Differences In Substance Use Research Articles

Differences in Substance Use Among Immigrants and the Canadian-Born Population

Differences in Substance Use Among Immigrants and the Canadian-Born Population

Act Healthy: A Randomized Clinical Trial Evaluating a Behavioral Activation Intervention to Address Substance Use and Medication Adherence Among Low-Income, Black/African American Individuals Living with HIV/AIDS.

There is a need for parsimonious behavioral interventions to support HIV and substance use treatment outcomes for low-income, Black/African American individuals living with HIV. This randomized clinical trial (N = 61) evaluated Act Healthy (AH), an integrated behavioral intervention to reduce substance use and improve medication adherence, compared to supportive counseling (SC) plus Life-Stepsmedication adherence counseling on substance use, craving, adherence-related outcomes, and depression over one year. Participants in AH had significantly steeper decreases in cravings compared to SC, but no significant differences in substance use. Across both groups, there was a significant increase in probability of being on antiretroviral therapy (ART) (86% on ART at 12months vs. 56% at baseline), and a significant decrease in medication nonadherence. Findings provide preliminary support for an intervention to reduce cravings and strategies to improve ART use in a hard-to-reach, vulnerable population at high risk for poor treatment outcomes and ongoing HIV transmission. TRIAL REGISTRATION: ClinicalTrials.gov trial registration number: identifier: NCT01351454. Retrospectively registered on May 10, 2011.

Family and parent-child relationship correlates of pediatric cancer survivors' substance use.

The primary aims of this research were to examine substance use among adolescent and young adult survivors of pediatric cancer (AYA survivors) and AYA without a history of chronic or life threatening illness (AYA comparisons) and to explore links between demographic, medical, caregiver-AYA, and family system factors with AYA substance use patterns. Participants included 289 AYA (survivors, n = 171; comparisons = 118; 51% female; Mage = 17.15, SDage = 2.86) and their caregivers (Mage = 46.54, SDage = 6.81; 88% mothers). AYA and caregivers completed the family environment scale, and caregivers completed the parenting relationship questionnaire at the initial assessment. Two years later, AYA completed an assessment of substance use. Chi-square and frequency analyses were used to compare differences in substance use among AYA survivors and comparisons. Multivariate analysis of variance was used to examine links between AYA substance use patterns with family and caregiver-AYA system level factors. Patterns of substance use did not differ between AYA survivors and comparisons. AYA survivors were more likely to report polysubstance use if caregivers endorsed problematic caregiver-AYA relationship patterns. Family functioning and caregiver relationship patterns did not predict AYA comparison substance use. AYA survivors were just as likely as AYA comparisons to engage in substance use, increasing their vulnerability to problematic health outcomes. Findings indicate that the role caregiver-AYA relationship patterns may have on youth at risk for substance use and potential mechanisms for future intervention.

216 Substance use during pregnancy and postpartum among women with perinatally-acquired HIV

Substance use during and after pregnancy may be a critical determinant of health for women living with HIV (WLHIV), but little is known about substance use patterns among pregnant and postpartum women living with perinatally-acquired HIV (WLPHIV). We sought to estimate prevalence of marijuana, alcohol, and opioid use during pregnancy and postpartum among WLHIV and determine associations between mode of HIV acquisition (perinatally- vs. non-perinatally acquired HIV) and substance use. We analyzed data on marijuana, alcohol, and opioid use from the Surveillance Monitoring for ART Toxicities study of the Pediatric HIV/AIDS Cohort Study, which has been enrolling pregnant WLHIV at 22 US sites since 2007. Included in the analysis were participants enrolled from 2007-2019 who were born after 1982 and had self-reported substance use data available in pregnancy, 1-year postpartum, or both. Prevalence of any marijuana, alcohol, opioid, and concomitant alcohol and marijuana use was compared by WLPHIV status, separately for pregnancy and postpartum. Multivariable log binomial regression models were fit using generalized estimating equations to estimate the relative risk of each substance use outcome by PHIV status, adjusting for race/ethnicity, age, and delivery year. A total of 1547 pregnancies of 1159 WLHIV had available data in pregnancy (N=1538) or postpartum (N=925); 19% (N=298) were among WLPHIV. WLPHIV were younger and more often identified as Hispanic. During pregnancy, no significant differences in substance use were observed by PHIV status (Table 1). Substance use was more common postpartum, with little difference in postpartum marijuana use by PHIV status (Table 2). However, the adjusted RR (aRR) for postpartum alcohol use was increased for WLPHIV (aRR 1.23, 95% CI 1.03-1.48). Although use of substances during and after pregnancy was frequent, there were no major differences in substance use based on mode of HIV acquisition. However, the high prevalence of substance use among all WLHIV, particularly postpartum alcohol and marijuana use, warrants further attention.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Assessment of use of psychoactive and other non-prescription drugs among students of selected tertiary institutions in Ekiti State South West Nigeria - A baseline study

