Drug abuse-related mortality: a study of teenage addicts over a 20-year period

Background: There is growing concern about increase in illicit drug use and associated fatalities in young people. Method: This longitudinal analysis of successive cohorts of addicts in England and Wales aged 15-19 years foll owed up over a 20-year period covering 1974 to 1993 (1) investigated trends in all-causes mortality; (2) examined teenage-specific mortality, i.e. dea ths during ages 15-19 years; (3) determined excess teenage-specific mortali ty; and (3) identified the main underlying causes of teenage-specific death in this population. The main outcome measures were overall mortality rates , teenage-specific mortality and standardised mortality ratios calculated f or four 5-year (period) successive cohorts. Results: Overall mortality rate in the study population (N = 9491) was 4.7/1000 person-years. The median a ge at death was 23 years (semi interquartile range = 3), with the majority (91.3%) of deaths occurring between ages 15 and 29 years. Excess teenage-sp ecific mortality in the population was 10.7 in males and 21.2 in females (g eneral population = 1), and increase in excess mortality in both sexes was evident in the last 5-year period of study. The majority of deaths (63.3%) resulted from accidental poisoning. Methadone and heroine/morphine accounte d for about two-thirds of accidental poisoning deaths, while suicide accoun ted for 11.4% of teenage-specific deaths. Conclusions: It is strongly recom mended that treatment services should be more responsive to the need for ca reful prescribing, dispensing and administration of substitute medication t o teenage addicts in their care. The development of needs-led, case-sensiti ve treatment services for young addicts is indicated.