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Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment

BMJ 2010; 341 doi: (Published 01 July 2010) Cite this as: BMJ 2010;341:c3172

More questions than answers...

Well done to Kimber et al for a study in a neglected population that
are not easy to engage for research. However, I'd be keen to know a bit
more detail before I would conclude that there is a reduced risk of death
that might merit greater promotion of opiate substitution.

1. 24% of the 228 pts who died did so from ODs. How many of these
were on opiate substitution at the time of overdose? The Procurator Fiscal
may take a dim view of concurrent opiate substitution along with suse of
street drugs

2. In addition, the level of death from blood-borne viruses in the group
is very high. Data about whether the BBV were acquired by pts in the
course of the study among the opiate substition. are not clear. If
there's ongoing injection, there's likely to be ongoing BBV risk even for
those testing negative at the beginning of the study period and over time
greater than the study period, mortality rates may change

3. An inherent weakness in many studies of IVDU is that of self-reported
behaviour. There's no easy way to corroborate injection cessation. The
authors do not mention this as a confounding variable

Competing interests:
interest in substance misuse

Competing interests: No competing interests

21 July 2010
D MacDonagh
Elmwood Practice, Belfast, BT 9 7HR