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Heroin Addiction and Related Clinical Problems: 2025, 27, 25

Heroin Addicts in Opioid Agonist Treatment Programme: 22 years of retrospective period observation of deceased before and after Covid 19 syndemic: A naturalistic study

Mercedes Lovrecic, and Barbara Lovrecic

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-25

Summary: Background: A pandemic occurs when a disease spreads across borders and affects large populations. A syndemic (synergistic epidemic) refers to the co-occurrence and interaction of two or more epidemics, which can exacerbate disease outcomes due to biological and social interactions. The COVID-19 syndemic disproportionately impacted vulnerable populations, including individuals with pre-existing conditions. This study compared characteristics of deceased heroin addicts enrolled in an opioid agonist treatment (OAT) programme who died before and during the COVID-19 syndemic. Methods: We conducted a retrospective comparative study involving heroin addicts enrolled in outpatient OAT in Izola between 1 January 2002 and 31 December 2023. Deceased cases were identified through naturalistic observation, with reports from relatives, partners, or friends. Clinical data were obtained from medical records. Statistical analyses included Fisher’s exact test and Poisson regression. Results: We identified 20 deaths during the 22-year period: 11 in the pre-COVID period (18 years) and 9 during the COVID period (4 years). Most deceased were male (pre-COVID: 82%; COVID: 89%). Males died significantly older during the COVID period (p = 0.002); females died younger, though not significantly. Disease-related deaths increased from 45% to 78%, though not statistically significant. Suicide was reported in 36% of pre-COVID deaths and none during COVID (p = 0.082). Patients still receiving OAT at the time of death were significantly older than those who had dropped out (p = 0.004). Conclusions: The COVID-19 syndemic appeared to increase mortality in this patient population, particularly from non-communicable diseases. Continuity in OAT was associated with increased longevity. These findings support the need for resilient and flexible addiction care models in future syndemic contexts.

Keywords: Covid-19 Syndemic; Heroin Addiction; Opioid Agonist Treatment; Mortality; Suicide; Disease-Related Deaths