Appel P W, Joseph H, Richman B L
New York State Office of Alcoholism and Substance Abuse Services, 501 Seventh Avenue, New York, NY 10018-5903, USA.
Mt Sinai J Med. 2000 Oct-Nov;67(5-6):444-51.
Causes of death and the mortality rates of active methadone patients and those who had left treatment were compared. Prior to the HIV epidemic, death rates among discharged methadone patients were more than twice that of patients who continued with their methadone treatment. However, the death rate from heroin-related causes in the post-treatment period was 51 times the rate among active patients. Alcohol-related conditions were the leading causes of death in patients more than 30 years old on methadone. During the post-treatment period, alcohol-related deaths were second to those of heroin-related causes. Alcohol-related deaths were particularly pronounced among black patients. Death rates among active male and female patients were identical, but the death rate for discharged female patients was greater than for discharged males. With the onset of the HIV epidemic in the 1980s, AIDS-related causes became the major cause of death in treatment. However, other causes of death, such as alcohol and other medical conditions, identified prior to the AIDS epidemic, persisted. AIDS-related deaths peaked in the mid-1990s and have recently subsided. However, within the past two years, deaths related to HCV have increased to 9% of all patient deaths in a major methadone program. With the emergence of HCV, deaths from this cause are expected to eclipse AIDS-related deaths within the next decade.
对正在接受美沙酮治疗的患者和已停止治疗的患者的死因及死亡率进行了比较。在艾滋病流行之前，出院的美沙酮患者的死亡率是继续接受美沙酮治疗患者的两倍多。然而，在停止治疗期间，与海洛因相关原因导致的死亡率是正在接受治疗患者的51倍。与酒精相关的疾病是30岁以上接受美沙酮治疗患者的主要死因。在停止治疗期间，与酒精相关的死亡仅次于与海洛因相关原因导致的死亡。与酒精相关的死亡在黑人患者中尤为明显。正在接受治疗的男性和女性患者的死亡率相同，但出院女性患者的死亡率高于出院男性。随着20世纪80年代艾滋病的流行，与艾滋病相关的原因成为治疗中的主要死因。然而，在艾滋病流行之前确定的其他死因，如酒精和其他医疗状况，依然存在。与艾滋病相关的死亡在20世纪90年代中期达到峰值，最近有所下降。然而，在过去两年中，在一个主要的美沙酮项目中，与丙型肝炎病毒（HCV）相关的死亡人数已增至所有患者死亡人数的9%。随着丙型肝炎病毒的出现，预计在未来十年内，由该病因导致的死亡人数将超过与艾滋病相关的死亡人数。
