Illicit Drug Use Research Articles

Domineidon is a big black gorilla. A psychiatric case report

Introduction: Schizophrenia affects about 1% of the population, starting before the age of 25 and persisting throughout life. The disease is characterized by the presence of positive symptoms such as delusions, hallucinations, thought disorganization, negative symptoms such as affective flattening, withdrawal, isolation, as well as cognitive symptoms, such as changes in attention and memory. Objective: To report a case of severe schizophrenia that presented a high degree of functional impairment and life cycle disruption. Methods: These informations was obtained through the collection of clinical data from the patient's medical record, information from family members and, the clinical evaluation. Results: The patient's mother reported the onset of symptoms at the age of 16, when her son would get very irritable for any reason. After killing his stepfather, the patient was caught in the act and taken to the Juvenile Detention Center. The patient tried to hang himself with his own hands several times, and was then admitted to a psychiatric clinic. He was treated with clozapine, starting with 25 mg and reaching a dose of 700 mg per day, without side effects of neutropenia, seizures, and sialorrhea. During his evolution, while still hospitalized, he showed good progress, with a reduction in delusions and hallucinations, demonstrating insight into his illness and self-criticism, returning to functionality. After being discharged from the hospital, he returned to social life with the family. Discussion: Schizophrenia can evolve severely, leading to the breakdown of the patient's life cycle, serious dysfunctions, and irreversible damage in biological, psychological, and social aspects. Poor adherence to treatment, the side effects of medications, refractoriness to drugs and therapies, as well as the use of illicit drugs, can be elements that, individually or in combination, worsen the prognosis of the disease. The use of clozapine is an important resource that can be used in cases refractory to other medications, bringing results. Conclusion: Even in the face of the patient's severe condition, there was a good response to treatment with clozapine.

Preferences for Starting Daily, On-Demand, and Long-Acting Injectable HIV Preexposure Prophylaxis Among Men Who Have Sex With Men in the United States (2021-2022): Nationwide Online Cross-Sectional Study.

Long-acting (LA) injectable preexposureprophylaxis (PrEP) and on-demand PrEP may improve overall PrEP uptake among men who have sex with men (MSM), but little is understood about the PrEP option preferences of MSM in practical scenarios where they may choose between various PrEP options. This study aims to examine the preferences for starting various PrEP options among a US nationwide online convenience sample of MSM from September 2021 to February 2022. Participants reporting no prior HIV diagnosis were provided brief descriptions of each PrEP option and were asked, "If [PrEP option] were available from your local doctor and you could access it for free, would you go to your doctor in the next month to start [PrEP option]?" Those who said "yes" to multiple options were asked to rank them in order of preference. MSM currently taking daily oral (DO) PrEP were asked whether they would switch to on-demand or LA PrEP options. Log binomial models were created to examine the association between willingness to start or switch to on-demand and LA PrEP with various sociodemographic and behavioral factors. In the analytic sample (N=7760), among the participants who did not use any PrEP in the past 12 months (n=5108, 66%), 54% (n=2445) reported willingness to start at least 1 PrEP option and 41% (n=1845) of participants showed interest in starting multiple PrEP options. Overall, the highest willingness was reported for on-demand PrEP (n=2235, 44%), followed by DO PrEP (n=2174, 43%) and LA PrEP (n=1482, 29%). LA PrEP was ranked first among those interested in multiple options. Characteristics associated with ranking LA PrEP as a first option to start PrEP versus DO or on-demand PrEP were region of residence (residing in the West vs Northeast), report of sexually transmitted infection diagnosis in the past year, report of illicit drug use other than marijuana in the past year, and prior awareness of LA PrEP. Among current DO PrEP users (n=2379, 31%), 58% (n=1386) were willing to switch to on-demand or LA PrEP, and LA PrEP was ranked first among participants who were open to switching to both options. Willingness to switch to LA PrEP was higher among those who used illicit drugs other than marijuana in the past year, who heard of LA PrEP prior to the survey, and those who took 15 or less doses of oral PrEP in the last 30 days. LA PrEP was the highest-ranked option among most MSM who were willing to try multiple options or switch from DO PrEP. These findings highlight that LA PrEP might fill coverage gaps among MSM who use illicit drugs, have had a recent sexually transmitted infection diagnosis, and have less than optimal DO PrEP adherence.

