title: The spectrum of unhealthy drug use and quality of care for hypertension and diabetes: a longitudinal cohort study.
abstract: OBJECTIVE
  Although it is well known that addiction is associated with adverse medical consequences, the effects of the spectrum of unhealthy drug use (illicit drug or prescription misuse) on chronic conditions such as hypertension and diabetes are understudied. This study evaluated the associations between measures of drug use (ie, frequency, severity and type) and standard quality metrics for inadequate blood pressure (BP) and blood glucose (BG) control.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Adult primary care patients with unhealthy drug use and hypertension or diabetes.
  
  
  METHODS
  Urban hospital-based primary care practice.
  
  
  METHODS
  Outcomes were (1) inadequate BP (systolic BP ≥ 140 or diastolic BP ≥ 90) and (2) inadequate BG (glycated haemoglobin ≥ 8%) control (Healthcare Effectiveness Data and Information Set criteria). Drug use was characterised by a primary independent variable, drug use frequency, and two secondary variables, severity of use and drug type. We fit separate regression models for each drug use measure and outcome.
  
  
  RESULTS
  Overall, 40% (65/164) of the sample with hypertension had inadequate BP control and 44% (24/54) of those with diabetes had inadequate BG control. More frequent drug use was not significantly associated with inadequate BP control (adjusted OR (AOR) 0.67; 95% CI 0.31 to 1.46, highest vs lowest tertile; AOR 0.72; 95% CI 0.36 to 1.41, middle vs lowest tertile) or BG control (AOR 0.27; 95% CI 0.07 to 1.10, highest vs lowest tertile; AOR 1.01; 95% CI 0.38 to 2.69, middle vs lowest tertile). Drug use severity was also not associated with BP or BG control. Cocaine use was associated with inadequate BG control compared to marijuana use (AOR 8.82; 95% CI1.86 to 41.90).
  
  
  CONCLUSIONS
  Among primary care patients with recent drug use and hypertension or diabetes, drug type was significantly associated with inadequate BG, but not BP control. Frequency and severity of use were not significant predictors of either outcome.
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Theresa W
authors.identifier: http://orcid.org/0000-0001-6043-0721
authors.initials: TW
authors.lastname: Kim
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Bernstein
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Na
authors.initials: N
authors.lastname: Wang
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: German
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D013287:Illicit Drugs / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D008385:Marijuana Smoking / Q000009:adverse effects; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D011787:Quality of Health Care; D019966:Substance-Related Disorders / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D013287:Illicit Drugs; C517652:hemoglobin A1c protein, human
keywords: PRIMARY CARE