Lifetime Illicit Drug Use Research Articles

The Use of Premixed Drugs in Commodity Packets in the Population: Prevalence and Correlates Revealed by the 2018 National Survey of Substance Use in Taiwan.

Administering premixed drugs in commodity packets was first reported in Asia in 2015, but there continues to be a dearth of related population-based data. This study aimed at examining (1) the prevalence of drug-packet use in the population and (2) the sociodemographic profiles, particularly gender distribution, of drug-packet users. Data were derived from a survey of 18,626 Taiwanese civilians, aged 12-64 years, using stratified, multi-stage, random sampling in 2018. Participants anonymously completed a computer-assisted self-interview on tablet computers which covered the use and problematic use of illicit drugs/inhalants, prescription drugs, and other psychoactive substances. Approximately 1.46% of respondents had a lifetime use of illicit drugs, with drugs in commodity packets (0.18%) being ranked the fifth-most commonly used illicit drugs, higher than nitrous oxide (0.14%) and heroin (0.09%). Ten formats of drug packets were endorsed by users. Approximately 81.6% of persons with drug packet use had lifetime use of other illicit drugs. The correlates of the use of drugs in commodity packets were different from those of the exclusive use of other drugs, particularly concerning the lack of gender differences in the former category in the whole sample and the subgroups of various sociodemographic characteristics and other substance use. Drugs in commodity packets have become a common way of administering illicit drugs in the population in Taiwan, and there were no gender differences among users. Our findings have implications for more efficient drug testing and culturally appropriate intervention for drug-packet use.

Perceived Risk of Weekly Marijuana Use Among Students Participating in the National Survey on Drug Use and Health

This study sought to assess the relationship of risk perception of weekly marijuana use and the influence of parental, peer, and school factors as predictors among U.S. adolescents. Data for this study was derived from the 2020 National Survey on Drug Use and Health. Students who reported strong parental involvement/support, peer disapproval of marijuana use, low perception of peer use, and enjoyed school were more likely to report that using marijuana weekly was a risk behavior. Students who reported no lifetime alcohol or illicit drug use were more likely to view weekly marijuana use as a risk behavior. Differences were also observed for sex of respondent. This study further adds evidence of the influence of parental, peer, and school factors as effective strategies to control adolescent marijuana use. There is a need for multidimensional programs that target adolescents’ perceptions of risk of marijuana use, as well as targeting significant others.

PS02 Illicit drug use in psoriasis and psoriatic arthritis and its relationship with suicidality in a tertiary population

Abstract Limited evidence suggests an increased lifetime prevalence of illicit drug use in psoriasis. To our knowledge, there are no data for psoriatic arthritis (PsA) in this regard. Given the pronounced psychiatric morbidity in psoriasis and PsA, including evidence of increased suicidality outcomes, we aimed to investigate illicit drug use prevalence and its relationship with disease characteristics and psychopathology in psoriasis. We surveyed 216 adults attending a specialist psoriasis service, 83 of whom had comorbid PsA. Participants completed paper questionnaires about the type, amount and frequency of lifetime and current illicit drug use (including cannabis, opioids, cocaine/stimulants, hallucinogens and volatile solvents). Participants also completed validated psychometric tools; suicidality was measured with the Sheehan Suicidality Tracking Scale. The prevalence of lifetime (21.7%) and current (6.0%) illicit drug use in PsA did not differ from the respective rates in psoriasis only (27.1% and 8.3%; P > 0.1), but patients with PsA showed lower regular use rates (2.7% in PsA vs. 12.9% in psoriasis only; P = 0.03). Dermatology Life Quality Index and Psoriasis Area and Severity Index scores were numerically higher among illicit drug users than nonusers, but the differences were not statistically significant. In our sample, lifetime illicit drug use was associated with increased lifetime suicidal planning and behaviour but not suicidal ideation. The association of drug use with suicidal planning remained after adjusting for age, sex, psychiatric comorbidity and alcohol consumption scores (odds ratio 2.44, 95% confidence interval 1.04–5.76). Patients reporting current drug use were more likely to have been previously diagnosed with anxiety but were not disproportionately affected by depression and alexithymia. The prevalence of lifetime illicit drug use in our study is consistent with findings from a recent North American psoriasis cohort. Although it is not clear why regular drug use is less prevalent in patients with PsA, increased medical attention may play a role. The higher prevalence of suicidal planning/behaviours, but not ideation, among patients with psoriasis with illicit drug use is an important and concerning finding. This aligns with some previous research suggesting that illicit drug use is associated with suicidality progression toward action, possibly due to impulse-control deficits. Early detection and management of drug use may help prevent suicidal behaviours in psoriasis. Study limitations include the cross-sectional design and social desirability bias-related under-reporting. Prospective cohorts are needed to further investigate the role of illicit drug use in patients’ psychiatric morbidity and quality of life, and address its sequelae within dermatology settings.

