Mortality risk among new onset injection drug users

Aims: To characterize mortality experience among those who only recently started injection. Design: Prospective study. Setting: Independent study clinic within high drug use neighborhoods. Participants In 1988-1989, we enrolled 256 adult injection drug users (IDUs) recruited through street outreach who had initiated injection within the prior 2 years. Measurements: Consenting participants underwent venipuncture for HIV antibody testing and interviews. We prospectively ascertained date and cause of death through follow-up contact and registry linkages. Analyses included standardized mortality ratios (SMRs) with local, state and national mortality data, adjusted for age, gender and race. Findings: Baseline median age was 30 years, 70% were male, 95% were African-American and 90% injected within the prior 6 months. We identified 69 deaths through October 2000; mortality rate was 3,3/100 person-years. The adjusted SMR with the USA (and Baltimore) as the reference for IDUs was 4.40 (2.43) for 1991-1992, which increased to 8.12 (4.13) by 1993-1994, decreased to 4.43 (2.13) by 1997-1998 and increased slightly to 5.35 (2.79) during 1999-2000. Excluding HIV-related mortality, SMRs remained elevated. Decline in SMRs was not linked to drug abuse treatment. Conclusions These data demonstrate excess mortality among new-onset IDUs compared with demographically similar peers in the general population, indicating the need for interventions to prevent premature death among young IDUs.