Polysubstance use: diagnostic challenges, patterns of use and health

Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States

OBJECTIVE

Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample.

METHODS

Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents.

RESULTS

About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use.

CONCLUSION

Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.

Ethanol inhibits dopamine uptake via organic cation transporter 3: Implications for ethanol and cocaine co-abuse

Concurrent cocaine and alcohol use is among the most frequent drug combination, and among the most dangerous in terms of deleterious outcomes. Cocaine increases extracellular monoamines by blocking dopamine (DA), norepinephrine (NE) and serotonin (5-HT) transporters (DAT, NET and SERT, respectively). Likewise, ethanol also increases extracellular monoamines, however evidence suggests that ethanol does so independently of DAT, NET and SERT. Organic cation transporter 3 (OCT3) is an emergent key player in the regulation of monoamine signaling. Using a battery of in vitro, in vivo electrochemical, and behavioral approaches, as well as wild-type and constitutive OCT3 knockout mice, we show that ethanol's actions to inhibit monoamine uptake are dependent on OCT3. These findings provide a novel mechanistic basis whereby ethanol enhances the neurochemical and behavioral effects of cocaine and encourage further research into OCT3 as a target for therapeutic intervention in the treatment of ethanol and ethanol/cocaine use disorders.

Latent Classes of Tobacco and Cannabis Use among Youth and Young Adults in the United States

Background: Research characterizing patterns of tobacco and cannabis use by product type and route of administration among youth and young adults (YAs) is limited. Methods: We conducted latent class analysis of tobacco and cannabis use (i.e., cigarettes, electronic nicotine delivery systems (ENDS), cigars, blunts, cannabis vaping, and other cannabis use (without blunting/vaping)) among youth (ages 15-17) and YAs (ages 18-24) who used at least one product in the past 30 days, using data from the Population Assessment of Tobacco and Health Study (Wave 4, 2016-2017). We used multinomial logistic regression models to examine associations between sociodemographic characteristics and use classes. Results: The latent use classes for youth included cigarettes (2.5%), ENDS (2.6%), blunts (2.5%), other cannabis (6.3%), ENDS + cannabis vaping (2.7%), and cigarettes + cigars + other cannabis (1.5%), while the latent use classes for YAs included cigarettes (11.7%), ENDS (3.9%), blunts (5.3%), other cannabis (7.0%), cigarettes + cigars (8.2%), and cigarettes + ENDS + cannabis vaping (4.9%). We compared use classes to never/former use for youth (82.0%) and YAs (59.0%) and found that they differed by each sociodemographic characteristic. For example, non-Hispanic Black YAs had higher odds of cigarettes + cigar use compared to non-Hispanic White YAs, whereas racial/ethnic minority youth and YAs had lower odds of other dual/poly use groups compared to their non-Hispanic White counterparts. Conclusions: We observed differences in use classes by sociodemographic characteristics for youth and YAs. Health professionals must consider tobacco and cannabis use patterns when implementing prevention and cessation interventions.

Pre-Loading with Drugs before Entering the Nighttime Entertainment District: A Scoping Review

Background: Nighttime entertainment districts attract many people who pre-load with alcohol and other substances before entering licensed venues. Despite the harms and dangers associated with both alcohol pre-loading and drug use respectively, there is a paucity of research on drug and polysubstance pre-loading. Objectives: The primary objectives of this scoping review are to systematically map out the body of existing literature on drug and polysubstance pre-loading, discuss methodological potentials and pitfalls in field-based research, identify gaps in knowledge, and derive practical implications and opportunities for future research. Methods: Using the PRISMA (ScR) guidelines, we conducted a search of Medline, PsycINFO, Embase, Scopus, CINAHL, Social Services Abstracts, Sociological Abstracts, and Web of Science databases. We followed this up by conducting an author and citation analysis of relevant articles. Results: Of the 632 data sources identified, 338 articles were reviewed after removing duplicates. Overall, only nine articles were included and thematically analyzed. In our review and analysis of the literature, we find people who drug pre-load to be a particularly vulnerable subset of the population. We also posit that the point-of-entry design has greater sensitivity than the commonly used portal-in design. From this, we also draw attention to various time points where field-based researchers can provide intervention. Conclusions: Given the high prevalence of young adults engaging in the behavior, clinicians should consider pre-loading behaviors when assessing for risk and vulnerability. Field-based research would elucidate the full breadth and scope of the growing pre-loading phenomenon and the dangers associated with this practice.

Prevalence and correlates of methamphetamine use in transitional age youth experiencing homelessness or housing instability in San Francisco, CA

INTRODUCTION

Substance use, including methamphetamine use, is a contributing factor in HIV acquisition and treatment. Stimulant use is linked to mental health yet there is limited data from youth in community-based settings.

DESIGN

One hundred marginally housed or homeless transitional age youth (TAY) were recruited at Larkin Street Youth Services and completed a survey on mental health and substance use.

METHODS

We conducted secondary data analysis using multivariable logistic regression models to identify the correlates of methamphetamine use among TAY.

RESULTS

The participants' mean age was 22. Of those who reported methamphetamine use in the past 3 months, 64% were Gay, Bisexual, or Pansexual. Factors independently associated with methamphetamine use were; living with HIV (adjusted odds ratio [aOR] = 3.18, 95% CI = 1.11-9.15), depressive symptoms (aOR = 6.02, 95% CI = 1.46-24.78), symptoms of PTSD (aOR = 13.38, 95% CI = 1.59-112.73), polysubstance use in the past 3 months (aOR = 50.02, 95% CI = 9.72-257.46) and a history of injection drug use (aOR = 8.38, 95% CI = 1.87-37.53).

CONCLUSIONS

Results from this study suggest a need to develop, adapt, and rapidly implement comprehensive interventions that address the combined epidemics of substance use, HIV, and mental health among TAY.

CLINICAL RELEVANCE

This article examines factors associated with methamphetamine use among transitional age youth (TAY) experiencing homelessness or housing instability. Several factors were associated with use, including depression, PTSD, HIV status, polysubstance use, and injection drug use. These findings highlight the need for nurses to assess for methamphetamine use among youth as well as associated mental health and physical health problems. Nurses should link TAY who are using methamphetamine to evidence-based treatment programs to address substance use and comorbid conditions.

Patterns of Substance Use During Early Pregnancy and Associations With Behavioral Health Characteristics

OBJECTIVES

The aims of the study are to identify patterns of early pregnancy substance use and to examine how these patterns relate to behavioral health conditions measured in early pregnancy.

METHODS

We conducted a retrospective observational study (N= 265,274 pregnancies) screened for alcohol, cannabis, nicotine, pharmaceutical opioids, and stimulants during the first trimester via self-report and urine toxicology tests in Kaiser Permanente Northern California from January 1, 2012, to December 31, 2019. To identify patterns of prenatal substance use, we conducted latent class analysis. We then calculated the prevalence of depression, anxiety, intimate partner violence, and family drug use history for each prenatal substance use group and compared the prevalences by estimating prevalence ratios using modified Poisson regression, adjusting for sociodemographic characteristics.

