title: Mortality among heroin users and users of other internationally regulated drugs: A 27-year follow-up of users in the Epidemiologic Catchment Area Program household samples.
abstract: BACKGROUND
  In contrast to research on more restricted samples of drug users, epidemiological studies open up a view of death rates and survivorship of those who have tried heroin a few times, with no acceleration toward sustained use patterns often seen in treatment and criminal justice samples. At their best, epidemiological estimates of heroin effects on risk of dying are not subject to serious selection biases faced with more restricted samples.
  
  
  METHODS
  Data are from 7207 adult participants aged 18-48 years in United States Epidemiologic Catchment Area Program field surveys, launched in 1980-1984. US National Death Index (NDI) records through 2007 disclosed 723 deaths. NDI enabled estimation of heroin-associated risk of dying as well as survivorship.
  
  
  RESULTS
  Estimated cumulative mortality for all 18-48 year old participants is 3.9 deaths per 1000 person-years (95% confidence interval, CI=3.7, 4.2), relative to 12.4 deaths per 1000 person-years for heroin users (95% CI=8.7, 17.9). Heroin use, even when non-sustained, predicted a 3-4 fold excess of risk of dying prematurely. Post-estimation record review showed trauma and infections as top-ranked causes of these deaths.
  
  
  CONCLUSIONS
  Drawing strengths from epidemiological sampling, standardized baseline heroin history assessments, and very long-term NDI follow-up, this study of community-dwelling heroin users may help clinicians and public health officials who need facts about heroin when they seek to prevent and control heroin outbreaks. Heroin use, even when sporadic or non-sustained, is predictive of premature death in the US, with expected causes of death such as trauma and infections.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, West Fee Hall, 909 Fee Road, East Lansing, MI 48824-1030, United States. Electronic address: clopez@msu.edu.
authors.forename: Catalina
authors.initials: C
authors.lastname: Lopez-Quintero
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Room 880B, 624 North Broadway, Baltimore, MD 21205, United States. Electronic address: kroth@jhsph.edu.
authors.forename: Kimberly B
authors.initials: KB
authors.lastname: Roth
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Room 880B, 624 North Broadway, Baltimore, MD 21205, United States. Electronic address: weaton@jhsph.edu.
authors.forename: William W
authors.initials: WW
authors.lastname: Eaton
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC 27710, United States. Electronic address: litzy.wu@duke.edu.
authors.forename: Li-Tzy
authors.initials: LT
authors.lastname: Wu
authors.affiliation: Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road. PO Box 100231, Gainesville, FL 32611, United States. Electronic address: lbcottler@ufl.edu.
authors.forename: Linda B
authors.initials: LB
authors.lastname: Cottler
authors.affiliation: Department of Psychiatry, Westchester Division, Weill Medical College of Cornell University, White Plains, NY 10605, United States. Electronic address: mbruce@med.cornell.edu.
authors.forename: Martha
authors.initials: M
authors.lastname: Bruce
authors.affiliation: Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, West Fee Hall, 909 Fee Road, East Lansing, MI 48824-1030, United States. Electronic address: janthony@msu.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Anthony
mesh_terms: D000293:Adolescent; D000328:Adult; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D003932:Heroin; D006556:Heroin Dependence / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D011634:Public Health; D012306:Risk; D019966:Substance-Related Disorders / Q000453:epidemiology; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003932:Heroin
keywords: Death; Drug use; Drugs; Heroin; Mortality; Opioids; Survivorship