There were fewer female than male treatment-seekers, and female drug users had higher excess mortality and also higher mean PYLL per decedent than males. There is a need for future research studies to assess if women in general, and indeed any subgroups of women, face any barriers to drug abuse treatment. For example, a qualitative research using interpretivist approach in order to understand women’s perceptions of drug use, treatment and barriers to treatment participation. A mixed methods research incorporating both qualitative and quantitative methodology could also be helpful.
Older drug users were few in this cohort. Further studies would be necessary to investigate if older persons who use drugs experience any barriers to treatment seeking, if those already in contact with treatment services encounter any barriers, and to identify the best ways to reduce such barriers. A qualitative research using interpretivist approach might be best suited for such studies since there seems to be few older people in the general population who use drugs. Hence, qualitative technique will help researchers to obtain deeper insights into the experiences, opinions and feelings of older drug users.
Being that accidental overdose was the single most important cause of death, further studies are needed to explore means of addressing accidental overdose.
Research studies conducted in other countries have documented positive results with take-home emergency naloxone and overdose response/management training (Lankenau et al. 2013; Strang et al. 2008) such as reduction in the rate of overdose deaths. Future studies could explore to see if such successes could be reproduced in Finland (especially among users of full opioid agonists) alongside with identifying factors that might hinder drug users from applying the overdose response techniques.
9 References
Academy of Finland. Research programme on substance use and addictions, 2006.
Available at:
http://www.aka.fi/Tiedostot/Tiedostot/ADDIKTIO/Ohjelmamuistio%20%28pdf%29.pdf [Accessed 04.03.2013].
Alho H, Sinclair D, Vuori E, & Holopainen A. Abuse liability of buprenorphine-naloxone tablets in untreated IV drug users. Drug and Alcohol Dependence 2007;88(1):75–78.
Arendt M, Munk-Jorgensen P, Sher L, & Jensen SO. Mortality among individuals with cannabis, cocaine, amphetamine, MDMA, and opioid use disorders: a nationwide follow-up study of Danish substance users in treatment. Drug and Alcohol Dependence 2011;114(2-3):134–139.
Arendt M, Munk-Jørgensen P, Sher L, & Jensen SO. Mortality following treatment for cannabis use disorders: Predictors and causes. Journal of Substance Abuse Treatment 2013;44(4):400–406.
Australian Bureau of Statistics 2006. Available at:
http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3321.0.55.001Explanatory%20Notes1 1991-2001?OpenDocument [Accessed 12.05.2015].
Avert. European HIV & AIDS statistics. Available at: http://www.avert.org/european-hiv-aids-statistics.htm [Accessed 27.05.2015].
Ayres RM, Eveson L, Ingram J, & Telfer M. Treatment experience and needs of older drug users in Bristol, UK. Journal of Substance Use 2012;17(1):19–31.
Bargagli AM, Hickman M, Davoli M, Perucci CA, Schifano P, Buster M, Brugal T, Vicente J, & COSMO European Group. Drug-related mortality and its impact on adult mortality in eight European countries. European Journal of Public Health 2006;16(2):198–202.
Basnet S. Characteristics of substance-abusing females with and without children seeking treatment in Helsinki, Finland. 2014. Master’s thesis. University of Eastern Finland.
Basnet S, Onyeka IN, Tiihonen J, Föhr J, Kauhanen J. Characteristics of drug-abusing females with and without children seeking treatment in Helsinki, Finland. Scandinavian Journal of Public Health 2015; 43(3):221–228.
Bartu A, Freeman NC, Gawthorne GS, Codde JP, & Holman CD. Mortality in a cohort of opiate and amphetamine users in Perth, Western Australia. Addiction 2004;99(1):53–60.
Beynon CM. Drug use and ageing: older people do take drugs! Age and Ageing 2009;38(1):8–10.
Beynon CM, & McVeigh J. The role of substance use in non-drug related deaths: a cross-sectional study of drug treatment clients in the North West of England. Journal of Substance Use 2007;12(1):39–47.
Beynon C, McVeigh J, Hurst A, & Marr A. Older and sicker: changing mortality of drug users in treatment in the North West of England. International Journal of Drug Policy 2010a;21(5):429–431.
Beynon CM, Roe B, Duffy P, & Pickering L. Self-reported health status and heath service contact, of illicit drug users aged 50 and over: a qualitative interview study in Merseyside United Kingdom. BMC Geriatrics 2009;9:45.