RESULTS

We identified the following 4 latent groups with different patterns of substance use: ( a ) predominantly alcohol and no other substances (9.30%), ( b ) predominantly cannabis and no other substances (4.88%), ( c ) predominantly nicotine and some pharmaceutical opioids (1.09%), and ( d ) high-polysubstance (alcohol, cannabis, nicotine, and stimulants; 0.36%); these pregnancies were compared with ( e ) no prenatal substance use (84.37%). The prevalence of all behavioral health conditions was elevated in all prenatal substance use groups compared with the no substance use group. Furthermore, the prevalence of depressive and anxiety disorders, intimate partner violence and family drug use history were greater in the high-polysubstance cluster than the alcohol and cannabis clusters.

CONCLUSIONS

Results highlight the importance of screening and interventions for all types of substance use during early pregnancy and suggest a particularly high need to prioritize targeting early interventions to pregnant and reproductive age individuals with polysubstance use.

Polysubstance use in South Asia

PURPOSE OF REVIEW

Polysubstance use is very common in the world, but there has been limited research in this area. South Asia is sandwiched between two of the world's largest heroin producing areas: the Golden Crescent and the Golden Triangle. The burden and prevalence of polysubstance use have not been estimated in this region of the world. We review the research findings on polysubstance use in different South Asian countries. The review also comments on the gaps in knowledge regarding polysubstance use in this region of the world.

RECENT FINDINGS

The available literature on polysubstance use from South Asia suggests its widespread presence in the region, ranging from 20 to 90%, more commonly among illicit opioid drug users and injection drug users. Most of the available data is from epidemiological studies. There are few studies on the adverse effects of polysubstance use, but the limited data clearly suggests an elevated risk of comorbid psychopathology and health problems.

SUMMARY

Polysubstance use still lacks a consensus definition. There is a need of more research on its prevalence, effects on health, and prevention and treatment.

Healthcare utilisation and costs associated with adherence to antipsychotics among people living with HIV/AIDS and schizophrenia: a population-based cohort study in British Columbia, Canada

OBJECTIVES

Non-adherence to antipsychotics is the greatest obstacle to treating schizophrenia. We assessed the economic and clinical impacts of adherence to antipsychotics among people living with HIV/AIDS (PLWH) and schizophrenia in British Columbia, Canada.

DESIGN AND SETTING

A population-based cohort study in British Columbia, Canada.

METHODS

Eligible PLWH were enrolled in the Seek and Treat for Optimal Prevention HIV/AIDS population-based cohort during 2001-2016, diagnosed with schizophrenia, on antipsychotics for ≥1 day, and followed for ≥1 year from schizophrenia diagnosis date or 1 January 2001, whichever occurred last.

PRIMARY AND SECONDARY OUTCOME MEASURES

A two-part model assessed the marginal effect of adherence on healthcare costs (in 2016 Canadian dollar), while logistic regression examined the effect on virological failure, and generalised linear mixed models examined the effect on hospital readmissions within 30 days and length of hospital stay.

RESULTS

Among 726 PLWH with schizophrenia, ≥80% adherence to antipsychotics increased from 25% (50/198) in 2001 to 41% (225/554) in 2016. In most years, we observed no difference in adherence to antipsychotics among those who used only injectables, only non-injectables, and a combination of both, or among those who have ever consumed typical/first-generation antipsychotics and who consumed only atypical/second-generation antipsychotics. Overall healthcare costs were higher in the non-adherent group ($C2185), driven by the average annual hospitalisation costs ($C5517), particularly among women ($C8806) and people who ever injected drugs (PWID) ($C5985). Non-adherent individuals also experienced higher hospital readmissions (adjusted odds ratio (aOR) 1.48, 95% CI 1.23 to 1.77), and longer hospital stays (adjusted mean ratio 1.23, 95% CI 1.13 to 1.35) in comparison to adherent individuals. We found no difference in virological failure by adherence groups, except when we stratified by gender where the aOR for women was 2.48 (95% CI 1.06 to 5.82).

CONCLUSIONS

Our results showed that implementing strategies and interventions to increase antipsychotic adherence, particularly among women and PWID, will be critical in addressing this public health challenge.

Subtypes in addiction and their neurobehavioral profiles across three functional domains

Rates of return to use in addiction treatment remain high. We argue that the development of improved treatment options will require advanced understanding of individual heterogeneity in Substance Use Disorders (SUDs). We hypothesized that considerable individual differences exist in the three functional domains underlying addiction-approach-related behavior, executive function, and negative emotionality. We included N = 593 participants from the enhanced Nathan Kline Institute-Rockland Sample community sample (ages 18-59, 67% female) that included N = 420 Controls and N = 173 with past SUDs [54% female; N = 75 Alcohol Use Disorder (AUD) only, N = 30 Cannabis Use Disorder (CUD) only, and N = 68 Multiple SUDs]. To test our a priori hypothesis that distinct neuro-behavioral subtypes exist within individuals with past SUDs, we conducted a latent profile analysis with all available phenotypic data as input (74 subscales from 18 measures), and then characterized resting-state brain function for each discovered subtype. Three subtypes with distinct neurobehavioral profiles were recovered (p < 0.05, Cohen's D: 0.4-2.8): a "Reward type" with higher approach-related behavior (N = 69); a "Cognitive type" with lower executive function (N = 70); and a "Relief type" with high negative emotionality (N = 34). For those in the Reward type, substance use mapped onto resting-state connectivity in the Value/Reward, Ventral-Frontoparietal and Salience networks; for the Cognitive type in the Auditory, Parietal Association, Frontoparietal and Salience networks; and for the Relief type in the Parietal Association, Higher Visual and Salience networks (pFDR < 0.05). Subtypes were equally distributed amongst individuals with different primary SUDs (χ2 = 4.71, p = 0.32) and gender (χ2 = 3.44, p = 0.18). Results support functionally derived subtypes, demonstrating considerable individual heterogeneity in the multi-dimensional impairments in addiction. This confirms the need for mechanism-based subtyping to inform the development of personalized addiction medicine approaches.

Genetic associations among internalizing and externalizing traits with polysubstance use among young adults

Though most genetic studies of substance use focus on specific substances in isolation or generalized vulnerability across multiple substances, few studies to date focus on the concurrent use of two or more substances within a specified time frame (i.e., polysubstance use; PSU). We evaluated whether distinct genetic factors underlying internalizing and externalizing traits were associated with past 30-day PSU above variance shared across general psychopathology and substance use (SU). Using Genomic Structural Equation Modeling, we constructed theory-driven, multivariate genetic factors of 16 internalizing, externalizing, and SU traits using genome-wide association studies (GWAS) summary statistics. Next, we fit a model with a higher order SU-related psychopathology factor as well as genetic variance specific to externalizing and internalizing (i.e., residual genetic variance not explained by SU or general psychopathology). GWAS-by-subtraction was used to obtain single nucleotide polymorphism effects on each of these factors. Polygenic scores (PGS) were then created in an independent target sample with data on PSU, the National Longitudinal Study of Adolescent to Adult Health. To evaluate the effect of genetic variance due to internalizing and externalizing traits independent of variance related to SU, we regressed PSU on the PGSs, controlling for sex, age, and genetic principal components. PGSs for SU-related psychopathology and non-SU externalizing traits were associated with higher PSU factor scores, while the non-SU internalizing PGS was not significantly associated with PSU. In total, the three PGSs accounted for an additional 4% of the variance in PSU above and beyond a null model with only age, sex, and genetic principal components as predictors. These findings suggest that there may be unique genetic variance in externalizing traits contributing to liability for PSU that is independent of the genetic variance shared with SU.

