Impact of Binge Alcohol on Mortality among People who Inject Drugs
INTRODUCTION:
While
the impacts of illicit drug use on mortality have been well described, the
impact of poly-substance that includes alcohol has received less attention. We
examined the impact of binge alcohol use on mortality among a cohort of people
who inject drugs (PWID) in a Canadian setting.
METHODS:
Using
data derived from a prospective cohort study of PWID in Vancouver, Canada
recruited between May 1996 and November 2013. We ascertained dates and causes
of death through a confidential linkage with the provincial registry and
examined the impact of binge alcohol use. The primary outcome of interest was
all-cause mortality. We used Cox proportional hazard regression to determine
factors associated with mortality, including socio-demographic characteristics,
drug use patterns and other risk behaviours.
RESULTS:
During
the study period, 2550 individuals were followed (844 of whom were HIV positive
at baseline) for a median of 75.4 months (interquartile range 37.9 113.2). Of
these, 795 (31%) participants reported binge alcohol use at some time during
the study period. In multivariable analyses, binge alcohol use remained
independently associated with all-cause-mortality (adjusted hazard ratio=1.41;
95% confidence interval: 1.06-1.88) after adjustment for other drug use
patterns.
CONCLUSIONS:
Binge
alcohol use was associated with time to all-cause mortality among PWID in this
setting. Since alcohol use is often overlooked as a risk factor for mortality
among this population, these findings highlight the continued need to
incorporate addiction treatment and public health interventions and policies
that address binge alcohol use to reduce alcohol related-harms.
...Our findings that binge
alcohol use is associated with an increased risk for mortality is unique as we
are unaware of any study that specifically examined binge alcohol use and
all-cause mortality risk for PWID. Nevertheless, our findings are congruent
with existing literature that focuses on fatal and non-fatal overdose mortality
for PWID, particularly for opioid users with alcohol use, although such results
have varied across geographic regions in their prediction of morbidity and
mortality (Coffin et al., 2003, Darke et al., 1996, Fischer et al., 2004, Kaye and Darke, 2004, Kerr et al., 2007, McGregor et al., 1998 and Sergeev et al., 2003). One Canadian study, which focused on overdose
mortality, identified alcohol use as a predictor of overdose in the unadjusted
model, however the adjusted model was not significant (Fischer et al., 2004). Another Canadian study that looked at non-fatal
overdose among polysubstance users found an independent association between
daily alcohol use and non-fatal overdose (OR 1.32 CI: 1.09–1.60) (Kerr et al., 2007). Our other multivariable findings are consistent with
published literature on increased mortality for PWID including HIV serostatus (Degenhardt et al., 2011a, Hayden et al., 2014 and Lappalainen et al., 2015) and daily cocaine injection (Degenhardt et al., 2011b and Hayden et al., 2014), while participation in a methadone maintenance
therapy was associated with a negative time to all cause mortality. This
suggests the need for a multi-pronged approach to intervention, including harm
reduction strategies, to address morbidity and mortality among PWID. Such an
approach should also include screening and treatment for binge or excessive
alcohol use...
- 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital 603-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6.
- 2British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital 603-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6 ; Department of Family Practice, University of British Columbia.
- 3British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital 603-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6 ; Department of Medicine, University of British Columbia.
- Addict Behav Rep. 2015 Dec 1;2:28-32.
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