The contributions of viral hepatitis and alcohol to liver-related deaths in opioid-dependent people

Drug Alcohol Depend. 2013 Aug 1;131(3):252-7. doi: 10.1016/j.drugalcdep.2012.11.012. Epub 2012 Dec 10.


Background: Mortality rates are elevated among heroin-dependent populations compared to the general population. Liver disease is emerging as an important contributor to mortality as the heroin-dependent population ages. Two major risk factors for liver disease are hepatitis C virus infection and chronic heavy alcohol use. Both of these are highly prevalent among heroin dependent people, but their relative contribution to liver-related mortality is poorly understood.

Methods: Data recording all prescriptions of opioid substitution treatment in New South Wales, Australia, 1997-2005, were linked to the National Death Index. Crude and standardised mortality rates and standardised mortality ratios were calculated for liver-related and other major causes of death. Frequency counts were obtained for viral hepatitis and alcohol mentions in underlying liver deaths.

Results: There were 208 underlying liver deaths for a CMR of 72.4 per 100,000 py (95% CI 62.9, 82.9), and liver deaths occurred at 9.8 times the general population rate (95% CI 8.5, 11.2). There were increases in liver-related mortality over time. Viral hepatitis was mentioned in three-quarters (n=156, 76%), and alcohol in 43% (n=90) of underlying liver deaths.

Conclusions: Liver-related deaths were shown to be increasing in this heroin-dependent population, and the majority of these deaths involved chronic viral hepatitis infection. Increased uptake of treatment for hepatitis C virus infection is crucial to reducing the burden of liver-related mortality in this population. Hepatitis B vaccination, and screening of OST patients for alcohol use disorders and delivery of brief interventions as clinically indicated may also be of benefit.

Keywords: Hepatitis C; Heroin; Liver disease; Mortality; Opioids.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alcohol Drinking / epidemiology
  • Alcohol Drinking / mortality*
  • Cohort Studies
  • Female
  • Hepatitis C / diagnosis
  • Hepatitis C / epidemiology
  • Hepatitis C / mortality*
  • Heroin Dependence / diagnosis
  • Heroin Dependence / epidemiology
  • Heroin Dependence / mortality*
  • Humans
  • Liver Diseases / diagnosis
  • Liver Diseases / epidemiology
  • Liver Diseases / mortality*
  • Male
  • New South Wales / epidemiology
  • Opioid-Related Disorders / diagnosis
  • Opioid-Related Disorders / epidemiology
  • Opioid-Related Disorders / mortality