Coping strategies as mediating mechanisms between adolescent polysubstance use classes and adult alcohol and substance use disorders

Adolescent polysubstance use is a robust predictor of substance use in adulthood and can be exacerbated by poor coping with stress over time. We examined whether latent classes of adolescents' polysubstance use predicted alcohol use disorder and substance use disorder diagnoses in adulthood via multiple stress coping strategies. Self-reported frequency of past 3-month alcohol, tobacco, and marijuana use in 792 adolescents (aged 16/17) were used to form latent classes of polysubstance use. Self-reported aggressive, reactive, substance use and cognitive coping strategies (ages 18/19, 22/23, 23/24) were examined as multiple mediators of polysubstance use classes and alcohol use disorder and substance use disorder in adulthood (age 26/27) controlling for demographic covariates. Latent class analysis resulted in High, Experimental, and Low polysubstance use classes. Those in high and experimental polysubstance use classes, compared to those in the low polysubstance use class, had greater use of aggressive and reactive coping strategies, which respectively predicted greater substance use disorder and alcohol use disorder in adulthood. Across all comparisons (high vs low, experimental vs low, and high vs experimental), higher polysubstance use was associated with greater substance use coping, which predicted both alcohol and substance use disorder. Greater polysubstance use, even experimental use, in adolescence is a significant risk factor for developing alcohol use disorder and substance use disorder in adulthood and this occurs, in part, via maladaptive stress coping strategies.

The Relationship between Traumatic Life Events and Polysubstance Use: Examining the Mediating Role of DSM-5 Level of Personality Functioning and Maladaptive Personality Traits

The experience of traumatic events in childhood is an important risk factor for the initiation and continuation of polysubstance use. This study aimed to examine the mediating role of DSM-5 level of personality functioning and maladaptive personality traits in the relationship between traumatic life events and polysubstance use. We used a mixed sample (N = 290; M_age = 40; SD_age = 12.26; 75.2% males) of patients with substance use disorder (SUD; including 90 mono-drug users and 113 polysubstance users) and non-users (including 87 university students) recruited using convenience sampling method from harm reduction-oriented drug treatment centers and universities respectively in Tehran, Iran. Participants completed the Level of Personality Functioning Scale-Brief Form, the Personality Inventory for DSM 5-Brief Form, and the Life Events Checklist-Revised. The results of structural equation modeling showed that DSM-5 level of personality functioning and maladaptive personality traits partially mediated the relationship between traumatic life events and polysubstance use. Experiencing traumatic events may contribute to the risk of polysubstance use through the effect of global personality dysfunction and specific personality traits. This proposed mediational model must be replicated using a longitudinal design across different populations.

Polysubstance use and its correlation with psychosocial and health risk behaviours among more than 95,000 Norwegian adolescents during the COVID-19 pandemic (January to May 2021): a latent profile analysis

Background

Polysubstance use represents an adolescent health risk; however, large-scale studies investigating this issue during the COVID-19 pandemic are scarce. We aim to (i) characterise substance use profiles among adolescents and (ii) identify correlates of such substance use profiles.

Methods

Norwegian nationwide survey data from 2021 were analysed using latent profile analysis. Participants were 97,429 adolescents aged 13–18. We assessed cigarette, e-cigarette and snus use, alcohol consumption, and cannabis and other illicit drug use. Correlates included psychosocial variables, health risk behaviours, and COVID-19-related problems.

Findings

We identified three adolescent profiles; those who use no substances (n = 88,890; 91%); those who use snus and alcohol (n = 6546; 7%); and those who use multiple substances (i.e., polysubstance profile; n = 1993; 2%). Boys, older adolescents, adolescents with lower socio-economic status, and those reporting low levels of parental control, and higher parental alcohol use, mental health problems, pain-related variables, and other health risk behaviours were most likely to be in the polysubstance profile. Adolescents with social and mental health issues related to COVID-19 were more at risk of being in the polysubstance profile. Adolescents who use snus and alcohol showed similar patterns of risk factors, but on a somewhat lower level than those in the polysubstance profile.

Interpretation

Adolescents who use multiple substances have an unhealthier lifestyle, are at a higher risk of experiencing psychosocial impairments, and report more problems related to the COVID-19 pandemic. Preventative strategies to reduce polysubstance use might help promote psychosocial well-being in adolescents across various life domains.

Funding

This study was funded by two grants from the 10.13039/501100005416Research Council of Norway (project #: 288083 and 300816). The 10.13039/501100014232Norwegian Directorate of Health has funded the data collection. The Research Council of Norway and the Norwegian Directorate of Health have not had any role in study design, data collection, data analysis, interpretation, and writing of the report.

Prevalence and correlates of the misuse of z-drugs and benzodiazepines in the National Survey on Drug Use and Health

Background

Benzodiazepines and non-benzodiazepine hypnotics (z-drugs) are commonly prescribed for their anxiolytic and hypnotic properties, though they can also be misused. In studies examining the epidemiology of prescription drug misuse, these medication classes are commonly combined, rendering inadequate knowledge of their patterns of misuse. The objective of this study was to characterize the population prevalence, conditional dependence, and sociodemographic and clinical correlates of the misuse of benzodiazepines and z-drugs.

Methods

Data from the National Survey on Drug Use and Health from 2015 to 2019 were used to estimate population-level prevalence and characteristics of benzodiazepine and z-drug misuse. Groups were derived based on past-year misuse of benzodiazepines alone, z-drugs alone, or both drug types. Unadjusted regression analyses were used to compare groups on characteristics of interest.

Results

Exposure to benzodiazepines and/or z-drugs via prescription or misuse was common; however, only 2% of the population was estimated to have misused a benzodiazepine in the past year, and less than 0.5% misused z-drugs. People who misused only z-drugs were generally older, more likely to have health insurance, more educated, and had less severe psychiatric symptoms. This group was also more likely to report misuse to cope with sleep difficulty. Although concurrent substance use was highly prevalent in all groups, people who misused z-drugs alone generally reported less concurrent substance use than the other groups.

Conclusion

The misuse of z-drugs is less common than benzodiazepines, and people who misuse only z-drugs appear to generally have lower clinical severity. Nonetheless, a substantial subgroup of people exposed to z-drugs report concurrent, past-year use of other substances. Further research on z-drug misuse, including consideration of whether it should be grouped with other anxiolytic/hypnotic drugs, is needed.

Efficacy of Brief Interventions for Comorbid Substance Misuse in Patients on Opioid Agonist Treatment: A Systematic Review and Meta-analysis

BACKGROUND AND AIMS

Multiple substance use is a common but underrecognized problem in patients on opioid agonist treatment (OAT). Co-occurring substance misuse is associated with poor clinical and psychosocial outcomes. We aimed ( a ) to determine the effect of screening and brief intervention (SBI) for substance misuse in people on OAT and (b) to qualitatively summarize the implementation of SBI.

METHODS

We performed a systematic review of clinical trials on the efficacy of SBI for alcohol and drug misuse in participants on OAT. We searched 5 electronic databases and included published studies and unpublished trials. We measured the standardized mean difference in substance risk scores before and after intervention. We also estimated the standardized mean difference in alcohol consumption per day before and after intervention.

