THE EPIDEMIOLOGY OF DEATH IN NARCOTIC ADDICTS1

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Abstract
Cherubin, C. (Dept. Medicine, Metropolitan Hospital, New York, N.Y. 10029), J. McCusker, M. Baden, F. Kavaler and Z. Amsel. The epidemiology of death in narcotic addicts. Am J Epidemiol 96: 11–22, 1972.—Information obtained from the Office of the Chief Medical Examiner of New York City, and the Narcotics Register of the New York City Department of Health was used to examine the epidemiology of deaths in narcotic addicts in this city. There was a marked increase in these deaths from 1967 through 1970, in parallel with other evidence of a marked expansion of the addict population. During 1964–1966 the number of deaths had been stable, as were the other indices of the addict population. When the deaths during 1967 were investigated, 80% were found to be assigned the death certificate diagnosis of “narcotism”. In nearly 90% of these deaths there was a recent intravenous injection with apparent sudden collapse, and evidence of pulmonary edema was frequently noted. Thus an “acute reaction” to injected material is probable. There was a marked seasonal variation in “narcotism” deaths, with a peak during the summer months, but not in other causes of death. There is also a summer peak in hepatitis in addicts, hospitalizations for cellulitis in addicts, and nonfatal “overdoses” Total reports of addicts are higher in the second half of the year. The demographic characteristics of the “narcotism” deaths were similar to those of the total addict population known to the Narcotics Register. This suggests that there is no especially high risk group among addicts for this cause of death. In contrast deaths due to trauma and infection were more common among older addicts. We conclude that the main cause of death in New York City narcotic addicts is an idiosyncratic reaction to an intravenous injection of unspecified material(s) and probably not a true pharmacologic overdose of narcotics. An increase in addiction activity during the summer would explain the summer peak in deaths, and hospital admissions for hepatitis and cellulitis.

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