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Research Summary

Even Occasional Cocaine, Opioid, or Amphetamine Use Persisting into Middle Age Increases Mortality

This secondary analysis of a prospective cohort study examined the impact of drug use on mortality over 18 years in a randomly selected sample of 4301 healthy adults aged 18–30 years from 4 US cities. Eligible persons completed questionnaires regarding cocaine, amphetamine, and recreational opioid use in 1987/1988 and again during at least 1 subsequent in-person examination through 2006. Trajectory analysis classed participants into 4 groups based on their pattern of drug use: 85.8% reported no use at any examination (nonusers); 7.9% matured out of early infrequent use (early occasional users); 3.7% started with infrequent use that persisted or increased over time (persistent occasional users); and 2.6% started with frequent use that diminished over time (early frequent/later occasional users).

  • All-cause mortality was 4.6% over 18 years of follow-up.
  • Unadjusted mortality was higher among persistent occasional users (8.1%) and early frequent/later occasional users (6.4%) compared with early occasional users (5%) and nonusers (3.1% [p=0.003]).
  • In proportional hazard models adjusted for multiple demographic, behavioral, and health-related factors, risk of death was higher for early frequent/later occasional users (hazard ratio [HR], 4.9) and was borderline significantly higher for persistent occasional users (HR, 3.3; p=0.06) compared with nonusers.


Results from this rigorous long-term cohort study confirm what has long been suspected: even after controlling for multiple important confounding factors, any use of cocaine, illicit opioids, and/or amphetamines persisting past young adulthood confers an increased risk of premature mortality. Clinicians can reasonably use this information to educate young adults who use these drugs and help motivate them to stop. Nonetheless, we await large long-term clinical trials to demonstrate whether such counseling will effectively reduce drug-related mortality. Peter D. Friedmann, MD, MPH


Kertesz SG, Khodneva Y, Richman J, et al. Trajectories of drug use and mortality outcomes among adults followed over 18 years. J Gen Intern Med. 2012;27(7):808–816.