Faculty Bibliography

BACKGROUND:We sought to estimate the prevalence of synthetic cannabinoid use and characteristics of people who use in the US general population. METHODS:We compared the prevalence of past-year synthetic cannabinoid use in 2023 to 2021 among individuals ages ≥ 12 surveyed via the National Survey on Drug Use and Health (N = 173,808). We also compared prevalence according to demographic and drug use characteristics and delineated correlates of past-year use. RESULTS:Synthetic cannabinoid use increased from 0.17 % in 2021 to 0.26 % in 2023, a 50.0 % increase (p = .042) (0.25 % prevalence in 2021-2023 overall). The largest increases were among those aged ≥ 35 (by 255.3 %), those with an annual family income of < $20,000 (by 242.1 %), and those who used methamphetamine in the past year (by 184.6 %) (Ps < .05). In our final multivariable model, those with less than a high school diploma (aOR=2.20, 95 % CI: 1.12-4.32) and those with past-year cannabis use (aOR=13.55, 95 % CI: 8.36-21.95) and use disorder (aOR=26.03, 95 % CI: 17.70-38.29) were at higher odds for synthetic cannabinoid use, as were people with methamphetamine use (aOR=3.08, 95 % CI: 1.18-8.01) and use disorder (aOR=4.74, 95 % CI: 2.17-10.37), and prescription opioid misuse (aOR=1.75, 95 % CI: 1.05-2.93) and use disorder (aOR=3.22, 95 % CI: 1.78-5.82). CONCLUSION/CONCLUSIONS:Survey data suggest that synthetic cannabinoid use is rare but increasing, particularly among people of lower socioeconomic status and people who use other drugs. Cannabis use disorder in particular is associated with higher odds for use. Research is needed to determine if overreporting is occurring due to confusion with emerging cannabis products.

Historically, recruiting research participants through social media facilitated access to people who use opioids, capturing a range of drug use behaviors. The current rapidly changing online landscape, however, casts doubt on social media's continued usefulness for study recruitment. In this viewpoint paper, we assessed social media recruitment for people who use opioids and described challenges and potential solutions for effective recruitment. As part of a study on barriers to harm reduction health services, we recruited people who use opioids in New York City to complete a REDCap (Research Electronic Data Capture; Vanderbilt University) internet-based survey using Meta (Facebook and Instagram), X (formerly known as Twitter), Reddit, and Discord. Eligible participants must have reported using opioids (heroin, prescription opioids, or fentanyl) for nonprescription purposes in the past 90 days and live or work in New York City. Data collection took place from August 2023 to November 2023. Including study purpose, compensation, and inclusion criteria caused Meta's social media platforms and X to flag our ads as "discriminatory" and "spreading false information." Listing incentives increased bot traffic across all platforms despite bot prevention activities (eg, reCAPTCHA and counting items in an image). We instituted a rigorous post hoc data cleaning protocol (eg, investigating duplicate IP addresses, participants reporting use of a fictitious drug, invalid ZIP codes, and improbable drug use behaviors) to identify bot submissions and repeat participants. Participants received a US $20 gift card if still deemed eligible after post hoc data inspection. There were 2560 submissions, 93.2% (n=2387) of which were determined to be from bots or malicious responders. Of these, 23.9% (n=571) showed evidence of a duplicate IP or email address, 45.9% (n=1095) reported consuming a fictitious drug, 15.8% (n=378) provided an invalid ZIP code, and 9.4% (n=225) reported improbable drug use behaviors. The majority of responses deemed legitimate (n=173) were collected from Meta (n=79, 45.7%) and Reddit (n=48, 27.8%). X's ads were the most expensive (US $1.96/click) and yielded the fewest participants (3 completed surveys). Social media recruitment of hidden populations is challenging but not impossible. Rigorous data collection protocols and post hoc data inspection are necessary to ensure the validity of findings. These methods may counter previous best practices for researching stigmatized behaviors.