Clearing the air: Heightened perception of harm from secondhand cannabis smoke exposure is associated with no in-home cannabis smoking in a 21-country convenience sample.

As countries adopt more lenient cannabis use policies, perception of harm from secondhand cannabis smoke (SHCS) exposure is decreasing and most cannabis smoking is taking place at home. We quantified the relationship of reported in-home cannabis smoking with perceived harm from SHCS exposure. The analytic sample comprised 28,154 adult respondents, from 21 countries, to the annual cross-sectional Global Drug Survey (2021) of users of licit or illicit drugs. Respondents reported perception of harm to non-smoking residents from SHCS exposure and past 30-day cannabis smoking in the home by anyone. Logistic regression estimated covariate-adjusted odds ratios and 95 % confidence intervals of in-home cannabis smoking (yes/no). The association between harm perception and in-home cannabis smoking by country of residence was also quantified. Sixty-one percent reported no in-home cannabis smoking in the last 30 days; mean perception of harm of SHCS exposure on a 10-point scale was 5.2. Those at the 75th (vs 25th) percentile of perceived harm had 70 % higher odds (OR = 1.7, 95 % CI = 1.6-1.8) of no in-home cannabis smoking. In all countries of residence, higher perception of harm was associated with reporting no in-home cannabis smoking, although not all were statistically significant. The strongest association was seen in Sweden (OR = 3.9, 95 % CI = 1.5-11.9) and New Zealand (OR = 2.3, 95 % CI = 2.0-2.7). Respondents who perceived SHCS as harmful were less likely to report in-home cannabis smoking. If this association subsequently proves causal, increasing awareness of the harms associated with SHCS exposure could substantially reduce residential cannabis secondhand smoke exposure.

Pretreatment Quality of Life and Substance Use Among Patients Diagnosed With Head and Neck Cancer.

There is a paucity of research on the effects of commonly used substances, such as cannabis and other drugs, on quality of life as a contributor to head and neck cancer (HNC) prognosis. We examined associations between non-alcohol or tobacco substance use (cannabis and other illicit drug) and self-reported quality of life in patients with HNC prior to starting treatment. This was a cross-sectional study of patients who presented for routine psych-oncologevaluation prior to treatment between 11/2015 and 9/2022. Primary exposures were cannabis use (never, past, or current users) and current illicit drug use (yes/no). The primary outcome measure was the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) subscales (physical, social/family, functional and emotional). Linear regression models examined associations between pretreatment substance use and FACT-HN subscales adjusting for demographic, socioeconomic, and clinical factors. Of 570 patients, 13.9% endorsed current cannabis and 13.9% current illicit drug use. The mean (SD) scores for FACT-HN subscales were physical well-being = 22.8 (5.0), social well-being = 22.7 (5.5), emotional well-being = 17.5 (4.5), and functional well-being = 18.7 (6.9). In the adjusted models, cannabis use was not independently associated with any FACT-HN subscales. However, patients who currently used illicit drugs reported worse emotional well-being (β = -1.32; 95% CI -2.45 to -0.20). No independent association was found between current illicit drug use and other subscales (physical, social, and functional). Illicit drug use, but not cannabis use, is negatively associated with pretreatment emotional well-being in patients with HNC. Further research exploring the relationships between longitudinal cannabis and illicit drug use and methods of consumption on QoL and cancer outcomes in patients with head and neck cancer is warranted.