Beynon CM, Taylor A, Allen E, & Bellis MA. Visual versus written cues: a comparison of drug injectors’ responses. Have surveys using the written word underestimated risk behaviors for hepatitis C? Substance Use & Misuse 2010b; 45(10):1491–1508.
Bjornaas MA, Bekken AS, Ojlert A, Haldorsen T, Jacobsen D, Rostrup M, & Ekeberg O. A 20-year prospective study of mortality and causes of death among hospitalized opioid addicts in Oslo. BMC Psychiatry 2008;8:8.
Blacken P, Hendriks V, Pozzi G, Tempesta E, Hartgers C, Koeter M, Fahrner EM,
Gsellhofer B, Küfner H, Kokkevi A, & Uchtenhagen A. European addiction severity index EuropASI manual. 1994. Available at:
http://www.emcdda.europa.eu/html.cfm/index3647EN.html [accessed 06.12.2010].
Bloor M, Gannon M, Hay G, Jackson G, Leyland AH, & McKeganey N. Contribution of problem drug users' deaths to excess mortality in Scotland: secondary analysis of cohort study. BMJ 2008;337:a478.
Boddiger D. Drug abuse in older US adults worries experts. Lancet 2008;372(9650):1622.
Bohnert AS, Roeder K, & Ilgen MA. Unintentional overdose and suicide among substance users: a review of overlap and risk factors. Drug and Alcohol Dependence 2010;110(3):183–
192.
Boys A, Marsden J, & Strang J. Understanding reasons for drug use amongst young people: a functional perspective. Health Education Research 2001; 16(4):457–469.
Brådvik L, Berglund M, Frank A, Lindgren A, & Löwenhielm P. Number of addictive substances used related to increased risk of unnatural death: a combined medico-legal and case-record study. BMC Psychiatry 2009;9:48.
British Broadcasting Corporation (BBC). Warning over vodka snorting fad. Online report, 20 October 2006. Available at:
http://news.bbc.co.uk/2/hi/uk_news/england/derbyshire/6069076.stm [Accessed 30.10.
2015].
Caiaffa WT, Zocratto KF, Osiman ML, Martinez PL, Radulich G, Latorre L, Muzzio E, Segura M, Chiparelli H, Russi J, Rey J, Vazquez E, Cuchi P, Sosa-Estani S, Rossi D, &
Weissenbacher M. Hepatitis C virus among non-injecting cocaine users (NICUs) in South America: Can injectors be a bridge? Addiction 2011;106(1):143–151.
Calabria B, Degenhardt L, Hall W, & Lynskey M. Does cannabis use increase the risk of death? Systematic review of epidemiological evidence on adverse effects of cannabis use.
Drug and Alcohol Review 2010;29(3):318–330.
Canadian Institute for Health Information (CIHI): Health indicators 2012. Available at:
https://secure.cihi.ca/free_products/health_indicators_2012_en.pdf [Accessed 14.09.2015].
Castillo M. Inhaling alcohol vapour puts you at risk of overdose. The CBS News, online report, 05 June 2013. Available at: http://www.cbsnews.com/news/inhaling-alcohol-vapor-puts-you-at-risk-of-overdose/ [Accessed 30.10.2015].
Chen CY, & Lin KM. Health consequences of illegal drug use. Current Opionion in Psychiatry 2009;22(3):287–292.
Clausen T, Waal H, Thoresen M, & Gossop M. Mortality among opiate users: opioid maintenance therapy, age, and causes of death. Addiction 2009;104:1356–1362.
Colon HM, Deren S, Robles RR, Kang SY, Cabassa M, & Sahai H. A comparable study of mortality among Puerto Rican injection drug users in East Harlem, New York, and Bayamon, Puerto Rico. Journal of Urban Health 2006;83(6):1114–1126.
Darke S, Degenhardt L, & Mattick R. Mortality among illicit drug users: epidemiology, causes, and intervention. Eds. Cambridge University Press, Cambridge; 2007.
Darke S, Mills KL, Ross J, & Teesson M. Rates and correlates of mortality amongst heroin users: findings from the Australian Treatment Outcome Study (ATOS), 2001-2009. Drug and Alcohol Dependence 2011;115(3):190–195.
