Substance Use & Misuse最新文献

Background: Philadelphia's opioid overdose crisis has reached unprecedented levels. However, overdose deaths involving non-opioids have also increased in recent years. As overdose deaths continue to increase, this study describes and compares the demographic characteristics, prescription drug histories, and exposure to potentially inappropriate prescribing practices (PIPPs), in the year before death of three groups of overdose decedents: (1) only opioid(s) detected in postmortem toxicology, (2) only non-opioid(s) detected, (3) both opioids and non-opioids co-detected [i.e. concomitant detections].

Methods: Philadelphia Medical Examiner's Office data on unintentional overdose deaths from July 1, 2017 to June 30, 2022, were matched to Pennsylvania Prescription Drug Monitoring Program data. Differences were assessed using chi-square analyses, z-tests of proportions, and a multinomial logistic regression.

Results: During the study period, 5,440 overdose deaths occurred in Philadelphia. Compared to the other two toxicology groups, a substantially larger proportion of non-opioid only decedents were Non-Hispanic Black (all z-tests p-values <0.001). In the year before death, a larger proportion of decedents with concomitant detections filled benzodiazepine and/or buprenorphine prescriptions and were exposed to PIPPs (all z-tests p-values <0.05). Differences by demographic characteristics, time period of death, and history of buprenorphine and benzodiazepine prescriptions remained statistically significant in the multinomial logistic regression (all p-values < 0.05).

Conclusions: To ensure that equitable policies and prevention programs are developed, more research is needed on (1) the intersectionality of demographic characteristics and the perceived risks, preferences, and access of non-opioids (including controlled drug prescriptions), and (2) the implications of current prescribing guidelines on people who may use multiple substances.

Objective: This study examined drug overdose deaths in Mexican-heritage Arizonans, with the goal of informing tailored overdose prevention programs for this community.

Methods: We analyzed death certificate data (from the Arizona Department of Health Services) for drug overdose deaths among Arizona residents from 2018-2022. We compared deaths in US-born and foreign-born Mexican-heritage Arizonans and, as a frame of reference, Non-Hispanic (NH) White Arizonans. We compared demographics, circumstances of death, and mortality rates, using descriptive statistics, multinomial logistic regression models, and age-standardized mortality rates and ratios.

Results: The age-standardized drug overdose mortality rate (per 100,000) was lower in the overall Mexican-heritage population (28.0) than in the NH White population (35.9). Nonetheless, the rate in the US-born Mexican-heritage male subgroup (59.5) was higher than in US-born NH White males (49.9) or any other subgroup examined. Synthetic opioids such as fentanyl were involved in higher proportions of deaths among US-born (64.6%) and foreign-born (65.1%) Mexican-heritage Arizonans than among NH White Arizonans (48.5%). In multinomial regression models, the risk of a medical place of death, relative to death at home, was significantly higher in the foreign-born (adjusted Relative Risk Ratio [aRRR] 1.82; 95% Confidence Interval [CI], 1.38-2.42) and US-born (aRRR 1.85; 95% CI, 1.62-2.11) Mexican-heritage groups than the NH White group, adjusting for age, sex, marital status, county of residence, overdose intent, and drugs involved.

Conclusions: Findings highlight disparate rates of overdose mortality in US-born Mexican-heritage Arizona men, also underscoring racial/ethnic/nativity-based differences in overdose circumstances and decedent characteristics.

Background: Supervised Consumption Sites (SCS) have proven effective in reducing overdose-related deaths by providing safe spaces for people who use substances. However, barriers such as stigma, operating hours, and travel distance can limit access to SCS. Virtual harm reduction services such as phone-based overdose response hotlines and apps have emerged as an alternative when SCS access is hindered. These collectively have also been named Mobile Overdose Response Services (MORS). At this time, little is known about how best to increase awareness of these services.

Materials and methods: For this qualitative study, 46 individuals across Canada were recruited to examine ways to improve awareness of virtual harm reduction. Semi-structured interviews with the participants were conducted. Data analysis using inductive thematic analysis informed by grounded theory was used to identify major themes.

Results: Participants identified enhanced social marketing as a priority to raise awareness and reduce the stigma associated with substance use and MORS. Social media campaigns, endorsements from peers and healthcare professionals, and community support were suggested marketing strategies. The study revealed the importance of connecting with existing resources and services, including outreach teams, to improve MORS penetration. A cohesive system and reference lists were advocated for smoother access and navigation.

Conclusion: This study offers insights into key partners' perspectives and recommendations around increasing overdose response hotline and app awareness, thereby contributing to user harm reduction efforts.

Background: Electronic cigarettes (e-cigs) contain fewer hazardous ingredients than traditional cigarettes, yet they still pose health hazards. This study evaluates experienced e-cig users' quitting interest and Quitline utilization.

