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What is the prevalence of drug use in the general population? Simulating underreported and unknown use for more accurate national estimates

Levy, Natalie S; Palamar, Joseph J; Mooney, Stephen J; Cleland, Charles M; Keyes, Katherine M
PURPOSE/OBJECTIVE:To outline a method for obtaining more accurate estimates of drug use in the United States (US) general population by correcting survey data for underreported and unknown drug use. METHODS:We simulated a population (n=100,000) reflecting the demographics of the US adult population per the 2018 American Community Survey. Within this population, we simulated the "true" and self-reported prevalence of past-month cannabis and cocaine use by using available estimates of underreporting. We applied our algorithm to samples of the simulated population to correct self-reported estimates and recover the "true" population prevalence, validating our approach. We applied this same method to 2018 National Survey on Drug Use and Health data to produce a range of underreporting-corrected estimates. RESULTS:Simulated self-report sensitivities varied by drug and sampling method (cannabis: 77.6-78.5%, cocaine: 14.3-22.1%). Across repeated samples, mean corrected prevalences (calculated by dividing self-reported prevalence by estimated sensitivity) closely approximated simulated "true" prevalences. Applying our algorithm substantially increased 2018 NSDUH estimates (self-report: cannabis=10.5%, cocaine=0.8%; corrected: cannabis=15.6-16.6%, cocaine=2.7-5.5%). CONCLUSION/CONCLUSIONS:National drug use prevalence estimates can be corrected for underreporting using a simple method. However, valid application of this method requires accurate data on the extent and correlates of misclassification in the general US population.
PMID: 34990827
ISSN: 1873-2585
CID: 5107312

Prevalence of Psychoactive Substance Use Among Middle-aged and Older Adults With Visual Impairment in the US

Han, Benjamin H; Leddy, Jason F; Lopez, Francisco A; Palamar, Joseph J
PMID: 34762104
ISSN: 2168-6173
CID: 5050662

Kratom Use Is Underestimated, but Prevalence Still Appears to Be Low [Letter]

Palamar, Joseph J
PMID: 34922652
ISSN: 1873-2607
CID: 5108602

Trends in binge drinking prevalence among older U.S. men and women, 2015 to 2019

Al-Rousan, Tala; Moore, Alison A; Han, Benjamin H; Ko, Roxanne; Palamar, Joseph J
BACKGROUND:Recent literature suggests that the gap in prevalence of binge drinking between men and women is closing, but little is known about sex-specific differences in trends and correlates of binge drinking among older Americans. METHODS:A total of 18,794 adults, aged 65 years and older were surveyed in the 2015-2019 National Survey on Drug Use and Health. We estimated trends in prevalence of past-month binge drinking (≥5 drinks on the same occasion for men and ≥4 drinks for women), stratified by sex. Correlates of binge drinking were estimated for men and women separately, focusing on demographic characteristics, chronic diseases, past-month tobacco and cannabis use, depression, and emergency department use. Multivariable generalized linear models using Poisson and log link were used to examine associations stratified by sex. RESULTS:Binge drinking among older men increased from 12.8% in 2015 to 15.7% in 2019 (p = 0.02) but remained stable among older women (7.6% to 7.3%, p = 0.97). In adjusted models, having a college degree was associated with higher risk of binge drinking among women (adjusted prevalence ratio [aPR] = 1.68, 95% CI: 1.13-2.50), but lower risk among men (aPR = 0.69, 95% CI: 0.56-0.85). Men who are separated or divorced were also at higher risk (aPR = 1.25, 95% CI: 1.05-1.50), but women were not. Both men and women reporting past-month use of tobacco (men aPR = 1.87, 95% CI: 1.61-2.17, women aPR = 2.11, 95% CI: 1.71-2.60) and cannabis (men aPR = 2.05, 95% CI: 1.63-2.58, women aPR = 2.77, 95% CI 2.00-3.85) were at higher risk of binge drinking. CONCLUSIONS:Binge drinking has increased among older men whereas it has remained stable among older women in the United States. Interventions should consider that although tobacco and cannabis use is associated with an increased risk of binge drinking among both older men and women, demographic correlates tend to differ by sex.
PMID: 34877662
ISSN: 1532-5415
CID: 5110232

Test-retest reliability and cross-cultural applicability of DSM-5 adopted diagnostic criteria for ketamine use disorders

Fitzgerald, Nicole D; Striley, Catherine W; Palamar, Joseph J; Copeland, Jan; Kurtz, Steven; Cottler, Linda B
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.
PMID: 34592704
ISSN: 1879-0046
CID: 5067572

Shifting awareness among electronic dance music party attendees that drugs may contain fentanyl or other adulterants

Palamar, Joseph J; Fitzgerald, Nicole D; Cottler, Linda B
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.
PMID: 34242960
ISSN: 1873-4758
CID: 5109322

Trends in Ketamine Use, Exposures, and Seizures in the United States up to 2019

Palamar, Joseph J; Rutherford, Caroline; Keyes, Katherine M
PMID: 34618543
ISSN: 1541-0048
CID: 5109392

When Accurate Drug Terminology Reduces Reporting and Readership: The Need for a Happy Medium Regarding "Synthetic Cannabis" Terminology

Palamar, Joseph J
PMID: 34481109
ISSN: 1873-4758
CID: 5067032

Moving away from piecemeal trends: The need for multiple data sources in drug use trend analyses

Palamar, Joseph J
PMID: 33604933
ISSN: 1465-3362
CID: 4788392

Decreasing perceived risk associated with regular cannabis use among older adults in the United States from 2015 to 2019

Han, Benjamin H; Funk-White, Makaya; Ko, Roxanne; Al-Rousan, Tala; Palamar, Joseph J
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.
PMID: 34037250
ISSN: 1532-5415
CID: 4894952