Investigating illicit drug hotspots and daily variations using sewer-network wastewater analysis

Previous wastewater-based epidemiology (WBE) research on illicit drug use has predominantly focused on wastewater treatment plant (WWTP) influents, but information on sewer-network wastewater is very limited. This study represents a pioneering small-scale WBE investigation based on the analysis of sewer-network wastewater samples from different sewer manholes in suburban (Tamsui region) and urban areas (Zhongshan and Wanhua regions) and a comparison of the results with those obtained from corresponding WWTP influents. Among sixteen illicit drugs, methamphetamine exhibited the highest concentration in sewer-network wastewater across both areas. Suburban–urban variations were observed, with more types of illicit drugs detected in the suburban area. Back-calculation indicated that methamphetamine and ketamine were the most-consumed illicit drugs in both sewer-network wastewaters and WWTP influents. Similar types of illicit drugs were detected in the sewer-network wastewaters and WWTP influents, indicating the representativeness of WWTP influents in assessing regional illicit drug abuse. Nevertheless, the sewer-network wastewater results offered additional information making it possible to pinpoint potential hotspots of illicit drug and identify peak usage periods throughout the day, in contrast to the WWTP influent results. In the non-suspected suburban area of Tamsui, high potential hotspots of methamphetamine (sampling points 3 and 6) and ketamine (sampling points 1 and 8) were identified. Although the Zhongshan and Wanhua regions were chosen as suspected hotspots of illicit drug abuse, more severe illicit drug use was observed in Wanhua. Moreover, a trend toward higher illicit drug use from early morning to morning was observed. Despite sampling challenges and higher costs, small-scale WBE via sewer-network wastewater analysis provides superior identification of drug abuse hotspots and peak usage periods. Therefore, this study provides valuable insights for law enforcement and can help prevent and combat illicit drug abuse by targeting potential hotspots and understanding daily illicit drug use dynamics.

Repurposing prescribed hydromorphone: Alternative uses of safer supply and tablet-injectable opioid agonist treatment to meet unaddressed health needs

BackgroundIn response to the ongoing overdose crisis in Canada, a number of opioid agonist treatment and safer supply programs provide people at high overdose risk with daily-dispensed tablet hydromorphone, with some requiring witnessed ingestion and others providing take-away doses. While these programs are intended to reduce overdose events by limiting people's use of the contaminated drug supply, the experiences of people receiving hydromorphone vary. In this article we explore the ways people repurpose hydromorphone to address unmet needs. MethodsThis article draws on in-depth qualitative interviews from two studies evaluating hydromorphone tablet distribution programs in British Columbia, Canada. We used thematic analysis to identify themes related to repurposing hydromorphone. We compared themes across the two studies to identify any similarities or differences in relation to the ways study participants discussed repurposing hydromorphone tablets. We utilize vignettes – snapshots of participant experiences – to analyse and represent the data. ResultsFour vignettes demonstrate how hydromorphone tablets are often being used to address and resolve unmet needs of people who use drugs. While most participants reported reducing their use of illicit drugs, a variety of instrumental uses of tablet hydromorphone were also discussed, including reducing anxiety, addressing sleep issues, withdrawal management, and managing chronic pain. ConclusionOur findings demonstrate how people who use drugs are maximizing the benefits of tablet hydromorphone distribution to address unmet needs. Hydromorphone distribution programs represent a public health and harm reduction intervention that is usefully addressing experiences related to structural vulnerabilities (such as inadequate pain management), which are often overlooked amongst stigmatized groups.

Associations and mediating factors between adverse childhood experiences and substance use behaviours in early adulthood: A population-based longitudinal study

BackgroundResearch has demonstrated positive associations between adverse childhood experiences (ACEs) and substance use behaviours in young adults. However, many of these are based on cross-sectional data. The pathway between ACEs and substance misuse among emerging adults is also not fully understood and few studies have investigated potential mediating factors. MethodsWe analysed data from the Child Cohort of the Growing Up in Ireland study, a nationally representative longitudinal sample of children recruited at 9 years of age (n = 4,729). Logistic regression was used to examine individual and cumulative ACE exposure relationships with substance use at age 20 years. Mediation analyses were used to assess whether parental and peer relationships and school engagement mediate ACE history associations with substance use behaviours. ResultsACE exposure relationships with current cannabis use, other illicit drug use and problematic drug use were observed. In particular, young adults who had experienced 2 ACEs or 3 + ACEs had an approximate two-fold (OR=1.80, 95 % CI: 1.29, 2.51) and approximate three-fold (OR=2.94, 95 % CI: 2.06, 4.19) increased odds of problematic drug use, respectively, when compared to participants who had experienced no ACEs during the study period. Mediation analyses suggested that parent and peer attachment and liking school partially mediate relationships between ACEs and substance use behaviours. ConclusionsChildren who have experienced ACEs are at higher risk of future substance use and problematic drug use. In supporting these children, identified mediators such as interpersonal relationships and school engagement may help guide selection of prevention interventions.

