Post-Soviet Central Asia: A summary of the drug situation

BackgroundThe paper aims to provide a snapshot of the drug situation in Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan using the EU methodology of “harmonised indicators of drug epidemiology.”MethodsMost of the data reported here were gathered and analysed within the framework of the EU-funded CADAP project in 2012. Together with members of CADAP national teams, we conducted extraction from the databases of national institutions in the field of (public) health and law enforcement, issued formal requests for the provision of specific information to national governmental authorities, and obtained national grey literature in Russian. In specific cases, we leaned on the expert opinions of the national experts, gathered by means of simple online questionnaires or focus group. In the rather scarce cases where peer-reviewed sources on the specific topics exist, it is used for comparisons and discussion.ResultsAll the post-Soviet Central Asian countries lack information on drug use in the general population. School surveys are relatively well developed in Kazakhstan, and Kyrgyzstan benefited from an international survey project on health in schools organised by private donors in 2009. For Tajikistan and Uzbekistan, the most recent available data on drug use in the school population are from 2006 and as such are of little relevance. Problem drug use is widespread in Central Asia and estimates of its prevalence are available for all four countries. All the post-Soviet Central Asian countries use a rather outdated system of narcological registers as the only source of data on drug users who are treated (and those investigated by the police), which was inherited from Soviet times. The availability of treatment is very low in all the countries reported on here except Kyrgyzstan; opioid substitution treatment (OST) was introduced first in Kyrgyzstan; Kazakhstan and Tajikistan are piloting their OST programmes but the coverage is extremely low, and in Uzbekistan the OST pilot programme has been abolished. HIV and hepatitis C virus (HCV) infections are concentrated in injecting drug users (IDUs) in Central Asia, with the situation in Kazakhstan having stabilised; HIV is on the increase among Kyrgyz IDUs. The sharp decrease in HIV and VHC seroprevalence among IDUs in Uzbekistan and Tajikistan still awaits an explanation. The system for monitoring of fatal drug overdoses needs substantial improvement in all the countries reported on here. Overall mortality studies of drug users registered in the narcological registers were performed in Uzbekistan, Kazakhstan, and Tajikistan; the highest excess mortality among registered drug users was found in Uzbekistan, and in all three countries, it was substantially higher for women than men. The seizures of illegal drugs are by far the highest in Kazakhstan; however, wild-growing cannabis represents 90% of these seizures. Uzbekistan was the country with the highest number of drug arrests. In Kazakhstan, after the decriminalisation of drug use in 2011, the number of reported drug-related offences dropped to below 50% of the figure for the previous year.ConclusionThe drug situation monitoring system in the four post-Soviet countries of Central Asia still needs substantial improvement. However, in its current state it is already able to generate evidence that is useful for the planning of effective national and regional drug policies, which would be of the utmost importance in the forthcoming years of the withdrawal of the International Security Assistance Force from Afghanistan.     

Mortality in heroin-assisted treatment in Switzerland 1994-2000

BACKGROUND: A major goal of heroin-assisted treatment in Switzerland has been to reduce the drug-related mortality of heroin users. Therefore, a continuous monitoring of deaths under treatment is essential. AIMS: To assess mortality of participants in heroin-assisted treatment in Switzerland over a 7-year period from 1994 to 2000, and to compare this mortality to the general population and to other populations of opioid users, as reported in the literature. METHOD: Estimation of person years under heroin-assisted treatment from the complete case registry of heroin-assisted treatment in Switzerland. Estimation of standardized mortality ratios comparing the population in treatment to the Swiss population (standardized to the year 2000). RESULTS: Over the 7-year period, the crude death rate of patients in heroin-assisted treatment, and including one month after discharge from treatment, was 1% per year. The standardized mortality ratio for the entire observation period was 9.7 (95% C.I. 7.3-12.8), with females having higher standardized mortality ratios (SMR 17.2) than males (SMR 8.4). There was no clear time trend. CONCLUSION: Mortality in heroin-assisted treatment was low compared to the mortality rate of Swiss opioid users 1990s (estimated to be between 2.5 and 3%). It was also low compared to mortality rates of opioid users in other maintenance treatments in other countries as reported in the literature. The SMR was also lower than that reported in the only meta-analysis in the literature: 13.2 (95% C.I. 12.3-14.1). The low mortality rate is all the more noteworthy as heroin-assisted treatment in Switzerland included only refractory opioid addicts with existing severe somatic and/or mental problems. DECLARATION OF INTEREST: No conflicts of interest declared.     