BackgroundSubstance abuse is causing increasing threats to the stability of young minds, from teenage to the older youths and is an issue of public health concern in Nigeria. This study was carried out to determine the prevalence of drug abuse among students of tertiary institutions in Ekiti State. MethodologyA comparative cross-sectional survey was carried out among students in tertiary institutions in Ekiti state with participants selected from Year 1 to Year 4. Data collection tool was the WHO questionnaire (STASSIS). Data was analysed to obtain descriptive and inferential data, Kruskal-Wallis test and chi square were used for analysis of variance and test of association. ResultThe majority of the students reported low use of all the drugs (64–90.1%) though moderate to high use were reported for: alcohol 35.1%, marijuana 15.7%, heroine 15.3%, tobacco 13.8% and cocaine 10.2%. There was a significant association between student's moderate to high use and university type. Students in private universities reported more use, especially heroine. Difference in substance use across the four years surveyed was significant with final year students (400 level) showing highest use. ConclusionTertiary students in Ekiti state are low users of psychoactive substances with a prevalence of 60–91%. Moderate to high prevalence of 10–31% was reported with alcohol as the substance with highest usage. Substance use varied significantly with university type with highest prevalence in the private institution and students at different academic levels with final year students being the highest users.

Developmental Differences in Sexual Orientation and Gender Identity–Related Substance Use Disparities: Findings From Population-Based Data

PurposeDespite well-established substance use disparities between sexual and gender minority adolescents and their heterosexual, cisgender peers, there remain questions about whether there are developmental differences in the onset and progression of these disparities across adolescence. These perspectives are critical for prevention efforts. We therefore estimate age-based patterns of five substance use behaviors across groups of adolescents defined by sexual orientation and gender identity (SOGI). MethodsData are from the 2013–2015 cycles of the California Healthy Kids Survey (N = 634,454). Substance use was assessed with past 30-day e-cigarette use, combustible cigarette use, alcohol use, heavy episodic drinking, and marijuana use. Two- and three-way interactions were used to assess differences in age-specific prevalence rates of each substance by (1) sex and sexual identity; and (2) gender identity. ResultsAcross all substances, SOGI differences in past 30-day use were present by age 12 years. Most disparities persisted to age 18 years and older. SOGI disparities in combustible and e-cigarette use were wider in late adolescence. Analyses by sexual identity show that sexual minority girls reported the highest rates of substance use across age, followed by sexual minority boys. ConclusionsSOGI differences in substance use emerged in early adolescence and appeared to persist and accelerate by late adolescence. Sexual minority girls had the highest rates of substance use across all ages. The findings underscore the urgent need for screening and prevention strategies to reduce substance use for sexual and gender minority youth.

Treatment Availability and Overdose Numbers in Florida Counties

Substance abuse rates within the United States have skyrocketed over the past few years, leading to increased costs to society and ultimately to overdose deaths. Most adults who suffer from a substance use disorder also suffer from a mental health disorder, which makes treatment much more difficult. Studies have also shown that there are regional differences in substance use, overdose deaths and the locations of substance use treatment centers. Some of the relationships between these variables have been examined, but little is known about the relationship between the prevalence of treatment and how it relates to the rates of overdose deaths. This study seeks to examine how the number of mental health providers, substance use treatment centers and portion of the county living in rural areas affects the overdose death rates within counties in Florida. As the opioid crisis continues to grow, it is imperative to determine effective policies to treat substance use disorders. As Florida is a largely diverse state containing large cities, the results of this study will help determine if further studies around the country should be conducted. Implications for policy and practitioners will also be discussed.