Methods: In a 2012 (Wave 1) baseline survey, 1875 (28.9%) provided consent consented to future study contact. This study focused on a follow-up survey sent in 2022 (4). The main indicators assessed were participants' were participants awareness, willingness, and motivations to utilize Quitlines to quit e-cigs. The Penn State Electronic Cigarette Nicotine Dependence Index (PSECDI) was used to assess the level of dependence on e-cigs. Descriptive statistics were used to examine the outcomes of interest. Additionally, a thematic analysis was performed to evaluate qualitative data.

Results: Participants (n = 195) had a mean age of 52.4 (SD = 12.1) years, 64.6% (n = 126) were male, and the majority were Caucasian/White (88.2%, n = 172). About 42% (n = 82/195) of respondents had previously tried to quit e-cig use. Of these, more than half (63.4%, n = 52/82); had heard of Quitline; however, very few (9.8%, n = 8/82) were interested in utilizing Quitline services for assistance with quitting e-cigs. The themes that emerged included the impersonal nature of telephone counseling, lack of trust in external assistance, belief in participants' ability to quit without help, and skepticism about the effectiveness of Quitline interventions.

Conclusion: There was widespread reluctance to utilize Quitline cessation services among experienced e-cig users. To enhance engagement in cessation programs, such as Quitline, it may be helpful to consider specialized counseling and support tailored to the unique challenges among e-cig users.

Background: Previous studies identified e-cigarette content on popular video and image-based social media platforms such as TikTok. While machine learning approaches have been increasingly used with text-based social media data, image-based analysis such as image-clustering has been rarely used on TikTok. Image clustering can identify underlying patterns and structures across large sets of images, enabling more streamlined distillation and analysis of visual data on TikTok. This study used image-clustering approaches to examine e-cigarette-related images on TikTok.

Methods: We searched for 13 hashtags related to e-cigarettes in November 2021 (e.g., vape, vapelife). We scraped up to 1000 posts per hashtag depending on the number of available posts, for 12,599 posts in total. After randomly selecting 13% of posts and excluding non-English (N = 278), non-e-cigarette-related (N = 88), and unavailable posts (i.e., posts that the uploader deleted) (N = 286), N = 838 e-cigarette TikTok images were included in our image clustering model. Using quantitative (e.g., silhouette scores) and qualitative evaluations, we categorized clusters into overarching themes based on the types of e-cigarette content depicted within each cluster.

Results: We identified N = 20 clusters, forming four overarching themes: (1) vapor clouds (e.g., vape tricks, vaping and exhaling vapor clouds, being captured as clouds from the mouth or nose or around the face); (2) devices (e.g., content presenting e-cigarette devices or individuals demonstrating use or modification of devices); (3) text (e.g., e-cigarette-related text inserted within images such as jokes); (4) other (i.e., e-cigarette-related images clustered based on other image characteristics such as color tones).

Conclusions: This study using the state-of-the-art image-clustering method successfully identified various e-cigarette-related images on TikTok. This study suggests that novel methodologies can be helpful to tobacco regulatory agencies looking to conduct rapid surveillance of e-cigarette content on social media.

The unregulated toxic drug crisis continues to be an urgent health issue in North America. Many families of people who use drugs have been significantly impacted by this issue. In addition to the thousands of North Americans who have been bereaved by drug mortality, many families are providing unpaid care to bridge gaps in services while navigating the grief and stress associated with caring for a loved one amidst a heavily politicized and rapidly changing context. Despite the impact on families, few interventions are in place to lessen the burden of the crisis. This commentary presents a call to action to include families of people who use drugs in a public health response to the toxic drug crisis. We emphasize the need for (1) the consideration and involvement of families in all aspects of policy and program decision making, (2) the recognition of families of people who use drugs within national caregiving and bereavement strategies; (3) increased supports and services for families; and (4) additional research and public health monitoring on the impact of the toxic drug crisis on families.

Background: Rates of cannabis use disorder (CUD) have increased disproportionately among Veterans Administration (VA) patients with psychiatric disorders compared to patients with no disorder. However, VA patient samples are not representative of all U.S. adults, so results on disproportionate increases in CUD prevalence could have been biased. To address this concern, we investigated whether disproportionate increases in the prevalence of cannabis outcomes among those with psychiatric disorders would replicate in nationally representative samples of U.S. adults.

Methods: Data came from two national surveys conducted in 2001-2002 (n = 43,093) and 2012-2013 (n = 36,309). Outcomes were any past-year non-medical cannabis use, frequent non-medical use (≥3 times weekly), and DSM-IV CUD. Psychiatric disorders included mood, anxiety and antisocial personality disorders. Logistic regression was used to generate predicted prevalences of the outcomes, prevalence differences calculated and additive interactions compared differences between those with and without psychiatric disorders.

