The American Journal of Drug and Alcohol Abuse, 37:155–164, 2011 Copyright © Informa Healthcare USA, Inc. ISSN: 0095-2990 print / 1097-9891 online DOI: 10.3109/00952990.2011.553977 Mortality associated with illegal drug use among adults in the United States Pradip K. Muhuri, Ph.D. and Joseph C. Gfroerer, B.A. Division of Population Surveys, Center for Behavioral Health Statistics and Quality, Substance Abuse & Mental Health Services Administration, Rockville, MD, USA Objectives: To examine all-cause and cause-specific mortality over a 15-year follow-up period in relation to at-baseline reported lifetime use of illegal drugs from five classes (marijuana, cocaine, heroin, hallucinogens, and inhalants) among adults in the United States (US) household population. Methods: The study involved 20,983 sample adults who responded to the 1991 National Health Interview Survey Drug and Alcohol Use supplemental questionnaire and also met the eligibility criteria for mortality follow-up. Cox proportional hazards models were estimated to examine the relationships. Results: Adults who at baseline reported lifetime heroin use were at significantly higher risk of all-cause death over the follow-up period (hazard rate ratio or HR = 2.02; 95% confidence interval or CI 1.26–3.23), compared with those who did not report using drugs from any of the five classes, even after adjusting for age, sex, race, education, marital status, cigarette smoking status, and alcohol use status. Those who at baseline reported lifetime cocaine (no heroin) use had a significantly higher rate of death associated with human immunodeficiency virus diseases over the follow-up period than nonusers of drugs from any of the five classes. Several limitations of the analysis are discussed. Conclusions: Further research is needed to understand and track the elevated mortality associated with illegal drug use and the correlates of drug-poisoning deaths. Keywords: health interview survey, death index, illegal drug use, all-cause and cause-specific mortality INTRODUCTION Illegal drug use can produce numerous adverse health effects. These include unintentional death by drug poi- soning, injury, and suicide; infectious diseases (e.g., vital hepatitis B & C and human immunodeficiency virus Address correspondence to: Pradip K. Muhuri, SAMHSA/CBHSQ, 1 Choke Cherry Road, # 7-1023, Rockville, MD 20857, USA. Tel: +240 276 1070. E-mail: pradip.muhuri@samhsa.hhs.gov (HIV)) from injecting drugs; cardiovascular disease due to cocaine use, mental and behavioral disorders due to use of psychoactive substances; pregnancy complications, low birth weight, and short gestation due to maternal use of drugs (1,2). Globally, illegal drug use accounts for .8% of the burden in disability-adjusted life years and .4% in mortality (2). The use of amphetamines, cocaine, and opioids has been shown to cause premature mortality in many countries and regions (3–7). Meta-analysis of published results has revealed that illegal drug use is one of the seven modifiable behav- ioral risk factors contributing to mortality in the United States (8,9). Approximately 95% of all unintentional poi- soning deaths that occur annually in the United States are attributed to drugs (10). Analyses of the data from the National Vital Statistics System have shown that unin- tentional drug-poisoning or overdose death rates have increased steadily since 1970. In 2007, 27,658 over- dose deaths occurred in the United States, and the age-adjusted rate of drug overdose death was 9.2 per 100,000; the major drug categories involved in these deaths were cocaine, heroin, and opioid pain medica- tion (such as oxycodone, hydrocodone, and methadone) (11). Although overdoses are the major cause of drug- related mortality, certain types of drugs including opi- oids are involved in large and increasing numbers of deaths (12). In recent years, poisoning deaths involv- ing opioid analgesics increased considerably, but deaths involving methadone increased more rapidly than those relating to other opioid analgesics, cocaine, or heroin (13). Overall, opioid analgesics accounted for much of the increase in the number of drug-poisoning deaths, surpassing heroin as well as cocaine in their involve- ment in those deaths (11,14). Analysis of the data from the Drug Abuse Warning Network has suggested similar patterns (15). Some of these studies have referred to the possibil- ity of medical examiners’ increased search for opioids in poisoning deaths resulting from publicity concerning fatal 155 Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by National Institutes of Health Library on 04/05/11 For personal use only.