Witnessing Community Violence, Gun Carrying, and Associations with Substance Use and Suicide Risk Among High School Students — Youth Risk Behavior Survey, United States, 2021

Community violence, including homicides involving firearms, is a significant public health concern. From 2019 to 2020, firearm-related homicides increased by 39% for youths and young adults aged 10-24 years, and rates of suicide by firearm increased by approximately 15% among the same age group. Findings from the nationally representative 2021 Youth Risk Behavior Survey were used to analyze disparities and correlates of witnessing community violence and gun carrying among a nationally representative sample of high school students. Chi-square tests and logistic regression accounting for the complex sampling of the survey were used to assess demographic differences by student sex, race and ethnicity, age, and sexual identity in ever witnessing community violence, gun carrying in the past 12 months, and their associations with substance use and suicide risk. Measures of substance use included current binge drinking and marijuana use and lifetime prescription opioid misuse and illicit drug use. Suicide risk included seriously considered attempting suicide and attempted suicide in the past 12 months. Overall, approximately 20% of students witnessed community violence and 3.5% of students carried a gun. American Indian or Alaska Native, Black, and Hispanic students were more likely to witness community violence and to report carrying a gun than their White peers. Males were more likely to witness community violence and carry a gun than females. Lesbian, gay, or bisexual students were more likely to witness community violence than their heterosexual peers. Also, witnessing community violence consistently was associated with increased odds of gun carrying, substance use, and suicide risk for both males and females and when comparing Black, White, and Hispanic students. These findings highlight the importance of comprehensive violence prevention strategies that incorporate health equity to mitigate the effects of violence exposure on substance use and suicide risk among youths.

Resources for the Assessment and Treatment of Substance Use Disorder in Adolescents

Substance Use Disorder (SUD) is understood as the persistent use of substances to the detriment of the individual's livelihood and wellness. SUD can have serious mental, physical, and social ramifications if not properly addressed. Though SUD can develop at any age, it is especially important to address in adolescents, given the rising prevalence of certain substances (e.g. cannabis) in that age group and the poor prognosis associated with early-onset SUD[1][2]. Data from the National Survey on Drug Use and Health show the lifetime use of illicit drugs in people ages 12-17 is 20.9%[3] The same survey found the rate of Substance Use Disorder in the past year for people ages 12-17 who used illicit drugs or alcohol to be 6.3% in 2020[3]. This paper is intended for clinicians and laypeople to gain a deeper understanding of SUD in adolescents, particularly relating to alcohol, cannabis, nicotine, and opioids. Though alcohol, cannabis, and nicotine are the substances most commonly used by this age demographic nationally[4], opioid use – and resulting deaths – have been on the rise. According to the Centers for Disease Control and Prevention (CDC), opioids were connected to about 75% of the nearly 92,000 drug deaths in 2020[5]. Beyond significant death rates in the general population, recent spikes in adolescent death rates tied to the synthetic opioid fentanyl – which held a relatively stable death rate from 2010 to 2019 until seeing a 94% increase from 2019 to 2020 and an additional 20% increase to 2021 - warrants inquiry into opioids for this population[6]. Each of these substances can have adverse, long-lasting effects on health if not managed properly, resulting in seriously compromised lifelong well-being [7]. This article explores SUD prevalence and reviews diagnostic criteria in relation to adolescence, including a synopsis of changes in SUD classification between the DSM-IV and DSM-5 and a discussion of ICD-11 and the Research Domain Criteria (RDoC) as a basis for research related to substance use. Effective assessment and consideration of co-occurring disorders are covered as well. Although the prognosis of SUD varies by an individual's environment and circumstances, a modal developmental course for SUD is discussed. Finally, a curated list of nationally recognized resources including hotlines, treatment locators, informational sites, and support groups are provided, along with tools to compile local resources. By addressing these aspects of adolescent SUD, the research team offers a broader view of its prevalence in the United States, key warning signs and comorbidities, and possible assessments and treatments for adolescents with SUD.

