Xylazine in Ohio: Insights from individuals with criminal legal system involvement and a history of illicit stimulant use.

Associations between prescription stimulant use as prescribed, nonmedical use, and illicit stimulant use among adults evaluated for substance use treatment, 2017-2021

Illicit stimulant use is prevalent among patients receiving injectable opioid agonist treatment (iOAT) and has been associated with early treatment discontinuation and illicit opioid use. Despite these concerns, little is known about the use of illicit stimulants in this population. As such, this study aimed to explore the processes by which patients receiving iOAT engage in the use of illicit stimulants. One-on-one in-depth qualitative interviews were conducted. Data collection and analysis followed an iterative approach of coding, searching for meaning, and returning to data collection to saturate categories and explicate relationships between them. Participants were patients receiving iOAT in Vancouver, Canada that reported the use of illicit stimulants (n = 31). The process of 'self-managing illicit stimulant use' was constructed from the data. This process was made up of three interrelated categories reflecting participants' engagement in illicit stimulant use: (i) distancing from the street environment; (ii) taking control of use; and (iii) mobilising support (clinical and social). For patients with opioid use disorder and concurrent stimulant use disorder, access to iOAT can promote the self-management of illicit stimulant use. Daily visits to the clinic for opioid agonist treatment present an important opportunity to offer services and supports for patients who use illicit stimulants. Interventions can be guided by patients, recognising them as experts in the management of their stimulant use.

Among military veterans in the United States, criminal legal system involvement is a risk factor for homelessness; however, the magnitude of and contributors to this association are not well understood. This study used national Electronic Health Record data from the Veterans Health Administration (VHA) to determine homelessness risk among veterans after legal involvement compared with veterans without legal involvement. Among veterans who received VHA health care in fiscal year 2022 and had no prior year homelessness or receipt of VHA homeless services, all veterans were coded as with legal involvement, defined by having an encounter with the VHA's Veterans Justice Programs (VJP), or without legal involvement; veterans without legal involvement were randomly selected without replacement by a 1:2 ratio. A Cox proportional hazards regression model was used to assess the risk of homelessness in the year after a veteran's index date (first VJP encounter for veterans with legal involvement, first clinical encounter for veterans without legal involvement). There were 24,679 veterans with legal involvement (33%) and 49,358 veterans without legal involvement (67%), with homeless rates of 22% and 2%, respectively. Veterans with legal involvement had a six times higher risk of homelessness over 1 year compared with veterans without legal involvement (adjusted hazard ratio = 6.15, 95% CI [5.73, 6.60], p < .0001). Veterans are at elevated risk for homelessness after legal involvement, suggesting the value of implementation approaches to engage VJP-involved veterans in primary prevention services and policy changes that enable engagement in housing services for legal-involved veterans. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Identifying early intervention opportunities for illicit stimulant use: A cross-sectional study of factors associated with illicit stimulant use among young people accessing integrated youth services in British Columbia, Canada

Associations between prescription and illicit stimulant and opioid use in the United States, 2015–2020

Stimulant use disorder (StUD) significantly contributes to substance-related morbidity and mortality in the United States. Overshadowed by the country's focus on opioid-related overdose deaths, stimulant and stimulant/opioid overdose deaths have increased dramatically over the last decade. Many individuals who use stimulants illicitly or have StUD have multiple, intersecting stigmatized characteristics which exacerbate existing barriers and create new obstacles to attaining addiction treatment. Illicit stimulant use, StUD, and stimulant-related overdose disproportionately impact minoritized racial and gender, and sexuality diverse groups. Historically, people who use illicit stimulants and those with StUD have been highly stigmatized, criminalized, and overly ignored by health care providers, policymakers, and the public compared to people who use other drugs and alcohol. As a result, most people needing treatment for StUD do not receive it. This is partly due to the lack of evidence-based treatment for StUD, which has resulted in few programs specializing in the care of people with StUD. The lack of available treatment is compounded by high rates of StUD in marginalized groups already reluctant to engage with the health care system. As health care professionals, we can improve outcomes for people with StUD by changing how we talk about, document, and respond to illicit stimulant use, related characteristics, behaviors, and social and structural determinants of health. To do this, we must seek to understand the lived realities of people with StUD and illicit stimulant use and use this knowledge to amend existing models of care.

Risk/benefit perceptions underlying lower African American Students' illicit stimulant use

Exploring weight control as motivation for illicit stimulant use

Linkage to Substance Use Disorder Treatment Through Syringe Services Programs and the Criminal Legal System: A Cross-Sectional Study.