RESULTS

We included a total of 8 studies; 5 of these were included in the meta-analysis, and all were reviewed for narrative synthesis. We observed a significant change in the pre-post brief intervention substance risk scores with a medium effect size (Hedges g = 0.752, 95% confidence interval, 0.405-1.099). Sensitivity analyses with different pretest-posttest correlations did not change our result. Modest effects of SBI were found in reducing both alcohol and illicit drug risk scores, and among the population on methadone and buprenorphine treatment. We also observed a significant decrease in alcohol consumption per day 3 months after SBI. Studies showed a limited and incomplete screening for substance misuse and delivery of brief intervention in OAT settings.

CONCLUSIONS

Screening and brief intervention may be a potential treatment for co-occurring substance misuse among patients on OAT.

Polysubstance use among young adults and differences in negative alcohol-related sexual experiences

This study aimed to compare negative alcohol-related sexual experiences among individuals who used (1) alcohol only, (2) alcohol plus marijuana, and (3) alcohol plus marijuana and stimulants. Participants in the analytic sample (N = 1,015; Mean age = 19.16 (SD = 0.79); 45.42% male) completed an online baseline survey as part of an intervention study. A hurdle negative binomial model examined the associations between polysubstance use and negative alcohol-related sexual experiences. Models examined if experiences varied by demographic factors. Compared to participants that only used alcohol, those who used alcohol plus marijuana and stimulants reported a higher likelihood and average number of negative alcohol-related sexual experiences in the past 3 months. Participants that used alcohol plus marijuana had a higher likelihood of having a negative alcohol-related sexual experience in the past 3 months compared to those who only used alcohol. These findings suggest the number and risk for negative alcohol-related sexual experiences increases with the number of substances being used.

Neighborhoods and adolescent polysubstance use in Jamaica

Background

The purpose of this study was to identify latent classes of polysubstance use among adolescents in Jamaica and the role of neighborhood factors in the association with polysubstance use class membership.

Methods

This secondary analysis utilized a national cross-sectional household drug use survey conducted across 357 households in Jamaica (April 2016-July 2016) among a total of 4,625 individuals. A total of 750 adolescents (11-17 years) were included in this analysis. Latent class analysis (LCA) was conducted to identify polysubstance use patterns as well as latent neighborhood constructs. Neighborhood factors included social disorganization, concentrated disadvantage, community resources, community violence, and police station concentration. Multinomial regression analysis was implemented to evaluate the association between polysubstance use class membership and latent classes of neighborhood factors.

Result

The prevalence of lifetime polysubstance use was 27.56%. Four classes of polysubstance use were identified by comparing a series of five class models. The Bootstrap Likelihood Ratio Test (BLRT) indicated a good fit for the four-class model (<0.001). The prevalence of alcohol latent classes was: (1) heavy alcohol users and experimental smokers (Class I) (15.20%), (2) most hazardous polysubstance users (Class II) (5.33%), (3) heavy smokers and moderate alcohol users (Class III) (7.07%), and (4) experimental alcohol users (Class IV) (72.44%). Three classes of neighborhoods were identified by comparing a series of four-class models. The prevalence of the neighborhood classes was: (1) low social disorganization and disadvantage (Class I) (58.93%), (2) high social disorganization and moderate disadvantage (Class II) (10.93%), and (3) high social disorganization related to perceived drug use and disadvantage (Class III) (30.13%). The BLRT indicated a good fit for the three-class model (p =  < 0.004). Multinomial regression analysis indicated that adolescents living in neighborhoods with high disorder and moderate disadvantage (Class II) were 2.43 times (odds ratio (OR)) = 2.43, confidence interval (CI)) = 1.30-4.56) more likely to be heavy alcohol users and experimental smokers (Class I) compared to experimental alcohol users, adjusting for sex, age, ethnicity, religion, and income. Class II of neighborhood classes presented with the highest levels of community violence (100%), perceived disorder crime (64.6%), police station concentration (6.7%), and community resources (low resources is 87.6%), while the concentrated disadvantage was moderate (14.8%).

Conclusions

Alcohol polysubstance use latent classes were identified among youth in this context. Neighborhoods with high disorder and moderate disadvantage (Class II) were associated with a higher likelihood of polysubstance use. The role of neighborhood conditions in shaping adolescent polysubstance use should be considered in policy, prevention, and treatment interventions.

Health outcomes associated with patterns of substance use disorders among patients with type 2 diabetes and hypertension: Electronic health record findings

AIMS

To identify substance use disorder (SUD) patterns and their association with T2DM health outcomes among patients with type 2 diabetes and hypertension.

METHODS

We used latent class analysis on electronic health records from the MetroHealth System (Cleveland, Ohio) to obtain the target SUD groups: i) only tobacco (TUD), ii) tobacco and alcohol (TAUD), and iii) tobacco, alcohol, and at least one more substance (PSUD). A matching program with Mahalanobis distance within propensity score calipers created the matched control groups: no SUD (NSUD) for TUD and TUD for the other two SUD groups. The numbers of participants for the target-control groups were 8009 (TUD), 1672 (TAUD), and 642 (PSUD).

RESULTS

TUD was significantly associated with T2DM complications. Compared to TUD, the TAUD group showed a significantly higher likelihood for all-cause mortality (adjusted odds ratio (aOR) = 1.46) but not for any of the T2DM complications. Compared to TUD, the PSUD group experienced a significantly higher risk for cerebrovascular accident (CVA) (aOR = 2.19), diabetic neuropathy (aOR = 1.76), myocardial infarction (MI) (aOR = 1.76), and all-cause mortality (aOR = 1.66).

CONCLUSIONS

The findings of increased risk associated with PSUDs may provide insights for better management of patients with T2DM and hypertension co-occurrence.

Patterns of polysubstance use among adults in Malaysia-A latent class analysis

INTRODUCTION

Polysubstance use is the use of more than one non-prescribed licit or illicit substance at one time. This is a common phenomenon, but little is known about the severity and the various substances used by adults in Malaysia.

OBJECTIVE

To determine the pattern of polysubstance use and its associated factors among general adults in Malaysia.

METHODOLOGY

This was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2019), a cross-sectional population survey with a two-stage stratified random sampling design. A total of 10,472 Malaysians aged 18 years and above participated in this survey. Polysubstance use was defined as concurrent use of more than one substance, either alcohol, tobacco, or drugs (opioids, marijuana, amphetamine/ methamphetamine or kratom). A latent class analysis (LCA) was used to identify the membership of polysubstance groups. The association of class membership with demographic profiles was examined using Multinomial Logistic Regression analysis.

RESULTS

Fit indices (AIC = 16458.9, BIC = 16443.6) from LCA supported 3 classes solution: Class 1; "moderate-drug" group primarily combination used of tobacco and alcohol (2.4%), Class 2; "high-drug" group using multiple substance including kratom (0.3%) and Class 3; "low-drug" group reporting minimal alcohol and tobacco use or non-user (97.3%). The multinomial model showed young adults (18-40 years) had a higher likelihood of being polysubstance users both for moderate-drug class (OR = 4.1) and high-drug class (OR = 3.9) compared to older age (≥60 years). Chinese (OR = 18.9), Indian (OR = 23.3), Indigenous Sabah & Sarawak (OR = 34.6) and others ethnicity (OR = 8.9) showed higher odds of being moderate-drug users than Malays. The greater odds of moderate-drug use for males (OR = 35.5), working groups (OR = 1.5) and low education level group (OR = 3.2).

