Associations Between Duration of Illicit Drug Use and Health Conditions: Results from the 2005–2007 National Surveys on Drug Use and Health
Introduction
Illicit drug use has been found to be associated with a variety of health conditions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30. Marijuana, the most commonly used illicit drug in the United States, has adverse effects on the respiratory system (increasing the risk of chronic cough, bronchitis, and emphysema 1, 2 and promoting cancer of the respiratory tract and lungs (3)) and cardiovascular system [triggering myocardial infarction (4)]). Marijuana use is also associated with impaired immune function leading to vulnerability to infection 5, 6.
Cocaine use has been found to have cardiovascular, neurological, and gastrointestinal effects 7, 8, 9, 10, 11, 12. Cocaine has direct suppressive effects on immune function and, along with needle use and sharing, increases the risk for HIV infection and other infectious diseases, such as tuberculosis 13, 14. Long-term heroin use is associated with liver and kidney disease, lung complications (pneumonia and tuberculosis), stroke or heart attack (caused by blood clots resulting from insoluble additives), and infections with hepatitis B and C, HIV, and other blood-borne viruses and bacteria 15, 16, 17, 18.
The health consequences of hallucinogen use include hallucinogen-induced persistent perceptual disorder, flashbacks, psychological problems, psychiatric illness, and impaired memory 19, 20, 21, 22. Inhalants can cause respiratory diseases, heart problems, liver toxicity, brain damage, and acute renal failure (26). Inhalant users also have increased risks of injecting drug use, HIV, suicidality, and psychiatric disorders 27, 28, 29, 30.
In general, acute effects of these specific illicit drugs have been more extensively studied than effects of long-term use. Some longitudinal studies have reported psychological and social outcomes related to general drug exposure and specific drug exposure among young people 31, 32, 33, 34. However, none of these studies systematically examined the physical health consequences of long-term drug use. Most of these studies have potential selection bias and applied limited adjustments for confounding. Since the majority of these longitudinal studies examined youths and followed them up only for a few years or until early adulthood and because some health conditions may not manifest until much later in life, in some cases after years of abstinence, the long-term physical and mental health effects of long-term drug use remain poorly understood.
Three cross-sectional studies have examined the effects of overall illicit drug use on a broad range of health conditions using samples obtained from county drug abuse treatment units (35), hospitals in Ontario (36), or from adoptees in Iowa (37). However, no studies have yet ever provided or compared estimates of the prevalence rates of health conditions among illicit drug users and nonusers in the general U.S. population. Furthermore, since illicit drug, alcohol, and tobacco use can contribute to some of the same health conditions 38, 39, 40, 41 and because use of multiple illicit drugs, alcohol, or tobacco is common among substance abusers, it is critical to disentangle the long-term effects of use of each illicit drug from alcohol and tobacco use. However, most previous studies only examined the medical effects of one particular illicit drug 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, alcohol 42, 43, 44, 45, 46, or tobacco 41, 47, 48. Little is known about the health consequences of long-term use of each illicit drug after controlling for the impact of alcohol and tobacco use among the general U.S. population. This critical piece of information can help the United States prepare for treating health problems among former and continuing illicit drug users, large numbers of whom are reaching older adulthood and experiencing an increased variety of health conditions.
To address this gap in knowledge, this study estimated and compared prevalence rates of lifetime health conditions by inferred duration of illicit drug use among the general U.S. adult population aged 35 to 49 using the 2005, 2006, and 2007 National Surveys on Drug Use and Health (NSDUH) data. Based on the same data, this study also investigated associations between duration of use of each specific illicit drug (marijuana, cocaine, heroin, hallucinogens, or inhalant) and each lifetime health condition after controlling for potential impact of non-medical use of prescription drugs, alcohol use, tobacco use, demographic characteristics, and other possible confounding factors.
Section snippets
Study Sample
We assessed 29,195 persons 35 to 49 years of age who participated in the 2005–2007 NSDUH, a nationally representative sample of the civilian, non-institutionalized population aged 12 or older in the United States. We restricted our analyses to this age group because (1) certain health conditions (e.g., heart disease, hypertension, diabetes, stroke, tinnitus, and cancer) are age related, it is critical to examine the age-stratified prevalence rates of health conditions; (2) persons under age 35
Results
Table 1 shows the prevalence rates of lifetime health conditions by duration of use of specific illicit drug among persons aged 35 to 49 in the United States in the period 2005–2007. Table 2 presents the unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) resulting from bivariate logistic regression models indicating differences in prevalence rates by duration of use of each specific illicit drug.
Table 3 presents the results of the 20 multivariate logistic regression models
Discussion
This is the first study presenting and comparing the prevalence rates of a broad range of health conditions by duration of use of specific illicit drug among persons aged 35 to 49 in the United States. This is also the first study examining the associations between durations of use of specific illicit drugs and a wide range of lifetime health conditions in a nationally representative sample after carefully controlling for potentially confounding factors. Our results confirmed the existing
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