Resources for the Assessment and Treatment of Substance Use Disorder in Adolescents

Substance Use Disorder (SUD) is understood as the persistent use of substances to the detriment of the individual's livelihood and wellness. SUD can have serious mental, physical, and social ramifications if not properly addressed. Though SUD can develop at any age, it is especially important to address in adolescents, given rising prevalence of certain substances (e.g. cannabis) in that age group and poor prognosis associated with early-onset SUD.[1][2] Data from the National Survey on Drug Use and Health show the lifetime use of illicit drugs in people ages 12-17 is 20.9%.[3] The same survey found the rate of Substance Use Disorder in the past year for people ages 12-17 who used illicit drugs or alcohol to be 6.3% in 2020.[3] This paper is intended for clinicians and lay people to gain a deeper understanding of SUD in adolescents, particularly relating to alcohol, cannabis, nicotine, and opioids. Though alcohol, cannabis, and nicotine are the substances most commonly used by this age demographic nationally,[4] opioid use – and resulting deaths – have been on the rise. According to the Centers for Disease Control and Prevention (CDC), opioids were connected to about 75% of the nearly 92,000 drug deaths in 2020.[5] Beyond significant death rates in the general population, recent spikes in adolescent death rate tied to the synthetic opioid fentanyl – which held a relatively stable death rate from 2010 to 2019 until seeing a 94% increase from 2019 to 2020 and additional 20% increase to 2021 - warrants inquiry into opioids for this population.[6] Each of these substances can have adverse, long-lasting effects on health if not managed properly, resulting in seriously compromised lifelong wellbeing.[7] This article explores SUD prevalence and reviews diagnostic criteria in relation to adolescence, including a synopsis of changes in SUD classification between the DSM-IV and DSM-5 and discussion of ICD-11 and the Research Domain Criteria (RDoC) as a basis for research related to substance use. Effective assessment and consideration of co-occurring disorders are covered as well. Although the prognosis of SUD varies by an individual's environment and circumstances, a modal developmental course for SUD is discussed. Finally, a curated list of nationally recognized resources including hotlines, treatment locators, informational sites, and support groups is provided, along with tools to compile local resources. By addressing these aspects of adolescent SUD, the research team offers a broader view of its prevalence in the United States, key warning signs and comorbidities, and possible assessments and treatments for adolescents with SUD.

Long-term behavioral effects of a school-based prevention program on illicit drug use among young adults.

Most universal drug abuse prevention efforts target early adolescents with the goal of delaying or preventing the onset of substance use. The present study examined long-term follow-up data from a large-scale randomized trial of a school-based prevention program that used cognitive-behavioral skills-training techniques to enhance social and personal competence skills and drug refusal skills. The preventive intervention was implemented in junior high schools, and pretest data were collected from students in the classroom. Approximately 13 years later, follow-up data were collected by mail from 2042 young adults. Rates of overall lifetime illicit drug use, as well as lifetime marijuana use, marijuana intoxication, and lifetime non-medical pill use, were lower among students who received the prevention program (Life Skills Training) during junior high school compared to control group participants. These findings support the hypothesis that comprehensive, universal school-based prevention programs can produce long-term effects on illicit drug use behavior.

Substance Use and Sleep Problems in Patients With Psychotic Disorders.

Substance use and sleep problems are common in patients with psychotic disorders, but their associations in these patients have not been evaluated. We aimed to investigate associations between substance use and sleep problems in a large nationwide cohort of patients with a psychotic disorder. This study is part of the Finnish SUPER study, which belongs to the Stanley Global Neuropsychiatric Genomics Initiative. In this cross-sectional, multicenter study, participants (N = 8616) were recruited from primary and specialized healthcare. Patients with schizophrenia, schizoaffective disorder, bipolar disorder, and psychotic depression were included. Information on current alcohol (Alcohol Use Disorders Identification Test-Concise) and cigarette use as well as on lifetime illicit drug use, including cannabis, benzodiazepines, amphetamines, and opioids, was collected using questionnaires. The sleep outcomes in our logistic regression analysis were short (≤6 h) and long sleep (≥10 h) duration, difficulties initiating asleep, early morning awakenings, fatigue, and poor sleep quality (SQ). Self-reported substance use was associated with a higher prevalence of sleep problems. After adjustments with age, gender, diagnostic group, and living status, hazardous alcohol use (eg, poor SQ odds ratio [OR] = 1.80, 95% CI: 1.49 to 2.16, P < .001), current smoking (short sleep duration OR = 1.28, 95% CI: 1.08 to 1.52, P = .005), and lifetime benzodiazepine misuse (difficulties initiating sleep OR = 2.00, 95% CI: 1.55 to 2.48, P < .001) were associated with sleep problems. Substance use was associated with sleep problems. Our findings underline the potential benefits of screening substance use when treating sleep problems in patients with psychotic disorders.