CONCLUSION

Our study highlights patterns and demographics related to the use of polysubstances among adults in Malaysia. These results would help formulate specific prevention programmes for these high-risk groups.

Predictors of Empirically Derived Substance Use Patterns Among Sexual and Gender Minority Populations of a Rural Midwestern State

Purpose: The study purpose was to (1) identify latent classes of substance use behaviors among a sample of sexual and gender minority (SGM) adults living in a predominantly rural midwestern state and (2) determine the association between SGM-related discrimination and the empirically derived substance use classes. Methods: We conducted a latent class analysis on 494 responses to a state-wide survey, followed by a multinomial logistic regression to test predictors of class membership, including distal experiences of discrimination and sociodemographic variables. Results: A three-class model fit best and included (1) polysubstance use, (2) binge drinking, and (3) no/low use classes. In the adjusted model, polysubstance class membership was positively associated with cisgender male identity and negatively associated with being 60 years of age or older and college educated. Binge drinking class membership was negatively associated with bisexual/pansexual identity and non-White race/ethnicity. In contrast to hypothesized outcomes guided by the Minority Stress Model, experiences of discrimination were not associated with membership in substance-using classes. Likewise, bisexual/pansexual individuals were not more likely to be members of polysubstance use or binge drinking classes, despite published reports of greater risk of substance use. Conclusion: These contradictions warrant intersectional approaches to advance substance use research, which may provide important evidence for targeted prevention/treatment interventions, particularly among polysubstance users.

Polysubstance Use Patterns among Outpatients Undergoing Substance Use Disorder Treatment: A Latent Class Analysis

Substance Use Disorders (SUDs) pose significant challenges to both individuals and society at large. The primary focus of existing research with clinical SUD populations has been on individual substances, but research is required to better understand the profiles of individuals who use different substances simultaneously. The purpose of the current study was, therefore, to identify patterns of use among subjects (n = 1025) who reported using multiple substances by adopting a Latent Class Analysis (LCA) methodology. The Addiction Severity Index (ASI-lite) was included as a measure of substance misuse, we performed LCA to identify patterns of substance use through the administration of the ASI-Lite. Responses were collected from the following substances: alcohol, cannabis/cannabinoids, opioids and heroin, and cocaine. Results identified two latent classes: (1) alcohol use dominant, and (2) poly-abuser use dominants. Class 1 represented 60.0% of the sample and refers to individuals with the dominant use of alcohol, of those a higher proportion (47%) reported low-frequency use (1 to 7 days per month) and 26% reported a frequency of use of 24 to 30 days per month. Furthermore, 18% used alcohol in combination with cocaine. Class 2 represents 40.0% of the sample. This class is characterized by low-frequency and high-frequency users of several substances. The results obtained highlight the importance of deepening the study of the concomitant use of substances in individuals with SUDs to better understand the health risk of the combined use of two or more substances.

Patterns and contexts of polysubstance use among young and older adults who are involved in the criminal legal system and use opioids: A mixed methods study

INTRODUCTION

Opioid prevention and treatment programs tailored to young adults involved in the criminal legal system are rare. We examined profiles of polysubstance use among younger and older adults involved in the criminal legal system who use opioids, and explored their experiences and motivations related to substance use. Information gleaned can inform the adaptation of existing programs and the development of novel approaches for young adults in the criminal legal system.

METHODS

Using a sequential mixed methods design we 1) quantitatively identified typologies of polysubstance users among adults aged 18-24 (n = 92) and those age 25 and over (n = 27) involved in the criminal legal system who use opioids, using latent class analysis and 2) qualitatively explored differences in personal motivations, cultural influences, and psychosocial contexts of substance use by class.

RESULTS

Our quantitative results supported a three-class typology: the majority of participants were in Class I (73 %, n = 87) and reported using primarily alcohol and marijuana. Participants in Classes II (15 %, n = 18) and III (12 %, n = 14) endorsed distinct and complicated polysubstance use profiles. Further, participants in Classes I and III were significantly younger than those in Class II. Qualitative analysis allowed us to understand associations between patterns of use, motivations, and contexts among young and older adults, comparing across classes.

CONCLUSIONS

Our results highlight the importance of attending to the needs of subpopulations based on age and use patterns to adapt and develop targeted treatment and prevention programs for high-risk adults involved in the criminal legal system.

Polysubstance use in young people accessing residential and day-treatment services for substance use: substance use profiles, psychiatric comorbidity and treatment completion

BACKGROUND AND AIMS

People with substance use disorders (SUDs) frequently present to treatment with polysubstance use and mental health comorbidities. Different combinations of substance use and mental health problems require different treatment approaches. Our study aimed to: (i) identify the shared substance use classes among young people at treatment admission, (ii) determine which mental health symptoms, quality of life (QoL) and service types were associated with the identified substance use classes, and (iii) prospectively determine which substance use classes and service types were more likely to complete treatment.

DESIGN

Cross-sectional and prospective study using service and outcome data.

SETTING

Substance use treatment services in Queensland and New South Wales, Australia.

PARTICIPANTS

De-identified service and outcome measure data were extracted from the files of 744 clients aged 18-35 years (48% male) admitted into seven residential and four day-treatment programmes.

MEASUREMENTS

Substance use and severity among tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, opioids, sedatives and inhalants. Other variables included: depression, anxiety, post-traumatic stress and psychotic symptoms, as well as QoL.

FINDINGS

Latent class analysis identified three polysubstance use classes: wide-ranging polysubstance users (WRPU; 22.45%), primary amphetamine users (56.45%) and alcohol and cannabis users (21.10%). The WRPU class had higher odds of psychotic symptoms than the alcohol and cannabis use class [odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.11-1.11]; and double the odds of residential programme enrolment than those in the amphetamine use class (OR = 2.35; 95% CI = 1.50-3.68). No other class differences on mental health or QoL variables were found. Clients enrolled in day-programmes had higher odds of completing treatment.

CONCLUSIONS

There appear to be high levels of polysubstance use among young people entering substance use treatment in Australia. Wide-ranging polysubstance users were more likely to report psychotic symptoms and be enrolled into a residential programme than primary amphetamine users and alcohol and cannabis users.

Specific polysubstance use patterns predict relapse among patients entering opioid use disorder treatment

Introduction

While polysubstance use has consistently been associated with higher rates of relapse, few studies have examined subgroups with specific combinations and time course of polysubstance use (i.e., polysubstance use patterns). This study aimed to classify and compare polysubstance use patterns, and their associations with relapse to regular opioid use in 2637 participants in three large opioid use disorder (OUD) treatment trials.

Methods

We explored the daily patterns of self-reported substance use in the 28 days prior to treatment entry. Market basket analysis (MBA) and repeated measure latent class analysis (RMLCA) were used to examine the subgroups of polysubstance use patterns, and multiple logistic regression was used to examine associations between identified classes and relapse.

Results

MBA and RMLCA identified 34 "associations rules " and 6 classes, respectively. Specific combinations of polysubstance use and time course (high baseline use and rapid decrease of use prior to initiation) predicts a worse relapse outcome. MBA showed individuals who co-used cocaine, heroin, prescription opioids, and cannabis had a higher risk for relapse (OR = 2.82, 95%CI = 1.13, 7.03). In RMLCA, higher risk of relapse was observed in individuals who presented with high baseline prescription opioid (OR = 1.9, 95% CI = 1.3, 2.76) or heroin use (OR = 3.54, 95%CI = 1.86, 6.72), although use decreased in both cases prior to treatment initiation.

