Faculty Bibliography

OBJECTIVES/OBJECTIVE:Binge drinking is a risk factor for a range of harms. This study estimates the national prevalence of binge drinking and adds to our understanding of correlates of binge drinking among older adults in the United States. DESIGN/METHODS:Cross-sectional analysis. SETTING/PARTICIPANTS/METHODS:A total of 10 927 adults, aged 65 years or older, from the 2015 to 2017 administrations of the US National Survey on Drug Use and Health. MEASUREMENTS/METHODS:tests. We then used multivariable generalized linear models using Poisson and log link to examine the association between covariates and binge drinking among all past-month alcohol users aged 65 years or older. RESULTS:Of 10 927 respondents, 10.6% (95% CI = 9.9%-11.2%) were estimated to be current binge drinkers. Binge drinkers were more likely to be male, have a higher prevalence of current tobacco and/or cannabis use, and have a lower prevalence of two or more chronic diseases compared to nonbinge drinkers. In multivariable analysis, among past-month alcohol users, the prevalence of binge drinking was higher among non-Hispanic African Americans than whites (adjusted prevalence ratio [aPR] = 1.44; 95% CI = 1.16-1.80), tobacco users (aPR = 1.52; 95% CI = 1.33-1.74), cannabis users (aPR = 1.41; 95% CI = 1.11-1.80), and those who visited the ED in the past year (aPR = 1.16; 95% CI = 1.00-1.33). CONCLUSION/CONCLUSIONS:Over a tenth of older adults in the United States are estimated to be current binge drinkers. Results confirm the importance of screening for binge drinking behaviors among older adults to minimize harms.

Background: Drug use among electronic dance music (EDM) party attendees is common; however, studies are needed to examine associations between drug use and sexual orientation as this can inform prevention and harm reduction efforts in the lesbian, gay, and bisexual (LGB) community. Methods: Data were examined from a repeated cross-sectional study of 3066 young adult EDM party attendees surveyed entering nightclubs and dance festivals in New York City between 2016 and 2018. Of these participants, 277 identified as gay/lesbian, 293 identified as bisexual, and 83 identified as other sexuality. We examined how sexual orientation relates to past-year use of various 'traditional' drugs (e.g., ecstasy/MDMA/Molly) and new psychoactive substances (NPS; e.g., "bath salts") in a bivariable and multivariable manner, stratified by sex. Results: Compared to heterosexual males, gay males were at higher odds for use of ecstasy, GHB, and methamphetamine; bisexual males were at higher odds for use of LSD and unknown powders, and males identifying as "other" sexuality were at higher odds for use of mushrooms and 2C drugs. Compared to heterosexual females, lesbians were at higher odds for use of mushrooms and GHB; bisexual females were at higher odds for use of cocaine, LSD, mushrooms, and tryptamines, and females identifying as "other" sexuality were at higher odds for use of cocaine and tryptamines. Conclusions: We determined differential risk of use of different drugs among those who attend EDM parties according to sexual orientation. Findings can be used to tailor prevention messaging to specific groups within the LGB community.

BACKGROUND/OBJECTIVES/OBJECTIVE:Lean (a.k.a.: Sizzurp, Purple Drank) is a recreational beverage that commonly contains codeine cough syrup. Despite its popularization in the hip-hop music scene, few epidemiologic studies have examined use. This study examined prevalence and correlates of use among a population at high-risk for drug use-electronic dance music (EDM) party attendees. METHODS:A total of 1029 EDM party attendees (ages 18-40) were surveyed in New York City in 2018 using time-space sampling. Prevalence and correlates of use of Lean were estimated. RESULTS:An estimated 15.5% of attendees have ever used Lean, and 3.4% of attendees have used in the past year. Only an estimated 0.2% have used in the past month, but 14.2% would use in the next month if offered by a friend. Three-quarters (75.4%) of users believed their Lean ever contained codeine and 32.4% believed it always or usually contained codeine. Past-year use was strongly associated with past-year nonmedical prescription opioid use (adjusted odds ratio = 10.77, P = 0.003), but not past-year use of other illegal drugs. Attendees who are black or bisexual are at higher odds for past-year use, and those with a college degree or higher are at lower odds for past-year use. DISCUSSION AND CONCLUSIONS/CONCLUSIONS:While use of Lean is not as prevalent as use of various other drugs (eg, ecstasy) in this high-risk population, over a tenth have tried it and/or are willing to use it if offered. SCIENTIFIC SIGNIFICANCE/CONCLUSIONS:Prevention efforts need to target potential users as frequent use of beverages containing codeine products can lead to dependence. (Am J Addict 2019:1-6).

Background: Posting on social media can have lasting consequences in one's social life and career. Research has not yet focused on social media or more modern forms of communication as social risk factors for individuals high on drugs. This study aims to examine prevalence and correlates of engaging in social media posting and related behavior while high. Methods: We examined data from 872 adults (39.8% female) who were surveyed entering electronic dance music (EDM) parties in New York City and reported lifetime illegal drug use. Participants were asked whether they were ever high on a drug while (1) posting on social media, (2) calling or texting someone, and (3) being in a photo. Those answering affirmatively were also asked whether they later regretted the behavior. We examined demographic and drug-related correlates of these behaviors. Results: Of the participants, 34.3% posted on social media while high (with 21.4% regretting it), 55.9% had texted or called someone while high (with 30.5% regretting it), and 47.6% had been in a photo while high (with 32.7% regretting it). Females and young adults (ages 18-24) were at high risk for posting on social media while high and at higher risk for engaging in more of these behaviors. Past-month marijuana users in particular were at increased risk for engaging in each of these behaviors. Conclusion: Engaging in these behaviors while high on drugs appears to be prevalent, and prevention and harm reduction efforts should seek to prevent or reduce likelihood of social harm that can result from such situations.