Darke S, & Ross J. Fatal heroin overdoses resulting from non-injecting routes of administration, NSW, Australia, 1992–1996. Addiction 2000;95(4):569–573.
Degenhardt L, Bucello C, Calabria B, Nelson P, Roberts A, Hall W, Lynskey M, Wiessing L
& the GBD illicit drug use writing group. What data are available on the extent of illicit drug use and dependence globally? Results of four systematic reviews. Drug and Alcohol Dependence 2011a;117(2-3):85–101.
Degenhardt L, Bucello C, Mathers B, Briegleb C, Ali H, Hickman M & McLaren J.
Mortality among regular or dependent users of heroin and other opioids: a systematic review and Meta-analysis of cohort studies. Addiction 2011b;106(1):32–51.
Degenhardt L, Hall W, Warner-Smith M, & Lynskey M. Illicit drug use. In: Ezzati M, Lopez AD, Rodgers A, & Murray CJL. (Eds.) Comparative quantification of health risks:
Global and regional burden of disease attributable to selected major risk factors, 2004 Available at: http://www.who.int/healthinfo/global_burden_disease/cra/en/. [Accessed 10.10.2011].
Degenhardt L, Hall W, & Warner-Smith M. Using cohort studies to estimate mortality among injecting drug users that is not attributable to AIDS. Sexually Transmitted Infections 2006;82(Suppl 3):iii56–iii63.
Degenhardt L, Larney S, Randall D, Burns L, & Hall W. Causes of death in a cohort treated for opioid dependence between 1985 and 2005. Addiction 2014;109(1):90–99.
Degenhardt L, Whiteford HA, Ferrari AJ, Baxter AJ, Charlson FJ, Hall WD, Freedman G, Burstein R, Johns N, Engell RE, Flaxman A, Murray CJ, & Vos T. Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010. Lancet 2013;382(9904):1564–1574.
de la Fuente L, Molist G, Espelt A, Barrio G, Guitart A, Bravo MJ, Brugal MT, & Spanish Working Group for the Study of Mortality among Drug Users. Mortality risk factors and excess mortality in a cohort of cocaine users admitted to drug treatment in Spain. Journal of Substance Abuse Treatment 2014;46(2):219–226.
Del Giudice P. Cutaneous complications of intravenous drug abuse. British Journal of Dermatology 2004;150(1):1–10.
Demirci AC, Erdoğan A, Yalçın Ö, Yıldızhan E, Koyuncu Z, Eseroğlu T, Önder A, & Evren C. Sociodemographic characteristics and drug abuse patterns of adolescents admitted for substance use disorder treatment in Istanbul. American Journal of Drug and Alcohol Abuse 2015;41(3):212–219.
Des Jarlais DC, McKnight C, Arasteh K, Feelemyer J, Perlam DC, Hagan H, & Cooper HLF. Transitions from injecting to non-injecting drug use: potential protection against HCV infection. Journal of Substance Abuse Treatment 2014;46(3):325–331.
Dias AC, Araújo MR, Dunn J, Sesso RC, de Castro V, & Laranjeira R. Mortality rate among crack/cocaine-dependent patients: a 12-year prospective cohort study conducted in Brazil.
Journal of Substance Abuse Treatment 2011;41(3):273–278.
Donaldson LJ, & Scally G. Donaldsons’ essential public health. 3rd ed. Radcliff Publishing, Oxford; 2009.
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2010a. Selected issue - trends in injecting drug use in Europe. Publications Office of the European Union, Luxembourg.
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2010b. Selected issue – treatment and care for older drug users. Publications Office of the European Union, Luxembourg.
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2011a. Mortality related to drug use in Europe: public health implications. Publications Office of the European Union, Luxembourg.
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2011b. Annual report 2011: the state of the drugs problem in Europe. Publications Office of the European Union, Luxembourg.
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2015. European Drug Report: trends and developments. Publications Office of the European Union, Luxembourg.
Evans JL, Tsui JI, Hahn JA, Davidson PJ, Lum PJ, & Page K. Mortality among young injection drug users in San Francisco: a 10-year follow-up of the UFO study. American Journal of Epidemiology 2012;175(4):302–308.
Evening Standard. Experts blast ‘snorting alcohol’ craze. Online report, 13 April 2012.
Available at: http://www.standard.co.uk/news/experts-blast-snorting-alcohol-craze-7228711.html [Accessed 30.10.2015].