Preadolescent individual, familial, and social risk factors associated with longitudinal patterns of adolescent alcohol, cannabis, and other illicit drug use in a population-representative cohort.

The aim of this exploratory study was to identify developmental patterns of adolescent concurrent alcohol, cannabis, and other illicit drug use and their preadolescent individual, familial, and social risk factors in a population-representative cohort from the province of Quebec, Canada (N = 1,593; 48.4% male). Age 12-17 years self-reports of alcohol, cannabis, and other illicit drug use were collected. Latent growth modeling was used to analyze developmental patterns of single- or polysubstance use (SU/PSU), and multinomial regression examined their association with risk factors assessed at age 10-12 years. Five developmental patterns were revealed, including nonusers (12.8% sample) and four classes reflecting different levels of SU/PSU (5.8%-37.5%), varying in severity based on onset, frequency, and type of substances used. Boys and girls were similarly represented throughout SU/PSU patterns. In comparisons with nonusers, several preadolescent risk factors were associated with increasing severity of SU/PSU. Possibly indexing fearlessness/disinhibition, low internalizing symptoms were common to all adolescent users. An earlier onset of substance use and increasing use of substances throughout adolescence were linked with having deviant peers for all user classes but later-onset users. Preadolescents manifesting externalizing problems and exposed to family adversity in addition to the above risk factors showed the earliest onset and most frequent adolescent SU/PSU, especially those also exposed to less appropriate parenting. Consistent with the developmental model of substance use, the nature, number, and severity of preadolescent risk factors distinguished between the type and severity of SU/PSU patterns in adolescence and call for a consistent strategy of universal, selective, and indicated preventive interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Substance Use in Adolescent and Young Adult Cancer Survivors: An Integrative Review.

The adolescent and young adult (AYA) ages are a time when individuals are susceptible to risky behaviors, including binge drinking, tobacco, marijuana, and illicit drug use. AYAs are at an increased risk for developing chronic health problems compared with their healthy peers, and substance use can pose additional risks. The purpose of this review is to compare substance use in AYAs with their healthy peers and identify contributing factors. A literature search was conducted of PubMed, Scopus, and OVID databases using keywords substance*, adolescent*, adolescence*, teens*, teenager*, young adult*, pediatric*, childhood*, cancer*, and oncology*. The initial search yielded 148 articles. Inclusion criteria specified English language and articles from January 1, 2013, to December 31, 2023. Studies were excluded if they did not include participants aged <18 years and without a noncancer comparison group. Five relevant articles were included after review and appraisal. Substance use was examined by substance use type and contributing factors, including caregiver-AYA relations, age, and depression/coping. Findings were mixed for substance use, including tobacco and alcohol use. Findings indicate no consistent pattern-substance use was both more and less common in AYAs than in their noncancer peers, or substance use did not differ between AYAs and their noncancer peers. With mixed results, each study identified some level of substance use in AYAs. Given this knowledge, when treating AYAs, providers should be diligent about screening for substance use during each visit. AYAs should be educated about the risk of substance use, especially as a vulnerable, at-risk population.

