{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:45:24Z","timestamp":1791499524018,"version":"4.3.4"},"reference-count":64,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,11,24]],"date-time":"2017-11-24T00:00:00Z","timestamp":1511481600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,11,24]],"date-time":"2017-11-24T00:00:00Z","timestamp":1511481600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To examine the mortality risk in a cohort of \u2018hard\u2010to\u2010reach\u2019 polysubstance users and its putative associations with substance use. Specifically, we estimated all\u2010cause mortality risk as a function of individual substance use indicators, and then as a function of their complex, \u2018real\u2010life\u2019 patterns as identified through latent class analysis (LCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study among street\u2010 and low\u2010threshold service\u2010recruited polysubstance users included between September and November 2013 and followed through the National Cause of Death Registry until 31 October 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Seven Norwegian cities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 884 users of illegal opioids and\/or stimulants. Of these, 357 were in opioid substitution treatment (OST) at the time of inclusion. Forty\u2010four participants died during follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Primary outcome: all\u2010cause mortality risk. Unadjusted and adjusted Cox proportional hazard (PH) regression models (covariates: male, age, homelessness\/shelter use, overdose experience, OST status, years of injecting, individual substance use indicators, city, use patterns). LCA models estimated separately for those in and those not in OST due to measurement invariance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The crude mortality rate was 2.52 per 100 person\u2010years. Standardized mortality ratio was 26.11 [95% confidence interval (CI)\u00a0=\u00a010.06\u201354.87] for women and 10.71 (95% CI\u00a0=\u00a06.39\u201316.81) for men. No single drug use indicator, such as \u2018heroin injection\u2019 or \u2018number of drugs used\u2019, was associated with the mortality risk. However, meaningful use patterns were identified; three OST and non\u2010OST patterns each. The non\u2010OST patterns \u2018polysubstance injectors\u2019 [hazard ratio (HR)\u00a0=\u00a03.45, 95% CI\u00a0=\u00a00.98\u201312.14] and \u2018low frequent injectors\u2019 (HR\u00a0=\u00a03.17, CI\u00a0=\u00a01.05\u20139.56) were associated significantly with the mortality risk even when adjusted for other known risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a Norwegian prospective cohort study, \u2018hard\u2010to\u2010reach\u2019 polysubstance users had a more than 10 times higher mortality risk than the general population. Mortality risk was not a function of any single drug use indicator, but two distinct combinations of substances, frequencies and routes of administration were associated with the mortality risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.14053","type":"journal-article","created":{"date-parts":[[2017,10,7]],"date-time":"2017-10-07T10:56:35Z","timestamp":1507373795000},"page":"729-739","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Patterns of substance use and mortality risk in a cohort of \u2018hard\u2010to\u2010reach\u2019 polysubstance users"],"prefix":"10.1111","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0829-2020","authenticated-orcid":false,"given":"Linn","family":"Gjersing","sequence":"first","affiliation":[{"name":"Department of Drug Policy Norwegian Institute of Public Health  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Line","family":"Bretteville\u2010Jensen","sequence":"additional","affiliation":[{"name":"Department of Substance Use Norwegian Institute of Public Health  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11,24]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"National Institue on Drug Abuse (NIDA).Overdose deaths rates. 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