Pre-AIDS mortality and morbidity among injection drug users in Amsterdam and Baltimore: An ecological comparison

Erik J.C. Van Ameijden, Anneke Krol, David Vlahov, Colin Flynn, Harry J.A. Van Haastrecht, Roel A. Coutinho

    Research output: Contribution to journalArticle

    Abstract

    Mortality and morbidity between injecting drug users in Amsterdam (n = 624) and Baltimore (n = 2,185) are compared to generate a hypothesis about the role of different health care systems and drug user policies (universal care and harm reduction versus episodic care and criminalization, respectively). Overdose/suicide mortality was twofold higher in Amsterdam; no sufficient explanation was found. Other independent 'risk factors' for overdose/suicide mortality were recent injecting, polydrug use, and HIV- seropositivity (especially with CD4 count < 200/mm3). High dose methadone maintenance was associated with lower mortality. Incidence of hospitalizations and emergency room visits was substantially lower in Amsterdam, suggesting that higher accessibility to primary care in Amsterdam lowers (inpatient) hospital visits and presumably societal costs.

    Original languageEnglish (US)
    Pages (from-to)845-865
    Number of pages21
    JournalSubstance Use and Misuse
    Volume34
    Issue number6
    DOIs
    StatePublished - Jan 1 1999

    Keywords

    • Drug overdose
    • Human immunodeficiency virus
    • Intravenous
    • Morbidity
    • Mortality
    • Substance use

    ASJC Scopus subject areas

    • Health(social science)
    • Medicine (miscellaneous)
    • Public Health, Environmental and Occupational Health
    • Psychiatry and Mental health

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  • Cite this

    Van Ameijden, E. J. C., Krol, A., Vlahov, D., Flynn, C., Van Haastrecht, H. J. A., & Coutinho, R. A. (1999). Pre-AIDS mortality and morbidity among injection drug users in Amsterdam and Baltimore: An ecological comparison. Substance Use and Misuse, 34(6), 845-865. https://doi.org/10.3109/10826089909037245