BackgroundPeople who co-use opioids and methamphetamine have high rates of incarceration. The criminal legal system is therefore increasingly tasked with providing substance use disorder treatment, including medications for opioid use disorder (MOUD). Unfortunately, treatment in carceral settings remains inconsistent and little is known about how people who co-use experience these treatment pathways. This qualitative study addresses this gap by analyzing how people navigate these overlapping systems of punishment and care.MethodsWe conducted in-depth, semi-structured interviews with 20 hospitalized patients in Washington State initiating MOUD with recent methamphetamine use and past-year criminal legal involvement. Interviews explored substance use trajectories, legal system contact, and treatment experiences. Using thematic analysis grounded in ethnographic principles, we identified common strategies and challenges participants faced in accessing and engaging with treatment.ResultsParticipants described legal system involvement as stigmatizing, unpredictable, and difficult to escape. Metaphors like “entrapment” and “contagious” were used to make sense of the legal system’s disruptive role and to show how social and structural factors increased people’s vulnerability to the legal system itself, sometimes in substance-dependent ways. To navigate this legal environment, participants adopted strategies of both compliance and non-compliance, toggling between them to minimize risk of harm and maintain autonomy. These same strategies were carried over into carceral treatment, which was often experienced as an extension of punishment and ill equipped to meaningfully capture polysubstance use.ConclusionsThis study contributes to the literature on carceral treatment, detailing the lived experience of people who co-use opioids and methamphetamine with treatment access and legal system involvement as the two become more tightly linked. Mandated treatment often replicates carceral control and fails to accommodate the realities of polysubstance use. People who co-use developed adaptive strategies to navigate these systems, reflecting the need for treatment models that respect autonomy and reduce harm rather than criminalize. Our findings thus support the need for policies that provide consistent access to care and disentangle treatment from coercive legal oversight.

BackgroundIndividuals with serious mental illness (SMI) have disproportionately high rates of criminal legal system involvement. For many, this becomes a repeated cycle of arrest and incarceration. Treatments that address symptoms of mental illness are a critical component of the continuum of services for people with SMI in the legal system; yet on their own, psychiatric treatments have not been successful at reducing criminal legal system involvement for this population. Research suggests that criminogenic risk factors, the major drivers of criminal legal system involvement, are disproportionately prevalent among individuals with SMI. However, promising criminogenic-focused interventions have only just begun to be adapted for individuals with SMI. The proposed study will examine the capacity of Forging New Paths (FNP), a novel criminogenic-focused group intervention developed for individuals with SMI, to engage its primary and secondary outcomes when delivered in community mental health settings.MethodsThe proposed pilot study will engage a small-scale clinical trial comprising three cycles of FNP delivered in a community mental health center in a Southeastern state in the U.S. The anticipated total sample size is N = 72 and will consist of community-dwelling adults with SMI who have a moderate or higher criminogenic risk level and a history of criminal legal system contact. This study will examine the extent to which FNP is able to engage its primary (aggression and community tenure) and secondary (criminal attitudes and impulsivity) treatment outcomes.DiscussionFNP provides an important new service for community-based mental health settings to reduce criminal legal system involvement (and recidivism) among the individuals they serve with SMI.Clinical Trial RegistrationNCT06290648.

This study aims to assess the prevalence of illicit use of stimulants and attention deficit hyperactivity disorder (ADHD) among a sample of medical students at the main universities in Riyadh, Saudi Arabia and their motivation for use. We examine the association between the use of stimulants and the students' academic performance. We also look into the possible adverse consequences of illicit stimulant use among students.The competitive nature of medical school might place the students at a higher risk of using stimulant drugs illicitly. Acquiring these stimulants illegally has become easier since the diagnosis and treatment of ADHD have risen. We are unaware of any other study exploring the prevalence of and motivation for illicit use of stimulants among medical students in Riyadh.A cross-sectional web-based survey was the study design we chose as we were targeting medical students in three governmental medical colleges in Riyadh, Saudi Arabia. The total sample population of 1,177 participants was divided into the three following groups: no previous use of stimulant drugs (Group 1), illicit use (Group 2), and medical use (Group 3). Of the 1,177 medical students, 29 (2.46%) were found to be using stimulants illicitly; 39 (3.31%) were using the stimulants medically as they had been diagnosed with ADHD. The ability to prolong study time was reported as the most common motive for illicit use by many students.The present study contributes to the literature by casting light on this serious issue in Riyadh. More educational effort is needed to promote awareness about the adverse effects of ADHD drugs and their illicit use among students.

