Long-term mortality, remission, criminality and psychiatric comorbidity of heroin dependence: 11-year findings from the Australian Treatment Outcome Study

Addiction. 2015 Jun;110(6):986-93. doi: 10.1111/add.12860. Epub 2015 Mar 2.


Aims: To determine the long-term mortality, remission, criminality and psychiatric comorbidity during 11 years among heroin-dependent Australians.

Design: Longitudinal cohort study.

Setting: Sydney, Australia.

Participants: A total of 615 participants were recruited and completed baseline interviews between 2001 and 2002. Participants completed follow-up interviews at 3, 12, 24 and 36 months post-baseline, and again at 11 years post-baseline; 431 (70.1%) of the original 615 participants completed the 11-year follow-up.

Measurements: Participants were administered the Australian Treatment Outcome Study (ATOS) structured interview, addressing demographics, treatment history, drug use, heroin overdose, criminality, health and mental health at all interviews. Overall, 96.1% of the cohort completed at least one follow-up interview.

Findings: At 11 years, 63 participants (10.2%) were deceased. The proportion of participants who reported using heroin in the preceding month decreased significantly from baseline (98.7%) to 36-month follow-up (34.0%; odds ratio = 0.01; 95% confidence interval = 0.00, 0.01) with further reductions evident between 36 months and 11 years (24.8%). However, one in four continued to use heroin at 11 years, and close to one-half (46.6%) were in current treatment. The reduction in current heroin use was accompanied by reductions in risk-taking, crime and injection-related health problems, and improvements in general physical and mental health. The relationship with treatment exposure was varied. Major depression was associated consistently with poorer outcome.

Conclusions: In an 11-year follow-up of patients undergoing treatment for heroin dependence, 10.2% had died and almost half were still in treatment; the proportion still using heroin fell to a quarter, with major depression being a significant predictor of continued use.

Keywords: Cohort; criminality; heroin; longitudinal; mortality; psychiatric comorbidity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Crime / statistics & numerical data*
  • Depressive Disorder, Major / complications
  • Depressive Disorder, Major / mortality*
  • Diagnosis, Dual (Psychiatry)
  • Drug Overdose / epidemiology
  • Female
  • Follow-Up Studies
  • Heroin / poisoning
  • Heroin Dependence / complications
  • Heroin Dependence / mortality*
  • Humans
  • Male
  • Mental Health
  • Needle Sharing / statistics & numerical data
  • New South Wales / epidemiology
  • Personality Disorders / complications
  • Personality Disorders / mortality*
  • Sex Distribution
  • Substance Abuse, Intravenous / complications
  • Substance Abuse, Intravenous / mortality*
  • Treatment Outcome


  • Heroin