In recent research my colleagues and I examined death in the Australian Treatment Outcome Study of heroin users, recruited in 2001. We looked at deaths over 2001-2015, causes of death, and the years of potential life lost associated with these deaths. At 2015, 12% of the cohort had died, a rate of around 1% per annum. This is 10 times the rate we would expect amongst the general population. Men were 7 times more likely to die than men in the general population, and women 17 times more likely than women in the general population. Each death was associated with 28 years of life lost if we take death before age 65 as the cut-off (a conservative measure often used in disease epidemiology). Using the years life lost before average life expectancy, there was an average of 44 years of potential life lost associated with these deaths. Accidental overdose and suicide accounted for three quarters of years of life lost. Given the prominent role of overdose and suicide, the majority of these fatalities appear preventable.
What can be done to reduce these high rates of mortality, and years of life lost? Long-term, stable treatment, such as opioid substitution or residential rehabilitation, is well demonstrated in this and other cohorts, to reduce drug use mortality, particularly from overdose. More specifically, suicide is preventable, and regular screening for suicidal ideation appears advisable for health professionals in contact with heroin users.
This work is to be published in Drug and Alcohol Dependence. Darke et al. (In press) Years of potential life lost amongst heroin users in the Australian Treatment Outcome Study cohort, 2001-2015. Drug and Alcohol Dependence.
This blog is based on Professor Shane Darke's presentation "Years of potential life lost amongst heroin users in the Australian Treatment Outcome Study cohort, 2001-2015" at the NDARC Seminar on Thursday, 31 March 2016.