INTRODUCTION/BACKGROUND:Vaping of nicotine and cannabis has increased substantially among US adults, but its impact on workplace productivity remains poorly understood. This study examines the associations between nicotine and cannabis vaping patterns and workplace absenteeism. METHODS:Cross-sectional data from a US nationally representative sample of noninstitutionalized part-time and full-time employed adults aged ≥ 18 from the 2022 National Survey on Drug Use and Health (N = 30,591) were analyzed. The associations between nicotine vaping (recency and frequency), cannabis vaping (recency), and workplace absenteeism (measured by self-reported number of missed days due to illness/injury and skipped work in the past month) were evaluated using negative binomial regression adjusting for sociodemographic characteristics and other past-month drug use. RESULTS:An estimated 10.4 % of full-time workers vaped nicotine in the past month and 6.4 % vaped cannabis. Compared to never-vapers of nicotine, those with any history of vaping had higher estimated incidence of absences with past-month vaping associated with increased incidence of missed work due to illness/injury (aIRR = 1.34, 95 % CI: 1.14-1.59) and skipping work (aIRR = 1.65, 95 % CI: 1.24-2.21). Past-month cannabis vaping was associated with increased estimated incidence of missed work due to illness/injury (aIRR = 1.35, 95 % CI: 1.06-1.72) and skipping work (aIRR = 1.70, 95 % CI: 1.32-2.18), although these rates did not differ significantly from those associated with non-vaped cannabis use. Associations were generally stronger among full-time workers compared to part-time workers. CONCLUSION/CONCLUSIONS:Both nicotine and cannabis vaping are associated with increased workplace absenteeism. Results support the development and implementation of workplace policies to address vaping-related productivity losses.

As the opioid crisis continues, now driven by use of fentanyl, naloxone is an increasingly important intervention to reverse overdoses. More research is needed on the willingness of populations at risk for unintentional fentanyl exposure (through adulterated drugs) to accept naloxone to reverse potential overdoses. Adults (n = 991) entering randomly selected nightclubs in New York City (NYC) were surveyed at the point-of-recruitment in 2024 and were asked about their willingness to accept a free naloxone kit. We examined the prevalence of reported willingness to accept naloxone and reasons for refusal, and we examined prevalence and correlates of participants accepting naloxone. During the survey, 65.2% of participants reported being familiar with naloxone, 62.1% agreed to accept naloxone, and 49.6% were recorded as accepting a kit. Those residing in NYC, compared to visitors, had a higher prevalence of recorded acceptance (aPR = 1.41, 95% CI: 1.11-1.79), as did those reporting familiarity with naloxone (aPR = 1.27, 95% CI: 1.02-1.58), and those with an average higher readiness to intervene in an opioid overdose (aPR = 1.18, 95% CI: 1.04-1.33). The majority who refused (56.1%) reported not being interested; 10.1% reported that they were not worried about overdoses, and 8.2% reported that they already had naloxone. Although 83.4% agreed that naloxone is used to reverse opioid overdoses, 35.4% reportedly thought that naloxone is used to reverse the effects of cocaine or any drug. While at least half of attendees were willing to accept a naloxone kit, lack of interest and lack of knowledge about naloxone were potential barriers to carrying naloxone.

BACKGROUND:Smoking among adults in substance use disorder (SUD) treatment programs is common with limited success in quitting. Given e-cigarettes' potential for smoking harm reduction, it is important to examine e-cigarette use among people in SUD treatment. METHODS:We analyzed data from adults who have received SUD treatment in the past year, from the 2020-2021 National Survey on Drug Use and Health (N = 1,246). We delineated correlates of lifetime and current (past-month) use e-cigarette use. RESULTS:Among adults receiving SUD treatment, an estimated 39.4 % (95 % CI: 34.1, 45.1) have used e-cigarettes in their lifetime and 19.5 % (95 % CI: 16.1, 23.6) of those currently vape. Among those reporting current vaping, an estimated 57.3 % (95 % CI: 44.9-68.8) currently smoke cigarettes and half (54.2 % [95 % CI: 41.1-66.7]) currently use cannabis. Compared to those who only received treatment for alcohol use disorder, those receiving treatment for drug use (aPR = 1.47, 95 % CI: 1.09-1.99) and alcohol and drug use (aPR = 1.60, 95 % CI: 1.16-2.22) had higher prevalence of lifetime e-cigarette use, and those reporting treatment for drug use only (aPR = 2.60, 95 % CI: 1.52-4.46) and alcohol and drug use (aPR = 2.82, 95 % CI: 1.63-4.87) also had higher prevalence of current e-cigarette use. CONCLUSIONS:The prevalence of e-cigarette use was higher among those in treatment for both drug or alcohol and drugs only than those receiving treatment for only alcohol use. Smoking harm reduction interventions can potentially include e-cigarette among those receiving drug treatment. There is also a need to address challenges of dual e-cigarette and cigarette use, as well as dual e-cigarette use with cannabis.