Examining the association between trenbolone, psychological distress, and aggression among males who use anabolic-androgenic steroids

Introduction: The link between anabolic-androgenic steroid (AAS) use and psychosocial effects such as aggression and violence is contentious. Few studies differentiate between types of AAS. This study focuses on trenbolone to assess its psychological risks and effects on aggression compared to other AAS. We hypothesised that there would be a positive relationship between trenbolone dosage and both psychological distress and aggression among people who use AAS. Methods: Using purposive and snowball sampling of people using AAS, we conducted an online survey to investigate the relationship between trenbolone use and other AAS use. Participants completed sections on demographics, trenbolone and other illicit drug use, the Kessler Psychological Distress Scale, and the Buss and Perry Aggression Questionnaire. Data were analysed using multinominal and multivariable regression. Results: The study included 282 males using AAS. Over 33% (n=93) reported currently using trenbolone, with 55.3% (n=156) of participants reporting having used trenbolone in the past, and 11.7% (n=33) reporting having never used trenbolone. Those who had never used trenbolone were not significantly different on age, height, weight, and BMI compared to those who had. After controlling for age and BMI, dose of trenbolone was significantly (p=0.045) associated with higher levels of verbal aggression. Conclusion: The study highlights trenbolone's association with increased verbal aggression among males using AAS, particularly at higher doses. Further research should continue to differentiate between AAS types and the accompanying health harms.

The relative contributions of genetic and non‐genetic factors to the risk of neuroblastoma

ABSTRACTPrevious literature has well‐established genetic factors as being associated with neuroblastoma (NB). About 1%–2% of NB cases are familial, with 85% of these cases predisposed to mutations in the PHOX2B and ALK genes. The genetic basis of sporadic NB has been studied through genome‐wide association studies and next‐generation sequencing approaches. Particularly, germline variants, as well as copy number variations, confer increased risks of NB, often with effect estimates ≥1.5, underscoring the strong genetic contributions to NB. However, the strength of the association varied in non‐genetic factors. Some risk factors, such as birth defects, maternal illicit drug use, and early infections, had relatively stronger associations (effect estimates ≥1.5 or ≤0.67), while some other factors remain inconclusive. This suggests that certain non‐genetic factors may play a more prominent role in NB risk, while further research is needed to clarify the impact of others. We synthesized and critically evaluated existing literature on the risk factors of NB to provide an overview, analyze the current state of knowledge, and outline a research path to address the relative contributions of genetic and non‐genetic factors in NB. Future epidemiologic studies should incorporate novel methods for measuring genetic and non‐genetic factors to comprehensively assess the full extent of factors contributing to NB. Furthermore, the utilization of dried blood spots holds promise to overcome technical and recruitment challenges for future studies. These strategies will contribute to a more holistic understanding of NB etiology and potentially lead to improved prevention strategies.

Socioeconomic inequalities in substance use among Norwegian adolescents between 2014 and 2022

Abstract Background Increasing use of substances is observed among adolescents in recent years. Early onset of substance use dramatically increases the risk of substance use disorder, dependence, and poorer psychological, social, and physical health, and is thus a public health concern. We explore trends in socioeconomic inequalities in past year use of cannabis and other illicit drugs between 2014 and 2022 among Norwegian adolescents. Methods This study is based on data retrieved from five waves of the nationwide Norwegian Ungdata survey (2014-2022) among adolescents attending upper secondary education (N = 282,259; 51 % girls). Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results The use of cannabis and other illicit drugs increased among boys (from 13% to 19%, and from 2% to 5%, respectively) and girls (from 8% to 14%, and from 1% to 3%, respectively) between 2014 and 2022. Higher prevalence’s was observed among the least affluence girls between 2020 and 2022, both in absolute and relative terms (SII: 0.01 to 0.06, RII: 0.97 to 1.52, p &amp;lt; 0.001). No inequalities were observed among boys during this time. While relative and absolute inequalities in use of other illicit drugs decreased in boys, absolute inequalities increased in girls. Boys were more likely than girls to have used cannabis and other illicit drugs, although the gender gap in cannabis use narrowed slightly during the study period. Conclusions Our data suggest increasing use of cannabis and other illicit drugs among Norwegian adolescent boys and girls between 2014 and 2022. Future studies should examine the potential causes of increasing substance use as a basis for understanding, and distinguishing between, the many intertwining factors that influence adolescent drug use behaviors. Key messages • The use of cannabis and other illicit drugs increased between 2014 and 2022 among Norwegian boys and girls. • While inequalities in the use of cannabis and ither illicit drug use increased in girls, small or no inequalities was observed among boys.