Mortality risk among recent-onset injection drug users in five U.S. cities

To quantify the risk of death among recent-onset (< 5 years) injection drug users, we enrolled 2089 injection drug users (IDUs) age 相似文献   

Mortality among individuals with cannabis, cocaine, amphetamine, MDMA, and opioid use disorders: a nationwide follow-up study of Danish substance users in treatment

This is a register-based cohort study of 20,581 individuals in treatment for illicit substance use disorders in Denmark between 1996 and 2006. All in all, 1441 deaths were recorded during 111,445 person-years of follow-up. Standardized mortality ratios (SMRs) associated with different primary substance types were calculated and Cox-regression analyses were performed in order to establish hazard ratios (HR) associated with injection drug use and psychiatric comorbidity. SMRs for primary users of specific substances were: cannabis: 4.9 (95% confidence interval (CI): 4.2-5.8), cocaine: 6.4 (CI: 3.9-10.0), amphetamine: 6.0 (CI: 4.2-8.3), heroin: 9.1 (CI: 8.5-9.8), and other opioids 7.7 (CI: 6.6-8.9). For MDMA ('ecstasy') the crude mortality rate was 1.7/1000 person-years (CI: 0.4-7.0) and the SMR was not significantly elevated. Injection drug use was associated with significantly increased hazard ratios in users of opioids and cocaine/amphetamine. Overall, psychiatric comorbidity was not associated with increased mortality (HR: 1.1 [CI: 0.9-1.2], p=.28), but an association was found specifically among cocaine/amphetamine users (HR: 3.6 [CI: 2.1-6.4], p<.001).     

Mortality Risk Among Recent-Onset Injection Drug Users in Five U.S. Cities

To quantify the risk of death among recent-onset (< 5 years) injection drug users, we enrolled 2089 injection drug users (IDUs) age ≤ 35 years (minimum age = 18 years) between 1997 and 1999. Median age was 24 years, 62.4% were male, 54.5% were non-Hispanic White, mean duration of injecting was 3 years, and 45.4% injected daily within the prior 6 months. Using the National Death Index, we identified 68 deaths over a follow-up period through December 2002 with a mortality rate of 7.10/1000 person years. Using age-, sex-, and race-adjusted data to the census and mortality, we calculated standardized mortality ratios (SMRs) over time. The adjusted SMR (with national data as the reference) for IDUs was 3.66 for 1997, which increased to 9.78 by 1998, decreased slightly to 7.08 by 1999, and continuously declined to 2.54 by 2002. These data confirm considerable excess mortality among recent onset injection drug users compared to non-IDU peers in the general population and indicate need for interventions such as increased quality and accessibility to drug abuse treatment and overdose prevention to prevent premature death among young IDUs.     

Patterns and 14-year trends in mortality among illicit drug users in Finland: The HUUTI study

