Mortality risk among recent-onset injection drug users in five U.S. cities.

To quantify the risk of death among recent-onset (< 5 years) injection drug users, we enrolled 2089 injection drug users (IDUs) age <or= 35 years (minimum age = 18 years) between 1997 and 1999. Median age was 24 years, 62.4% were male, 54.5% were non-Hispanic White, mean duration of injecting was 3 years, and 45.4% injected daily within the prior 6 months. Using the National Death Index, we identified 68 deaths over a follow-up period through December 2002 with a mortality rate of 7.10/1000 person years. Using age-, sex-, and race-adjusted data to the census and mortality, we calculated standardized mortality ratios (SMRs) over time. The adjusted SMR (with national data as the reference) for IDUs was 3.66 for 1997, which increased to 9.78 by 1998, decreased slightly to 7.08 by 1999, and continuously declined to 2.54 by 2002. These data confirm considerable excess mortality among recent onset injection drug users compared to non-IDU peers in the general population and indicate need for interventions such as increased quality and accessibility to drug abuse** treatment and overdose prevention to prevent premature death among young IDUs.