Internalizing and externalizing subtypes in female patients with co-occurring post-traumatic stress disorder and substance use disorders

BackgroundResearch has described subtypes with more internalizing and more externalizing symptoms in samples of patients with post-traumatic stress disorder (PTSD) and samples of patients with substance use disorders (SUD). ObjectiveThis study sought to examine the respective subtypes in female PTSD-SUD patients and potential relationships with substance use characteristics. MethodsWe performed a latent class analysis (LCA) in 343 adult female participants of a multisite therapy trial on PTSD and SUD. We derived externalizing symptoms from the Assessment of DSM-IV Personality Disorders (ADP-IV) questionnaire. We assessed internalization using the Symptom Checklist-27 (SCL-27) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). We collected substance use–related information using the Addiction Severity Index-Lite (ASI-lite). ResultsLCA suggested four latent classes including an externalizing (10.8%), a moderately internalizing class (31.0%), and a highly internalizing class (22.0%), as well as a class with a low severity of psychological symptoms (36.3%). Externalizing participants used more substances than any other class, while the duration of substance use did not differ between groups. Regular use started at a significantly younger age among the members of the highly internalizing subgroup compared to the moderately internalizing and low severity participants, but at an older age compared to the externalizing group members. ConclusionsThe finding of two internalizing subgroups along with an externalizing and a low severity class emphasizes the heterogeneity and complexity of populations with PTSD and SUD. This heterogeneity bears implications for research among this group of patients, but also for their treatment, especially considering our results on differences in substance use.

Higher and Higher? Drug and Alcohol Use and Misuse among HIV-Vulnerable Men, Trans Men, and Trans Women Who Have Sex with Men in the United States

Background: Substance use (SU) and misuse are disproportionately more common among sexual and gender minority (SGM) individuals compared to their heterosexual peers. Yet, little is known about regional and demographic differences in use and misuse among SGM. In this study, we investigated regional and demographic differences in SU and misuse in a U.S. national, internet-based cohort (n = 6,280) of men and trans persons who have sex with men. Methods: Data collected included the WHO ASSIST (substance) and AUDIT (alcohol) SU scales to estimate recent (≤ 3 months) non-problematic use (≤ 3 ASSIST, ≤ 10 AUDIT) and misuse (≥4 ASSIST, ≥11 AUDIT). We used bivariate and multivariable logistic models to examine demographic and regional factors associated with SU and misuse. Results: Participants reported using alcohol (85.6%), cannabis (53.9%), and inhalants (39.1%) in the past three months. More than one-third self-reported misuse of cannabis, Gamma-Hydroxybutyrate (GHB), inhalants, methamphetamines, and prescription sedatives. We observed regional differences in substance use for cannabis (Southeast aOR = 0.76, 95% CI: 0.63–0.93; West aOR = 1.27, 95% CI: 1.02–1.59, ref. Northeast) and prescription Stimulants (Midwest aOR = 1.39, 95% CI: 1.00–1.93), as well as for cannabis misuse (Southeast aOR = 0.83, 95% CI: 0.69–0.99). We also observed significant associations between socioeconomic factors with use and misuse. Conclusions: Findings suggest geographic differences in misuse of certain substances among men and trans persons who have sex with men in the US, and that socio-economic factors, also play a key role in indicating risk.

Polyvictimization and Substance Use Among Sexual Minority Cisgender Women

Background: Violent victimization and substance use are higher among sexual minority cisgender women (SMCW) than heterosexual cisgender women. Unknown, however, is how polyvictimization—experiencing multiple types of violent victimization—affects substance use among SMCW. Purpose/Objectives: This study explores the relationship between polyvictimization and substance use among a small sample of SMCW. Methods: An exploratory secondary data analysis was conducted on data from a convenience sample of 115 SMCW currently in relationships (70.4% lesbian, 73.9% non-Hispanic white) via a cross-sectional survey. Lifetime physical, sexual, and crime-related violent victimization were measured via the Trauma History Questionnaire. Past-year substance use was measured via the Drug Abuse Screening Test (DAST-10). Mann-Whitney U testing and linear regression modeling were used to examine differences in substance use by victimization status (victimized/non-victimized) and the association between polyvictimization and substance use. Results: Lifetime prevalence of violent victimization was high with 60.9% of the sample reporting at least one type of victimization: 10.4% experienced physical, 22.6% experienced sexual, and 22.6% experienced crime-related violent victimization. Substance use was significantly greater for victimized participants than non-victimized participants. Modeling showed that as violent victimization increased by one unit, substance use scores increased by .30 units. Conclusion/Importance: Preliminary evidence suggests that increase in violent victimization was associated with increased substance use among SMCW. Findings indicate a need for additional confirmatory research with more representative samples and longitudinal data. Behavioral health practitioners are urged to consider the implications of these findings and assess for past cumulative violence and current risk of substance use disorder, to appropriately facilitate treatment planning.

