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

Data could lead to better advice for primary-care doctors struggling with a rising tide of older adult patients still in throes of youthful bad habits.

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.

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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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