Drug deaths

What kills heroin addicts? It has long been known that it is older, more experienced heroin users who die through heroin use rather than new users. This is important since so-called ‘overdose’ deaths are the major way intravenous drug users kill themselves around the world and hence are the major social cost of illicit drug use.

The story used to be that polydrug use was most common among older, experienced heroin users who used heroin in conjunction with alcohol and benzodiazepines. This suggested that the term heroin ‘overdose’ was a misnomer - deaths were in fact due to the synergistic effects of these other drugs on the respiratory depressant effects of heroin. Then even normal heroin doses could prove fatal.

In the newspapers this morning the higher incidence of death among older injecting heroin users (the press release is here) is re-attributed to the fact that older heroin users have damaged livers which are unable to metabolise heroin. It is unclear that it is the heroin use itself that is liver-destroying rather than the spread of hepatitis through injecting equipment but still it is the wonky livers that seem to cause many of the deaths.

One thing that surprised me about the polydrug theory was that overdose deaths fell off so rapidly in the wake of the so-called heroin drought of 2001. I would have though that polydrug substitutions, with the limited amount of heroin that was around, would have induced a spate of overdose deaths. In fact the number of fatal overdoses fell from 968 in 1999 to 306 in 2001. This evidence is more consistent with the wonky liver theory than polydrug theory.