Differences in substance use by sexual orientation and gender among Jewish young adults in Israel

BackgroundThis study focuses on sexual orientation and gender-based differences among Israeli young adult substance use behaviors. In addition, it evaluates young adult perception of substance use and acceptance of substances use by close friends.MethodsWe conducted a cross-sectional study. A self-reported anonymous questionnaire was distributed to a convenience sample of 496 young-adults (age: M = 23.14, SD = 2.48), which included 126 heterosexual males, 128 heterosexual females, 131 gay men, and 111 lesbians.ResultsThis study revealed significant sexual orientation and gender differences in all outcomes examined. Significant substance usage differences were found for same-sex orientation as 52% reported cannabis use and 24% reported using other illegal substances during the past 12 months compared to 34 and 6% (respectively) among heterosexuals. Significant gender differences were found, as male participants reported 50% cannabis use and 19% reported other illegal substance use in the past 12 months compared to 35 and 11% (respectively) among females.Additionally, compared with heterosexuals, gay men and lesbians perceived/assessed significantly higher substance usage rates among their close friends and higher levels of substance use acceptance by close friends. Regression models indicated the important role of respondent perceived and acceptance of substance use among close friends.Binge drinking, cannabis use, and other illegal substance use were positively associated with participants’ perceived substance use and substance use acceptance level by close friends, after controlling for gender, sexual orientation, age, and level of education.ConclusionsClose friends and community norms can play an important role in shaping substance usage among young adults, especially among gay men and lesbians. The results of the current study highlight the need for developing prevention and harm reduction drug policies for Israeli young adults, especially for gay men and lesbians. Interventions should also focus on young adult peers and community norms related to substance use by professionals in educational, policy-making, and therapeutic contexts.

Gender Difference in Substance Use and Psychiatric Outcomes Among Dually Diagnosed Veterans Treated in Specialized Intensive PTSD Programs

Objectives Posttraumatic stress disorder (PTSD) is a problem of growing importance among female veterans, which is especially challenging when accompanied by comorbid substance use disorder (SUD). Since women are still a small minority of Veterans Health Administration (VHA) patients, there is concern that outcomes among dually diagnosed women may be worse than among men. Method National program evaluation data were collected at admission and 4 months after discharge from 7,074 dually diagnosed veterans including 203 women (2.9%) treated at 57 specialized intensive VHA PTSD treatment programs between 1993 and 2011. Multiple regression was used to compare clinical change in women and men adjusting for baseline differences. Results Women showed no significant differences from men in measures of substance use or total PTSD symptoms at admission although they were more likely to have experienced sexual trauma and less likely to report combat exposure. With adjustment for these differences, there were no significant gender differences in length of stay, satisfaction with treatment, or measures of change in substance use or total PTSD symptoms 4 months after discharge. Reductions in an index of days of substance use was associated with reduction in total PTSD symptoms among both women (R = 0.33; p = .01) and men (R = 0.44, p < .0001) with no significant gender difference. Conclusion No significant gender differences were observed in substance use or PTSD outcomes, despite the extreme minority status of women in VHA programs. Highly vulnerable women can benefit as much as men, even when treatment is not formally tailored to address gender-specific needs.

Substance use prevalence rates among migrant and native adolescents in Europe: A systematic review.

Migrant adolescents show specific risk and protective factors associated with substance use, but the extent to which prevalence rates differ between migrant and native-born youth in Europe remains unclear. The present study aims to provide a comprehensive review of all available substance use prevalence studies on differences in substance use between migrant and native-born adolescents in Europe. In this systematic review, PubMed, Medline and Pre-Medline, EMBASE and PsycINFO were searched for articles comparing substance use prevalence rates (tobacco, alcohol, illicit drugs) between migrant and native-born adolescents or young adults aged 11 to 29 years in European countries. The Joanna Briggs Institute prevalence critical appraisal tool was used for quality assessment. Fifteen studies met the inclusion criteria. The findings unanimously showed lower alcohol use in migrant compared to native-born adolescents, in particular among migrant adolescents from non-European countries and/or with a Muslim background. For tobacco and illicit drug use, findings were mixed. The results suggest a healthier behaviour profile among migrants than among native-born adolescents regarding alcohol use. Therefore, it would be beneficial to develop interventions to support migrant communities in maintaining their healthier alcohol use practices upon arrival in the host country. Compared to native-born adolescents, migrant adolescents are less likely to use alcohol. The findings on tobacco and illicit drug use were mixed. A European standard for surveys regarding substance use among adolescents is needed to investigate fluctuations, causes, and consequences of substance use differences between migrants and natives at the European level.

