Faculty Bibliography

BACKGROUND: Alcohol use is common among older adults, and this population has unique risks with alcohol consumption in even lower amounts than younger persons. No recent studies have estimated trends in alcohol use including binge alcohol use and alcohol use disorders (AUD) among older adults. METHODS: We examined alcohol use among adults age >/=50 in the National Survey on Drug Use and Health (NSDUH) from 2005 to 2014. Trends of self-reported past-month binge alcohol use and AUD were estimated. Logistic regression models were used to examine correlates of binge alcohol use and AUD. RESULTS: The prevalence of both past-month binge alcohol use and AUD increased significantly among adults age >/=50 from 2005/2006 to 2013/2014, with a relative increase of 19.2% for binge drinking (linear trend p<0.001) and a 23.3% relative increase for AUD (linear trend p=0.035). While males had a higher prevalence of binge alcohol use and AUD compared to females, there were significant increases in both among females. In adjusted models of aggregated data, being Hispanic, male, and a smoker or illicit drug user were associated with binge alcohol use, while being male, a smoker, an illicit drug user, or reporting past-year depression or mental health treatment were associated with AUD. CONCLUSIONS: Alcohol use among older adults is increasing in the US, including past-month binge alcohol use and AUD with increasing trends among females. Providers and policymakers need to be aware of these changes to address the increase of older adults with unhealthy drinking.

Molly has been the street name for powder or crystalline ecstasy (3,4-methylenedioxymethamphetamine [MDMA[) in the United States since at least 2008; however, few studies have examined Molly use or included Molly in the definition of ecstasy/MDMA. Prevalence of self-reported ecstasy use is being underreported on surveys due to the lack of inclusion of "Molly", although Molly is often so adulterated with novel psychoactive substances such as synthetic cathinones ("bath salts") that the name "Molly" may no longer adequately represent ecstasy/MDMA. The author recommends that Molly use and Molly purity be further studied to more adequately inform prevention and harm reduction.

BACKGROUND AND AIMS: The ageing United States (US) population is providing an unprecedented population of older adults who use recreational drugs. We aimed to estimate the trends in the prevalence of past-year use of cannabis, describe the patterns and attitudes, and determine correlates of cannabis use by adults age 50 and older. DESIGN: Secondary analysis of the National Survey on Drug Use and Health survey from 2006 to 2013, a cross-sectional survey given to a nationally representative probability sample of populations living in US households. SETTING: USA. PARTICIPANTS: 47,140 survey respondents age >/=50. MEASURES: Estimates and trends of past-year use of cannabis. FINDINGS: The prevalence of past-year cannabis use among adults age >/=50 significantly increased from 2006/2007 through 2012/2013, with a 57.8% relative increase for adults ages 50-64 (linear trend p < 0.001), and a 250% relative increase for those >/=65 (linear trend p = 0.002). When combining data from 2006 to 2013, 6.9% of older cannabis users met criteria for cannabis abuse or dependence, and the majority of the sample reported perceiving no risk or slight risk associated with monthly cannabis use (85.3%) or weekly use (79%). Past-year users were more likely to be younger, male, non-Hispanic, not have multiple chronic conditions, and use tobacco, alcohol, or other drugs compared with non-past-year cannabis users. Conclusions The prevalence of cannabis use has increased significantly in recent years among US adults >/=50 years of age.

BACKGROUND: Ecstasy (MDMA) use has regained popularity in the United States, particularly in the form of "Molly," which is often marketed as pure MDMA. Surveys have generally not included "Molly" in the definition of ecstasy, so rates of use may be underestimated. As popularity of ecstasy increases, research is needed to examine use among those at highest risk for use-nightlife attendees. METHODS: We surveyed 679 young adults (age 18-25) entering nightclubs and festivals holding electronic dance music (EDM) parties in New York City in 2015. A variation of time-space sampling was utilized. We examined prevalence and correlates of self-reported lifetime ecstasy use. RESULTS: Self-reported lifetime ecstasy use was common (42.8%, 95% CI: 32.8, 52.7). Use was most common among older participants, frequent party attendees, and those reporting higher levels of exposure to users. Those surveyed outside of festivals were less likely to report use compared to those surveyed outside of nightclubs (AOR = 0.37, p = .015). Over a third of ecstasy users (36.8%)reported use in pill, powder, and crystal form. Ecstasy users were also more likely to report use of other drugs, including novel psychoactive substances (e.g., 2C series drugs, synthetic cathinones ["bath salts"]). Half (50.4%) reported suspecting (21.9%) or finding out (28.5%) that their ecstasy had ever contained a drug other than MDMA. CONCLUSION: A large percentage of nightlife attendees in NYC report lifetime ecstasy use. Findings should inform prevention and harm reduction programming. Further research is needed as ecstasy continues to change (e.g., in form, purity, and name).

