Faculty Bibliography

BACKGROUND/UNASSIGNED:Early onset of drug use could lead to long-term impairments, and research suggests that substance use and substance use disorders are more common among lesbian, gay, and bisexual (LGB) individuals. We sought to determine whether adults of different sexual identities were at differential risk for an earlier onset of drug use. METHODS/UNASSIGNED:We examined data from adults participating in the five waves (2015-2019) of the National Survey on Drug Use and Health, a nationally representative sample of noninstitutionalized adults in the United States. We determined whether current sexual identity was associated with retrospectively reported age of the first use of marijuana, cocaine, inhalants, ecstasy, and methamphetamine. RESULTS/UNASSIGNED:Compared to heterosexual individuals of the same sex, gay men had a later age of onset of use of all five drugs examined (marijuana, cocaine, inhalants, ecstasy, and methamphetamine) and bisexual men had a later onset of marijuana and inhalant use. Bisexual women had earlier age of onset for marijuana, cocaine, and ecstasy use. When examining early initiation (prior to age 15), both lesbian and bisexual women had greater odds of early initiation for marijuana, cocaine, and ecstasy; bisexual men had greater odds of early initiation for cocaine. Gay men had lower odds of initiation prior to age 15 for marijuana, inhalants, and methamphetamine. CONCLUSIONS/UNASSIGNED:Current sexual identity is a correlate of earlier onset drug use. Longitudinal research is needed to further examine such associations as sexual identity can shift over time. Results are discussed in relation to prevention efforts aiming younger LGB persons.

BACKGROUND:Despite increasing prevalence of nonmedical ketamine use globally, data on ketamine use disorders, which are classified in the DSM-5 under criteria for phencyclidine, are limited. This study assessed the reliability and applicability of DSM-based diagnostic criteria for ketamine use disorder. METHODS:Participants who used ecstasy were recruited through the Tri-City Study of Club Drug Use, Abuse, and Dependence in St. Louis, Miami, and Sydney. Those who reported using ketamine (lifetime use >5 times) were included in these analyses (n = 205). Participants were interviewed using the computerized Substance Abuse Module for Club Drugs (CD-SAM) at baseline and 7 days later for the reliability of diagnoses and individual diagnostic criteria. RESULTS:Overall, 29.3% met DSM-5 adopted criteria for ketamine use disorder at Time 1. Moderate to excellent test-retest reliability was observed consistently across study sites for any ketamine use disorder (κ = 0.57, Y = 0.61) and severe ketamine use disorder (κ = 0.62, Y = 0.79). Continued use of ketamine despite knowledge of physical or psychological problems was the most frequently endorsed individual criterion (59.0%), followed by reported withdrawal (30.2%) and physically hazardous use (29.8%). All individual criteria had acceptable reliability estimates (κ ≥ 0.41). CONCLUSIONS:Diagnoses of ketamine use disorder can be reliably evaluated using this fully structured diagnostic instrument's questions and algorithm. Ketamine-related withdrawal among people who use ketamine should be re-evaluated. Considering that after-effects of this dissociative anesthetic can last for many hours, it is important to explore a different timeframe for possible withdrawal effects.

BACKGROUND:Drugs like ecstasy, cocaine, and counterfeit prescription pills can contain fentanyl. We examined knowledge about potential adulteration/contamination of such drugs among people attending electronic dance music (EDM) parties. METHODS:Adults in New York City were surveyed entering randomly selected EDM parties during the summers of 2018 (n=1,029) and 2019 (n=559). Surveys assessed perceptions that: 1) ecstasy/Molly can contain adulterants more dangerous than MDMA, 2) cocaine can contain fentanyl, and 3) prescription pills from non-pharmacy sources can contain fentanyl. We compared prevalence of perceptions between 2018 and 2019. RESULTS:Prevalence of agreeing that cocaine can contain fentanyl increased from 42.1% to 58.6%, a 39.2% increase (p=.003). Increases in agreement were not significant regarding ecstasy potentially containing adulterants (55.0% vs. 59.0%) and non-pharmacy prescription drugs potentially containing fentanyl (46.8% vs. 52.9%). Those reporting past-year ecstasy use in particular reported increased agreement that ecstasy can be adulterated (from 52.9% to 80.0%, a 51.2% increase; p<.001) and those reporting past-year cocaine use reported increased agreement that cocaine can be adulterated (from 48.2% to 70.7%, a 46.7% increase; p=.016). CONCLUSIONS:Knowledge of potential adulteration or contamination of commonly used drugs in this high-risk scene is increasing. Continued education about possible drug contents is needed.

