A microsimulation, drawing on surveillance and published data, modelled 3.3 million US people who inject drugs over 2025–2034. The base case extends the 1999–2019 linear rise in overdose deaths. It projects 487 249 deaths from injection drug use: 348 650 from overdose and 138 599 from injection-related infections. It also projects 29 715 new HIV and 218 186 new HCV infections or reinfections. Hospitalisations for severe injection-related infections reach 1.7 million. Healthcare costs total $565 billion: $431 billion for drug use itself and $135 billion for injection-related infections. The cohort admits no new entrants, costs are healthcare-only, and the overdose trend is assumed rather than observed.
Why it is interesting: Overdose causes most deaths, but injection-related infections cause about a fifth of all deaths in the cohort. If the recent 24.5% fall in overdose deaths persists, longer survival adds 36 679 infections.
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