Is early exposure to cannabis associated with bipolar disorder? Results from a Finnish birth cohort study.

Background and aimsThere are few longitudinal studies assessing the association of cannabis use and subsequent onset of bipolar disorder. We aimed to measure the association between early cannabis exposure and subsequent bipolar disorder.Design, Setting and ParticipantsObservational study linking a sample from the northern Finland birth cohort 1986 (n = 6325) to nation‐wide register data to examine the association of life‐time cannabis exposure at age 15/16 years and subsequent bipolar disorder until age 33 (until the end of 2018); 6325 individuals (48.8% males) were included in the analysis.MeasurementsCannabis exposure was measured via self‐report. Bipolar disorder was measured via bipolar disorder‐related diagnostic codes (ICD‐10: F30.xx, F31.xx) collected from the Care Register for Health Care 2001–18, the Register of Primary Health Care Visits 2011–18, the medication reimbursement register of the Social Insurance Institution of Finland 2001–05 and the disability pensions of the Finnish Center for Pensions 2001–16. Potential confounders included demographic characteristics, parental psychiatric disorders, emotional and behavioral problems and other substance use.FindingsThree hundred and fifty‐two adolescents (5.6%) reported any cannabis use until the age of 15–16 years. Of the whole sample, 66 (1.0%) were diagnosed with bipolar disorder. Adolescent cannabis use was associated with bipolar disorder [hazard ratio (HR) = 3.46; 95% confidence interval (CI) = 1.81–6.61]. This association remained statistically significant after adjusting for sex, family structure and parental psychiatric disorders (HR = 3.00; 95% CI = 1.47–6.13) and after further adjusting for adolescent emotional and behavioral problems (HR = 2.34; 95% CI = 1.11–4.94). Further adjustments for frequent alcohol intoxications, daily smoking and lifetime illicit drug use attenuated the associations to statistically non‐significant.ConclusionsIn Finland, the positive association between early cannabis exposure and subsequent development of bipolar disorder appears to be confounded by other substance use.

Examining the Associations between Adverse Childhood Experiences, Health Risk Behaviours, and Psychological Well-Being in a Convenience Sample of Lithuanian University Students.

This study examines the associations between adverse childhood experiences (ACEs), health risk behaviours, and psychological well-being among Lithuanian university students. A cross-sectional survey was carried out with a convenience sample of 393 students (80.7% females and 19.3% males) recruited from mostly undergraduate courses (96.4%) in Lithuanian universities. Participants, aged 18–25 years (21.07 ± 1.53), completed a web-based survey in which they were asked to retrospectively self-report on ACEs while answering questions on health risk behaviours (e.g., smoking, substance use, riding a car with a drunk driver) and psychological well-being. Only 8.7% of the study sample experienced no ACEs, and almost half of the sample (48.9%) experienced ≥4 ACEs. Findings from adjusted models showed that, compared with students with no ACEs, those who experienced ≥4 ACEs had higher odds of lifetime illicit drug use (AOR = 2.73, p < 0.05), riding with a drunk driver (AOR = 2.44, p < 0.05), suicidal ideation before age 18 (AOR = 28.49, p < 0.01) and in the past 12 months (AOR = 5.39, p < 0.01). An increased number of ACEs was also associated with lower psychological well-being (B = −3.94, p < 0.001). Findings from this study have implications for mental health professionals as well as university administrators, as students with a higher number of traumatic experiences may require greater levels of support and services.

Food addiction and lifetime alcohol and illicit drugs use in specific eating disorders.

