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

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. 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.

Mortality Risk for Cocaine Abusers in Relation to Heroin Use: A Follow-Up Study

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Substance use among Persons with Homeless Experience in Primary Care

“…Less severe substance use is associated with cancer risk, poor hypertension control, and worse mental health. 20,21 Less severe substance use is particularly significant for homeless persons, who are at greater risk of falls and injuries. 50 Persons with past problematic use, especially with ongoing use of other substances, incur risk of relapse.…”

Trajectories of energy drink consumption and subsequent drug use during young adulthood

“…A form of multivariate mixture modeling, this method uses PROC TRAJ (Jones et al, 2001) in SAS (SAS Institute Inc., 2008) and has proven helpful in understanding other substance use patterns longitudinally (Caldeira et al, 2012a; Caldeira et al, 2012b; Jackson et al, 2005; Kertesz et al, 2012; Suerken et al, 2016). We tested all one- to seven-group solutions with a second-degree polynomial in a series of three alternative sets of analyses.…”