Long-Term Consequences of Heroin and Cocaine Addiction

1
Long-Term Consequences of Heroin and Cocaine
Addiction

• Yih-Ing Hser, Ph.D.
• UCLA Integrated Substance Abuse Programs
• Drug Abuse in the 21st Century
• What Problems Lie Ahead for the Baby Boomers?
• September 2004

2

• Background
• 33-year follow-up of a heroin sample
• 12-year follow-up of a cocaine sample

• Relevance
• Many in old ages
• Natural history data

3
Overview

• Long-term substance use trajectories
• Mortality/morbidity
• Mental health

4
Sample Characteristics


Mean age
(last interview year)
Birth year
Pre 1941
1941-1945
1946-1950
1951-1955
1956-1960
1961-1965
gt 1965
Ethnicity
African American
Latino/Hispanic
White
33-year Follow-up Heroin Sample 33-year Follow-up Heroin Sample
581 male 581 male
57
1996/97 1996/97

370 63.7
209 36.0
2 0.3





8
56
36
12-year Follow-up Cocaine Sample 12-year Follow-up Cocaine Sample
321 male veterans 321 male veterans
48
2002/03 2002/03

9 2.8
22 6.8
70 21.8
89 27.7
95 29.6
32 10.0
4 1.2

68
7
25
Baby boomers
5
Average Ages at Key Events Over Lifespan
6
Mortality Rates
Increase with Age
Heroin Sample Has a Higher Mortality Rate

Age Category in 1992
Under 30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
gt 70
Total
Heroin Sample Heroin Sample
N 581 Deaths by 1997 ()




117 33.3
245 41.2
124 50.0
63 74.6
21 80.0
11 90.9
581 48.9
Cocaine Sample Cocaine Sample
N 321 Deaths by 2003 ()
17 0
71 7.0
94 5.3
86 14.0
53 17.0
(45 and older)




321 8.7
7
Cumulative Percent of Reporting Ever Used by Age
at First Use
8
Percent of Any Weekly Drug Use Over Time
9
Past Year Use
Still High
among Older Addicts
Heroin Sample Heroin Sample Heroin Sample
55 or Younger (N72) 56-60 (N111) Older than 60 (N59)
66.8 65.8 69.5
30.6 22.5 23.7
54.2 33.3 30.5
23.6 12.6 3.4
26.4 25.2 18.6
55.6 40.5 42.4
Cocaine Sample Cocaine Sample
50 or Younger (N174) Older than 50 (N92)
55.8 66.3
15.7 14.1
44.3 39.1
10.9 2.2
35.1 37.0
3.5 5.4


Tobacco
Daily alcohol
Marijuana
Amphetamine
Cocaine/crack
Heroin
Based on self-report and urinalysis
10
Rates of Abstinence (for 5 or More Years)
Increase
with Age
Heroin Sample Heroin Sample Heroin Sample
55 or Younger (N 72) 56-60 (N 111) Older than 60 (N 59)
37.5 50.5 50.9
-- -- --
Cocaine Sample Cocaine Sample
50 or Younger (N 174) Older than 50 (N 92)
-- --
49.4 56.5


Heroin
Cocaine
11
Alcohol Dependence in the Past 12 Months
Heroin Sample Heroin Sample Heroin Sample
55 or Younger (N 72) 56-60 (N 111) Older than 60 (N 59)
18.1 13.1 13.8
Cocaine Sample Cocaine Sample
50 or Younger (N 174) Older than 50 (N 92)
7.5 10.9


Alcohol dependence
12
Older Ages Reporting
Worse
Health Functioning
Cocaine Sample Cocaine Sample
50 or Younger (N174) Older than 50 (N92)
86.6 70.4
82.3 63.9
73.7 69.9
87.5 78.7
67.2 53.8
66.2 52.7
Heroin Sample Heroin Sample Heroin Sample
55 or Younger (N72) 56-60 (N111) Older than 60 (N59)
78.7 74.4 64.8
75.3 65.2 60.5
75.9 77.2 77.8
85.3 82.5 80.4
61.4 60.9 61.8
60.5 56.7 51.1

SF-36
Physical functioning
Role limitation due to physical health
Emotional well-being
Social functioning
Pain
General health
Higher scores indicate better functioning and
health
13
Older Ages Reporting
More
Health/Medical Conditions
Heroin Sample Heroin Sample Heroin Sample
55 or Younger (N72) 56-60 (N111) Older than 60 (N59)
32.0 36.9 44.8
12.5 11.7 15.5
0.0 0.9 0.0
20.8 26.1 32.8
9.7 8.1 10.3
20.8 26.1 19.0
5.6 10.8 13.8
25.0 33.3 39.7
4.2 1.8 3.5
Cocaine Sample Cocaine Sample
50 or Younger (N174) Older than 50 (N92)
24.1 52.2
10.3 15.2
2.3 3.3
16.7 26.1
10.4 20.0
15.0 19.6
5.8 12.0
25.3 27.2
4.0 10.9