Background and aimsFood addiction (FA) and substance use (SU) have frequently been reported in patients with eating disorders (EDs). Our study aimed to assess the prevalence rates of FA and/or lifetime problematic alcohol and illicit drug use among patients with specific ED, such as: bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorder (OSFED). We sought to identify clinical, psychopathological, and personality profiles involved in these addictive behavior-based phenotypes.MethodsThe total sample was 527 patients (176 BN, 115 BED, and 236 OSFED). FA was assessed through the Yale Food Addiction Scale 2.0. To determine lifetime SU, a semi-structured clinical interview was carried out.ResultsPatients with BN had the highest rates of FA both with and without SU. No gender differences were obtained for the prevalence of current FA and/or lifetime SU. Patients reporting at least one addictive-related behavior exhibited increased clinical severity compared to those who reported none. Increased impulsivity (such as high lack of premeditation, sensation seeking, and positive urgency) and low self-directedness were differentiating factors for presenting one or two addictive behaviors.Discussion and ConclusionsOverall, patients presenting with at least one addictive-like behavior reported a poorer clinical status than those without. Also, patients with FA and SU exhibited a more dysfunctional profile characterized by high impulsivity and low self-directedness. These findings would support the need for targeted treatments to reduce impulsivity and increase self-directedness, especially in patients with any addictive-related behavior, as a step towards improving their treatment outcome.

Food Insecurity and Its Association With Alcohol and Other Substance Use Among High School Students in the United States.

Studies show that food insecurity is associated with adverse health behaviors for children and adults. However, published data among adolescents are limited. The objective of this study was to examine the association between food insecurity and substance use behaviors among US high school students. Data from the 2017 Youth Risk Behavior Survey in 10 states were combined to examine the association between household food insecurity and adolescent use of alcohol, marijuana, prescription opioid misuse, and illicit drugs using logistic regression. Among surveyed respondents, 12.3% of high school students reported experiencing food insecurity. In unadjusted analyses, the prevalence of substance use was higher among students with food insecurity compared to food secure students: current binge drinking (16.2% vs 11.5%), current marijuana use (24.0% vs 16.2%), lifetime prescription opioid misuse (21.3% vs 12.6%), and lifetime use of illicit drugs (12.3% vs 5.0%) (all p < .05). In adjusted models, food insecurity was associated with lifetime prescription opioid misuse and lifetime use of illicit drugs (aPR 1.38 and 1.70, respectively). Students with food insecurity are a potential group at a higher rise of substance misuse and may benefit from prevention programs designed to address their needs.

Illicit Drug Use in Canada and Implications for Suicidal Behaviors, and Household Food Insecurity: Findings from a Large, Nationally Representative Survey.

Background and Aims: Illicit drug use is an ongoing health and social issue in Canada. This study aimed to investigate the prevalence of illicit drug use and its implications for suicidal behaviors, and household food insecurity in Canada. Design: Cross-sectional population survey. Setting: Canada, using the 2015–2016 Canadian Community Health Survey, a nationally representative sample selected by stratified multi-stage probability sampling. Participants: A total of 106,850 respondents aged ≥ 12 years who had completed information on illicit drug use. Measurements: Illicit drug use was assessed through a series of questions about illicit drug use methods. Respondents who reported lifetime illicit drug use but no past-year use were considered to have prior illicit drug use. In this survey, illicit drug use included cannabis use. Findings: Overall, the prevalence of lifetime, past-year, and prior illicit drug use was 33.2% (9.8 million), 10.4% (3.1 million), and 22.7% (6.7 million), respectively. In models adjusting for sociodemographic covariates, prior illicit drug use was significantly associated with increased odds of past-year suicidal ideation (adjusted odds ratio [AOR] 1.21, 95% CI 1.04–1.40), and plans (1.48, 1.15–1.91), and past-year household food insecurity (1.27, 1.14–1.41), and the odds were much higher among prior injecting drug users than prior non-injecting drug users. No significant correlation was found between prior illicit drug use and past-year suicidal attempts, but there was a strong association between past-year illicit drug use and past-year suicidal attempts. Conclusions: Our findings suggest that even after people have stopped taking illicit drugs, prior illicit drug use, especially for prior injecting drug use, continues to be associated with increased risks of subsequent suicidal ideation, and plans, and household food insecurity.

Non-medical Use of Prescription Gabapentinoids (Gabapentin and Pregabalin) in Five European Countries.