Results: Cannabis outcomes increased more among those with psychiatric disorders. The difference in prevalence differences included any past-year non-medical cannabis use, 2.45% (95%CI = 1.29-3.62); frequent non-medical cannabis use, 1.58% (95%CI = 0.83-2.33); CUD, 1.40% (95%CI = 0.58-2.21). For most specific disorders, prevalences increased more among those with the disorder.

Conclusions: In the U.S. general population, rates of cannabis use and CUD increased more among adults with psychiatric disorders than other adults, similar to findings from VA patient samples. Results suggest that although VA patients are not representative of all U.S. adults, findings from this important patient group can be informative. Greater clinical and policy attention to CUD is warranted for adults with psychiatric disorders.

Background: Methamphetamine use is disproportionately high in rural settings, with rates increasing during the COVID-19 pandemic. While syringe service programs reduce disease transmission among people who inject drugs, limited research exists around the value of smoking equipment, specifically pipes, in minimizing harms associated with rural methamphetamine use.

Methods: We conducted semi-structured interviews with people who use methamphetamine in rural southern Illinois. Inclusion criteria involved methamphetamine use in the past 30 days. Interview guides explored attitudes and behaviors regarding pipe use practices and pipe access. Interviews were recorded, transcribed, and coded. The data were analyzed for emergent themes using a sequential, deductive process.

Results: Nineteen participants, average age 37.1 (SD + 8.7), were interviewed. 53% were women, and 89% were white. All reported smoking methamphetamine, and 84% reported injecting. Participants reported engaging in smoking instead of injection to decrease wounds, pain, and infections. Smoking enabled some to use socially as opposed to alone, as was typically the case when they injected. Participants expressed interest in pipe distribution through a harm reduction agency. They shared that, were a harm reduction agency to distribute pipes, it would connect people to other services such as HIV testing, naloxone, and safer sex supplies.

Conclusions: Pipe distribution may function as a harm reduction strategy by decreasing injection and solitary drug use and linking patients to additional services. Given disproportionate methamphetamine use in rural regions, this intervention could specifically address drug-related harms that impact rural populations.

Background: Few studies to date have examined the number of comorbid substances used alongside Prescription Opioid Misuse (POM) to predict suicidal behaviors among US young adults.

Objective: This study investigated the relationship between comorbid substance use with POM and suicidal behaviors among the US young adults.

Methods: Data were from individuals aged 18-25 (N = 69,204, 51.8% female) in the 2015-2019 National Surveys on Drug Use and Health (NSDUH). The final analytic sample for logistic regression was 36,892 young adults.

Results: After controlling for key covariates, the combination of POM and three or more illicit drugs were at the greatest odds of suicidal ideation (OR = 2.57, 95% CI = 1.61 - 4.11, p < 0.001) and attempts (OR = 3.57, 95% CI = 1.89 - 6.76, p < 0.001) compared to those without POM or drug use.

Conclusions: The study provides evidence of a dose-response relationship between the number of illicit drugs uses alongside POM and the suicide risk as a clinically important phenomenon with implication for intervention. Findings highlight that POM, with or without illicit drug use, can serve as a behavioral and clinical indicator for identifying young adults at heightened risk of suicidality. This group warrants prioritized intervention targets to ensure timely access to developmentally appropriate clinical treatment, aiming to mitigate addiction progression and prevent harm and mortality.

Introduction: Blunt and hemp wraps, as a means of consuming cannabis, have emerged into the retail space where the prevalence has been increasing since 2017. There is limited epidemiological research on the prevalence of use of these products across the U.S. particularly among young adults who are at greater risk of tobacco and cannabis use.

Methods: This study draws from a U.S. national representative sample of young adults (n = 1178) captured in May 2022. Respondents participated in an online survey about their use of blunt and hemp wraps. Multinomial regression was used to examine differences in sociodemographic characteristics (gender, race/ethnicity, sexual orientation, educational attainment, and region) in relation to use of each wrap type.

Results: One quarter (22.7%) of young adults reported ever having used a blunt wrap, 3.2% in the past 30-days. One in seven (14.3%) had ever used a hemp wrap, 2.3% in the past 30-days. Non-Hispanic Black young adults were 1.55 and 2.91 times as likely to have ever used blunt or hemp wraps, respectively, compared to non-Hispanic Whites. Similarly, participants who identified as gay or lesbian or bisexual similarly had greater odds of having ever used blunt or hemp wraps. Hispanic young adults were 2.49 times as likely to have used hempwraps compared to non-Hispanic Whites.

Conclusion: Blunt and hemp wrap use is prevalent among young adults, particularly among minoritized populations. Continued research and surveillance of use of these products is needed to fully evaluate the impact their use may have on the broader population.