Substance-Related Mortality in Iran: A Retrospective Study of National Registered Data (2014-2018) Using Joinpoint Regression Analysis

Background and purpose: This study was carried out to analyze the trend of death due to substance abuse and related factors in Iran in order to design and implement preventive and therapeutic interventions for substance related deaths. Materials and methods: In this cross-sectional study, we investigated the data of 6810 deaths caused by drug abuse, registered in the "System of Registration and Classification of Causes of Death", defined by ICD-10 criteria and based on the reports of Ministry of Health and Legal Medicine Organization in 2014-2018. Variables including age, gender, type of poisoning and the type of substance leading to death were examined. Description of these data and examination of the time trend of the raw mortality rate were performed using joinpoint regression analysis and percentage of annual changes (APC) and average percentage of annual changes (AAPC) were calculated in SPSS V23. Results: The average age of the deceased was 39.2±17.0 years. Majority of them were men. Central regions followed by western regions of Iran accounted for the highest number of deaths that was related to opioid poisoning. Accidental poisoning and poisoning with unknown intention were the most frequent causes. Deaths due to opioids (APC=27.2, P=0.008) and stimulants (APC=109.24, P=0.1) overdose showed an increasing trend and a peak in 2014 in Iran. A decreasing trend was found in two groups of sedative-hypnotic-anxiolytics and other drugs, but it was not statistically significant. No trends were found for alcohol-related deaths. Conclusion: There is a considerable increasing trend in accidental deaths, especially caused by opioids and mainly in middle-aged men which requires limiting measures. It is recommended to intensify drug monitoring and provide trainings about using naloxone as an emergency antidote to opiate overdose to families, police and emergency staff in early stages of drug poisoning.