Background: Non-medical use (NMU) of prescription GABA analogs (pregabalin and gabapentin) has been reported especially in opiate dependent persons. However, by now the prevalence of NMU of gabapentinoids in the general population has not been sufficiently evaluated. The aim of this research paper is to determine the prevalence of prescription GABA analog NMU and associated demographics in five European countries with special detail of Spain.Methods: The RADARS Survey of Non-Medical Use of Prescription Drugs Program (NMURx) is a harmonized series of contemporaneous cross-sectional surveys of adults conducted in multiple countries. NMURx collects data from the general population in each participating country about NMU of prescription drugs, illicit drugs, and associated demographics. NMU was defined as “using a medication without a doctor's prescription or for any reason other than what was recommended by their doctor.” Responses from Spain (4Q2017, n=10,062) were analyzed in detail. Comparative data were available from France, Germany, Italy, and UK. Responses were collected using non-probability quota sampling and post-stratification population weighting was applied to reflect the national distributions of adults, based on age, gender, and census region. Rates of NMU and associated demographics were reported as rate of past 90-day NMU per 100,000 adult population with 95% confidence intervals.Results: Germany (1,197 per 100,000 adult population [95% CI: 1,004.3–1,379.1]) and United Kingdom (1,067 per 100,000 adult population [95% CI: 851.3–1,283.2]) presented the highest prevalence of gabapentinoids NMU. In Spain the prevalence of past 90 days GABA analog NMU was: 344.4, 95% (CI 204.8–484.0), with male predominance. Those who non-medically use GABA analogs had a higher prevalence of lifetime chronic pain, lifetime illicit drug use, and previous substance abuse treatment. In Spain, 20% of respondents who ever have used gabapentinoids, reported a lifetime NMU; the prevalence was higher for pregabalin 624 (6.2%) than for gabapentin 444 (4.4%). The main reasons for use were to self-treat pain and other medical conditions.Conclusions: The risk of NMU of gabapentinoids should not be neglected. Subjects with a history of chronic pain and lifetime substance use disorders had an increased risk of NMU of gabapentinoids.

Childhood mental health and juvenile delinquency: A within-family comparison

IntroductionChild metal health is associated with prospective delinquent outcomes. However, this association might be confounded by genetic and other shared factorsObjectivesWe aimed to examine the association between the behavioral symptoms of Attention-Deficit/Hyperactivity Disorder, conduct disorder, depression, and oppositional defiant disorder in childhood (age 4-12) and the prospective delinquent outcomes as measured by lifetime illicit drug use, criminal activities, and victimization prior to age 18, using the nationally representative U.S. survey that allowed us to compare siblings in the same mother.Methods Aged-adjusted subscales or ADHD, conduct disorder, depression, and ODD were obtained from the mother-reported survey responses. Within-family analyses were performed to control for family-specific unobserved factors as well as child-specific observed factors.ResultsAntisocial scores in childhood were strongly associated with lifetime arrest, probation, and incarceration as well as lifetime illicit drug use in adolescence. ADHD scores are associated with lifetime victimization in physical attack and rape, but not with criminal activities or illicit drug use.ConclusionsConduct disorder consistently increases lifetime illicit drug use and criminal activities independently of genetic factors and gender. ADHD is not associated with lifetime illicit drug use or criminal activities, but is associated with lifetime victimization. No significant gender differences are found although anxiety/depression symptoms are often positively associated with delinquent outcomes only among females.

Substance Use Trajectories: Nonmedical Use (NMU) of Prescription Stimulants via Non-Oral Routes of Administration Among Adults Recruited from Reddit

