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Research Summary

Leading Causes of Premature Death in Heroin Users

Many studies on mortality in heroin users report traditional mortality data, which does not account for age at death. To examine causes of premature death and years of potential life lost (YPLL) among heroin users, researchers assessed 581 ethnically diverse men who had been admitted to a compulsory drug treatment program in California for heroin-dependent criminal offenders. Subjects were evaluated every 10 years over 33 years.

  • During follow-up, 282 subjects (49%) died. Mean age was 25 years at study entry and 47 years at death. On average, YPLL before age 65 was 18 years per person.
  • The leading causes of death were heroin overdose (17% of deaths), chronic liver disease (15%), cardiovascular disease (12%), cancer (11%), accidents (8%), and homicide (7%).
  • The leading causes of YPLL were heroin overdose (22% of all YPLL), chronic liver disease (14%), accidents (10%), cardiovascular disease (9%), homicide (9%), and cancer (5%).
  • YPLL for each cause of death examined was significantly and substantially higher among subjects in this study than among the U.S. population (e.g., 43 YPLL versus 12 YPLL from unintentional injuries, including overdoses and accidents).


This study’s strength is its consideration of premature mortality among heroin users. The results revealed disparities between leading causes of death and YPLL among heroin users and extremely large discrepancies in YPLL between heroin users and the U.S. population. One conclusion from this study is that inadequate drug treatment capacity may be partly responsible for the higher number of premature deaths among persons with opioid dependence.

Julia H. Arnsten, MD, MPH


Smyth B, Hoffman V, Fan J, et al. Years of potential life lost among heroin addicts 33 years after treatment. Prev Med. 2007;44(4):369–374.