Drug and Alcohol Dependence 79 (2005) 137–143 Mortality in heroin-assisted treatment in Switzerland 1994–2000 J¨ urgen Rehm a,b,c,∗ , Ulrich Frick a,d , Christina Hartwig a,e , Felix Gutzwiller f , Patrick Gschwend a , Ambros Uchtenhagen a a Addiction Research Institute, Konradstr. 32, CH 8031 Zurich, Switzerland b Section Population Health and Regulatory Policies, Centre for Addiction and Mental Health, Toronto, Canada c Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada d Psychiatric University Hospital, Regensburg, Germany e Zentrum f ¨ ur Interdiziplin¨ are Suchtforschung (ZIS), Hamburg University, Germany f Institut f ¨ ur Sozial- und Pr ¨ aventivmedizin Universit¨ at Z ¨ urich, Zurich, Switzerland Received 16 August 2004; received in revised form 10 January 2005; accepted 13 January 2005 Abstract Background: A major goal of heroin-assisted treatment in Switzerland has been to reduce the drug-related mortality of heroin users. Therefore, a continuous monitoring of deaths under treatment is essential. Aims: To assess mortality of participants in heroin-assisted treatment in Switzerland over a 7-year period from 1994 to 2000, and to compare this mortality to the general population and to other populations of opioid users, as reported in the literature. Method: Estimation of person years under heroin-assisted treatment from the complete case registry of heroin-assisted treatment in Switzer- land. Estimation of standardized mortality ratios comparing the population in treatment to the Swiss population (standardized to the year 2000). Results: Over the 7-year period, the crude death rate of patients in heroin-assisted treatment, and including one month after discharge from treatment, was 1% per year. The standardized mortality ratio for the entire observation period was 9.7 (95% C.I. 7.3–12.8), with females having higher standardized mortality ratios (SMR 17.2) than males (SMR 8.4). There was no clear time trend. Conclusion: Mortality in heroin-assisted treatment was low compared to the mortality rate of Swiss opioid users 1990s (estimated to be between 2.5 and 3%). It was also low compared to mortality rates of opioid users in other maintenance treatments in other countries as reported in the literature. The SMR was also lower than that reported in the only meta-analysis in the literature: 13.2 (95% C.I. 12.3–14.1). The low mortality rate is all the more noteworthy as heroin-assisted treatment in Switzerland included only refractory opioid addicts with existing severe somatic and/or mental problems. Declaration of interest: No conflicts of interest declared © 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: Heroin; Heroin-assisted treatment; Mortality; Switzerland 1. Introduction The problems associated with illicit heroin use increased dramatically in Switzerland from the 1980s to the early 1990s. These problems were partially related to open drug scenes and public perception (Klingemann, 1996); and partly due to the spread of HIV and its associated costs (Zeltner, 1996). The reaction by public health authorities was to im- ∗ Corresponding author. Tel.: +41 1448 1160; fax: +41 1 448 1170. E-mail address: jtrehm@aol.com (J. Rehm). prove the situation of heroin addicts by implementing dif- ferent measures, and integrating and combining these into successive national programs (Swiss Federal Health Office, 1991). The goats of these programs can be summarized into four broad categories (Cattaneo et al., 1993): (1) Reduce the number of new drug consumers/addicts. (2) Increase the number of addicts who become abstinent. (3) Reduce opiate-associated health consequences and the social discrimination and stigmatization of consumers and/or addicts. 0376-8716/$ – see front matter © 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.drugalcdep.2005.01.005