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 alcohol-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.