TOBACCO USE AS A DISTAL PREDICTOR OF MORTALITY AMONG LONG-TERM NARCOTICS ADDICTS

Background. This study examined patterns of tobacco and narcotics use, associated morbidity, and subsequent mortality among long-term narcotics addicts. Methods. The analysis included 405 patients selected from admissions to the California Civil Addict Program during 1962 through 1964. Measures were obtained at admission and at two face-to-face interviews conducted in 1974-1975 and 1985-1986 and included use of narcotics, tobacco, alcohol, and other substances, as well as morbidity and mortality information. Results. For the 405 addicts interviewed initially in 1974-1975, the average age was 36.7 years, the mean age at onset of smoking was 13.1 years, and first narcotics use occurred at 18.4 years. Ninety-eight percent reported experience with cigarette smoking, 84% were currently smoking, and 31% tested positive for opiates by urinalysis. In 1985-1986, at the second interview, among the 328 interviewed, 74% reported current smoking and 32% tested positive for opiates. Seventy-seven (19%) had died. Major proximal causes of death included drug overdose, violence, and alchol-related conditions. The death rate of the smokers identified in 1974-1975 was four times that of nonsmokers. The only other distal variable that predicted mortality was disability status in 1974-1975. Conclusions. Smoking status and disability history were major distal predictors of subsequent death. However, tobacco-attributable mortality was directly substantiated as a proximal cause of death by only 16% of the death certificates. (C) 1994 Academic Press, Inc.