ObjectiveAnxiety and depression are prevalent mental health problems in people who use illicit stimulants. Improved understanding of the temporal relationship between methamphetamine, ecstasy/MDMA, or cocaine use with anxiety or depression informs public health interventions and treatment options for those experiencing this co-occurrence. This narrative systematic review sought to examine associations and temporality between the use of methamphetamine, ecstasy/MDMA, or cocaine, with anxiety or depressive symptoms.MethodSystematic searches of 4 electronic databases were conducted up to August 2023. Study eligibility included the measurement of anxiety and/or depressive symptoms, and frequency of illicit stimulant use (methamphetamine, cocaine, or ecstasy/MDMA) at two separate time points, with data analysis of the association between these variables. The Joanna Briggs Critical Appraisal Checklist was utilised to assess quality. Data was extracted, and a narrative synthesis incorporating an eight-criteria framework to assess associations was conducted.Results4432 studies were screened for eligibility; 11 studies (3 RCTs and 8 prospective cohort studies) were included. Evidence for an association between depressive symptoms and methamphetamine use was demonstrated in six studies, with temporal evidence in three studies supporting methamphetamine use preceding depressive symptoms. Three studies reported an association between cocaine use and depressive symptoms. Evidence for associations with any of the illicit stimulants and anxiety symptoms was lacking. ConclusionsThere was some evidence to support a case for temporality, particularly for methamphetamine use and depressive symptoms. Investing in longitudinal studies is pivotal to understanding the dynamic and reciprocal relationship between illicit stimulant use and anxiety or depressive symptoms. A limitation of the study was the variation in the measurement and analysis of outcomes.

Introduction: Cocaine and methamphetamine, stimulants with potent central nervous system effects, are known to be cardiotoxic. They increase the risk of hypertension, coronary artery disease, coronary vasospasm, arrhythmias, cardiomyopathy, cardiac arrest, and stroke. Despite these well-documented risks, the National Survey on Drug Use and Health reports that illicit stimulant use is increasing. Research Question: How have mortality rates changed over time when cardiovascular disease (CVD) is the underlying cause of death and illicit stimulant use is a contributing factor? Aims: To describe trends in cardiovascular mortality rates from 1999-2023 and to stratify the analysis by race, ethnicity, sex, age, CVD subcategories, and stimulant type. Methods: We leveraged CDC WONDER data to model age-adjusted CVD mortality rates from 1999 to 2023 using joinpoint regression. For each stimulant type, demographic group, and CVD subcategory, we report annual percent changes (APCs) for each time segment and average annual percent changes (AAPCs) to estimate overall trend direction and magnitude. Results: From 1999 to 2023, stimulant-involved CVD mortality rates increased significantly, with an AAPC of 6.4%, contrasting sharply with the 2.0% decline in overall CVD mortality rates (Table). Each subcategory of CVD mortality (ischemic heart disease, hypertension; cerebrovascular disease) showed AAPC increases when stimulants were involved, with hypertensive diseases experiencing the largest AAPC rise at 9.1%. Stratifying by drug type, methamphetamine-involved CVD death rates increased by 14.9% AAPC, compared to a 3.1% increase for cocaine-involved deaths. Demographic stratification revealed additional differences. Non-Hispanic White individuals had the highest AAPC (9.2%), followed by Asian/Pacific Islander (5.6%), Hispanic (5.4%), Non-Hispanic Black (3.0%), and American Indian/Alaskan Native individuals (1.9%). A higher AAPC also was observed among those aged ≥65 years (14.6%). Conclusions: Cardiovascular deaths where stimulants were a contributing cause have increased rapidly over the past 25 years despite the overall decline in the CVD mortality rate during the same period. The largest increases were seen in hypertensive diseases, methamphetamine-involved deaths, non-Hispanic White individuals, and older individuals. This study extends our understanding but is limited by potential inaccuracies in the recorded causes of death.

Use of illicit stimulants such as methamphetamine, cocaine, and ecstasy is an increasing health problem. Chronic use can cause neurotoxicity in animals and humans but the long-term consequences are not well understood. The aim of the current study was to investigate the long-term effect of stimulant use on the morphology of the human substantia nigra. We hypothesised that history of illicit stimulant use is associated with an abnormally bright and enlarged substantia nigra (termed ‘hyperechogenicity’) when viewed with transcranial sonography. Substantia nigra morphology was assessed in abstinent stimulant users (n = 36; 31±9 yrs) and in two groups of control subjects: non-drug users (n = 29; 24±5 yrs) and cannabis users (n = 12; 25±7 yrs). Substantia nigra morphology was viewed with transcranial sonography and the area of echogenicity at the anatomical site of the substantia nigra was measured at its greatest extent. The area of substantia nigra echogenicity was significantly larger in the stimulant group (0.273±0.078 cm2) than in the control (0.201±0.054 cm2; P<0.001) and cannabis (0.202±0.045 cm2; P<0.007) groups. 53% of stimulant users exhibited echogenicity that exceeded the 90th percentile for the control group. The results of the current study suggest that individuals with a history of illicit stimulant use exhibit abnormal substantia nigra morphology. Substantia nigra hyperechogenicity is a strong risk factor for developing Parkinson's disease later in life and further research is required to determine if the observed abnormality in stimulant users is associated with a functional deficit of the nigro-striatal system.