Examining the link between age of alcohol initiation, adolescent alcohol use and adult substance use

Abstract Background Understanding the relationship between adolescent alcohol use and adult substance use is important for prevention programmes. Existing evidence presents divergent findings and potential mechanisms are debated. Methods We estimated associations between the age of alcohol initiation and alcohol use at age 17 and substance use at age 20 in a nationally representative cohort (n = 4554). Weighted logistic regression models were fitted using Generalised Estimating Equations in multiply imputed and complete case data. Results Our analysis identified that 27% of participants reported first alcohol use at ≤ 14 years old, with 37% engaging in risky alcohol use by age 17. At age 20, 14% reported hazardous alcohol use, while 38% used tobacco, 24% cannabis, and 28% other drugs. The age at which alcohol was initiated and risky alcohol use at 17 years old were both strongly associated with alcohol, tobacco, cannabis and other illicit drug use at 20 years old. Sequential change in effect estimates coupled with non-overlapping confidence intervals suggest a dose-response relationship between age of alcohol initiation and tobacco and other drug use at age 20. Conclusions First use of alcohol at 14 or younger was common. Earlier alcohol initiation and risky alcohol use are each associated with substantially elevated risk for substance use at 20 years old even after accounting for common liability factors. Acknowledgement: Growing Up in Ireland (GUI) is funded by the Department of Children, Equality, Disability, Integration and Youth (DCEDIY). It is managed by DCEDIY in association with the Central Statistics Office (CSO). Results in this report are based on analyses of data from Research Microdata Files provided by the CSO. Neither the CSO nor DCEDIY take any responsibility for the views expressed or the outputs generated from these analyses. Key messages • Delaying alcohol initiation and preventing risky alcohol use during adolescence may reduce levels of substance use in young adults. • Self-reported early use of alcohol remains common.

Factors associated with over-the-counter drug misuse among young people: a narrative review

Abstract Background Over-the-counter (OTC) medications are sold directly to customers without requiring a doctor’s prescription. Misuse of OTC drugs is higher in adolescents and young adults than in the general population. This review is the first to narratively synthesize the factors associated with OTC drug misuse among adolescents and young adults (14-25 years old). Aim To identify the factors that are associated with OTC drug misuse among adolescents and young adults (14-25 years). Methods A comprehensive search of three electronic databases, including MEDLINE, PsycINFO and Web of Science, was conducted to retrieve publications between 1 January 1997 and 31 July 2023. The AXIS tool was used to aid critical appraisal. Papers were analysed using thematic analysis. Results Eight studies were eligible for inclusion in this narrative review We identified four key themes: motivational factors; health literacy; illicit drug use and socioeconomic status. Sensation-seeking and using OTC drugs for recreational purposes were associated with OTC misuse. Limited health literacy and lack of understanding of OTC drugs were significant factors for misusing OTC drugs. Greater use of OTC drugs at the same time as alcohol and other illicit drugs represented that they were at increased risk for misusing OTC drugs. Finally, adolescents and young adults with low income, from rural areas and with lower educational attainment were most likely to misuse OTC drugs. Conclusions Although over-the-counter medications (OTCs) encourage self-medication, their rising misuse has led to a public health problem to which nations worldwide are responding. Therefore, education and awareness among OTC drug users policy will be helpful further on strategies to prevent the misuse of OTC drugs. Key messages • This review identifies some of the factors for misusing OTC drugs, and education and awareness among OTC drug users policy may be helpful further in strategies to prevent the misuse of OTC drugs. • This review also identifies that changing the user habits and availability of OTC drugs policy may also be helpful in further strategies to prevent the misuse of OTC drugs.

