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

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

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

Sample Characteristics Mean age (last interview year) Birth year Pre > 1965 Ethnicity African American Latino/Hispanic White Baby boomers 33-year Follow-up Heroin Sample 581 male / % % 20.3% 8% 56% 36% 12-year Follow-up Cocaine Sample 321 male veterans / % 226.8% % % % % 41.2% 68% 7% 25%

Average Ages at Key Events Over Lifespan

Mortality Rates Age Category in 1992 Under > 70 Total Heroin Sample N = 581 Deaths by 1997 (%) Cocaine Sample N = 321 Deaths by 2003 (%) *17.0 (*45 and older) Increase with Age Heroin Sample Has a Higher Mortality Rate

Cumulative Percent of Reporting Ever Used by Age at First Use CocaineMarijuanaHeroin AmphetamineTobaccoAlcohol

Percent of Any Weekly Drug Use Over Time CocaineMarijuana Heroin

Past Year Use* Heroin Sample 55 or Younger (N=72) (N=111) Older than 60 (N=59) Cocaine Sample 50 or Younger (N=174) Older than 50 (N=92) Tobacco Daily alcohol Marijuana Amphetamine Cocaine/crack Heroin *Based on self-report and urinalysis Still High among Older Addicts

Rates of Abstinence (for 5 or More Years) Heroin Sample 55 or Younger (N = 72) (N = 111) Older than 60 (N = 59) Cocaine Sample 50 or Younger (N = 174) Older than 50 (N = 92) Heroin Cocaine Increase with Age

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

Older Ages Reporting 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 Heroin Sample 55 or Younger (N=72) (N=111) Older than 60 (N=59) Cocaine Sample 50 or Younger (N=174) Older than 50 (N=92) Worse Health Functioning

Older Ages Reporting On-going Cardiovascular disease 1 Respiratory disease 2 TB Digestive disease 3 Hepatitis Dental problems Diabetes Arthritis-Rheumatism STDs 4 1 Hypertension, Hardening of arteries/heart attack, Other 2 Asthma, Emphysema/Lung Cancer, TB 3 Cirrhosis, Hepatitis, Ulcer, Hernia rapture, Spastic colon 4 AIDS/HIV, Gonorrhea, Syphilis, Herpes, Others Heroin Sample 55 or Younger (N=72) (N=111) Older than 60 (N=59) Cocaine Sample 50 or Younger (N=174) Older than 50 (N=92) More Health/Medical Conditions

Medical Testing Results Show* Over half (58.3%) had hypertension One-fifth (22.4%) had high total cholesterol Over half (54.6%) were overweight (using body/mass index) Source: Hser et al., Journal of Behavioral Medicine (in press) High * Heroin subsample Levels of Cardiovascular Risk

Medical Testing Results Show* 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 High Levels of Infectious Diseases

High 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 Medical Testing Results Show* Levels of Abnormal Functions

Mental Health Problems Symptom Checklist Depression Anxiety Somatization Obsessive Compulsive Interpersonal sensitivity Heroin Sample 55 or Younger (N=72) (N=111) Older than 60 (N=59) Cocaine Sample 50 or Younger (N=174) Older than 50 (N=92) Higher scores indicate greater problem severity Increase with Age among Cocaine Sample

Abstinence from Primary Drug Show 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 Heroin Sample Abstinent 5 or more years (N = 113) Abstinent less than 5 years (N = 129) Cocaine Sample Abstinent 5 or more years (N = 138) Abstinent less than 5 years (N = 128) Better Health Functioning

Abstinence from Primary Drug Show On-going Cardiovascular disease 1 Respiratory disease 2 TB Digestive disease 3 Hepatitis Dental problems Diabetes Arthritis-Rheumatism STDs 4 1 Hypertension, Hardening of arteries/heart attack, Other 2 Asthma, Emphysema/Lung Cancer, TB 3 Cirrhosis, Hepatitis, Ulcer, Hernia rapture, Spastic colon 4 AIDS/HIV, Gonorrhea, Syphilis, Herpes, Others Heroin Sample Abstinent 5 or more years (N = 113) Abstinent less than 5 years (N = 129) Cocaine Sample Abstinent 5 or more years (N = 138) Abstinent less than 5 years (N = 128) Better Health/Medical Conditions

Abstinence from Primary Drug Show Symptom Checklist Depression Anxiety Somatization Obsessive Compulsive Interpersonal sensitivity Higher scores indicate greater problem severity Heroin Sample Abstinent 5 or more years (N = 113) Abstinent less than 5 years (N = 129) Cocaine Sample Abstinent 5 or more years (N = 138) Abstinent less than 5 years (N = 128) Better Mental Health

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