Faculty Bibliography

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.

3,4-methylenedioxymethamphetamine (MDMA; commonly referred to as "ecstasy" or "molly") is a substituted amphetamine drug that is used recreationally for its acute psychoactive effects, including euphoria and increased energy, as well as prosocial effects such as increased empathy and feelings of closeness with others. Acute adverse effects can include hyperthermia, dehydration, bruxism, and diaphoresis. Post-intoxication phenomena may include insomnia, anhedonia, anxiety, depression, and memory impairment, which can persist for days following drug cessation. MDMA acts as a releasing agent for monoamine neurotransmitters, including dopamine (DA), norepinephrine (NE) and serotonin (5-HT), by interfering with vesicular storage and transporter function, thus increasing extracellular levels of DA, NE, and 5-HT. Medical intervention in response to adverse events is complicated by the fact that illicitly-acquired MDMA is frequently adulterated, contaminated, or outright replaced with other psychoactive drugs such as synthetic cathinones ("bath salts") or methamphetamine, often unknown to the person using the drug. This review provides background on the legal status of MDMA and its use patterns, including proposals for its use as an adjunct in psychotherapy. It also discusses the pharmacological properties, mental and physical health effects, and interactions of MDMA with other drugs, with special focus on harm reduction strategies. This information will help healthcare providers assess adverse health effects related to MDMA/ecstasy use in order to facilitate appropriate treatment strategies and improve patient outcomes.

OBJECTIVE:This analysis evaluated the validation results of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) tool for older adults. METHODS:We performed a subgroup analysis of older adults aged ≥65 (n = 184) from the TAPS tool validation study conducted in 5 primary care clinics. We compared the interviewer and self-administered versions of the TAPS tool at a cutoff of ≥1 for identifying problem use with a reference standard measure, the modified World Mental Health Composite International Diagnostic Interview. RESULTS:The mean age was 70.6 ± 5.9 years, 52.7% were female, and 49.5% were non-Hispanic Black. For identifying problem use, the self-administered TAPS tool had sensitivity of 0.91 (95% CI: 0.75-0.98) and specificity of 0.91 (95% CI: 0.85-0.95) for tobacco; sensitivity of 0.68 (95% CI: 0.45-0.86) and specificity of 0.88 (95% CI: 0.82-0.93) for alcohol; and sensitivity 0.86 (95% CI: 0.42-1.00) and specificity 0.94 (95% CI: 0.90-0.97) for cannabis. The interviewer-administered TAPS tool had similar results. We were unable to evaluate its performance for identifying problem use of individual classes of drugs other than cannabis in this population due to small sample sizes. CONCLUSIONS:While the TAPS had excellent sensitivity and specificity for identifying tobacco use among older adults, the results for other substances lack precision, and we were unable to evaluate its performance for prescription medications and individual illicit drugs in this sample. This analysis underlines the critical need to adapt and validate screening tools for unhealthy substance use, specifically for older populations who have unique risks.

BACKGROUND:Ketamine's potential for treating depression has drawn increased clinical interest in recent years. However, despite growing therapeutic use, recreational use among individuals with depression remain underexplored. METHODS:We analyzed data from the 2015-2022 National Survey on Drug Use and Health focusing on adults in the US. Trends in past-year ketamine use, overall and by depression status, were estimated separately for 2015-2019 and 2021-2022 due to methodological changes in the survey. We also delineated correlates of ketamine use in each period, focusing on depression, sociodemographic characteristics, and other past-year drug use. RESULTS:Overall ketamine use prevalence increased from 2015 to 2019 (from 0.11 % to 0.20 %, an 81.8 % increase, p < 0.01) and from 2021 to 2022 (from 0.20 % to 0.28 %, a 40.0 % increase, p < 0.05). From 2015 to 2019, use increased among adults with and without depression (by 139.3 % [p < 0.05] and 66.7 % [p < 0.05], respectively), while from 2021 to 2022, an increase occurred only among those without depression (by 38.9 %, p < 0.05). Multivariable models revealed that depression was associated with increased odds of ketamine use in 2015-2019 (aOR = 1.80, 95 % CI: 1.12-2.89) but not in later years. New sociodemographic correlates emerged in 2021-2022, including adults aged 26-34 and those with a college degree being at higher odds for use. Various drugs (especially ecstasy/MDMA and gamma-hydroxybutyrate) were consistently associated with higher odds of use. CONCLUSION/CONCLUSIONS:We identified differential patterns and correlates of ketamine use over time. Shifts may be related to the evolving ketamine landscape and/or changing survey methodology. Monitoring of use patterns is crucial to inform prevention and harm reduction strategies.