Gender differences in psychoactive substance use among undergraduates in a developing country

ABSTRACT Background: The use of psychoactive substances constitutes one of the leading social problems confronting students. Some gender differences have been reported in the use of substances. Aim and objectives: To identify the gender differences in substance use among students in Nigeria. Methods: This was a cross-sectional study conducted among 763 students of Imo State University Owerri. A self-administered structured questionnaire was used to obtain the socio-demographic data and information on the reasons, and consequences of substance use. Results: A total of 763 students were studied. More males used substances compared to females (χ2 = 10.6, p˂0.01). More females used psychoactive substances out of curiosity (51.9%), and because a family member used psychoactive substance (55.7%). More males used psychoactive substances to be accepted by friends (χ2 = 7.33, p˂0.01), to make life more enjoyable (χ2 = 18.6, p˂ 0.01), to appear bold and strong (χ2 = 21.7, p < .01), and to cope with the stress (χ2 = 6.52, p˂0.01). Skipping classes regularly (χ2 = 6.98, p˂0.01) and being charged for sexual molestation (χ2 = 5.64, p˂0.02) were more among those who abused substances. Conclusion: There are differences in the rate and reasons for the use of psychoactive substances between the genders. In the design of preventive approaches in students, these should be borne in mind.

Differences in Substance Use and Sexual Risk by Sexual Orientation and Gender Identity Among University and Community Young Adults in a U.S.-Mexico Border City.

Ethnic and sexual minority young adults in El Paso, Texas, are at high risk for substance use, human immunodeficiency virus (HIV), and hepatitis C virus (HCV). In 2014, a Hispanic-serving higher education institution partnered with two community-based organizations to implement integrated substance use interventions and HIV and HCV prevention among young adults on campus and in surrounding communities. Among the 95 young adults, aged 18-24 years, who responded to a needs assessment survey, 91.5% were Hispanic, 53.7% were female, and 27.4% were sexual or gender minorities (SGMs) as defined by behavior and identity. SGMs had significantly higher rates of current smoking, drinking when bored, and of being told they had a drinking problem. Compared with the other young adult survey respondents, SGMs had lower health risk perceptions for tobacco, alcohol, and marijuana use and reported similar or higher rates of lifetime drug use during sex and higher rates of HIV risk behaviors. Study findings have implications for including measures for sexual orientation and gender identity in substance use studies, examining regional and cultural norms that may intersect to shape substance use among SGMs, and incorporating unique risk contexts for SGMs in interventions for substance use.

Racial Differences in Substance Use During Pregnancy and Neonatal Birth Measurements [22C

INTRODUCTION: Illicit drug use during pregnancy causes changes in neonatal growth parameters that are associated with neurodevelopmental outcomes and childhood chronic diseases. This study aims to describe racial differences in substance use and birth measurement outcomes. METHODS: A retrospective study of singleton births from August 2013 through December 2014 was conducted using urine drugs screen collected universally at the initiation of prenatal care. Excluded were multiple gestations and preterm deliveries. Reported are substance use patterns and race (Caucasian, African American, and Asian) as well as mean neonatal birth measurements (head circumference, birth length, and birthweight). RESULTS: 2,270 patients met study criteria. There was a significant difference in birthweight between Caucasians, Asians and African Americans at baseline without substance use (3,386 g, 3,338 g and 3,181 g respectively, P&lt;.001). However those with substance use had no significant difference in birth measurements seen between races. Infants of Caucasian mothers with substance use were noted to have significantly smaller birthweights compared with Caucasian nonusers (3,386 g vs 3,191 g, P&lt;.001). Whereas infant birthweights of African American mothers with substance use were not different from African American nonusers (3,181 g vs 3,170 g, P=.738). Of the 117 Asians screened in the study, there were no substance users. CONCLUSION: Our study addresses the racial differences of drug use during pregnancy and its effect on neonatal growth measurements at birth. Substance use impacts overall birthweight in Caucasian substance users but not African Americans. Efforts should be taken to describe substance use patterns by race and its effect on neonatal growth outcomes long term.

