Pre-AIDS Mortality and Morbidity Among Injection Drug Users in Amsterdam and Baltimore: An Ecological Comparison

• NCJ Number: 178178
• Journal: Substance Use and Misuse Volume: 34 Issue: 6 Dated: 1999 Pages: 845-865
• Author(s): Eric J. C. van Ameijden Ph.D; Anneke Krol M.Sc; David Vlahov Ph.D.; Colin Flynn M.Sc; Harry J. A. van Haastrecht Ph.D.; Roel A. Coutinho Ph.D.
• Date Published: 1999
• Length: 21 pages
• Grant Number(s): DA04334; DA08009
• Sponsoring Agency: National Institute on Drug Abuse
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America
• Note: DCC

Annotation

This study compared the mortality and morbidity of injecting drug users in Amsterdam (n=624) and Baltimore, Md., (n=2,185) 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).

Abstract

The Baltimore drug-user policy has been fairly typical for the United States and can be characterized by criminalization and medicalization. This is operationalized by laws against the possession and sale of drugs and drug paraphernalia, with needle exchange programs being illegal until recently. Also, the goal of methadone programs is mainly detoxification of addicts, and the threshold to attend these programs is relatively high. The Netherlands, including Amsterdam, has a "harm reduction" policy; abstinence is the primary goal, but if this is not considered feasible, harm associated with drug use should be minimized, both for the drug user and society. Possession of injection equipment and a small amount of heroin, cocaine, or other drugs is tolerated, and a large-scale needle exchange program has operated since 1984. Other differences between the two cities are related to the health care system, including medical insurance. Overdose/suicide mortality was twice as high in Amsterdam as in Baltimore; no sufficient explanation for this fact could be found. Other independent "risk factors" for overdose/suicide mortality were recent injecting, polydrug use, and HIV-seropositivity (especially with CD4 count greater than 200/mm). High-dose methadone maintenance was associated with lower mortality. The 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. Due to identified study limitations, causal relationships regarding differences between the cities could not be established. 4 tables and 42 references