Finnish Information Centre for Register Research. Register-based research. Available at:
https://rekisteritutkimusen.wordpress.com/register-based-research/ [Accessed 03.06.2015].
Forsell M, & Nurmi T. Päihdehuollon huume-asiakkaat 2014. [The drug treatment clients in 2014]. Available at: https://www.julkari.fi/bitstream/handle/10024/126907/Tr17_FI.pdf [Accessed 21.10.2015].
Forsell M, Virtanen A, Jääskelainen M, Alho H, & Partanen A. Drug situation in Finland 2010: Drug-related treatment. 2010. National Institute for Health and Welfare (THL), Helsinki.
Fugelstad A, Annell A, & Ågren G. Long-term mortality and causes of death among hospitalized Swedish drug users. Scandinavian Journal of Public Health 2014;42(4): 364–
369.
Galea S, & Vlahov D. Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration. Public Health Reports 2002;117(suppl 1):s135–
s145.
Gardner JW, & Sanborn JS. Years of potential life lost (YPLL)—what does it measure?
Epidemiology 1990;1(4):322–329.
Gfroerer J, Penne M, Pemberton M, & Folsom R. Substance Abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort. Drug and Alcohol Dependence 2003; 69(2):127–135.
Ghuran A, van der Wieken LR, & Nolan J. Cardiovascular complications of recreational drug use: are an important cause of morbidity and mortality. BMJ 2001;323(7311):464–466.
Gibson A, Degenhardt L, Mattick RP, Ali R, White J, & O'Brien S. Exposure to opioid maintenance treatment reduces long-term mortality. Addiction 2008;103(3):462–468.
Gibson A, Randall D, & Degenhardt L. The increasing mortality burden of liver disease among opioid-dependent people: cohort study. Addiction 2011;106(12):2186–2192.
Gill J & Johnson P. Research methods for managers. 3rd ed. Sage publications, London;
2002.
Giraudon I, Vicente J, Matias J, Mounteney J, & Griffiths P. Reducing drug related mortality in Europe – a seemingly intractable public health issue. Adicciones 2012;24(1):3–
7.
Gissler M, & Haukka J. Finnish health and social welfare registers in epidemiological research. Norsk Epidemiologi 2004;14(1):113–120.
Gossop M, Stewart D, Marsden J, Kidd T, & Strang J. Changes in route of drug administration among continuing heroin users: outcomes 1 year after intake to treatment.
Addictive Behavior 2004;29(6):1085–1094.
Gossop M, Stewart D, Treacy S, & Marsden J. A prospective study of mortality among drug misusers during a 4-year period after seeking treatment. Addiction 2002;97(1):39–47.
Gotway MB, Marder SR, Hanks DK, Leung JW, Dawn SK, Gean AD, Reddy GP, Araoz PA, & Webb WR. Thoracic complications of illicit drug use: an organ system approach.
RadioGraphics 2002;22(Suppl 1):119–135.
Gowing LR, Ali RL, Allsop S, Marsden J, Turf EE, West R, & Witton J. Global statistics on addictive behaviours: 2014 status report. Addiction 2015;110(6):904–919.
Greenfield SF, & Grella CE. What is “women-focused” treatment for substance use disorders? Psychiatric Services 2009;60(7):880–882.
Hakkarainen P, Karjalainen K, Ojajärvi A, & Salasuo M. Huumausaineiden ja kuntodopingin käyttö ja niitä koskevat mielipiteet Suomessa vuonna 2014. [Drug use, doping and public opinion in Finland: results from the 2014 Drug Survey].
Yhteikuntapolitiikka 2015;80(4):319–333.
Hakkarainen P & Metso L. Huumeiden käytön uusi sukupolvi. [Drug use: the new generation]. Yhteiskuntapolitiikka 2003;68(3):244–256.
Hakkarainen P, Metso L, & Salasuo M. Hamppuikäpolvi, sekakäyttö ja doping – vuoden 2010 huumekyselyn tuloksia. [The hemp generation, mixed use and doping – results from the 2010 Drug Survey]. Yhteikuntapolitiikka 2011;76(4):397–411.
Häkkinen M, Launiainen T, Vuori E, & Ojanperä I. Benzodiazepines and alcohol are associated with buprenorphine poisoning. European Journal of Clinical Pharmacology 2012;68(3):301–309.
