Drug-related deaths in Stockholm during the period 1985-1994 : causes and manners of death in relation to type of drug abuse, HIV-infection and methadone treatment

Abstract

During the period from 1984 to 1994 great changes occurred in the situation for drug addicts In Stockholm. The HIV-infection among intravenous drug addicts was detected in 1984 and a general HIV-screening started in 1985. In order to prevent the spread of the HIV-infection among drug addicts the medical and social drug treatment services were enlarged. A new methadone maintenance programme was started in Stockholm in 1987. There were approximately 4,500 IDUs in Stockholm 1992 and about 50% of them were opiate users. The rest mainly used amphetamine.

The purpose of the thesis was to evaluate all drug-related deaths that occurred in the Stockholm area during a ten-year period, 1985-1994, in relation to main drug of abuse, HIV-infection and methadone treatment. The material comprises 830 drug-related deaths and 21 suicides among HIV-infected persons, examined at the Department of Forensic Medicine in Stockholm 1985-1994, 74 HIV-infected addicts who had died in hospital during the same period and 547 HIV-infected persons who were registered in the County of Stockholm between 1984 and 1994. Two cohorts were followed up: 101 compulsory treated drug addicts, 1986-93, and 1640 hospitalised drug users, 1985-92.

Both the number of deaths among drug addicts in general and among HIV-infected drug addicts increased during the period. There were different causes and manners of death in relation to main drug of abuse. The majority of the heroin-related deaths were in connection with intravenous injection and there were few deaths from external violence. Amphetamine-related deaths were often due to accidents, homicides, suicides and somatic disease caused by long-standing drug abuse. Many of the cannabis-related deaths were due to traffic accidents, homicides and impulsive and violent suicides. There were few suicides among HIV-infected persons. Among the infected drug addicts there was no relation between suicide and the duration of infection. No addicts with an AIDS-diagnosis died from suicide. The majority of the HIV-infected heroin users died from injection after a short infection time and most amphetamine users died from somatic complications after a relatively long time of infection.

The results from the two cohort studies show a lower mortality among those in the methadone programme from violent causes and poisoning among both HIV-seronegative and infected heroin users including those with a very long-standing and intensive drug abuse who had undergone coercive treatment. Most deaths in the methadone programme were due to HIV-related disease. A forensically based register of drug-related deaths in Stockholm 1985-94 has been established and it is concluded that this register gives a more comprehensive picture of drug-related deaths than the official cause-of-death register.