On-going
Cardiovascular disease1
Respiratory disease2
TB
Digestive disease3
Hepatitis
Dental problems
Diabetes
Arthritis-Rheumatism
STDs4
1Hypertension, Hardening of arteries/heart
attack, Other 2Asthma, Emphysema/Lung Cancer,
TB 3Cirrhosis, Hepatitis, Ulcer, Hernia rapture,
Spastic colon 4AIDS/HIV, Gonorrhea, Syphilis,
Herpes, Others
14
Medical Testing Results Show
High
Levels of Cardiovascular Risk

• Over half (58.3) had hypertension
• One-fifth (22.4) had high total cholesterol
• Over half (54.6) were overweight (using
  body/mass index)

Heroin subsample
Source Hser et al., Journal of Behavioral
Medicine (in press)
15
Medical Testing Results Show
High
Levels of Infectious Diseases

• Four-fifths (85.6) tested positive for Hepatitis
  B
• Nearly all (94.2) tested positive for Hepatitis
  C
• Over one-quarter (27.3) had a positive TB skin
  test
• Nearly one-quarter (23.8) tested positive for
  syphillis
• HIV rate was very low (1.8)
• Heroin subsample

16
High
Medical Testing Results Show
Levels of Abnormal Functions

• More than half had abnormal liver function by at
  least one indicator (ALT, AST, billirubin)
• 18.8 had diabetes
• 27-35 had abnormal pulmonary function
• Heroin subsample

17
Mental Health Problems
Increase
with Age among Cocaine Sample
Cocaine Sample Cocaine Sample
50 or Younger (N174) Older than 50 (N92)
1.48 1.64
1.29 1.45
1.41 1.61
1.53 1.75
1.53 1.63

Symptom Checklist
Depression
Anxiety
Somatization
Obsessive Compulsive
Interpersonal sensitivity
Heroin Sample Heroin Sample Heroin Sample
55 or Younger (N72) 56-60 (N111) Older than 60 (N59)
1.53 1.50 1.41
1.33 1.28 1.30
1.43 1.46 1.48
1.57 1.61 1.59
1.49 1.41 1.33
Higher scores indicate greater problem severity
18
Abstinence from Primary Drug Show
Better
Health Functioning

SF-36
Physical functioning
Role limitation due to physical health
Emotional well-being
Social functioning
Pain
General health
Heroin Sample Heroin Sample
Abstinent 5 or more years (N 113) Abstinent less than 5 years (N 129)
76.4 70.7
70.4 64.3
84.0 70.6
86.2 79.8
64.4 58.5
62.0 51.1
Cocaine Sample Cocaine Sample
Abstinent 5 or more years (N 138) Abstinent less than 5 years (N 128)
83.4 78.4
77.5 74.2
77.5 66.9
86.2 82.5
64.4 60.5
63.6 59.3
Higher scores indicate better functioning and
health
19
Abstinence from Primary Drug Show
Better
Health/Medical Conditions

On-going
Cardiovascular disease1
Respiratory disease2
TB
Digestive disease3
Hepatitis
Dental problems
Diabetes
Arthritis-Rheumatism
STDs4
Heroin Sample Heroin Sample
Abstinent 5 or more years (N 113) Abstinent less than 5 years (N 129)
30.1 43.8
12.4 13.3
0.9 0.0
18.6 32.8
7.1 10.9
15.0 29.7
16.8 3.9
32.7 32.0
1.8 3.9
Cocaine Sample Cocaine Sample
Abstinent 5 or more years (N 138) Abstinent less than 5 years (N 128)
30.4 37.5
8.7 15.6
2.9 2.3
18.1 21.9
12.3 15.2
10.9 22.7
8.7 7.0
25.4 26.6
4.4 8.6
1Hypertension, Hardening of arteries/heart
attack, Other 2Asthma, Emphysema/Lung Cancer,
TB 3Cirrhosis, Hepatitis, Ulcer, Hernia rapture,
Spastic colon 4AIDS/HIV, Gonorrhea, Syphilis,
Herpes, Others
20
Abstinence from Primary Drug Show
Better
Mental Health
Cocaine Sample Cocaine Sample
Abstinent 5 or more years (N 138) Abstinent less than 5 years (N 128)
1.43 1.66
1.25 1.45
1.45 1.51
1.47 1.75
1.44 1.70

Symptom Checklist
Depression
Anxiety
Somatization
Obsessive Compulsive
Interpersonal sensitivity
Heroin Sample Heroin Sample
Abstinent 5 or more years (N 113) Abstinent less than 5 years (N 129)
1.32 1.64
1.20 1.40
1.37 1.54
1.51 1.66
1.32 1.50
Higher scores indicate greater problem severity
21
Conclusions

• Overall
• Chronicity of addiction
• Adverse consequences
• elevated mortality, particularly heroin
• health/medical problems
• mental health problems

• Older ages
• Substance use (heroin, alcohol) persist in older
  ages
• Greater health and mental health problems

• Abstinence
• Increases with age
• Less health and mental health problems