BackgroundAlthough mortality is a known complication of illicit drug use, robust epidemiological studies on drug-related mortality in Finland are scarce. We examined all deaths, specific causes of death, and trends in mortality among a large number of illicit drug users in Finland during a 14-year period.MethodsDetails of 4817 clients who sought treatment for drug use at Helsinki Deaconess Institute between 1997 and 2008 were linked to national cause of death register to identify all deaths and causes of death. Standardised mortality ratios (SMRs) were calculated to compare all-cause deaths in our study cohort with those in the general population. Trends in mortality rates were assessed using Poisson (log-linear) regression.ResultsA total of 496 deaths occurred during 41,567.5 person-years with crude mortality rate of 1193.2 per 100,000 person-years. Mean follow-up was 8.6 years and the mean age at death was 33.8 years. Most deaths (84.1%) occurred among male clients, 189 deaths occurred in the 25–34 age-group and all-cause SMR was 8.9 [95% confidence interval (CI) = 8.1–9.7]. Two-thirds (64.9%) were deaths from external causes and 35.1% from disease-related causes. The four leading causes of death were accidental poisoning/overdose (n = 165), suicide (n = 108), mental and behavioural disorders (n = 49) and circulatory system diseases (n = 45). Younger clients died from acute effects of drug use while older clients died more from chronic health conditions. A decline in annual rates was noted for all-cause mortality (P = 0.01), deaths from mental and behavioural disorders (P < 0.001) and suicides (P < 0.001).ConclusionThe four leading causes of death among illicit drug users are preventable. Overdose management training, drug education and other preventive measures could help reduce mortality.     

Tyler asbestos workers: A mortality update in a cohort exposed to amosite

ABSTRACT

The Tyler asbestos plant produced pipe insulation from 1954 to 1972 and exclusively used amosite asbestos. There were 1130 former workers of this plant during the period of operation. A death certificate mortality analysis was published regarding this plant in 1998 for the period through 1993. This study represents an update of the mortality analysis with additional certificates collected for deaths occurring through 2011.Searches of the National Death Index database were conducted in 2004 and again in 2013. At the time of the latter search, only deaths occurring through 2011 were available. In total, 265 distinct additional death certificates were secured and added to 304 available from the original study. After the new certificates were coded (ICD-9), data were analyzed using the Centers for Disease Control and Prevention Life Table Analysis System (LTAS) and standard mortality ratios (SMR) generated with 95% confidence limits (CL). LTAS constructs cause-specific mortality rates by age, gender, race, and person-time at risk, and compares observed rates with a referent population in order to derive SMR. A significant excess number of deaths due to nonmalignant respiratory disease (asbestosis) and from select malignant neoplasms were identified. There were in total 23 mesothelioma deaths (4% of deaths), with 16 pleural and 7 peritoneal. The SMR for malignant neoplasms of the trachea, bronchus, and lung was 244 (with 95% CL 196, 300), suggesting that exposed workers from this cohort were nearly 2.5-fold (244 %) more likely to die from this cause as the general referent population. The analysis also showed that exposures of short duration (<6 mo) produced significantly elevated SMR for all respiratory cancers, lung cancer, and pleural mesothelioma. There was a significant difference in median duration of exposure for mesothelioma types, confirming association of peritoneal mesothelioma with longer duration of exposure. Deaths due to intestinal cancer (predominantly colon; not including rectum) were also found in excess. The mortality experience of the Tyler cohort continues to be followed with great interest, given the exclusivity of exposure to amosite. Data confirm the inherent pathogenicity of this fiber type for nonmalignant disease as well as select cancers, particularly relevant given the importance of this amphibole’s use in the United States.     

静脉吸毒人群前瞻性队列研究1年随访死因分析

目的:了解四川省某地区静脉吸毒人群的死亡情况.方法:于2002年¨月筛选和招募静脉吸毒人群队列376人,队列随访1年.筛选时调查静脉吸毒人群的社会人口学和吸毒行为特征,对死亡人员进行死因分析.结果:队列随访1年中死亡28人,死亡率为77.32/1000人年,标准化死亡比(SMR)为47.46,95%可信区间为[31.52～68.47].死因中因吸毒过量死亡占64.3%(18人),与吸毒有关的意外伤害死亡占14.3%(4人),其他21.4%(6人).队列随访中未见艾滋病病例.结论:需进一步加强吸毒人群的死亡研究,以便开展针对性的干预措施来降低静脉吸毒人群的死亡率.     