OBJECTIVES: The purpose of this study was to evaluate the prevalence of poor sleep health (ie, poor sleep quality and short sleep duration) in a sample of men who have sex with men (MSM). In addition, this study examined whether poor sleep health was associated with depressive symptoms, substance use, and sexual risk behaviors in this sample. DESIGN: Cross-sectional survey. PARTICIPANTS: Broadcast advertisements were placed on a popular smartphone application for MSM in January 2016 to recruit users in the London metropolitan area (n=202) to complete a Web-based survey, which included validated measures of sleep quality and duration. MEASUREMENTS: Poor sleep quality was defined based on self-report as very or fairly bad. Short sleep duration was defined as less than 7 hours each night. Regression models were used to assess associations between sleep variables and self-reported depressive symptoms, substance use, and sexual risk behaviors. RESULTS: About one-third (34.6%) of the respondents reported poor sleep quality and almost half (43.6%) reported sleeping less than 7 hours every night. Several poor sleep health variables were independently associated with depressive symptoms, substance use (eg, use of alcohol or marijuana), and condomless anal intercourse. For example, typical nightly sleep duration of less than 7 hours was associated with condomless receptive anal intercourse with a higher number of sexual partners (incidence rate ratio, 2.65; 95% confidence interval: 1.63-4.30; P<.001). CONCLUSION: Sleep health promotion interventions should be developed for MSM, which may promote positive mental health as well as reduce substance use and sexual risk behaviors in this population.

BACKGROUND: Synthetic cannabinoids use has been a public health concern given association with hospitalization and death among users. While national reports estimate that reported use is declining among adolescents, differences by birth cohort may indicate subgroups who remain at higher risk, both in the overall adolescent population and among demographic subgroups. METHODS: We estimated age, period, and cohort models of self-reported past-year synthetic cannabinoid use (queried as "synthetic marijuana" ["K2," "Spice"]) among 54,865 adolescents aged 13-19 attending high school from 2011 to 2015. RESULTS: Past-year use decreased from 11.86% in 2011 to 4.75% in 2015. This decrease was best represented as a linear downward trend. When stratified by key covariates, however, results indicated evidence of a positive cohort effect for students of higher socioeconomic status (SES). For those students, use did not decrease at the same rate as the overall population; younger cohorts of high SES students remain at higher risk for synthetic cannabinoid use than older cohorts as well as lower SES peers. A similar and stronger association was found for frequent marijuana users (>/=20 occasions of past-year use). Multi-level models indicated that groups at highest risk included older adolescents, Hispanics and other/mixed race students, cigarette users, and frequent marijuana users. CONCLUSION: Synthetic cannabinoid use is associated with morbidity as well as mortality; continued attention to reducing synthetic cannabinoid use remains an important public health priority to maximizing student health.