Supplemental Material for Preadolescent Individual, Familial, and Social Risk Factors Associated With Longitudinal Patterns of Adolescent Alcohol, Cannabis, and Other Illicit Drug Use in a Population-Representative Cohort

Supplemental Material for Preadolescent Individual, Familial, and Social Risk Factors Associated With Longitudinal Patterns of Adolescent Alcohol, Cannabis, and Other Illicit Drug Use in a Population-Representative Cohort

Characterizing a syndemic: STI symptoms, substance use &amp; violence among incarcerated Peruvian women

Abstract Background Despite increasing rates of incarceration and sexually transmitted infections (STIs) among women globally, STI epidemiological data for this vulnerable at-risk population is limited. We therefore characterized patterns of STI symptoms and explored covariates and drivers of STI symptoms among incarcerated women in Peru. Methods Among 249 incarcerated women surveyed on substance use, depression, sexual behavior, STI symptoms and violence, univariate and bivariate analysis informed a latent profile analysis (LPA) and logistic regression assessing for syndemic associations between violence, substance use, and STI symptoms. Results Most participants were Peruvian (93.5%), in their late 30s (median=37; range:18-70 years), sentenced to &amp;lt; 5 years (86.6%) and had completed high school (78.7%). 36.9 had ≥2 STI; A minority were pregnant (2.6%), had children residing with them in prison (7.2%); symptoms. The LPA model with the best fit revealed the largest (39%) group with a ‘syndemic’ profile involving co-occurrence of multiple STI symptoms, substance use, and experiences of interpersonal violence (IPV); 86.6% of this latent class were &amp;lt;50 years old. The substance use and violence ‘syndemic’ profile was associated significantly higher likelihood of having multiple STI symptoms (2+ symptoms: PR = 1.88 (95% CI 1.18, 2.99) or 3+ symptoms PR = 2.55 (95% CI 1.32, 4.93). Conclusions and Recommendations The syndemic of younger incarcerated women with substance use and IPV with STI symptoms portends a group at substantially higher risk for HIV and given the structured setting of prisons, should be routinely screened for and treated for STIs. Moreover, these settings can and should screen for and address substance use and IPV and intervene before these women are released to community settings to not only improve individual but public health needs. Key messages • In line with syndemic theory, incarcerated women presenting with multiple STI symptoms (≥2) were more likely to be engaged in substance use (illicit drug use and/or alcohol) and experience violence. • Post-hoc analysis also revealed the rate of substance use was higher among women who engaged in commercial sex work (CSW) pre-incarceration compared to those who were not engaged in CSW.

Severity and Number of Substances Used are Independently Associated with Antiretroviral Therapy Adherence Over Time among People with HIV in the Current Treatment Era.

Substance use is associated with decreased antiretroviral therapy (ART) adherence among people with HIV (PWH). Adherence plays a significant role in mediating the negative effects of substance use on HIV suppression and is a principal modifiable patient-level factor in improving HIV suppression and reducing ART drug resistance. Understanding substance use and ART adherence, particularly with rapidly changing substance use epidemiology and ART regimens, is vital to improving HIV care. Among 10,557 PWH (2010-2021) from 8 academic clinical sites nationally we examined longitudinal associations of substance use severity and number of substances used (measured using AUDIT-C and modified ASSIST) with patient-reported ART adherence (visual analog scale). Alcohol (68% any use, 18% unhealthy use [AUDIT-C > 4 men, > 3 women]), marijuana (33%), and methamphetamine (9%) use were most reported. Polysubstance use was common (32%). Both higher severity substance use and higher number of substances used were associated with lower ART adherence. Severity of methamphetamine use had the strongest dose-response association with ART adherence (low severity [ASSIST 1-3]: -3.05%, 95% CI: -4.23%, -1.87%; moderate [ASSIST 4-26]: -6.20%, 95% CI: -7.08%, -5.33%; high [ASSIST > 26]: -10.77%, 95% CI: -12.76%, -8.78%). Severe substance use, especially methamphetamine, and higher number of illicit drugs used were associated with declines in adherence at levels that were likely clinically meaningful in the modern era of ART. Findings support integrating substance use care with HIV care and potential benefits of harm reduction strategies for improving adherence such as encouraging lower levels of substance use and fewer number of substances used.