Huang CL, & Lee CW. Factors associated with mortality among heroin users after seeking treatment with methadone: A population-based cohort study in Taiwan. Journal of Substance Abuse Treatment 2013;44(3):295–300.
Huston P, & Naylor D. Health services research: reporting on studies using secondary data sources. Canadian Medical Association Journal 1996;155(12):1697–1709.
Institute for Digital Research Education [IDRE] 2015). What statistical analysis should I use? Statistical analyses using SPSS. Available at:
http://www.ats.ucla.edu/stat/spss/whatstat/whatstat.htm [Accessed 09.09.2015].
Jessup MA, Humphreys JC, Brindis CD, & Lee KA. Extrinsic barriers to substance abuse treatment among pregnant drug dependent women. Journal of Drug Issues 2003;
33(2):285–304.
Jimenez-Treviño L, Saiz PA, García-Portilla MP, Díaz-Mesa EM, Sánchez-Lasheras F, Burón P, Casares MJ, Marina P, Gutiérrez E, & Bobes J. A 25-year follow-up of patients admitted to methadone treatment for the first time: mortality and gender differences.
Addictive Behaviors 2011;36(12):1184–1190.
Kahila H, Gissler M, Sarkola T, Autti-Rämö I, & Halmesmäki E. Maternal welfare, morbidity and mortality 6–15 years after a pregnancy complicated by alcohol and substance abuse: A register-based case–control follow-up of 524 women. Drug and Alcohol Dependence 2010;111(3):215–221.
Kajantie M, Manderbacka K, McCallum A, Notkola IL, Arffman M, Forssas E, Karvonen S, Kortteinen M, Leyland A, & Keskimäki I. How to carry out register-based health services research in Finland? Compiling complex study data in the REDD project. Sosiaali- ja terveysalan tutkimus- ja kehittämiskeskus (STAKES), 2006. Available at:
https://www.julkari.fi/bitstream/handle/10024/77679/DP1-2006.pdf?sequence=1 [Accessed 03.06.2015].
Kankaanpää A, Ariniemi K, Heinonen M, Kuoppasalmi K, & Gunnar T. Use of illicit stimulant drugs in Finland: a wastewater study in ten major cities. Science of the Total Environment 2014;487:696–702.
Karjalainen K, Lintonen T, Impinen A, Mäkelä P, Rahkonen O, Lilsunde P, & Ostamo A.
Mortality and causes of death among drugged drivers. Journal of Epidemiology &
Community Health 2010;64(4):506–512.
Kedia S, Sell MA, & Relyea G. Mono- versus polydrug abuse patterns among publicly funded clients. Substance Abuse Treatment, Prevention and Policy 2007;2:33.
Kivelä P, Krol A, Simola S, Vaattovaara M, Tuomola P, Brummer-Korvenkontio H, &
Ristola M. HIV outbreak among injecting drug users in the Helsinki region: social and geographical pockets. European Journal of Public Health 2007;17(4):381–386.
Kokkevi A, Richardson C, Palermou B, & Leventakou V. Reliability of drug dependents’
self-reports. Drug and Alcohol Dependence 1997;45(1–2):55–61.
Kossarova L, Holland W, Nolte E, & McKee M. Measuring ‘avoidable’ mortality:
Methodological note. 2009. The London School of Economics and Political science.
Available at:
http://eprints.lse.ac.uk/46390/1/Measuring%20avoidable%20mortality%20%28lsero%29.pd f [Accessed 14.09.2015].
Kung H, Pearson JL, & Liu X. Risk for male and female suicide decedents ages 15–64 in the United States: results from the 1993 National Mortality Followback survey. Social Psychiatry and Psychiatric Epidemiology 2003;38(8):419–426.
Kuo CJ, Liao YT, Chen WJ, Tsai SY, Lin SK, & Chen CC. Causes of death of patients with methamphetamine dependence: a record-linkage study. Drug and Alcohol Review 2011;30(6):621–628.
Lankenau SE, Wagner KD, Silva K, Kecojevic A, Iverson E, McNeely M, & Kral AH.
Injecting drug users trained by overdose prevention programs: Responses to witnessed overdoses. Journal of Community Health 2013;38(1): 133–141.
Lee CT, Chen VC, Tan HK, Chou SY, Wu KH, Chan CH, & Gossop M. Suicide and other-cause mortality among heroin users in Taiwan: a prospective study. Addictive Behaviors 2013;38(10):2619–2623.
