Faculty Bibliography

PURPOSE OF REVIEW/UNASSIGNED:As the overdose crisis evolves, it is important to monitor fentanyl consumption patterns. This review provides an overview of recent findings regarding illegally manufactured fentanyl (IMF) availability, use, and associated harms in the US. RECENT FINDINGS/UNASSIGNED:Availability of IMF has increased, especially in pill form, and the increasing adulteration of IMF with veterinary tranquilizers such as xylazine complicates overdose response. Prevalence in the general population based on self-reported IMF use is rare, and likely underestimated. Transitions from injection to smoking have been documented in recent years, particularly in the western US. Fentanyl-stimulant polysubstance use has also been observed increasingly among IMF-related overdose deaths. SUMMARY/UNASSIGNED:Shifts in routes of administration, availability of counterfeit pills containing fentanyl, and common adulterants add complexity to the landscape of IMF use and related harms. Additional data is needed for monitoring changes in consumption patterns to inform prevention and harm reduction efforts.

BACKGROUND AND AIMS/OBJECTIVE:'Tusi', also known as 'tusibí' or 'pink cocaine', is a drug concoction which previously emerged in Latin America and Europe and has recently acquired popularity in the United States (US). Consumers are often unaware that Tusi contains a mixture of ketamine and other drugs, and the concoction can be confused with 2C/2C-B (ring-substituted phenethylamines/4-bromo-2,5-dimethoxyphenethylamine) or cocaine. This study aimed to estimate the prevalence and correlates of past-year Tusi use in the electronic dance music (EDM) nightclub-attending population in New York City (NYC), US. DESIGN AND SETTING/METHODS:This cross-sectional study included surveys and optional saliva testing of adults entering randomly selected EDM events in NYC in 2024. PARTICIPANTS/METHODS:Adults aged ≥18 years entering EDM events at nightclubs (n = 1465). MEASUREMENTS/METHODS:Exposures were demographic characteristics and past-year use of other drugs. The primary outcome was self-reported past-year use of Tusi, and in a subsample, biologically confirmed exposure to various drugs determined by saliva testing. FINDINGS/RESULTS:Based on self-report, an estimated 2.7% [95% confidence interval (CI) = 1.9-3.9] of adults in the NYC EDM nightclub-attending population have used Tusi in the past year. Compared with white individuals, Hispanic individuals were at higher odds for use [adjusted odds ratio (aOR) = 5.10, 95% CI = 1.96-13.25]. Compared with those who did not use, those who used ecstasy/3,4-Methylenedioxymethamphetamine (MDMA) (aOR = 6.59, 95% CI = 1.60-27.16), ketamine (aOR = 3.44, 95% CI = 1.18-10.08) and/or 2C series (aOR = 14.82, 95% CI = 4.77-46.04) in the past year were at higher odds for use. Compared with those not reporting Tusi use, those reporting past-year use were more likely to have saliva test positive for cocaine, ketamine, MDMA, methamphetamine and/or synthetic cathinones (Ps < 0.001). They were also more likely to test positive for cocaine, ketamine or methamphetamine after not reporting past-year use (Ps < 0.01). CONCLUSIONS:An estimated 2.7% of electronic dance music-nightclub attending adults in New York City appear to have used Tusi in the past year, with higher use among Hispanic individuals and people exposed (sometimes unintentionally) to other drugs.

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.

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.