NMU of prescription stimulant medications (RxStim) intended for treatment of attention deficit/hyperactivity disorder (ADHD) is a growing public health concern, particularly when used via non-oral routes of administration. However, the role of non-oral routes of administration for RxStim NMU in the larger substance abuse pathway is less well studied. The purpose of this study was to characterize RxStim NMU and investigate substance use trajectories among adults who reported non-oral RxStim NMU recruited from Reddit.Eligible participants must have been located in the US, English speaking, age 18 y, and have reported RxStim NMU via a non-oral route (any route other than ingestion) within the past 5 y. Participants were recruited from Feb-Sep 2019 using banner ads on Reddit, the 5th most visited website in the US. Participants completed an online survey which captured demographics, lifetime RxStim NMU and illicit substance use; they were compensated for their time. For purposes of this study, NMU included ANY of the following: (1) use for any reason, even once, without their own prescription, (2) use in ways other than prescribed, and (3) use for the feeling or experience the medication caused.Respondents (n=225) were primarily male (86.2%), 18-24 (48.0%) or 25-34 (43.1%) years of age, and Caucasian (78.2%), Black (7.1%) or Hispanic (5.3%). Lifetime diagnosis of ADHD was reported by 27.6%, with 53.2% diagnosed at age 11-19 and 35.5% at age 20+ years. RxStim NMU via snorting was reported by 99.1%, smoking 3.6% and injecting 6.2% (multiple routes could be reported). Almost all (n=222; 98.7%) also reported lifetime illicit drug use, among whom 182 (82.0%) initiated substance use by using an illicit drug (77.9% marijuana, 1.8% cocaine/crack, 0.9% inhalants, 0.9% hallucinogens, 0.5% methamphetamine/amphetamines) prior to RxStim NMU. Forty (18.0%) respondents initiated with RxStim NMU; 14.4% then initiated marijuana use, 0.9% initiated cocaine/crack use, 0.9% initiated barbiturate use, and 0.5% initiated heroin, inhalant, methamphetamine/amphetamine, and hallucinogen use. Average age of initial RxStim NMU was 18.7 (SD 3.7) years and most often was via swallowing (89.1%) followed by snorting (10.9%). Respondents began using marijuana at age 15.9 (SD 2.5), cocaine or crack at 19.7 (SD 3.3), and heroin at 20.9 (SD 5.5).Engagement in RxStim NMU via a non-oral route of administration is most often preceded by marijuana use. Among this Reddit-recruited population of non-oral RxStim nonmedical users, only 1 in 4 reported an ADHD diagnosis and <1 in 5 reported RxStim NMU as their first substance use experience; most of these then added marijuana and few moved toward cocaine/crack or methamphetamine. RxStim NMU via non-oral routes is associated with a larger pattern of risky substance use behaviors. Nearly all non-oral RxStim NMU is associated with concomitant drug use, especially marijuana.Funding. Arbor Pharmaceuticals, LLC.

Testing the validity of national drug surveys: comparison between a general population cohort and household surveys.

ABSTRACTBackground and AimsThere are concerns that national population‐based estimates of illicit drug use are underestimated. We investigated this by comparing estimates of illicit substance use at age 24 from the Crime Survey for England and Wales (CSEW) with a birth cohort (Avon Longitudinal Study of Parents and Children, ALSPAC) and by comparing the Smoking and Alcohol Toolkit Studies (STS/ATS) to ALSPAC.DesignCross‐sectional household survey and cross‐sectional data from one wave of a longitudinal birth cohort.SettingEngland and Wales.ParticipantsYoung adults aged 23–25 reporting on substance use in 2017 to CSEW (n = 1165), ALSPAC (n = 3389) and STS/ATS (n = 950).MeasurementsLifetime and past‐year illicit drug use, smoking status and hazardous drinking at age 24.FindingsThe 2017 CSEW estimate of lifetime illicit drug use was 40.6%, compared with 62.8% in ALSPAC (risk difference % [RD%] = 22.2%; 95% CI = 18.9–25.5%; P ≤ 0.001). The RD in lifetime use between ALSPAC and the CSEW was 23.2% (95% CI = 20.0–26.4%) for cannabis, 16.9% (95% CI = 14.4–19.4%) for powder cocaine and 24.8% (95% CI = 22.6–27.0%) for amphetamine. Past‐year drug use was 16.4% in CSEW, compared with 36.7% in ALSPAC (RD% = 20.3%; 95% CI = 17.6–23.0%; P ≤ 0.001). For past‐year substance use, the RD between ALSPAC and the CSEW was 15.4% (95% CI = 12.9–17.9%) for cannabis, 14.8% (95% CI = 13.0%–16.6%) for powder cocaine and 15.9% (95% CI = 14.5–17.4%) for amphetamine. Levels of current smoking were similar between STS (27.4%) and ALSPAC (29.4%). Hazardous drinking was substantially higher in ALSPAC (60.3%) than the ATS (32.1%; RD% = 28.2%; 95% CI = 24.8–31.6%; P ≤ 0.001).ConclusionsThe Avon Longitudinal Study of Parents and Children provides one source of validation for measurements of drug use in government household surveys and indicates that illicit drug use may be underestimated in the Crime Survey for England and Wales.