Beyond the drug-terror nexus: Drug trafficking and state-crime relations in Central Asia

BackgroundIn the wake of collapse of the Soviet Union, Central Asia has transformed into a key hub along the Afghan opiates trafficking routes. Around 30 percent of the heroin manufactured in Afghanistan is estimated to be smuggled through Central Asian republics in its way to booming drug markets in Russia and Eastern Europe.MethodsBuilding upon available evidence and extensive fieldwork research, the article seeks to confute mainstream analyses which emphasize connections between criminal and terrorist networks. The focus is on conducive factors for the establishment of drug routes in Central Asia, the characteristics of drug related networks, and the nature of political-criminal relations across the region.ResultsIt is argued that in all five Central Asia republics strategic partnerships have formed between drug traffickers and state actors around the exploitation of drug rents and that mafias’ influence on politics is stronger in Tajikistan and Kyrgyzstan, the region's poorest countries.ConclusionBy moving the focus from narco-terror to the state-crime connections, the article provides a critical insight into political economy issues surrounding a complex and multifaceted phenomenon such as the drug trade.     

A record linkage study of hospital episodes for drug treatment clients in Scotland, 1996–2006

Despite drug users’ high mortality rates, their contacts with hospital and psychiatric treatment have received comparatively little quantification. We provide a comprehensive summary and characterisation of the hospital and psychiatric treatment episodes of a national cohort of drug treatment clients during 1996–2006. Drug treatment records were linked to national registers of deaths, hepatitis C virus (HCV) diagnoses and hospital and psychiatric episodes (hereafter hospital episode). Allowing for overdispersion, we calculated hospital episode rates (HERs) by main diagnosis at discharge; standardised hospital episode ratios (SHERs) during 2001/2002 to 2005/2006 only and Cox regression analyses of time-to-hospital-episode. The Scottish Drug Misuse Database (SDMD) cohort comprised 69,457 individuals and 350,317 person-years (pys) with 107,723 hospital episodes by 27,124 individuals: 70,094 hospital episodes occurred during 229,504 pys in 2001/2002 to 2005/2006. The five discharge-diagnoses with highest SHERs were: mental and behavioural disorders 40.3 (95% CI: 38.6–42.1), circulatory system disease 3.7 (3.5–4.0), infectious and parasitic diseases 3.7 (3.4–4.0), diseases of the skin and subcutaneous tissue 3.5 (3.4–3.7), injury, poisoning and other consequences of external causes 3.4 (3.3–3.5). HCV-diagnosed clients were at over twofold greater risk of hospital episode (hazard ratio (HR), for those without diagnosis, 0.41, 95% CI: 0.39–0.43) and alcohol misuse increased risk (HR: 1.69, 95% CI: 1.60–1.80). HERs and SHERs align with SDMD clients’ cause-specific mortality pattern. Interventions for drug treatment clients might incorporate preventive strategies to address the significantly elevated diagnosis-specific SHERs – in particular, dual diagnoses with mental illness.     

A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility

BackgroundA supervised injection facility (SIF) has been established in North America: Insite, in Vancouver, British Columbia. The purpose of this paper is to conduct a cost-effectiveness and cost-benefit analysis of this SIF using secondary data gathered and analysed in 2008. In using these data we seek to determine whether the facility's prevention of infections and deaths among injecting drug users (IDUs) is of greater or lesser economic cost than the cost involved in providing this service – Insite – to this community.MethodsMathematical modelling is used to estimate the number of new HIV infections and deaths prevented each year. We use the number of these new HIV infections and deaths prevented, in conjunction with estimated lifetime public health care costs of a new HIV infection, and the value of a life, in order to calculate an identifiable portion of the societal benefits of Insite. The annual costs of operating the SIF are used to measure the social costs of Insite. In using this information, we calculate cost-effectiveness and benefit-cost ratios for the SIF.ResultsThrough the use of conservative estimates, Vancouver's SIF, Insite, on average, prevents 35 new cases of HIV and almost 3 deaths each year. This provides a societal benefit in excess of $6 million per year after the programme costs are taken into account, translating into an average benefit-cost ratio of 5.12:1.ConclusionVancouver's SIF appears to be an effective and efficient use of public health care resources, based on a modelling study of only two specific and measurable benefits—HIV infection and overdose death.     

