title: Mortality Risk Among Heroin Abusers: Clients and Non-clients of Public Treatment Centers for Drug Addiction.
abstract: In Europe, the prevalence of problematic heroin consumption is declining but, in spite of the constant rise in the number of treated patients, many of them do not turn to a public treatment center (PTC) for their drug addiction. The aim of this study is to study the mortality risk separately for heroin abusers PTC clients and non-PTC clients (i.e., those never treated at a PTC).
  
  
  METHODS
  Cohort study on 959 subjects resident in the metropolitan area of Bologna who went to a health service (i.e., hospital, emergency unit) or to a PTC following problems due to heroin abuse for the first time between 01/01/2004 and 31/12/2009. Standardized mortality ratios (SMRs) were calculated, and regression analysis using the Poisson method was used.
  
  
  RESULTS
  Elevated and statistically significant SMRs were found in both genders, irrespective of the contact facility, being higher for PTC clients. Among non-PTC clients 28% of deaths overall were from AIDS or infectious diseases (6% PTC clients), 17% from opiate overdose (6% PTC clients) and 14% from violent causes (6% PTC clients). Multivariate analysis showed a higher mortality risk for patients who used both heroin and cocaine and for concomitant abuse of benzodiazepines.
  
  
  CONCLUSIONS
  The characteristics of patients never before treated for addiction prompts a reflection on the presence of a hidden group of patients who are hard to reach, who have a high mortality risk and who turn to health care treatment facilities only in the event of an emergency.
authors.affiliation: a Epidemiological Monitoring Center on Addiction , Mental Health and Dependences , ASL Bologna , Bologna , Italy.
authors.forename: Raimondo Maria
authors.initials: RM
authors.lastname: Pavarin
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D001569:Benzodiazepines; D002423:Cause of Death; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007239:Infections / Q000401:mortality*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D015995:Prevalence; D012044:Regression Analysis; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000401:mortality; D014754:Violence; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines
keywords: AIDS; cohort study; heroin; mortality; overdose; public treatment service