The association between smoking and loneliness among Chinese university freshmen.

BackgroundIn Chinese culture, smoking can promote social connectedness and integration. We therefore hypothesized that smoking would be negatively associated with loneliness in China. Given that loneliness is common and associated with adverse academic and health outcomes in university freshmen, examining correlates of loneliness in this population may deepen our understanding on the etiology of loneliness. This study investigated the association between smoking and loneliness in Chinese university fresh students.MethodsIn this cross-sectional study, by using a two-stage cluster sampling approach, we recruited a total of 1,452 fresh students from a comprehensive university in Wuhan, China. These students completed a self-administered questionnaire containing the Chinese six-item De Jong Gierveld Loneliness Scale (DJGLS) and standardized questions on socio-demographics, internet use, and substance use, including smoking and use of alcohol and illicit drugs. Multiple linear regression was used to test the independent association of loneliness with smoking.ResultsIn Chinese university freshmen, current smokers had significantly higher DJGLS scores than non-smokers (11.9±4.60 vs. 8.53±3.72, t=7.351, P<0.001). After controlling for socio-demographic variables, current drinking, lifetime illicit drug use, and daily hours of internet use, the positive association between current smoking and DJGLS score remained statistically significant (unstandardized coefficient: 3.053, P<0.001).ConclusionsSmoking is independently and positively associated with loneliness in Chinese university freshmen. Smoking cessation might be helpful for preventing and reducing loneliness among Chinese university fresh students.

Family structure and youth illicit drug use, use disorder, and treatment services utilization

ObjectivesThe study aimed to examine family structure’s relation to youth illicit drug use, use disorders, and treatment services utilization. MethodsUsing pooled data from the 2015 to 2017 National Survey on Drug Use and Health, we examined the prevalence of youth (12–17 years old) past-year and lifetime illicit drug use (N = 41,579), drug use disorders among each type of drug users (n = 149–5,445), and treatment service utilization among youth with drug use disorders (n = 1,335) across two-parent, one-parent, and no-parent families. Bivariate analyses and logistic regression models were used to compare differences across family structure. ResultsOn average about 25% youth ever used illicit drugs, 20% of the past-year users had a drug use disorder, and less than 10% of the past-year users with disorders received treatment services. Family structure was associated with drug use prevalence, in particular, the use of marijuana, heroin/cocaine/methamphetamine, and hallucinogens, but was not related to the rate of drug use disorders and treatment service utilization, even after adjusting for covariates. ConclusionsThe findings suggest that family structure is associated with youth drug use initiation but not drug use disorders or treatment service utilization. Youth in single and non-parent families are especially vulnerable to drug use initiation and should be specifically targeted by prevention programs.

Correlates of indicators of potential extra-medical opioid use in people prescribed opioids for chronic non-cancer pain.

The opioid-related behaviours in treatment (ORBIT) scale are a measure of recent indicators of potential extra-medical opioid use. Indicators of potential extra-medical opioid use are divergent practices among people prescribed opioids that may place them at risk of harm. This study aimed to examine the correlates of indicators of potential extra-medical opioid use in people prescribed opioids for chronic non-cancer pain (CNCP). The Pain and Opioids IN Treatment (POINT) study is a prospective cohort study of people prescribed opioids for CNCP in Australia. People prescribed opioids solely for opioid dependence were excluded. This cross-sectional study utilised logistic regression to determine the characteristics associated with reporting any indicators of potential extra-medical opioid use. Of the 1505 participants, 38% reported at least one indicator of potential extra-medical opioid use, most commonly asking for an increase in prescribed opioid dose (21%) and early prescription renewal (12%). Indicators of potential extra-medical opioid use were associated with younger age (adjusted odds ratio [AOR] = 0.98; 95% confidence interval [CI] = 0.92, 0.99), male sex (AOR = 1.53; 95% CI = 1.15, 2.04), lifetime pharmaceutical opioid use disorder (AOR = 1.87; 95% CI = 1.31, 2.66) and lifetime illicit drug use disorder (AOR = 1.72; 95% CI = 1.18, 2.52). Over one-third of the POINT cohort reported one or more indicators of potential extra-medical opioid use. Lifetime substance use disorders were associated these divergent practices, highlighting the importance of clinical monitoring and patient education for this patient group. Longitudinal studies are needed to investigate whether indicators of potential extra-medical opioid use predict opioid use disorders in this population.