A record‐linkage study of drug‐related death and suicide after hospital discharge among drug‐treatment clients in S cotland, 1996–2006

Aims To investigate the relationship between time after hospital discharge and drug‐related death ( DRD ) and suicide among drug users in S cotland, while controlling for potential confounders. Design Cohort study. Setting and participants The 69 457 individuals who registered for drug treatment in Scotland during 1 A pril 1996–31 M arch 2006. Measurements Time‐at‐risk was from the date of an individual's first attendance at drug treatment services after 1 A pril 1996 until the earlier date of death or end‐of‐study, 31 M arch 2006, and was categorized according to time since the most recent hospitalization, as during hospitalization, within 28 days, 29–90 days, 91 days to 1 year and >1 year since discharge from most recent hospital stay versus ‘never admitted’ (reference). Findings Time‐periods soon after discharge were associated with increased risk of DRD . DRD rates per 1000 person‐years were: 87 (95% CI : 72–103) during hospitalization, 21 (18–25) within 28 days, 12 (10–15) during 29–90 days and 8.5 (7.5–9.5) during 91 days to 1 year after discharge versus 4.2 (3.7–4.7) when >1 year after most recent hospitalization and 1.9 (1.7–2.1) for those never admitted. Adjusted hazard ratios by time since hospital discharge (versus never admitted) were: 9.6 (95% CI : 8–12) within 28 days, 5.6 (4.6–6.8) during days 29–90, thereafter 4.0 (3.5–4.7) and 2.3 (2.0–2.7) when >1 year. Non‐drug‐related suicides were less frequent than DRDs (269 versus 1383) but a similar risk pattern was observed. Conclusions In people receiving treatment for drug dependence, discharge from a period of hospitalization marks the start of a period of heightened vulnerability to drug‐related death.