Racial Differences in Substance Use Patterns During Pregnancy [23C

INTRODUCTION: Substance use during pregnancy remains a significant public health problem. Studies have reported racial differences in substance use, however this has not been addressed in the pregnant population. This study describes associations between maternal race and substance use patterns in pregnancy. METHODS: A retrospective study of singleton births from August 2013 through December 2014 was conducted using universal urine drug screen (UDS) collected at the initiation of prenatal care. Excluded were multiple gestations and preterm deliveries. The data is shown by frequency of substance use (no use, any use, use of specific substances) and maternal race (Caucasian, African American, Asian). RESULTS: 2,270 patients met study criteria. There were 1,030 (45%) Caucasians, 802 (35%) African Americans, and 117 (5%) Asians identified. Caucasian and African Americans had approximately the same rates of substance use, 30.0% and 32.5% respectively. It is notable that 93.1% of African Americans with a positive UDS were positive for only THC, compared to 63.8% of Caucasians. Polysubstance use was much higher in Caucasians than any other racial group, with 31.7% of Caucasian users positive for opiates, 12.0% for benzos, and 5.8% for cocaine. No Asians had a positive UDS. CONCLUSION: Our study addresses the racial differences of substance use during pregnancy, specifically detailing the substances used. Our study strongly suggests the need for local and state initiatives to better understand the racial trends for substance use in pregnancy in order to tailor prenatal care interventions that optimize pregnancy outcomes.

Exploring differences in substance use among emerging adults at-risk for problem gambling, and/or problem video gaming

ABSTRACT Both problem gambling (PG) and problem video gaming (PVG) contribute to physical, psychological, and interpersonal issues, and are associated with elevated substance use. This is particularly troublesome among emerging adults (18–27 years) who report high levels of substance use and represent a significant proportion of the gamblers and video game players. The present study assessed PG and PVG symptoms among 1,621 emerging adults (54.5% female; M = 20.55, SD = 2.70) in conjunction with their frequency of using cigarettes, alcohol, marijuana, and other drugs (e.g. cocaine, opioids). Results revealed that 6.1% and 22.7% of emerging adults were at-risk for PG or PVG, respectively. Those at at-risk for either PG or PVG had used substances more frequently than those who were either non-problematic or at low-risk. A small subset of participants (2.2%) were at-risk for both PG and PVG and were the most likely to report using cigarettes, marijuana, and other drugs frequently, even after accounting for the effects of age, gender, race, and gambling and video gaming frequency. As such, exhibiting a risk for both PG and PVG places individuals at greater risk for substance use. The implications of these findings to policy and future research are discussed.

267. Differences in Substance Use, Sexual Risk Behaviors and Depression in Commercially Sexually Exploited and At-Risk-For Youth Versus 2014 Youth Risk Behavior Survey Participants

267. Differences in Substance Use, Sexual Risk Behaviors and Depression in Commercially Sexually Exploited and At-Risk-For Youth Versus 2014 Youth Risk Behavior Survey Participants

Rural-urban differences in cannabis detected in fatally injured drivers in the United States

While there is a vast literature on rural and urban differences in substance use, little is known in terms of cannabis positive drug tests among fatally injured drivers. In the present study, we examined rural-urban differences in cannabis detected in fatally-injured drivers. Data were drawn from the 2015–2017 Fatality Analysis Reporting System. Multivariable logistic regression was performed to examine rural-urban differences in the percentage of cannabis detected in fatally-injured drivers. Analyses were stratified by rural-urban classification and sex. A positive cannabis test in fatally-injured drivers was more prevalent in urban locations. Compared to fatally-injured drivers in rural locations, urban drivers had higher odds of a positive test for cannabinoids (aOR: 1.21, 95% CI 1.14–1.28). Non-Hispanic Black drivers had higher odds of testing positive for cannabinoids (aOR: 1.43, 95% CI 1.31–1.55). Those aged at least 25 years had lower odds of a positive test for cannabinoids. Drivers involved in a weekend nighttime crash (aOR: 1.14, 95% CI 1.03–1.26) and weekday nighttime (aOR: 1.15, 95% CI 1.05–1.26) had higher odds of testing positive for cannabinoids compared to drivers involved in a weekend daytime crash. Results showed significant rural-urban differences in the prevalence of cannabis detected in fatally-injured drivers.