Unequal cannabis use among European adolescents: the mediating role of perceived access and risk

Abstract Introduction Cannabis use among adolescents is a public health concern, because of its association with the use of other illicit drugs, mental health disorders, and social problems. Most studies show that adolescents from low socioeconomic status (SE) background are more likely to use cannabis, but the causes of SE inequalities remain to be understood. We test whether access and risk perceptions of cannabis use among disadvantaged adolescents explain the SE gradient. Objectives The aim of this study was to measure the mediating effect of access perception and risk perception on the association between SE status and cannabis use among European adolescents in 2019. Methods A cross-sectional, observational, analytical study was conducted, among 16-year-old students, based on data from the European School Survey Project on Alcohol and Drugs (ESPAD) in 2019. The outcome was cannabis use (experimental, regular, and problematic) and the exposure was SE status (parental education and subjective social status). Mediating variables were perceived accessibility and perceived risk of cannabis use. We used logistic regressions, where the odds ratio (OR) reduction measures the part of the association explained by the mediators. Results Regular and problematic cannabis use was significantly more prevalent among adolescents with a lower SE background (low parental education and low subjective social status, p &amp;lt; 0,001). This relationship remained significant after adjustment for perceived access and risk, and the modification of ORs was of a small magnitude (a non-significant reduction of the association). Conclusions Perceived accessibility and risk showed a weak mediating effect of the association between SE background and cannabis use. Consequently, these factors cannot be considered as major explanations for the higher use among worse-off adolescents. Reinforcing information or imposing stronger barriers in access may not help reduces SE inequalities in cannabis consumption. Key messages • Perceived accessibility and risk hardly explain the association between socioeconomic background and cannabis use among European adolescents. • Reinforcing information or imposing stronger barriers in access may not help reduces socioeconomic inequalities in cannabis use.

Prescription Opioid Misuse, Comorbid Substance Use, and Suicidal Behaviors Among US Young Adults: Findings from 2015–2019 National Survey on Drug Use and Health

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.

Risk Factors for Increased Opioid Use During Postoperative Intensive Care.

In the ICU, opioids treat pain and improve ventilator tolerance as part of an analgosedation approach. Identifying predictors of opioid consumption during the ICU course might highlight actionable items to reduce opioid consumption. To identify risk factors for opioid use during a postoperative ICU course. Patients enrolled in the Michigan Genomics Initiative single-center prospective observational cohort study completed baseline preoperative sociodemographic and mental/physical health questionnaires and provided blood samples for genetic analysis. Included patients were 18 years old and older, admitted to ICU postoperatively, and received opioids postoperatively. The primary outcome was ICU mean daily oral morphine equivalent (OME) use. The association between OME and phenotypic risk factors and genetic variants previously associated with pain were analyzed through univariable and multivariable linear regression models. The cohort consisted of 1865 mixed-surgical patients with mean age of 56 years (sd, 15 yr). Preoperative opioid users were more likely to continue to receive opioids throughout their ICU stay than opioid-naive patients. OME (log10 scale) was most strongly associated with ICU mechanical ventilation (β = 0.27; 95% CI, 0.15-0.38; p < 0.0001; effect size 1.85 for receiving > 24 hours of mechanical ventilation), preoperative opioid use (β = 0.22; 95% CI, 0.16-0.29; p < 0.0001; effect size 1.67 for receiving preoperative opioids), major surgery (β = 0.21; 95% CI, 0.12-0.30; p < 0.0001; effect size 1.62 compared with minor surgery), and current/former illicit drug use (β = 0.12; 95% CI, 0.01-0.23; p = 0.04; effect size 1.30 for drug use). Younger age, centralized pain, and longer anesthetic duration were also significantly associated with OME but with smaller effect sizes. Selected genetic variants (FKBP5, COMT, and OPRM1) were not associated with OME use. Mechanical ventilation and preoperative opioids were the strongest risk factors for postoperative ICU opioid consumption, whereas psychologic factors and genetic variants were not associated.