Little is known about ecstasy/MDMA use among Asian American and Pacific Islander populations. Research is important because AAPIs face unique cultural factors that may influence use. We estimated the prevalence and correlates of lifetime ecstasy/MDMA use based on a representative sample of US AAPI adults aged ≥18 from the 2015-2020 National Survey on Drug Use and Health. An estimated 5.1% of AAPI adults used ecstasy in their lifetime. Compared to males, females had higher odds of use (aOR = 1.45, 95% CI: 1.08-1.98). Compared to those aged 18-25, those aged 26-34 were at increased odds for use (aOR = 1.99, 95% CI: 1.30-3.06), while those aged ≥50 were at lower odds for use. Lifetime use of other substances including cannabis (aOR = 28.4, 95% CI: 17.1-47.2), ketamine (aOR = 10.9, 95% CI: 1.63-73.4), LSD (aOR = 3.82, 95% CI: 1.98-7.37), cocaine (aOR = 3.77, 95% CI: 2.54-5.59), psilocybin (aOR = 3.29, 95% CI: 1.75-6.16), prescription opioids (aOR = 2.43, 95% CI: 1.44-4.09), and prescription stimulants (aOR = 1.96, 95% CI: 1.29-2.99) were associated with increased odds of ecstasy/MDMA use. We estimated that over 1 in 20 AAPI adults have ever used ecstasy/MDMA. Variations by age, sex, family income, substance type, and mental health service utilization emphasize the need for targeted public health strategies.

BACKGROUND:Off-label prescribing of ketamine to treat psychiatric disorders has been increasing, as has recreational use and availability of illicit ketamine. It is important to examine trends in ketamine-related poisonings to inform public health efforts. METHODS:We examined data from poisonings (exposures) involving ketamine reported to Poison Centers in the US between 2019 and 2023 (n = 1519). Annual trends were examined for number of exposures and characteristics of exposures, and we delineated correlates of major (life-threatening) adverse effects and death compared to less severe outcomes. RESULTS:The number of reported ketamine exposures increased from 205 in 2019 to 414 in 2023. Most cases involved ketamine ingestion (57.2 %), and a plurality involved misuse or "abuse" (36.2 %) and moderate effects (44.8 %). The percentage of cases involving suspected suicide attempts doubled from 12.7 % in 2019 to 25.9 % (a 103.9 % increase; P < 0.001); ingestion use increased from 46.0 % to 65.2 % (a 41.7 % increase; P < 0.001), and cases involving ketamine in liquid form decreased from 65.1 % to 41.2 % (a 36.7 % decrease; P < 0.001). Cases with major effects or death decreased from 23.4 % in 2019 to 15.6 % in 2023 (a 33.2 % decrease; P = 0.039). A major event or death was experienced by 18.6 % of cases, but prevalence was lower for those who inhaled ketamine (aPR=0.49, 95 % CI:0.29-0.85) compared to those who did not inhale. DISCUSSION/CONCLUSIONS:Poisonings involving ketamine are at their highest in reporting history. Both medical and recreational ketamine use and related adverse events need to be monitored, especially as off-label prescribing of take-home oral formulations appears to be increasing.

INTRODUCTION/BACKGROUND:Law enforcement seizure data can indicate potential shifts in drug availability. We examined trends in the size of illicit fentanyl seizures in the United States from 2018 through 2023. METHODS:Using national High Intensity Drug Trafficking Areas data, we examined trends in the weight of fentanyl powder and number of fentanyl-containing pills per seizure with a focus on federal and other common state-level weight cutoffs that indicate various levels of trafficking (e.g., 1-4 g, 40-399 g, ≥400 g). RESULTS:Between 2018 and 2023, the plurality of fentanyl powder seizures weighed 40-399 g (27.7%), followed by seizures weighing 4-39 g (25.8%), 1-4 g (18.6%), ≥400 g (17.4%), and <1 g (10.4%). During this period, there was a decrease in the percentage weighing ≥400 g (annual percentage change [APC] = -5.3, 95% confidence interval [CI] -9.4, -1.0) and an increase in the percentage weighing 1-4 g (APC = 5.6, 95% CI 3.2, 8.1). With respect to fentanyl pill seizures, the plurality contained 40-399 pills (10 = 1 g; 25.4%), followed by 400-3999 (21.8%), <10 pills (20.4%), 10-39 pills (18.6%) and ≥4000 pills (13.8%). During this period, there was a decrease in seizures of <10 pills (APC = -12.6, 95% CI -23.2, -0.7) and increases in seizures containing 400-3999 (APC = 14.0, 95% CI 5.3, 23.1) and ≥4000 pills (APC = 12.6, 95% CI 7.4, 17.8). DISCUSSION AND CONCLUSIONS/CONCLUSIONS:The size of fentanyl seizures varies greatly, with a sizeable portion legally classified as drug trafficking. While the weight of fentanyl powder seizures is decreasing, the size of pill seizures is increasing. The increasing availability of fentanyl pills in particular needs to be monitored to inform prevention and harm reduction efforts.