BACKGROUND:Drug use is prevalent among electronic dance music (EDM) party attendees, but research is needed to determine the extent of adverse drug-related outcomes in this population in order to better inform prevention and harm reduction efforts. METHOD/METHODS:1029 adults were surveyed entering EDM parties in New York City in 2018. Those reporting past-year use of a drug were asked if they experienced a harmful or very unpleasant effect after use in which they were concerned about their immediate safety. They were also asked about co-use of other drugs and whether they sought help. RESULTS:We estimate that a third (33.5%) of EDM party attendees have experienced a drug-related adverse effect in the past year. Two-thirds (67.8%) of adverse effects involved use of alcohol. Relative to use, adverse effects most commonly resulted from use of opioids (e.g., prescription opioid misuse, 41.2%) or alcohol (33.9%). Among those reporting an adverse effect, concomitant use of other drugs was common, particularly among users of LSD (56.5%), ketamine (56.3%), cocaine (55.7%), and ecstasy/MDMA/Molly (47.7%). Adverse effects resulting from synthetic cathinone ("bath salt") use were most likely to result in a hospital visit (57.1%). CONCLUSION/CONCLUSIONS:Adverse effects from drug use are common among those in the EDM party scene and polydrug use appears to be a common risk factor. More research is needed, however, to determine the extent of event-specific adverse outcomes. Results can inform prevention and harm reduction efforts in this population.

Low perception of risk is a risk factor for heroin use. Research is needed to determine whether this risk factor for heroin use is affected by the use of other drugs. Data were analyzed from participants in the 2015/2016 National Surveys on Drug Use and Health who denied lifetime heroin use (N= 110,102). We examined how recency of use of various drugs and number of drugs used relate to perceptions that using heroin is not a great risk. Results from multivariable models suggest that no lifetime drug use, and recent prescription opioid misuse and methamphetamine use, in particular, were associated with higher odds of perceiving that heroin use is not of great risk. Recent marijuana use was associated with lower odds of reporting that heroin use is not of great risk. Use of more drugs in one's lifetime, past year, and/or past month tended to be associated with lower odds of reporting heroin use as not a great risk. Prevention experts should consider that recent prescription opioid misuse in particular is a risk factor for the lower perception of risk, while individuals reporting no lifetime drug use may also require better education regarding harms associated with heroin use.

BACKGROUND:Biological testing can be used to validate or detect underreported drug use. Since hair testing is increasingly used in survey research, we examined how the utility of hair testing compares to a more common method-urine testing. METHODS:532 adults (ages 18-29) reporting past-month heroin use and/or nonmedical prescription opioid use were surveyed about past-month use of various drugs. Participants were urine-tested and the majority (79.3%) provided a hair sample for analysis. We examined the utility of urine vs. hair-testing in detecting past-month use of various drugs. RESULTS:Compared to hair testing, urine testing was able to confirm higher proportions of self-reported use of heroin/opioids (85.5% vs. 80.9%), marijuana (73.9% vs. 22.9%), benzodiazepines (51.3% vs. 15.1%), and methadone (77.0% vs. 48.7%), while hair testing was more likely to detect reported cocaine use (66.3% vs. 48.0%) (Ps<.01). Compared to hair testing, urine testing was more likely to detect unreported use of marijuana (11.3% vs. 0.9%), and benzodiazepines (14.4% vs. 5.4%), and hair testing was more likely to detect unreported use of cocaine (27.0% vs. 5.8%) and oxycodone (19.7% vs. 1.4%) (Ps<.001). When added to urine testing, hair testing increased detection of reported and non-reported use of cocaine and oxycodone ranging from 14 to 22%. CONCLUSIONS:While hair testing is efficacious in detecting drug use in wide window periods (e.g., past-year use), it is less efficacious than urine testing when testing for past-month use of select drugs among opiate/opioid users. However, hair testing is particularly efficacious in detecting unreported use of cocaine and/or oxycodone.

Novel synthetic opioids include various analogs of fentanyl and emerging non-fentanyl compounds with different chemical structures, such as AH-7921, MT-45 and U-47700. In recent years, these drugs have rapidly emerged on the drug market, and their abuse has been increasing worldwide. The motivations for use of these new compounds include their legal status, ready availability, low cost, users' curiosity or preference for their particular pharmacological properties and the intention to avoid detection. Furthermore, more common drugs like heroin are now increasingly being replaced or cut with fentanyl or new designer opioids; thus, many drug users are unintentionally or unknowingly using synthetic fentanyl analogs. In this scenario, the detection of new psychoactive substances in hair can provide insight into their current diffusion among the population and social characteristics of these synthetic drug users. In this manuscript, we describe a simple, fast, specific and sensitive UHPLC-MS-MS method able to detect 13 synthetic opioids (including fentanyl analogs) and metabolites in hair samples. Furthermore, the method includes the detection of 4-anilino-N-phenethyl-piperidine (4-ANPP), which is considered both a precursor and a metabolite of several fentanyl analogs. The method was applied to 34 real hair samples collected in New York City from subjects who had reported past-year non-medical opioid and/or heroin use. In total, 17 samples tested positive for at least one target analyte, with oxycodone (nine samples) and tramadol (eight samples) being the most common. Among these, the method was able to quantify furanyl-fentanyl and fentanyl in the pg/mg range in two samples. Simultaneously, also 4-ANPP was detected, giving evidence for the first time that this compound can be selected as a marker of fentanyl analogs use via hair testing. In conclusion, this study confirmed the increasing diffusion of new synthetic opioids and "fentalogs" with high potency among non-medical opioid users.