'Dabbling' in hard drugs in middle age linked to increased risk of death

ScienceDaily (Jan. 27, 2012) — Young
adults often experiment with hard drugs, such as cocaine,
amphetamines and opiates, and all but about 10 percent stop as
they assume adult roles and responsibilities. Those still using
hard drugs into their 50s are five times more likely to die
earlier than those who do not, according to a new study by
University of Alabama at Birmingham researchers published
online Jan. 27, 2012, in the Journal of General Internal
Medicine.

According to the National Survey on Drug Use and Health, 9.4
percent of Americans ages 50-59 and 7 percent of adults ages
35-49 reported use of a drug other than marijuana sometime in
the past year. The study’s lead author, Stefan Kertesz, M.D.,
associate professor in the UAB Division of Preventive Medicine.
and colleagues attempted to discover if lifelong hard-drug use
shortens lifespan to better enable primary-care doctors to
advise patients who use drugs recreationally.

“While government guidelines have not endorsed screening for
drugs in primary care, many doctors are challenged when they
discover patients continue to dabble with them,” Kertesz says.
“In primary-care practice, we often hear from stable patients
who report using some cocaine, irregularly, perhaps on
weekends. It’s an underappreciated but very common situation.
The typical question physicians have to ask is ‘If this patient
doesn’t have addiction, what advice can I give other than
noting that it’s unwise to break the law?’ After all, we are
supposed to be doctors, not law enforcement.”

Kertesz and a research team from other universities looked at
data from the Coronary Artery Risk Development in Young Adults
Study for their analysis. CARDIA, funded by the National Heart,
Lung and Blood Institute, is a long-term research project
involving more than 5,000 black and white men and women from
Birmingham, Chicago, Minneapolis and Oakland, designed to
examine the development and determinants of cardiovascular
disease and its risk factors. Participants ages 18-30 were
recruited and followed from 1985 to 2006.

The research team looked specifically at the reported use of
“hard drugs” by 4,301 of the CARDIA participants. They compared
people who stopped drug use early to those who continued and
calculated the likelihood of premature death among these
groups.

“Fourteen percent of the people in the study reported recent
hard-drug use at least once, and of these, half continued using
well into middle age,” Kertesz says. “But, most of the drug
users in our study were not addicts. They were dabblers who
used just a few days a month.”

Kertesz and his colleagues found that older hard-drug users
were more likely to report being raised in economically
challenged circumstances in a family that was unsupportive,
abusive or neglectful. The team also found that those who were
heavy drug users into young adulthood and continued at lower
levels into middle age were roughly five times more likely to
die than persons who didn’t use drugs.

“We can’t assume that drugs caused death, as in an overdose,”
he says. “Rather what we found is that middle-age adults who
continue to dabble in hard drugs represent a group that is at
risk of bad outcomes — which could include death from trauma,
heart disease or other causes that are not a direct result of
their drug use — at a higher rate than people who stopped using
drugs.”

Kertesz added that the team’s findings are a reminder that
people who continue to use drugs are potentially quite
vulnerable. They often have grown up under economic and
psychosocial stress from childhood onward. They continue to
smoke and drink and they remain at elevated risk of premature
death.

“Based on the data we hope to offer better advice to
primary-care doctors struggling with the rising tide of
drug-taking by adults who have not left behind many of the bad
habits they learned in young adulthood,” he says.

Study co-authors include Yulia Khodneva, M.D., Monika Safford,
M.D., and Joseph Schumacher, Ph.D., UAB Division of Preventive
Medicine; Jalie Tucker, Ph.D., UAB School of Public Health;
Joshua Richman, M.D., Ph.D., UAB Department of Surgery; Bobby
Jones, Ph. D., Department of Statistics, Carnegie Mellon
University; and Mark J. Pletcher, M.D., departments of
Epidemiology & Biostatistics and Medicine, University of
California, San Francisco.

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The above story is reprinted from materials provided by University of Alabama at
Birmingham, via Newswise.

Note: Materials may be edited for content and length. For
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Journal Reference:

Stefan G. Kertesz, Yulia Khodneva, Joshua Richman, Jalie A.
Tucker, Monika M. Safford, Bobby Jones, Joseph Schumacher, Mark
J. Pletcher. Trajectories of Drug Use and Mortality
Outcomes Among Adults Followed Over 18 Years.
Journal of General Internal Medicine, 2012; DOI:
10.1007/s11606-011-1975-3

Note: If no author is given, the source is cited
instead.

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'Dabbling' in hard drugs in middle age linked to increased risk of death