BACKGROUND/OBJECTIVES/OBJECTIVE:Cannabis use among older adults is increasing sharply in the United States. While the risks and benefits of cannabis use remain unclear, it is important to monitor risk factors for use, including low perception of harm. The objective of this study was to estimate recent national trends in perceived risk associated with cannabis use among older adults. DESIGN/METHODS:Trend analysis. SETTING/PARTICIPANTS/METHODS:A total of 18,794 adults aged 65 and older participating in the 2015-2019 National Survey on Drug Use and Health, a cross-sectional nationally representative survey of non-institutionalized individuals in the United States. MEASUREMENTS/METHODS:We estimated the prevalence of older adults who believe that people who smoke cannabis once or twice a week are at great risk of harming themselves physically and in other ways. This was examined across cohort years and stratified by demographic characteristics, diagnosis of chronic disease, past-month tobacco and binge alcohol use, and all-cause emergency department use. RESULTS:Between 2015 and 2019, perceived risk associated with regular use decreased from 52.6% to 42.7%, an 18.8% relative decrease (p < 0.001). Decreases in perceived risk were detected in particular among those never married (a 32.6% relative decrease), those who binge drink (a 31.3% relative decrease), use tobacco (a 26.8% relative decrease), have kidney disease (a 32.1% relative decrease), asthma (a 31.7% relative decrease), heart disease (a 16.5% relative decrease), chronic obstructive pulmonary disease (a 21.5% relative decrease), two or more chronic conditions (a 20.2% relative decrease), and among those reporting past-year emergency department use (a 21.0% relative decrease) (ps < 0.05). CONCLUSIONS:The perceived risk of regular cannabis use is decreasing among older adults. We detected sharp decreases in risk perception among those with chronic disease and high-risk behaviors, including tobacco and binge alcohol use. As the number of older adults who use cannabis increases, efforts are needed to raise awareness of the possible adverse effects with special emphasis on vulnerable groups.

Individuals with mental illness are at risk of developing co-occurring substance use disorders (SUDs). We assessed whether unmet need for mental health treatment in the past year was a risk factor for past-month use of marijuana, cocaine, methamphetamine, and misuse of prescription opioids in this population. Data from adults diagnosed with mental illness who were not diagnosed with SUD were examined from the 2015-2018 National Survey on Drug Use and Health (N = 33,104). An estimated 20.8% (95% CI: 20.1-21.5) of adults in the US with mental illness have experienced unmet need in the past year. Those reporting marijuana use (29.7% vs. 19.5%, p < .001) and/or prescription opioid misuse (35.7% vs. 20.5%, p < .001) were more likely to report unmet need than those not reporting use. In multivariable models, unmet need remained a risk factor for marijuana use (aOR = 1.37, 95% CI: 1.24-1.54) and prescription opioid misuse (aOR = 1.65, 95% CI: 1.29-2.13). Unmet need was not a risk factor for cocaine or methamphetamine use. Cost as a barrier to treatment was a risk factor for marijuana use (aOR = 1.37, 95% CI: 1.19-1.58) and prescription opioid misuse (aOR = 1.95, 95% CI: 1.43-2.64). Policies aimed at improving mental healthcare access may be effective in reducing substance use in this population.

BACKGROUND:Novel psychoactive substances (NPS) present continuous and growing challenges for the scientific, medical, and interventional communities as emerging substances on recreational drug markets change national and international drug landscapes. NPS account for an increasing proportion of adverse events, hospitalizations, and deaths due to increasing potency and unanticipated biological effects compared to predecessors. This study evaluated the utility of drug use forums as an early indicator or predictor of impending intoxications with potentially harmful or lethal outcomes prior to their occurrences. METHODS:Eight NPS were selected for evaluation to assess the relationship between online mentions of drugs and their involvement in toxic exposures or overdoses. Mentions on Reddit drug forum discussions were tallied and toxicology testing results from forensic investigations in the US were assessed. The selected NPS covered several subclasses and a predetermined time range (2013-2020). They included carfentanil, U-47700, eutylone, flualprazolam, N-ethylpentylone, 5F-MDMB-PICA, isotonitazene, and brorphine. RESULTS:Seven NPS (excluding 5F-MDMB-PICA) appeared in discussions on Reddit prior to their implication in poisonings or intoxications. Distinct increases and decreases in number of mentions and number of exposures were observed. For most substances (n = 5, 63%), a rise in Reddit mentions was soon followed by a corresponding rise in toxicology positivity. Peak positivity for carfentanil and flualprazolam, however, preceded peak Reddit mentions. CONCLUSIONS:This study demonstrated the utility of social media sites, such as Reddit, as a predictor for future trends in NPS-related exposures. These results provide confirmation that activity on drug use forums in the virtual world can help predict changes in exposures associated with new or re-emerging NPS in the real world. The results warrant further evaluation as a strategy for inclusion in early warning systems.