Citation

van Ameijden EJ, Krol A, Vlahov D, Flynn C, van Haastrecht HJ, Coutinho RA. Subst. Use Misuse 1999; 34(6): 845-865.

Affiliation

Division of Public Health and Environment, Municipal Health Service, Amsterdam, The Netherlands. evameijden@GGGD.amsterdam.nl

Copyright

(Copyright © 1999, Informa - Taylor and Francis Group)

DOI

unavailable

PMID

10227114

Abstract

Mortality and morbidity between injecting drug users in Amsterdam (n = 624) and Baltimore (n = 2,185) are compared 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). Overdose/suicide mortality was twofold higher in Amsterdam; no sufficient explanation was found. Other independent "risk factors" for overdose/suicide mortality were recent injecting, polydrug use, and HIV-seropositivity (especially with CD4 count < 200/mm3). High dose methadone maintenance was associated with lower mortality. 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.

Language: en