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Addict Behav. 2013 Mar;38(3):1601-4. doi: 10.1016/j.addbeh.2012.10.007. Epub 2012 Oct 22.

Mortality in a cohort of young primary cocaine users: controlling the effect of the riskiest drug-use behaviors.

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  • 1National School of Public Health, Carlos III Health Institute, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Spain.



Published studies indicate that primary cocaine users (PCUs) have a mortality rate 4-8 times higher than their age-sex peers in the general population. Most PCUs are primary intranasal cocaine users, never-injectors and never-opioid users (PICUNINOs) and are usually underrepresented in cohort mortality studies. The aim is to estimate excess mortality in all PCUs and in the subgroups of never-opioid users and PICUNINOs in Spain.


714 PCUs aged 18-30 were street-recruited in 2004-2006 in Spain and followed until 2010 to ascertain vital status. Drug use was self-reported at baseline and 1-2years later. Mortality was compared with that of the general population using standardized mortality ratios (SMRs).


SMRs were 4.7 (95% CI: 2.4-9.0), 2.5 (95%CI: 0.8-7.8) and 3.1 (95% CI: 1.0-9.6), respectively, among all participants, never-opioid users and PICUNINOS when using only baseline data on drug use, and 1.2 (95% CI: 0.2-8.5) and 1.4 (95% CI: 0.2-9.9) among the latter two subgroups, when using baseline plus follow-up data.


Short-term mortality in young Spanish PCUs is 5 times higher than in the general population. This excess mortality may largely be explained by a history of opioid use or the risk of starting such use.

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