Suicide and other-cause mortality among heroin users in Taiwan: A prospective study

Aims

The present study investigates one-year incidence of mortality from suicide and other causes among heroin users in Taiwan.

Design

A prospective national register-based cohort study.

Setting

All heroin users who attended the methadone maintenance treatment (MMT) programs in all treatment centers in Taiwan.

Participants

The sample comprised 10,842 heroin users attending MMT. Between Jan 2006 and Dec 2007, cases were identified through the multiple-center register system and followed until Dec 2008 for date and cause of death on the Taiwan national mortality database.

Measurements

Standardized mortality ratios within one year of starting MMT were calculated as a ratio of actual versus expected numbers of deaths in the general population in Taiwan. Cox regression models were fitted to estimate the effects of gender, age, education and marital status as well as heroin related behaviors.

Findings

In total, 256 cases died, 67 through suicide. The mortality rate (per 100 person-years) in the first year of all-cause and suicide was 1.71 and 0.45 respectively, representing 7.5- and 18.4-fold age- and gender-standardized mortality ratio (SMR) compared to the general population. Besides, the mortality rate in the first year of overdoses, murder, HIV, somatic was 0.19, 0.02, 0.07, and 0.75 respectively, representing 68.4-, 27.7-, 76.8-, and 4.3-fold SMR increases to the general population. Older age and unemployment were independent risk factors for mortality. Females had higher standardized mortality ratio than males for suicide and all-cause mortality.

Conclusions

Results showed higher risk of suicide and other-cause mortality among heroin users in MMT than general population. Suicide is an important contributor to overall excess mortality among heroin users in MMT, and especially among women. Suicide prevention and physical health monitoring are important components of MMT programs.     

Mortality study of pathologists and medical laboratory technicians.

Membership lists of professional bodies were used to establish study populations of British pathologists (1955-73) and medical laboratory technicians (1963-73). The standardised mortality ratio (SMR) for pathologists was 60 and for medical laboratory technicians 67. Twenty-seven of the 310 deaths were due to suicide. These numbers gave SMRs of 250 for pathologists and 243 for medical laboratory technicians. Suicide was the commonest cause of death in female technicians. Access to lethal chemicals at work is a possible factor explaining the high proportion of suicide by poisoning compared with the general population. Suicide rates for pathologists exceed those of all medical practitioners; similary medical laboratory have higher rates than all laboratory technicians. Excess deaths from lymphatic and haemopoietic neoplasms were noted in English male pathologists (observed 8, expected 3-3; P less than 0-01). This difference is not due to Hodgkin's disease or leukaemia and remains unexplained. No other neoplastic diseases were noted as causing excess mortality in either occupational group but a small, possibly spurious, excess number of deaths was noted for aortic aneurysm in male pathologists (observed 4, expected 1-8).     

‘Alternative facts’: Public opinion surveys on the death penalty for drug offences in selected Asian countries

Backgroundin recent years, many Asian countries have witnessed an intensification in populist discourses identifying the death penalty as a central tool of drug control, with public opinion surveys referred to as invaluable evidence of public support for the death penalty. This paper will address the claim that the public supports capital punishment, and the role of surveys in shaping this discourse.Methodsreview of thirty-nine public opinion surveys on the death penalty carried out in five Asian countries which retain the death penalty for drugs or are considering re-introducing it. The review was conducted by analysing and comparing design, methodology, findings, and the relationship between these elements.Resultsall but two surveys recorded a majoritarian support for the death penalty, driven by beliefs in (a) deterrent effect of the death penalty, and (b) perfect justice – both disproven. Complex surveys found a low intensity of support, and a limited interest and knowledge by the public in capital punishment. Support for capital punishment is lower for drug offences specifically, and it decreases significantly when expressed with reference to real-life cases.Limited data suggest that the public in the focus countries has reservations on the effectiveness of the death penalty to reduce drug offences, and prefers a discretionary system of punishment. The analysis also revealed correlations between the framing of survey questions and their findings.ConclusionPublic opinion surveys conducted in China, Malaysia, the Philippines, Singapore, and Thailand suggest that the public knows little and has little interest in the death penalty. Although majoritarian, its support is based on a faulty understanding of key facts related to capital punishment, and an increase in knowledge is correlated to a decrease in support. More rigorous polling exercises demonstrate that public support for capital punishment – both in general and for drug offences specifically – is instinctive, abstract, elastic, and contextual.     

