Tobacco smoking and illegal drug use each contribute substantially to premature mortality among people who use heroin, with illegal drugs accounting for more early deaths, but tobacco smoking remains a major preventable cause of death later in life, according to study results published in Addiction.
Researchers analyzed data from 106,789 individuals who used illegal opioids in England between 2001 and 2018, using the Clinical Practice Research Datalink and Office for National Statistics mortality data. A life-table model was applied to estimate cause-specific and all-cause mortality by age. Six major causes of death were analyzed, with assumptions made about their attribution to tobacco or illegal drugs. The risk of premature death (before age 70), years of life lost (YLL), and changes under hypothetical scenarios where tobacco, drugs, or both were eliminated were calculated using Poisson models and Monte Carlo simulations.
Among 13,010 deaths before age 70 in a cohort of people who used illegal opioids in England (2001–2018), 33.6% were due to drug poisoning, 9.1% to respiratory cancers or chronic obstructive pulmonary disease (COPD), 9.0% to other cancers, 8.5% to cardiovascular diseases, 2.3% to viral hepatitis, and 37.6% to other causes. Drug poisoning mortality peaked at age 47, while smoking-related and cardiovascular deaths rose steadily with age. Life-table modeling estimated a 63.2% (95% CI, 62.2-64.1) risk of premature death in this group, compared with 16.2% in the general population. Of these premature deaths, 27.6% (17.5% absolute risk) were attributed to illegal drugs and 23.6% (14.9% risk) to tobacco smoking.
Each person in the cohort lost a mean of 12.2 years of life before age 70. Among these, 4.9 years were attributable to illegal drugs (40.4% of total YLLs) and 1.7 years to tobacco smoking (13.8%). Simulated scenarios showed that eliminating tobacco would reduce risk of death before age 70 by 11.8 percentage points (to 51.5%) and save 1.7 YLL per person, while eliminating illegal drugs would reduce the risk by 9.4 points (to 53.9%) and save 4.9 YLL. Eliminating both exposures would lower risk to 39.1% and reduce YLLs to 6.45 per person.
Among people who use heroin, tobacco smoking is likely to cause a similar number of premature deaths as illegal drugs.
Study limitations included a lack of generalizability, the effect of cessation of illegal drug use or tobacco smoking was not estimated, and the broad categories used may have excluded smoking- and drug-attributable deaths. The study authors concluded, “[a]mong people who use heroin, tobacco smoking is likely to cause a similar number of premature deaths as illegal drugs.”
This article originally appeared on Psychiatry Advisor