Conclusions

Our analyses identified subgroups with distinct patterns of polysubstance use. Different patterns of polysubstance use differentially predict relapse outcomes. Interventions tailored to these individuals with specific polysubstance use patterns prior to treatment initiation may increase the effectiveness of relapse prevention.

Exploring the dynamic transitions of polysubstance use patterns among Canadian youth using Latent Markov Models on COMPASS data

Background

Understanding what factors lead to youth polysubstance use (PSU) patterns and how the transitions between use patterns can inform the design and implementation of PSU prevention programs. We explore the dynamics of PSU patterns from a large cohort of Canadian secondary school students using machine learning techniques.

Methods

We employed a multivariate latent Markov model (LMM) on COMPASS data, with a linked sample (N = 8824) of three-annual waves, Wave I (W_I, 2016-17, as baseline), Wave II (W_II, 2017-18), and Wave III (W_III, 2018-19). Substance use indicators, i.e., cigarette, e-cigarette, alcohol and marijuana, were self-reported and were categorized into never/occasional/current use.

Outcomes

Four distinct use patterns were identified: no-use (S1), single-use of alcohol (S2), dual-use of e-cigarettes and alcohol (S3), and multi-use (S4). S1 had the highest prevalence (60.5%) at W_I, however, S3 became the prominent use pattern (32.5%) by W_III. Most students remained in the same subgroup over time, particularly S4 had the highest transition probability (0.87) across the three-wave. With time, those who transitioned typically moved towards a higher use pattern, with the most and least likely transition occurring S2→S3 (0.45) and S3→S2 (<0.01), respectively. Among all covariates being examined, truancy, being measured by the # of classes skipped, significantly affected transition probabilities from any low→high (e.g., OR_S2→S4 = 2.41, 95% CI [2.11, 2.72], p < 0.00001) and high→low (e.g., OR_S3→S1 = 0.38, 95% CI [0.33, 0.44], p < 0.00001) use directions over time. Older students, blacks (vs. whites), and breakfast eaters were less likely to transition from low→high use direction. Students with more weekly allowance, with more friends that smoked, longer sedentary time, and attended attended school unsupportive to resist or quit drug/alcohol were more likely to transition from low→high use direction. Except for truancy, all other covariates had inconsistent effects on the transition probabilities from the high→low use direction.

Interpretation

This is the first study to ascertain the dynamics of use patterns and factors in youth PSU utilizing LMM with population-based longitudinal health surveys, providing evidence in developing programs to prevent youth PSU.

Funding

The Applied Health Sciences scholarship; the Microsoft AI for Good grant; the Canadian Institutes of Health Research, Health Canada, the Canadian Centre on Substance Abuse, the SickKids Foundation, the Ministère de la Santé et des Services sociaux of the province of Québec.

Examining the heterogeneity of polysubstance use patterns in young adulthood by age and college attendance

Substance use in young adulthood and polysubstance users (PSU), in particular, pose unique risks for adverse consequences. Prior research on young adult PSU has identified multiple classes of users, but most work has focused on college students. We examined PSU patterns by age and college attendance during young adulthood in two nationally representative samples. Using National Epidemiological Survey on Alcohol and Related Conditions (NESARC) Wave 1 and NESARC-III data sets, multigroup latent class analysis (MG-LCA) was employed to examine PSU patterns based on age (18-24 vs. 25-34) and determine whether solutions were similar (i.e., statistically invariant) by college attendance/graduation. Classes were estimated by binary past-year use of sedatives, tranquilizers, opioids/painkillers, heroin, amphetamines/stimulants, cocaine, hallucinogens, club drugs, and inhalants, and past-year frequency of alcohol, cigarette, and cannabis use. PSU patterns are largely replicated across waves. Model fit supported 3-class solutions in each MG-LCA: Low frequency-limited-range PSU (alcohol, cigarettes, and cannabis only), medium-to-high frequency limited-range PSU (alcohol, cigarettes, and cannabis only), and extended-range PSU (ER PSU; all substances). Apart from one model, MG-LCA solutions were not invariant by college attendance/graduation, suggesting important differences between these groups. Except for alcohol, cannabis, and cigarette use frequency, results showed that probabilities of illicit and prescription drug use declined in the older age group. Findings also supported examining college and noncollege youth separately when studying PSU. ER PSU may be uniquely vulnerable to coingesting substances, particularly for nongraduates, warranting future research to classify patterns of simultaneous PSU and identify predictors and consequences of high-risk combinations (e.g., alcohol and opioids). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A factor analytic approach to understanding health risk behaviors and resilience among multi-racial/ethnic adolescents in New Mexico

OBJECTIVE

This study examined the factor validity of health risk behaviors and resilience indicators and their covariation across a large racially/ethnically diverse adolescent population.

DESIGN

The study subsample (47% Hispanic, 31% White Non-Hispanic, 17% American Indian) was derived from the 2013 New Mexico Youth Risk Resilience Survey (YRRS; N-19,033). We conducted a confirmatory factor analysis on the 6 health risk domains identified by the CDC as contributing most to adolescent morbidity/mortality: (1) cigarette use, (2) alcohol and other illicit drug use, (3) marijuana use, (4) sexual activity, (5) nutrition habits, and (6) physical activity.

RESULTS

A 4-factor CFA model of adolescent health risk behaviors was replicated, and a hypothesized 6-factor structure based on behaviors that contribute most to adolescent morbidity/mortality was confirmed. The pattern of covarying risk behaviors differed by Hispanic, Native American, and Non-Hispanic White groups. We also confirmed a single external resilience-interference factor (decreased parental support, low school/community engagement, negative peer associations) that positively correlated with all six risk behaviors.

CONCLUSION

This study described the structure of adolescent health risk behaviors within a context of psychosocial resilience for American Indian and Hispanic adolescents in contrast to Non-Hispanic White adolescents. Our findings provided evidence for the construct validity of six health-risk behavior dimensions within a large racially/ethnically diverse adolescent sample, which reveal different patterns of loadings, degrees of model fit, and factor inter-correlations across the three racial/ethnic groups. Patterns of covarying risk behaviors differed in strength and direction by racial/ethnic group. Results suggest that interventions should target multiple behaviors and be tailored for different racial/ethnic groups. Targeting health risk and resilience indicators supports the use of multi-level health interventions at the individual, school, family, and community level by identifying individuals based on external resilience scores.

Validation of the Motivational Inventory Underlying Substance Use Engagement (MI-USE)

Given the growing number of fatalities associated with the use of multiple types of drugs, there is an urgent need for a tool that allows clinicians and researchers to quickly assess diverse reasons for substance use. Here, we sought to validate the Motivational Inventory Underlying Substance Engagement (MI-USE), a new measure that assesses motivations for use across different types of substances. Participants were 538 adults ages 18-60 (48% women) who reported substance use problems and past-year drug or alcohol use. Analyses were conducted to discover and validate the factor structure of the MI-USE and evaluate its construct validity. A 30-item model best fit the MI-USE, with one General Factor capturing overall motivation to engage in substance use and eight motive-specific factors that indexed unique motivations for substance use: Emotional Coping (relief from unpleasant emotions), Pleasure-Seeking (feel pleasurable or exciting emotions and sensations), Dependence Severity (avoid withdrawal and cravings), Expansion (enhance self-insight and spirituality), Social Coping (increase confidence and attractiveness), Advantage (gain a physical or mental advantage), Physical Coping (relief from unpleasant bodily sensations), and Sleep (mitigate sleep problems). Evaluation of the measure's construct validity and internal consistency support the chosen model and interpretation of the motive-specific factors. Results provide initial validation of the MI-USE as a reliable and valid tool for assessing diverse substance use motivations. It improves upon existing measures by allowing clinicians and researchers to simultaneously evaluate motivations for multiple forms of substance use, which facilitates personalized treatment planning and research on polysubstance use.

