Understanding causes of death due to chronic drug use

Background: People who use drugs experience an increased risk of mortality; however despite drug-related deaths occurring both due to acute drug overdose and co-morbid health conditions, there is currently limited contextual information and interventions for secondary-related diseases associated with chronic drug use. An understanding of the links between co-morbid health conditions and chronic drug use could help to guide the development of initiatives specifically targeted to reduce chronic drug-related health harms. The aim of this project is to evaluate the causes of death due to chronic drug use, in order to recognise how healthcare provision for this demographic can be best tailored to prevent fatalities.
 
Methods: Data was extracted from the National Programme on Substance Abuse Deaths (NPSAD), a database of deaths following psychoactive drug use populated by coroner reports from across England, Wales, and Northern Ireland. Cases were those where death occurred 2003-2022 and decedents were known to use drugs, where no drugs were implicated in causing death, where death was deemed unintentional at conclusion of coronial inquest, and death was not due to traumatic injury.
 
Results: A total of 762 cases were extracted for analysis. Deaths related to chronic drug use more than doubled over the 20-year study period (2003-2007 mean average: 28 deaths per year; 2018-2022 mean average: 75 deaths per year), with average age at time of death also increasing (2003-2007 mean average: 40.1 years; 2018-2022 mean average: 45.6 years). Infection was the most commonly cited underlying cause of death (30.8% of cases, n=235/762)) with respiratory (8.3% of these cases, n=63/235) and cardiac (6.6% of these cases, n=50/235) infections predominating. The second most commonly cited underlying cause was IV drug use (26.0% of cases, n=198/762). There was high correlation (96.2%) between people who were known injecting drug users and had an infection-related cause of death.
 
Conclusions: Deaths related to chronic drug use in the UK are increasing. Initiatives to combat the onset and treatment of bacterial infection in this cohort would be of particular value to reverse this trend. The Hepatitis B vaccination drive in the mid-2000s decreased the number of deaths due to this viral infection, demonstrating the feasibility and impact of such initiatives.