title: Mortality in a cohort of young primary cocaine users: controlling the effect of the riskiest drug-use behaviors.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: National School of Public Health, Carlos III Health Institute, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Spain. gbarrio@isciii.es
authors.forename: Gregorio
authors.initials: G
authors.lastname: Barrio
authors.forename: Gemma
authors.initials: G
authors.lastname: Molist
authors.forename: Luis
authors.initials: L
authors.lastname: de la Fuente
authors.forename: Fermín
authors.initials: F
authors.lastname: Fernández
authors.forename: Anna
authors.initials: A
authors.lastname: Guitart
authors.forename: María J
authors.initials: MJ
authors.lastname: Bravo
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Brugal
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D019970:Cocaine-Related Disorders / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000401:mortality; D012309:Risk-Taking; D013030:Spain / Q000453:epidemiology; D055815:Young Adult