Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Abstract

Background: Drug users who are leaving/completing inpatient medication-free treatment may, like drug users released from prison, have an elevated risk of dying from fatal overdoses. This is mainly explained by their low drug tolerance. Methods: Two hundred and seventy-six drug users who had been admitted to eleven inpatient facilities in Norway, were followed prospectively after discharge from treatment during an eight year period (1998-2006). The following instruments were used: EuropASI, SCL-25 and MCMI-II. Information on deaths and causes of death were obtained from the National Death Register. Results: A total of 36 deaths were registered after discharge from treatment during the observation period, of which 24 were classified as overdose deaths. During the first 4 weeks after discharge six persons died, yielding an unadjusted excess mortality of 15.7 (rate ratio) in this period (CI 5.3-38.3). All were dropouts and all deaths were classified as opiate overdoses. There was no significant association between time in index treatment and mortality after discharge, nor did any background characteristics correlate significantly with elevated mortality shortly after discharge. Conclusions: The elevated risk of dying from overdose within the first four weeks of leaving medication-free inpatient treatment is so dramatic that preventive measures should be taken. More studies from similar inpatient programmes are needed in order to obtain systematic knowledge about determinants of overdose deaths shortly after leaving treatment, and possible preventive measures.

276 norske stoffmisbrukere som i perioden 1998-1999 begynte i medikamentfri døgnbehandling ble fulgt opp i 8 år med hensyn til dødelighet. I løpet av perioden døde36 personer og 24 dødsfall ble klassifisert som overdoser. I løpet av de fire første ukene etter at de forlot behandlingen døde seks personer av overdoser, hvilket gir en overdødelighet på 15.7 (rate ratio). Alle avsluttet behandlingen prematurt. Det var ingen sammenheng mellom tid i behandling og dødelighet etter at de avsluttet behandlingsoppholdet. Heller ingen andre bakgrunnsfaktorer hadde sammenheng med overdosedød rett etter avsluttet behandling.

Risikoen for overdosedød i løpet av de fire første ukene etter avsluttet behandling er så dramatisk at forebyggende tiltak bør iverksettes. Ytterligere forskning fra lignende behandlingstiltak er viktig for å få mer og systematisk kunnskap om mulige faktorer som har sammenheng med overdosedød rett etter behandlingsslutt, og kunnskaper om mulige forebyggende strategier.