The quantification of mortality resulting from the regular use of illicit opiates

Aims/Design. Estimates of mortality associated with illicit opiate use prov ide useful information to those directing and monitoring local, national an d international policies and programmes. Most studies investigating the ass ociation have, however, been small with imprecise estimates of increased mo rtality. The current study combines data from a number of international stu dies in a meta-analysis to estimate more precisely mortality associated wit h illicit opiate use. Because HIV infection among injecting drug users diff ers dramatically between countries and localities, we excluded studies wher e AIDS was a major contributor to mortality. Studies were included only whe re AIDS-specific mortality accounted for less than 2% of total mortality. F indings. Our results show a mortality rate for people regularly using illic it opiates, which is more than 13 times greater than that observed for the general community. It is estimated that 9.4% of total mortality in Australi ans aged 15-39 years of age can be attributed to regular use of illicit opi ates. Application of this aetiological fraction to Australian mortality dat a for 1992 indicate that approximately 401 male and 161 female deaths occur red as a result of opiate use. This represents some 15429 and 6261 person-y ears of life lost (to age 70) for males and females, respectively. Conclusi ons. The mortality rate for illicit opiate users is approximately 13 rimes greater than for the general population. The large number of years of life lost is reflective of the relatively young population (15-39 years of age) in which opiate-related mortality occurs. Relative risk estimates can also be applied to data on the prevalence of illicit opiate use in other countri es to produce locally based aetiological fractions and estimates of person- years of life lost.