Patterns and Correlates of Polysubstance Use Among Individuals With Severe Alcohol Use Disorder

AIM

The present study examined patterns and correlates of polysubstance use among individuals with severe alcohol use disorder (AUD).

METHODS

Participants were 2785 individuals (63% female; mean age = 43 years, range = 18-78 years) from the Genes, Addiction and Personality Study. All participants met lifetime criteria for severe AUD (6+ symptoms). We used latent class analysis to identify patterns of frequency of lifetime use for cigarettes, marijuana, cocaine, stimulants, sedatives, opioids and hallucinogens. A variety of demographic and behavioral correlates of latent class membership were tested in univariable and multivariable models.

RESULTS

A five-class solution was selected: extended range polysubstance use (24.5%); cigarette and marijuana use (18.8%); 'testers,' characterized by high probabilities of smoking 100 or more cigarettes, using marijuana 6+ times, and trying the remaining substances 1-5 times (12.3%); moderate range polysubstance use (17.1%) and minimal use (reference class; 27.3%). In univariable analyses, all potential correlates were related to latent class membership. In the multivariable model, associations with gender, race/ethnicity, age of onset for alcohol problems, dimensions of impulsivity, depressive symptoms, antisocial behavior and family history density of alcohol problems remained significant, though the pattern and strength of associations differed across classes. For instance, sensation-seeking, lack of premeditation and family history were uniquely associated with membership in the extended range polysubstance use class.

CONCLUSION

Patterns of polysubstance use are differentially related to demographic and behavioral factors among individuals with severe AUD. Assessing use across multiple substances may inform the selection of targets for treatment and prevention.

Types of criminal legal system exposure and polysubstance use: Prevalence and correlates among U.S. adults in the National Survey on Drug Use and Health, 2015-2019

INTRODUCTION

Criminal legal system (CLS) exposed adults experience higher rates of substance use, substance use disorder (SUD), and overdose. As most CLS exposed adults are not incarcerated, it is important to focus on CLS exposure across the carceral continuum.

METHODS

This research used pooled data from adult respondents (N = 206,314) in the National Survey on Drug Use and Health (2015-2019). Survey weighted descriptive statistics and Poisson regression were used to estimate prevalence of polysubstance use (i.e., concurrent use) across CLS exposure types (i.e., arrest, probation, parole), identifying relevant correlates.

RESULTS

The prevalence of polysubstance use was higher among CLS exposed adults, and nearly two-thirds of CLS exposed adults who used multiple types of substances indicated having an SUD. Comparing CLS exposure types, polysubstance use was less likely among adults on probation (IRR=0.89, 95%CI=0.84,0.94) or parole (IRR=0.82, 95%CI=0.76,0.87) compared to those arrested. Polysubstance use was also more likely among adults on probation (IRR=1.09, 95%CI =1.01,1.17) compared to those on parole. While some characteristics (i.e., age, ethnicity, SUD) were consistently associated with polysubstance use across types of CLS exposure, other characteristics (i.e., sexual identity, marital status, suicidal ideation) were not.

CONCLUSIONS

There is heterogeneity in health risks as a function of CLS exposure type. Further research is needed to identify causal mechanisms and differences based on demographic characteristics. Given high levels of polysubstance use across CLS exposure types, a shift towards a more comprehensive approach in substance use epidemiology may facilitate building an evidence-base to maximize treatment related interventions to reduce polysubstance-involved overdoses.

Prevalence and sociodemographic factors associated with polysubstance use: analysis of a population-based survey in Jamaica

BACKGROUND

In Latin America and the Caribbean, there is a dearth of research exploring polysubstance use. This study aims to determine the prevalence, varying combinations and associated sociodemographic characteristics of polysubstance use in Jamaica.

METHODS

This study involved a secondary data analysis of the Jamaica National Drug Prevalence Survey 2016 dataset where 4,623 participants between the age of 12 and 65 years from each household were randomly selected as respondents. Statistical analysis was performed to determine the prevalence and the sociodemographic correlates of polysubstance use among Jamaicans.

RESULTS

19.6% of respondents used two or more drugs in their lifetime. Of this amount 68.7% reported past year use and 61.9% reported past month use. Bivariate analyses reported polysubstance use was statistically significantly higher amongst males (U = 54,579, p = 0.000), those living in rural areas (U = 91,892, p = 0.003), non-Christian (U = 89,514, p = 0.014), and married persons (U = 74,672, p = 0.000). Past month polysubstance use was statistically significantly higher among employed persons than unemployed persons were (U = 81,342, p = 0.001). Surprisingly, there was a lack of significant differences between education level, household income and past month concurrent polysubstance use (p = 0.609; p = 0.115 respectively). Logistic regression model indicated males were 3.076 times more likely than females to report past month polysubstance use than females. Also, when compared to those 55-65 years old, participants 35-54 years were 2.922 times more likely and those 18-34 years were 4.914 times more likely to report past month polysubstance use. Additionally, those living in rural areas were 1.508 times more likely than participants living in urban areas to report past month polysubstance use. As it relates to occupational status, when compared to armed forces, skilled workers were 4.328 times more likely and unskilled workers were 7.146 times more likely to report past month polysubstance use.

CONCLUSIONS

One in five Jamaicans identified as polysubstance users, predominated by marijuana as the most common factor amongst the polysubstance combinations examined, signalling the need for early marijuana interventions.

Clinical management of cannabis withdrawal

BACKGROUND AND AIMS

Cannabis withdrawal is a well-characterized phenomenon that occurs in approximately half of regular and dependent cannabis users after abrupt cessation or significant reductions in cannabis products that contain Δ⁹ -tetrahydrocannabinol (THC). This review describes the diagnosis, prevalence, course and management of cannabis withdrawal and highlights opportunities for future clinical research.

METHODS

Narrative review of literature.

RESULTS

Symptom onset typically occurs 24-48 hours after cessation and most symptoms generally peak at days 2-6, with some symptoms lasting up to 3 weeks or more in heavy cannabis users. The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood and loss of appetite. Less common physical symptoms include chills, headaches, physical tension, sweating and stomach pain. Despite limited empirical evidence, supportive counselling and psychoeducation are the first-line approaches in the management of cannabis withdrawal. There are no medications currently approved specifically for medically assisted withdrawal (MAW). Medications have been used to manage short-term symptoms (e.g. anxiety, sleep, nausea). A number of promising pharmacological agents have been examined in controlled trials, but these have been underpowered and positive findings not reliably replicated. Some (e.g. cannabis agonists) are used 'off-label' in clinical practice. Inpatient admission for MAW may be clinically indicated for patients who have significant comorbid mental health disorders and polysubstance use to avoid severe complications.

