10. tbl. 100. árg. 2014

Injecting drug abuse: Survival after intensive care admission and forensic toxicology reports at death

Notkun vímuefna í æð: Afdrif sjúklinga eftir innlögn á gjörgæslu og niðurstöður réttarefnafræðilegra rannsókna við andlát

Introduction: Injecting drug abuse is a worldwide problem with serious consequences for the individual and for society. The purpose of this study was to gather information on the most serious complications of injecting drug use from two perspectives, intensive care admissions and forensic toxicology reports.

Material and methods: Firstly, intensive care admissions related to injecting drug abuse during a five year period were reviewed for demographics, complications and 5 year survival. Secondly, information from forensic toxicology reports regarding deaths amongst known injecting drug abusers were gathered for the same period.

Results: A total of 57 patients with a history of active injecting drug use were admitted to intensive care or approximately 1% of admissions, most often for overdose (52%) or life threatening infections (39%). Median age was 26, males were 66%. The most common substances used were prescription drugs. Hospital mortality was 16% and five year survival 65%. Average time from hospital discharge to death was 916±858 days. During the study period 38 deaths of individuals with a history of injecting drugs were identified by forensic toxicology reports or 4.1/105 population/year (age 15-59). Cause of death was most often overdose (53%), usually from prescription opiates but multiple drug use was common.

Discussion: The life expectancy of injecting drug abusers after intensive care admission is substantially decreased, with 35% death rate within five years. A widespread use of prescription drugs is of concern. Injecting drug abuse seems to be a similar health problem in magnitude in Iceland as in other Scandinavian countries.

Table I.

Toxicological screening in fatal cases of injecting drug use. All findings in blood from the toxicological screening of 20 cases of fatal drug overdose.

Fig 1. ICU admissions related to injecting drug abuse during the study period 2003 to 2007. Gender distribution and number of survivors and deaths are shown for each year.

Fig 2. Kaplan Meier graph showing the rate of survival amongst injecting drug abusers admitted to ICU during 2003-2007. The follow up period was from January 1st 2003 to December 31st 2012.

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