BACKGROUND AND OBJECTIVES: Although new psychoactive substances (NPS) continue to emerge at a rapid rate, US national surveys only measure the use of non-specific categories of NPS and are not designed to access high-risk populations. In this paper we report lifetime use of specific NPS (of 58) and examine correlates of use among a high-risk population: nightlife attendees. METHODS: The self-selected sample from the Global Drug Survey (2013) consisted of 2,282 respondents in the US, aged 16-60 years, who reported nightclub attendance in the last year. Multivariable logistic regression models determined unique predictors of lifetime use. RESULTS: Lifetime use of a wide range of NPS was reported (any NPS; 46.4%), including synthetic cannabinoids (24.8%), tryptamines (eg, 4-AcO-DMT, 23.0%), psychedelic phenethylamines (eg, 2C-B, 25I-NBOMe; 21.7%), euphoric stimulants (eg, BenzoFury; 16.2%), and synthetic cathinones (eg, methylone; 10.5%). Females (AOR = 0.49 [.41, .60]) and older respondents (age 22-60; AOR = .73 [.59, .89]) were at lower odds of reporting any lifetime NPS use. Frequent nightclub attendance was associated with increased odds of reporting lifetime NPS use overall (eg, weekly compared with less than once a month, AOR = 2.33 [1.70,3.19]), but not specifically with synthetic cannabinoid use. DISCUSSION AND CONCLUSIONS: Among a self-selected sample of nightclub attendees, a large range of novel substances were reported, and young attendees, males, and those who attended more frequently were at increased odds of reporting use. SCIENTIFIC SIGNIFICANCE: Harm reduction initiatives are needed to reduce risk of harm in this population, where environmental characteristics may augment risks associated with consuming lesser-known psychoactive substances. (Am J Addict 2016;XX:1-8).

BACKGROUND: Novel psychoactive substances (NPSs) continue to emerge in the United States and worldwide. Few epidemiological studies have examined the prevalence and correlates of use. OBJECTIVE: We examined the extent of NPS use in a high-risk population-attendees of electronic dance music (EDM) parties at nightclubs and festivals. METHODS: We surveyed 682 adults (age 18-25) entering EDM events at nightclubs and festivals in New York City (NYC) in 2015. A variation of time-space sampling was used. We examined the prevalence of self-reported use of 196 NPS and correlates of any NPS use. RESULTS: Over a third (35.1%) of participants reported lifetime use of any NPS. Self-reported use of synthetic cannabinoids was most prevalent (16.3%), followed by psychedelic phenethylamines (14.7%; 2C series: 10.3%, 2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine [NBOMe] series: 9.0%, Dox series: 3.5%), synthetic cathinones ("bath salts", 6.9%), other psychedelics (6.6%), tryptamines (5.1%), and dissociatives (4.3%). 2C-I was the most prevalent 2C series drug (5.1%); methylone was the most prevalent synthetic cathinone (3.3%), 2-MeO-ketamine was the most prevalent dissociative (3.7%), and 1P-lysergic acid diethylamide (LSD) (2.9%) was the most prevalent non-phenethylamine psychedelic. Risk factors for NPS use included Ecstasy/MDMA/Molly, LSD, and ketamine use; identifying as bisexual (compared to heterosexual), reporting higher frequency of nightclub/festival attendance, and being surveyed outside of a festival (compared to those surveyed outside of nightclubs). DISCUSSION: NPS use is prevalent in the nightclub and festival scenes in NYC. Since individuals in these scenes-especially frequent attendees-are at high risk for use, prevention and harm reduction services need to be geared toward this population.

BACKGROUND: National surveys suggest ecstasy (3,4-methylenedioxymethamphetamine [MDMA]) use has decreased substantially among adolescents in the US since 2001; however, the recent phenomenon of "Molly" (ecstasy marketed as "pure MDMA") may be leading to underreporting of use as not all users are aware that "Molly" is a form of ecstasy. METHODS: We examined 2014 data from Monitoring the Future, a nationally representative survey of high school seniors in the US (N=6250, modal age: 18). Three randomly distributed survey forms asked about ecstasy use, and one included "Molly" in the definition. Self-reported lifetime, 12-month, and 30-day ecstasy use were compared to determine whether including "Molly" in the definition was associated with higher prevalence or frequency of use. RESULTS: The form including "Molly" in the definition had significantly higher prevalence than the two (combined) forms that did not. Lifetime use (8.0% vs. 5.5%) and 12-month use (5.1% vs. 3.6%) were significantly higher with "Molly" in the definition. Lifetime prevalence remained higher with "Molly" in the definition when controlling for correlates of ecstasy use; however, 12-month use did not. Differences in prevalence were associated with lifetime occasions of use, with lower concordance between forms at lower levels of lifetime occasions (e.g., 1-2 times). Survey form was not related to number of times used among more frequent users. CONCLUSIONS: Prevalence of ecstasy use appears to be underestimated when "Molly" is not included in the definition of ecstasy/MDMA. Surveys should include "Molly" in the definition of ecstasy to more adequately assess prevalence of use.