Faculty Bibliography

OBJECTIVE/UNASSIGNED:The authors sought to examine substance use patterns across the sexual identity spectrum, particularly among individuals who describe their sexual identity using different terms or express uncertainty about their orientation-groups that remain poorly understood beyond lesbian, gay, or bisexual (LGB) categories. METHODS/UNASSIGNED:Using data from the 2023 National Survey on Drug Use and Health among individuals ≥12 years of age (N=52,525), the authors examined past-year substance use across five sexual identity groups: heterosexual, gay/lesbian, bisexual, those using a different term to describe their sexual identity, and those unsure of their identity. Associations were examined between sexual identity (overall and disaggregated by sex using sex-specific heterosexual reference groups) and past-year use of cannabis, hallucinogens, cocaine, inhalants, methamphetamine, and misuse of prescription opioids, tranquilizers/sedatives, and stimulants. RESULTS/UNASSIGNED:Substance use was higher across all other sexual identity groups compared with heterosexual individuals. Bisexual and gay/lesbian individuals showed elevated odds across most substances examined, particularly inhalants, hallucinogens, and cannabis. Both individuals using different terms and those unsure of their sexual identity showed elevated odds for inhalants, hallucinogens, cannabis, and prescription tranquilizer/sedative misuse, with those using different terms additionally showing elevated odds for prescription stimulant misuse. In sex-disaggregated analyses, both males and females showed elevated odds across multiple substances, with females generally showing elevations across a greater number of substances, although some estimates for males were suppressed due to small sample sizes. CONCLUSIONS/UNASSIGNED:These findings extend our understanding of substance use beyond LGB categories, revealing nuanced patterns among emerging identity groups, underscoring the importance of targeted screening and prevention strategies.

INTRODUCTION/BACKGROUND:As new psychoactive substances (NPS) continue to emerge both in the US and globally, research is needed to determine the extent of adverse effects associated with NPS use beyond poisonings or mortality to inform prevention and harm reduction efforts in this population. METHODS:Data were from the National Drug Early Warning System Rapid Street Reporting study, which uses a venue-intercept design to survey adults (≥ 18 years) in US cities over weekend periods. Between January 2022 and November 2023, 6039 individuals were surveyed in 20 cities regarding their use of a range of NPS and other common drugs. Those reporting past 12-month use of a drug were asked if they experienced a harmful or very unpleasant effect after use. RESULTS:Overall, among those reporting any past 12-month NPS use (n = 259), over a quarter (27.03%) reported experiencing an adverse effect related to the use of at least one NPS in the past 12 months. Among those reporting NPS use, those who also reported past 12-month opioid use had over two times the prevalence of reporting an adverse effect related to NPS use (adjusted prevalence ratio 2.66, 95% confidence interval 1.41, 5.01). Symptom profiles were broadly similar between NPS and common drug classes. DISCUSSION AND CONCLUSIONS/CONCLUSIONS:Adverse effects from NPS appear to be common among those self-reporting NPS use, particularly among those reporting polysubstance use. More data are needed to determine event-specific adverse outcomes involving the use of NPS and other drugs.

PURPOSE OF REVIEW/UNASSIGNED:Tusi, also known as "pink cocaine," has emerged across nightlife scenes in Latin America, Europe, Australia, and the United States (US). Tusi is typically a drug mixture containing ketamine and 3,4-methylenedioxymethamphetamine (MDMA). Due to tusi's inconsistent chemical makeup, surveillance and harm reduction efforts have proven difficult for researchers and consumers alike. This review synthesizes evidence from peer-reviewed literature, drug checking programs, toxicology reports, and law enforcement data published between 2020 and 2025 to characterize tusi's composition, epidemiology, and associated risks. RECENT FINDINGS/UNASSIGNED:Drug checking services in various countries have identified ketamine and MDMA as the main components of tusi with additional substances often added (e.g., synthetic cathinones, cocaine, methamphetamine) in varying combinations. Laboratory data from Spain show that ketamine concentrations in tusi have increased over time. Surveys in Spain and Colombia highlight increases in initiation, polysubstance use involving tusi, and misclassification of its contents. Toxicology and case series reports indicate that harms associated with use stem largely from polysubstance mixtures rather than any single component, yet morbidity and mortality data typically focus on individual drugs detected. SUMMARY/UNASSIGNED:Tusi exemplifies a novel trend in emerging drugs: it is a blend of substances rather than a single compound, with its identity shaped by its distinctive color and association with nightlife. Its inconsistent composition and frequent co-use with stimulants and dissociatives elevate risk while complicating surveillance. Standardized survey items, expanded drug checking, and improved toxicological monitoring are needed to track and respond to this evolving mixture in the global drug supply.

BACKGROUND:Alkyl nitrites, commonly known as "poppers," have been widely used as recreational inhalants since the 1970s, particularly among men who have sex with men (MSM). Despite regulatory restrictions in the United States, poppers remain available under misleading product labels (eg, nail polish removers). Limited epidemiologic research has focused on trends in prevalence and correlates of poppers use, particularly among populations that include non-MSM individuals. METHODS:We analyzed data from a repeated cross-sectional survey of adults entering electronic dance music events at nightclubs in New York City (NYC) between 2017 and 2024 (N = 3332). We estimated trends in past-year poppers use overall and stratified by demographic and drug use-related factors in the NYC nightclub-attending population, and we also delineated correlates of use. RESULTS:s < .05). CONCLUSION/CONCLUSIONS:While sexual minority males remain at highest risk for poppers use, prevalence is also increasing among traditional lower-risk groups, underscoring the need for expanded public health messaging and harm reduction strategies.

