up study of Danish substance users in treatment.
This is a register-based cohort study of 20,581 individuals in treatment for illicit substance use disorders in Denmark between 1996 and 2006. All in all, 1441 deaths were recorded during 111,445 person-years of follow-up. Standardized mortality ratios (SMRs) associated with different primary substance types were calculated and Cox-regression analyses were performed in order to establish hazard ratios (HR) associated with injection drug use and psychiatric comorbidity. SMRs for primary users of specific substances were: cannabis: 4.9 (95% confidence interval (CI): 4.2-5.8), cocaine: 6.4 (CI: 3.9-10.0), amphetamine: 6.0 (CI: 4.2-8.3), heroin: 9.1 (CI: 8.5-9.8), and other opioids 7.7 (CI: 6.6-8.9). For MDMA ('ecstasy') the crude mortality rate was 1.7/1000 person-years (CI: 0.4-7.0) and the SMR was not significantly elevated. Injection drug use was associated with significantly increased hazard ratios in users of opioids and cocaine/amphetamine. Overall, psychiatric comorbidity was not associated with increased mortality (HR: 1.1 [CI: 0.9-1.2], p=.28), but an association was found specifically among cocaine/amphetamine users (HR: 3.6 [CI: 2.1-6.4], p<.001).
Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark.mikkaren@rm.dk
Mikkel
M
Arendt
Povl
P
Munk-Jørgensen
Leo
L
Sher
Signe O W
SO
Jensen
D000328:Adult; D000661:Amphetamine; D000701:Analgesics, Opioid; D002188:Cannabis; D003042:Cocaine; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000401:mortality / Q000628:therapy; D018817:N-Methyl-3,4-methylenedioxyamphetamine; D009293:Opioid-Related Disorders / Q000401:mortality / Q000628:therapy; D012042:Registries; D019966:Substance-Related Disorders / Q000401:mortality* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
D000701:Analgesics, Opioid; D000661:Amphetamine; D003042:Cocaine; D018817:N-Methyl-3,4-methylenedioxyamphetamine