Original Research

Journal of General Internal Medicine

, Volume 27, Issue 7, pp 808-816

Trajectories of Drug Use and Mortality Outcomes Among Adults Followed Over 18 Years

  • Stefan G. KerteszAffiliated withCenter for Surgical Medical and Acute Care Research at the Birmingham VA Medical CenterDivision of Preventive Medicine, University of Alabama at Birmingham School of MedicineDepartment of Health Behavior, University of Alabama at Birmingham School of Public Health Email author 
  • , Yulia KhodnevaAffiliated withDepartment of Health Behavior, University of Alabama at Birmingham School of Public Health
  • , Joshua RichmanAffiliated withDepartment of Surgery, University of Alabama at Birmingham School of Medicine
  • , Jalie A. TuckerAffiliated withDepartment of Health Behavior, University of Alabama at Birmingham School of Public Health
  • , Monika M. SaffordAffiliated withDivision of Preventive Medicine, University of Alabama at Birmingham School of Medicine
  • , Bobby JonesAffiliated withDepartment of Statistics, Carnegie Mellon University
  • , Joseph SchumacherAffiliated withDivision of Preventive Medicine, University of Alabama at Birmingham School of Medicine
  • , Mark J. PletcherAffiliated withDepartment of Epidemiology and Biostatistics, University of California at San Francisco

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ABSTRACT

BACKGROUND

For adults in general population community settings, data regarding long-term course and outcomes of illicit drug use are sparse, limiting the formulation of evidence-based recommendations for drug use screening of adults in primary care.

OBJECTIVE

To describe trajectories of three illicit drugs (cocaine, opioids, amphetamines) among adults in community settings, and to assess their relation to all-cause mortality.

DESIGN

Longitudinal cohort, 1987/88 – 2005/06.

SETTING

Community-based recruitment from four cities (Birmingham, Chicago, Oakland, Minneapolis).

PARTICIPANTS

Healthy adults, balanced for race (black and white) and gender were assessed for drug use from 1987/88—2005/06, and for mortality through 12/31/2008 (n = 4301)

MEASUREMENTS

Use of cocaine, amphetamines, and opioids (last 30 days) was queried in the following years: 1987/88, 1990/91, 1992/93, 1995/96, 2000/01, 2005/06. Survey-based assessment of demographics and psychosocial characteristics. Mortality over 18 years.

RESULTS

Trajectory analysis identified four groups: Nonusers (n = 3691, 85.8%), Early Occasional Users (n = 340, 7.9%), Persistent Occasional Users (n = 160, 3.7%), and Early Frequent/Later Occasional Users (n = 110, 2.6%). Trajectories conformed to expected patterns regarding demographics, other substance use, family background and education. Adjusting for demographics, baseline health status, health behaviors (alcohol, tobacco), and psychosocial characteristics, Early Frequent/Later Occasional Users had greater all-cause mortality (Hazard Ratio, HR = 4.94, 95% CI = 1.58–15.51, p = 0.006).

LIMITATIONS

Study is restricted to three common drugs, and trajectory analyses represent statistical approximations rather than identifiable “types”. Causal inferences are tentative.

CONCLUSIONS

Four trajectories describe illicit drug use from young adulthood to middle age. Two trajectories, representing over one third of adult users, continued use into middle age. These persons were more likely to continue harmful risk behaviors such as smoking, and more likely to die.

KEY WORDS

opioids stimulants cocaine trajectory epidemiology longitudinal data