Journal of General Internal Medicine

, Volume 27, Issue 7, pp 808–816 | Cite as

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

  • Stefan G. Kertesz
  • Yulia Khodneva
  • Joshua Richman
  • Jalie A. Tucker
  • Monika M. Safford
  • Bobby Jones
  • Joseph Schumacher
  • Mark J. Pletcher
Original Research



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.


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


Longitudinal cohort, 1987/88 – 2005/06.


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


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)


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.


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).


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


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.


opioids stimulants cocaine trajectory epidemiology longitudinal data 



The authors acknowledge the kind support of Hwan-seok Choi and Cindy Wang in the conduct of statistical analyses, and the advice of Cora E. Lewis concerning the design and conduct of the CARDIA study.

Support: NIDA: R01-DA-025067; NHLBI: N01-HC-95095 AND NO1-HC-48047

Conflicts of Interest

None disclosed.

Supplementary material

11606_2011_1975_MOESM1_ESM.docx (32 kb)
ESM 1 (DOCX 31 kb)


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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Stefan G. Kertesz
    • 1
    • 2
    • 3
  • Yulia Khodneva
    • 3
  • Joshua Richman
    • 6
  • Jalie A. Tucker
    • 3
  • Monika M. Safford
    • 2
  • Bobby Jones
    • 4
  • Joseph Schumacher
    • 2
  • Mark J. Pletcher
    • 5
  1. 1.Center for Surgical Medical and Acute Care Research at the Birmingham VA Medical CenterBirminghamUSA
  2. 2.Division of Preventive MedicineUniversity of Alabama at Birmingham School of MedicineBirminghamUSA
  3. 3.Department of Health BehaviorUniversity of Alabama at Birmingham School of Public HealthBirminghamUSA
  4. 4.Department of StatisticsCarnegie Mellon UniversityPittsburghUSA
  5. 5.Department of Epidemiology and BiostatisticsUniversity of California at San FranciscoSan FranciscoUSA
  6. 6.Department of SurgeryUniversity of Alabama at Birmingham School of MedicineBirminghamUSA

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