Faculty Bibliography

BACKGROUND:Use of party drugs is common among nightclub attendees, but more information is needed regarding both intentional use and unknown exposure to synthetic cathinones, fentanyl, and xylazine in this high-risk population. METHODS:Throughout 2024, participants attending nightclubs in New York City were surveyed and had their saliva analyzed for drug exposure using targeted and untargeted analysis (n = 1024). We calculated the prevalence of synthetic cathinone, fentanyl, and xylazine exposure overall and in relation to demographic and drug use characteristics. RESULTS:11 (1.1 %) tested positive for one or more synthetic cathinones, 1.5 % (n = 15) tested positive for fentanyl or its precursor (4-ANPP), and 4 (0.4 %) tested positive for xylazine. All but one exposure to fentanyl was linked to unreported past-month use (93.3 %) and 54.5 % of synthetic cathinone exposures were linked to unreported past-month use (ps<.05). Three of four participants (75.0 %) testing positive for xylazine also tested positive for fentanyl exposure. Most (n = 8) synthetic cathinone exposures involved methylmethcathinone (MMC), and there were also detections of chloromethcathinone (CMC, n = 4), N-N-dimethylpentylone (n = 2), N-ethylpentylone (n = 2), and eutylone (n = 2). Compared to those testing positive for synthetic cathinones, those testing positive for fentanyl were more likely to identify as heterosexual and/or test positive for prescription opioid use, and less likely to have a college degree or to test positive for MDMA use (ps<.05). CONCLUSIONS:Unintentional exposure to these drugs is occurring, often because they have been added as adulterants in more common drugs. Results can inform prevention and harm reduction education in this population and in the general population.

INTRODUCTION/BACKGROUND:Fentanyl-related deaths involving stimulants have increased in the US, but little is known about nonfatal overdoses involving use. We examined national trends in nonfatal fentanyl-related exposures involving co-use of cocaine or methamphetamine. METHODS:In this cross-sectional analysis, data from US poison centers were used to estimate annual trends in reported exposures involving fentanyl and stimulant use from 2015 to 2023. Cases included patients aged ≥13 with exposures involving intentional misuse or "abuse" of fentanyl where nonfatal adverse effects occurred (n=13,173). Co-exposure trends were examined, and multivariable logistic regression models were used to estimate how region and medical outcome severity were associated with (1) fentanyl-cocaine use (vs. fentanyl, no cocaine use) and (2) fentanyl-methamphetamine use (vs. fentanyl, no methamphetamine use). RESULTS:Between 2015 and 2023, among fentanyl-related exposures, cocaine use increased from 1.3% to 10.0% (669.2% increase, p<.001) and methamphetamine use increased from 1.5% to 10.8% (620.0% increase, p<.001). Exposures in the Northeast were associated with higher odds of cocaine co-use, while exposures in the Midwest, South, and West were associated with higher odds of methamphetamine co-use. Compared to those with less severe effects, those with a major (life-threatening) effect had higher odds of cocaine co-use, but lower odds of methamphetamine co-use. CONCLUSIONS:Similar to drug-related mortality trends, nonfatal fentanyl poisonings involving co-use of cocaine or methamphetamine increased in recent years and became increasingly widespread. Differences in experience of life-threatening adverse effects linked to different stimulants suggests varying risk according to which stimulant is involved.

BACKGROUND:As new psychoactive substances (NPS) continue to emerge both in the US and globally, it is important to investigate characteristics of persons who use these substances. METHODS:Data on self-reported NPS use come from the National Drug Early Warning Rapid Street Reporting study, which uses a venue-intercept design to assess drug use and associated adverse effects among adults (≥18 years) in a given US city over a weekend period. Between January 2022 and November 2023, 6039 individuals were surveyed in person in 20 unique cities regarding prevalence and correlates of past 12-month NPS and other drug use. RESULTS:In the overall sample, 259 (4.3 %) individuals reported any past 12-month NPS use. Synthetic cannabinoids (n = 150, 2.5 %), novel opioids (n = 34, 0.6 %), and synthetic cathinones (n = 33, 0.6 %) were the most frequently reported NPS classes used. Those also reporting past 12-month common stimulant use (aOR=2.39, 95 % CI:1.68-3.39) and a higher number of common drugs used in the past 12 months (aOR=1.28, 95% CI:1.18-1.40) had higher odds of reporting any NPS use; those with a college education were found to have lower odds of reporting NPS use (aOR=0.46, 95% CI:0.28-0.78). CONCLUSIONS:While the self-reported use of individual classes of NPS was low relative to other drugs in this large, multi-city sample, NPS use was most common among those reporting polysubstance use. Those who used synthetic cannabinoids appeared to represent a distinct subgroup. Given the continued public health concern posed by NPS, surveys which systematically ask about specific NPS are increasingly needed.

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:Ketamine-related poisonings and law enforcement seizures have been increasing in the United States, but population surveys suggest that recreational use has been rare with trends being relatively stable. This study aimed to estimate trends and correlates of use among nightclub attendees-a population known for high prevalence of party drug use. METHODS:Adults entering randomly selected nightclubs in New York City were surveyed in 2017 (n = 674), 2018 (n = 724), 2019 (n = 541), 2021 (n = 160), 2022 (n = 322), and 2024 (n = 911) (total N = 3332; 56.3 % male, 52.7 % age ≥26). Trends in lifetime, past-year, and past-month ketamine use were estimated using logistic regression, and correlates and trends in characteristics of people who used in the past month were also estimated. RESULTS:Between 2017 and 2024, lifetime ketamine use increased from 16.6 % to 22.7 % (a 36.7 % increase), past-year use increased from 7.4 % to 14.3 % (a 94.0 % increase), and past-month use increased from 3.1 % to 6.8 % (an 118.1 % increase, Ps<0.001). Past-month use particularly increased among those aged ≥26 (by 222.0 %), females (by 216.6 %), those with a college degree (by 161.0 %), and among people who identify as bisexual or "other" sexuality (by 445.0 %), and among those who used cocaine (by 213.8 %), ecstasy/MDMA (by 94.9 %), and/or LSD (238.2 %) in the past month (Ps<0.01). Identifying as gay/lesbian (aOR=2.03, 95 % CI: 1.19-3.48) and past-month use of cocaine (aOR=8.17, 95 % CI: 4.97-13.43) in particular were associated with increased odds for past-month use. CONCLUSIONS:Recreational ketamine use is increasing among this population so an increased focus on both prevention and harm reduction is needed.

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.