The Netherlands Drug Situation 2010 - Trimbos-instituut

Figure 12.1.1:Number of deaths among drug users in Amsterdam160Number1401201008060402001993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009Overdose 37 39 26 26 22 25 27 31 32 29 21 22 29 21 25 22 29Other causes* 102 86 92 90 76 67 73 76 112 96 128 61 84 58 66 87 65Total 139 125 118 116 98 92 100 107 144 125 149 83 113 79 91 109 94*The category "other causes" includes mortality not related to drugs (base-rate mortality), and mortality indirectlyrelated to drugs. Cases are counted among all drug users who have (ever) been registered in the CentralMethadone Register of the Amsterdam Municipal Health Service. This may result in an overestimation of thenumber of cases in the category ‘other causes’.Each year more deaths were due to “causes other than overdose". In 2005 the numberof deaths temporarily increased, but in general there is a stabilizing downward trendsince 2003.Apart from the absolute number of deaths per year, the Municipal Health Service Amsterdamalso monitors the mortality rates per observed person years. In order to conducta proper follow-up of drug users, only methadone patients who are likely to stay in Amsterdamare included in this monitoring system. Moreover, only those methadone patientsare included who have a known address in the city and were born in the Netherlands,Surinam, the Netherlands Antilles, Turkey, or Morocco.Figure 12.1.2 gives the mortality per 1,000 person years of observation for the four-yearperiods from 1985-1988 to 2001-2004, and the five-year period 2005-2009. A steadyincrease in the baseline mortality is seen, which is related to the ageing of the populationof opiate users. Moreover, while the overdose mortality showed a declining trend, asteady increase was seen in mortality due to other causes until 2001-2004, which mightbe indirectly related to the ageing of the population (more somatic and psychiatric comorbidity).This trend seems to be stabilizing in the period 2005-2009. The standardizedmortality ratios further decreased from 6.4 in 2006 to 4.5 in 2008 and 2009. Probably,the majority of injecting drug users who are at highest risk of dying have died alreadyand current risk ratios tend to decrease to the level among non-injecting drug users.180