Drug Abuse,HIV, and HCV in Asian Countries

Drug abuse and co-occurring infections are associated with significant morbidity and mortality. Asian countries are particularly vulnerable to the deleterious consequences of these risks/problems, as they have some of the highest rates of these diseases. This review describes drug abuse, HIV, and hepatitis C (HCV) in Asian countries. The most commonly used illicit drugs include opioids, amphetamine-type stimulants (ATS), cannabis, and ketamine. Among people who inject drugs, HIV rates range from 6.3 % in China to 19 % in Malaysia, and HCV ranges from 41 % in India and Taiwan to 74 % in Vietnam. In the face of the HIV epidemics, drug policies in these countries are slowly changing from the traditional punitive approach (e.g., incarcerating drug users or requiring registration as a drug user) to embrace public health approaches, including, for example, community-based treatment options as well as harm reduction approaches to reduce needle sharing and thus HIV transmission. HIV and HCV molecular epidemiology indicates limited geographic diffusion. While the HIV prevalence is declining in all five countries, use of new drugs (e.g., ATS, ketamine) continues to increase, as well as high-risk sexual behaviors associated with drug use—increasing the risk of sexual transmission of HIV, particularly among men who have sex with men. Screening, early intervention, and continued scaling up of therapeutic options (drug treatment and recovery support, ART, long-term HIV and HCV care for drug users) are critical for effective control or continued reduction of drug abuse and co-infections.     

Mortality following treatment for cannabis use disorders: Predictors and causes

The aim of the study was to determine excess mortality associated with cannabis use disorders. Individuals entering treatment for cannabis use disorders were followed by use of Danish registers and standardized mortality ratios (SMRs) estimated. Predictors of different causes of death were determined. A total of 6445 individuals were included and 142 deaths recorded during 26,584 person-years of follow-up. Mortality was predicted by age, comorbid use of opioids, and lifetime injection drug use. For different causes of death the SMRs were: accidents: 8.2 (95% CI 6.3–10.5), suicide: 5.3 (95% CI 3.3–7.9), homicide/violence: 3.8 (95% CI 1.5–7.9), and natural causes: 2.8 (95% CI 2.0–3.7). Following exclusion of those with secondary use of opioids, cocaine, amphetamine, or injection drug use, SMRs for all causes of death remained significantly elevated except for homicide/violence. The study underlines the need to address mortality risk associated with cannabis use disorders.     

丹参-红花药对配伍前后对大鼠肝药酶亚型CYP1A2、CYP2E1和CYP3A4活性的影响

目的 研究丹参、红花药对配伍前后对大鼠肝药酶亚型CYP1A2、CYP2E1和CYP3A4活性的影响。方法 分别选用咖啡因、氯唑沙宗和咪达唑仑作为CYP1A2、CYP2E1和CYP3A4的探针药物。将大鼠随机分为4组,即空白对照组、丹参（1.2 g生药/kg）组、红花（0.4 g生药/kg）组、丹参（1.2 g生药/kg）+红花（0.4 g生药/kg）组,按上述剂量ig给药7 d。于末次给药后30 min,尾iv探针药物咖啡因、氯唑沙宗和咪达唑仑溶液,在不同的时间点取血进行检测;以甲硝唑为内标,采用HPLC法检测探针药物咖啡因、氯唑沙宗和咪达唑仑的量,评价各药物组对大鼠CYP3A4、CYP2E1和CYP1A2活性的影响。结果 与空白对照组比较,丹参组咖啡因、氯唑沙宗和咪达唑仑的清除率（CL）有所增强,曲线下面积（AUC）减少,其半衰期（t_1/2）有减少趋势,但差异均不显著;红花组咖啡因和氯唑沙宗的CL有所降低,但差异不显著,咪达唑仑的CL显著降低（P<0.01）,氯唑沙宗的AUC增加,但差异不显著,咖啡因和咪达唑仑的AUC明显增加（P<0.05、0.01）;丹参+红花组咖啡因和氯唑沙宗的CL明显降低（P<0.05）,曲线下面积（AUC）明显增加（P<0.05）,其t_1/2有延长趋势,但差异不显著。结论 丹参、红花配伍后对CYP450亚型CYP1A2和CYP2E1有抑制作用,这可能是丹参、红花配伍协同增效的作用机制之一。     

