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

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 

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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