Lehtonen LA. Government registries containing sensitive health data and the implementation of EU directive on the protection of personal data in Finland. Medicine and Law 2002;21(3):419–425.
Loebstein R, Mahagna R, Maor Y, Kurnik D, Elbaz E, Halkin H, Olchovsky D, Ezra D, &
Almog S. Hepatitis C, B, and human immunodeficiency virus infections in illicit drug users in Israel: prevalence and risk factors. Israel Medical Association Journal 2008;
10(11):775–778.
Lucena J, Blanco M, Jurado C, Rico A, Salguero M, Vazquez R, Thiene G, & Basso C.
Cocaine-related sudden death: a prospective investigation in south-west Spain. European Heart Journal 2010;31(3):318–329.
Mahdi AS, & McBride AJ. Intravenous injection of alcohol by drug injectors: report of three cases. Alcohol & Alcoholism 1999;34(6):918–919.
Manfredi R, Sabbatani S, & Agostini D. Trend of mortality observed in a cohort of drug addicts of the metropolitan area of Bologna, North-Eastern Italy, during a 25-year-period.
Collegium Antropologicum 2006;30(3):479–488.
Mathers BM, & Degenhardt L. Examining non-AIDS mortality among people who inject drugs. AIDS 2014;28(Suppl 4):435–444.
Mathers BM, Degenhardt L, Bucello C, Lemon J, Wiessing L, & Hickman M. Mortality among people who inject drugs: a systematic review and meta-analysis. Bulletin of the World Health Organization 2013; 91(2):102–123.
Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, Wodak A, Panda S, Tyndall M, Toufik A, Mattick RP, & 2007 Reference Group to the UN on HIV and Injecting Drug Use. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 2008;372(9651):1733–1745.
Maxwell JC, Pullum TW, & Tannert K. Deaths of clients in methadone treatment in Texas:
1994-2002. Drug and Alcohol Dependence 2005;78(1):73–81.
McLellan AT, Kushner H, Metzger D, Peters R, Smith I, Grissom G, Pettinati H, &
Argeriou M. The fifth edition of the addiction severity index. Journal of Substance Abuse Treatment 1992;9(3):199–213.
Merrall EL, Bird SM, & Hutchinson SJ. Mortality of those who attended drug services in Scotland 1996–2006: record-linkage study. International Journal of Drug Policy 2012;23(1):24–32.
Metso L, Winter T, & Hakkarainen P. Suomalaisten huumeiden käyttö ja huumeasenteet – huumeaiheiset väestökyselyt Suomessa 1992–2010. [Drug use and drug attitudes among Finns – drug-related population surveys in Finland 1992–2010]. Helsinki: National Institute for Health and Welfare (THL). Report 17/2012.
Morrison DS. Homelessness as an independent risk factor for mortality: results from a retrospective cohort. International Journal of Epidemiology 2009;38(3):877–883.
Neaigus A, Gyarmathy VA, Miller M, Frajzyngier VM, Friedman SR, & Des Jarlais DC.
Transitions to injecting drug use among noninjecting heroin users: social network influence and individual susceptibility. Journal of Acquired Immune Deficiency Syndrome 2006;41(4):493–503.
Neale J. Suicidal intent in non-fatal illicit drug overdose. Addiction 2000;95(1):85–93.
Neale J, Bloor M, & Weir C. Problem drug users and assault. International Journal of Drug Policy 2005;16(6):393–402.
Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D & Degenhardt L.
Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet 2011;378(9791):571–583.
Nolte E, & McKee M. Does health care save lives? Avoidable mortality revisited. London:
The Nuffield Trust, 2004. Available at:
http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/does-healthcare-save-lives-mar04.pdf [Accessed 14.09.2015].
Novak SP, & Kral AH. Comparing injection and non-injection routes of administration for heroin, methamphetamine, and cocaine users in the United States. Journal of Addictive Diseases 2011;30(3):248–257.
Nyhlén A, Fridell M, Hesse M, & Krantz, P. Causes of premature mortality in Swedish drug abusers: a prospective longitudinal study 1970–2006. Journal of Forensic and Legal
Nyhlén A, Fridell M, Hesse M, & Krantz, P. Causes of premature mortality in Swedish drug abusers: a prospective longitudinal study 1970–2006. Journal of Forensic and Legal