Mortality and Cause of Death—A 30-Year Follow-Up of Substance Misusers in Sweden

Background: This article presents a 30-year follow-up study of a cohort of 1163 substance misusers who were in inpatient treatment in the early 1980s. Data was originally collected in the Swedish Drug Addict Treatment Evaluation (SWEDATE). Objectives: The aim is to examine the overall mortality and identify causes of death in different groups based on self-reported most dominant substance misuse among those who have died during January 1984–December 2013. Methods: SWEDATE-data was linked to the National Cause of Death Register. Five mutually exclusive study groups were created based on self-reported most dominant substance misuse for the last 12 months before intake to treatment: Alcohol, Cannabis, Stimulants, Opiates, and Other. The Standardized Mortality Ratio (SMR) was calculated. Results: During the follow-up, 40% died. SMR is 10.3 for women and 11.7 for men. The study groups differed regarding SMR; 13.1 in the Alcohol group, 9.2 in the Cannabis group, 9.6 in the Stimulants group, 16.7 in the Opiates group and 10.8 in the Other group. Drug related death was the most common cause of death (28% only underlying, 19% both underlying and contributing) followed by alcohol related reasons (17% vs. 9%). Conclusions: Alcohol misuse among substance abusers might have a negative impact on mortality rates. Methodological changes in how drug related deaths is registered affects the interpretation of the statistics of cause of death. Further analysis on the relation between drug related cause of death and drug misuse related death is needed.     

Strategies for Accessing and Retaining Asian Drug Users in Research Studies

SUMMARY

Based on a research project that investigates drug use and HIV risk behaviors among Asian drug users in San Francisco, this paper describes barriers and strategies for accessing, recruiting, and retaining Asian drug users. It also presents culturally appropriate and group specific strategies and underlying cultural norms that outreach workers use to build rapport with targeted drug users and community members. The paper describes culturally appropriate strategies for outreach workers and project staff to recruit and retain Asian drug users. These strategies acknowledge diversities within the targeted ethnic groups and offer flexibility to create other strategies specific to targeted Asian drug users.     

Drinking and intoxication when the children are around: Conflicting norms and their resolutions

Background and aim: Research indicates an association between substance use and premature death and that misuse of illicit drugs is more closely linked to mortality than alcohol misuse. Given that these studies often are based on homogeneous treatment populations, we sought to analyse long-term mortality among both alcohol and drug misusers in a representative treatment system sample by examining: (1) excess death ratios (SMR, standardised mortality ratio) in comparison with the general population and (2) risk factors for mortality within the sample.

Method: Prospective study (N?=?1659; 28% women) interviewed when starting treatment in Stockholm County, 2000–2002, and followed-up with regard to mortality up to 8 years after baseline. Analyses were based on death certificates and intake interview data (demographics, social situation/support, ICD-10 alcohol/drug dependence, treatment experiences). The strength of the study is the prospective design, that we have been able to link mortality to interview data, and to reach a heterogeneous treatment population.

Results: (1) SMR was 5.7 (no sex difference). (2) Logistic regression showed that being older, male, retired and having reported living with a substance misuser were identified as risk factors for mortality within the sample. Housing organised by authorities and no dependence on alcohol/drugs were protective factors. The mortality risk did not differ between alcohol and drug-dependent cases. Neither was homelessness, living situation (3 years) nor education predictive of mortality.

Conclusions: No difference regarding mortality risk between treated alcohol and drug-dependent patients in Sweden is found when controlling for age.