BACKGROUND/UNASSIGNED:The ketamine landscape in the USA is rapidly shifting, especially given recent increases in off-label prescribing of ketamine as a psychiatric treatment. Research is needed to determine the extent to which illicit ketamine is available, nonmedically used, and associated with morbidity and mortality in the USA. METHODS/UNASSIGNED:This observational study used eight unique annual repeated cross-sectional datasets to examine illicit ketamine availability (using seizure data as a proxy), use, and consequences of use, including self-reported nonmedical use among noninstitutionalized individuals aged ≥12 years (2006-2014, 2015-2019, and 2021-2023) and among 12th grade students (2000-2023). Further, it assessed reported ketamine-related poisonings (1991-2023) and mortalities (2020-2023), diversion of undispensed pharmaceutical ketamine (2008-2024), drug seizures testing positive for ketamine (2001-2024), and the number and total weight of ketamine seizures from two additional law enforcement agencies (2017-2024 and 2019-2024). Piecewise linear regression models were used to estimate annual trends. FINDINGS/UNASSIGNED:Nonmedical ketamine use among individuals aged ≥12 years increased between 2021 (0.19%) and 2023 (0.34%) (b [slope] = 0.08 [SE = 0.001], p = 0.0072). Regarding reported poisonings, there was initial increase from 1994 to 2000 (from 0.17 to 1.40 per 1,000,000 population; b = 0.20 [SE = 0.02], p < 0.0001), a decrease through 2003 (0.58 per 1,000,000 population; b = -0.34 [SE = 0.08, p = 0.0002) and an increase from 2017 through 2023 (from 0.76 to 1.54 per 1,000,000 population; b = 0.12 [SE = 0.03], p = 0.0002). The number of reported diversions increased from 2008 (n = 23) to 2017 (n = 202) (b = 18.72 [SE = 2.20], p < 0.0001) and again from 2021 (n = 183) to 2024 (n = 286) (b = 39.00 [SE = 12.04], p < 0.0001). Regarding seizures, there was an increase in ketamine reports to one agency from 2015 (n = 1448) through 2024 (n = 4008) (b = 201.41 [SE = 57.83], p = 0.0023). In another source, there was an increase in seizures from 2022 (n = 247) through 2024 (n = 502) (b = 127.50 [SE = 10.40], p = 0.0003). Rates of ketamine-involved deaths did not significantly shift between 2020 and 2023. Nonmedical use declined among 12th grade students, first from 2000 (2.49%) through 2005 (1.61%) (b = -0.19 [SE = 0.06], p = 0.0039] and then again from 2005 through 2023 (0.9%) (b = -0.04 [SE = 0.01], p = 0.0019). INTERPRETATION/UNASSIGNED:Ketamine poisonings, pharmaceutical diversion, and seizures have increased; trends in nonmedical ketamine use vary. Prevention and harm reduction are needed as use and morbidity are expected to continue to increase. FUNDING/UNASSIGNED:National Institute on Drug Abuse at the National Institutes of Health.

The U.S. Drug Enforcement Administration (DEA) proposed a rule in which they intend to place the psychedelic phenethylamines 2,5-dimethoxy-4-chloroamphetamine (DOC) and 2,5-dimethoxy-4-iodoamphetamine (DOI) into Schedule I of the Controlled Substances Act. We examined the epidemiology of use and availability of these substances. We examined national trends in seizures of these compounds (which indicate availability) using DEA National Forensic Laboratory Information System (NFLIS) and High Intensity Drug Trafficking Areas (HIDTA) data. We also examined the prevalence of self-reported use on the National Survey of Drug Use and Health (NSDUH), a nationally representative sample of noninstitutionalized individuals aged ≥12 in the United States. The scientific literature was also systematically searched for reports of poisonings linked to use. Between 2005 and 2024, NFLIS received 795 submissions of drugs testing positive for DOC, with a peak of 152 in 2012. There was then a decrease through 2024, with only two submissions containing DOC in 2023-2024. Forty submissions contained DOI, with no submissions testing positive in 2019-2024. Three DOC seizures were recorded by HIDTA in 2017-2021, with none in 2022-2024. HIDTA had no recorded seizures of DOI. Between 2005 and 2023, there were 37 and 10 type-in mentions of lifetime DOC and DOI use, respectively, in NSDUH responses, suggesting a lifetime prevalence of < 0.01% among the noninstitutionalized U.S. population. We located three reports of poisonings linked to DOC use (in 2008-2024) and none linked to DOI use. Availability, recreational use, and poisoning related to the use of DOC and especially DOI appear to be rare.

PURPOSE OF REVIEW/UNASSIGNED:As the overdose crisis evolves, it is important to monitor fentanyl consumption patterns. This review provides an overview of recent findings regarding illegally manufactured fentanyl (IMF) availability, use, and associated harms in the US. RECENT FINDINGS/UNASSIGNED:Availability of IMF has increased, especially in pill form, and the increasing adulteration of IMF with veterinary tranquilizers such as xylazine complicates overdose response. Prevalence in the general population based on self-reported IMF use is rare, and likely underestimated. Transitions from injection to smoking have been documented in recent years, particularly in the western US. Fentanyl-stimulant polysubstance use has also been observed increasingly among IMF-related overdose deaths. SUMMARY/UNASSIGNED:Shifts in routes of administration, availability of counterfeit pills containing fentanyl, and common adulterants add complexity to the landscape of IMF use and related harms. Additional data is needed for monitoring changes in consumption patterns to inform prevention and harm reduction efforts.