CONCLUSIONS

The clinical significance of cannabis withdrawal is that its symptoms may precipitate relapse to cannabis use. Complicated withdrawal may occur in people with concurrent mental health and polysubstance use.

Lifetime Dual Disorder Screening and Treatment Retention: A Pilot Cohort Study

The coexistence of a substance use disorder and another mental disorder in the same individual has been called dual disorder or dual diagnosis. This study aimed to examine the prevalence of lifetime dual disorder in individuals with alcohol or cocaine use disorder and their retention in treatment. We conducted a pilot cohort study of individuals (n = 1356) with alcohol or cocaine use disorder admitted to treatment in the public outpatient services of Barcelona (Spain) from January 2015 to August 2017 (followed-up until February 2018). Descriptive statistics, Kaplan−Meier survival curves and a multivariable Cox regression model were estimated. The lifetime prevalence of screening positive for dual disorder was 74%. At 1 year of follow-up, >75% of the cohort remained in treatment. On multivariable analysis, the factors associated with treatment dropout were a positive screening for lifetime dual disorder (HR = 1.26; 95% CI = 1.00−1.60), alcohol use (HR = 1.35; 95% CI = 1.04−1.77), polysubstance use (alcohol or cocaine and cannabis use) (HR = 1.60; 95% CI = 1.03−2.49) and living alone (HR = 1.34; 95% CI = 1.04−1.72). Lifetime dual disorder is a prevalent issue among individuals with alcohol or cocaine use disorders and could influence their dropout from treatment in public outpatient drug dependence care centres, along with alcohol use, polysubstance use and social conditions, such as living alone. We need a large-scale study with prolonged follow-up to confirm these preliminary results.

Cultural Protection from Polysubstance Use Among Native American Adolescents and Young Adults

Reservation-based Native American youth are at disproportionate risk for high-risk substance use. The culture-as-treatment hypothesis suggests aspects of tribal culture can support prevention and healing in this context; however, the protective role of communal mastery and tribal identity have yet to be fully explored. The objectives of this study were to investigate (1) the relationship between cultural factors and high-risk substance use, which includes polysubstance use, early initiation of alcohol and illicit drugs, and binge drinking, and (2) substance use frequency and prevalence of various substances via cross-sectional design. Multiple logistic regression modeling was used to analyze data from 288 tribal members (15–24 years of age) residing on/near the Fort Peck Reservation in the Northern Plains. When controlling for childhood trauma and school attendance, having at least a high school education (OR = 0.434, p = 0.028), increased communal mastery (OR = 0.931, p = 0.007), and higher levels of tribal identity (OR = 0.579, p = 0.009) were significantly associated with lower odds of polysubstance use. Overall prevalence of polysubstance use was 50%, and binge drinking had the highest single substance prevalence (66%). Prevalence of early initiation of substances (≤ 14 years) was inhalants (70%), alcohol (61%), marijuana (74%), methamphetamine (23%), and prescription drug misuse (23%). Hydrocodone, an opioid, was the most frequently misused prescription drug. Findings indicate programs focused on promoting education engagement, communal mastery, and tribal identity may mitigate substance use for Native American adolescents living in high-risk, reservation-based settings.

Is lower severity alcohol use disorder qualitatively different than more severe manifestations? An evaluation of multivariate symptom clusters

BACKGROUND AND AIMS

Alcohol use disorder (AUD), since the release of DSM-V, is conceptualized and studied as a unidimensional construct. However, previous research has identified clusters of AUD symptoms related to excessive consumption/tolerance, loss of control/social dysfunction and withdrawal/craving that have shown differential genetic risks, personality associations and predictive ability. Although past 'variable-centered' (e.g. factor-analytic) studies have demonstrated the importance of these clusters, the current study aimed to examine how these clusters commonly manifest using a 'person-centered' approach (e.g. latent class).

DESIGN

Cross-sectional in-person assessment.

SETTING

Indiana, USA.

PARTICIPANTS

A convenience sample of 1390 young adults (mean age = 21.43, SD = 2.47) recruited for an over-representation of alcohol problems (65% with AUD).

MEASUREMENTS

Latent class analysis (LCA) was conducted on 23 criteria from the Semi-Structured Interview on the Genetics of Alcoholism (SSAGA) that align with DSM-V AUD symptoms. Identified latent classes were characterized using multinomial regressions to examine the association of class and measures of alcohol use, other externalizing psychopathology, internalizing problems and personality.

FINDINGS

LCA results identified a 'Low Problems' class (34% of sample), a 'Heavy Consumption' class (26%) characterized by high endorsement probabilities of essentially only consumption/tolerance symptoms, a 'Consumption and Loss of Control' class (31%) characterized by endorsing consumption/tolerance and loss of control/social dysfunction symptoms, and finally a 'Consumption, Loss of Control and Withdrawal' class (9%) characterized by high endorsement probabilities of all symptom clusters. Multinomial regression results indicated an increasing spectrum of severity in terms of psychological impairment.

CONCLUSIONS

AUD appears to manifest as different clusters of symptoms at different severity levels.

Young adult opioid misuse indicates a general tendency toward substance use and is strongly predicted by general substance use risk

OBJECTIVE

To examine whether young adult opioid misuse reflects a general tendency toward substance use and is influenced by general substance use risk or whether it is a different phenomenon from other drug use.

METHODS

At ages 23 (2016) and 26 (2019), a panel of young adults (n = 3794 to 3833) in the United States self-reported their past-month substance use (opioid misuse, heavy drinking, cigarettes, cannabis) and substance-specific risk factors (perceptions of harm; approval of use; and use of each substance by friends and romantic partners). Structural equation models examined non-opioid and opioid-specific associations between latent risk and substance use factors.

RESULTS

Opioid misuse and opioid-specific risk factors shared significant variance with latent substance use and latent substance use risk, respectively, which were strongly associated. A statistically significant residual correlation between opioid-specific risk and opioid misuse remained.

CONCLUSION

Young adult opioid misuse reflects a general tendency toward substance use and is strongly predicted by risk for substance use. Opioid-specific risk factors play only a small independent role. Existing evidence-based substance use interventions may be effective in preventing opioid misuse among young adults.

Predictors of Frequent Emergency Department Use and Hospitalization among Patients with Substance-Related Disorders Recruited in Addiction Treatment Centers

Few studies have assessed the overall impact of outpatient service use on acute care use, comparing patients with different types of substance-related disorders (SRD) and multimorbidity. This study aimed to identify sociodemographic and clinical characteristics and outpatient service use that predicted both frequent ED use (3+ visits/year) and hospitalization among patients with SRD. Data emanated from 14 Quebec (Canada) addiction treatment centers. Quebec administrative health databases were analyzed for a cohort of 17,819 patients over a 7-year period. Multivariable logistic regression models were produced. Patients with polysubstance-related disorders, co-occurring SRD-mental disorders, severe chronic physical illnesses, and suicidal behaviors were at highest risk of both frequent ED use and hospitalization. Having a history of homelessness, residing in rural areas, and using more outpatient services also increased the risk of acute care use, whereas high continuity of physician care protected against acute care use. Serious health problems were the main predictor for increased risk of both frequent ED use and hospitalization among patients with SRD, whereas high continuity of care was a protective factor. Improved quality of care, motivational, outreach and crisis interventions, and more integrated and collaborative care are suggested for reducing acute care use.

Signals of increasing co-use of stimulants and opioids from online drug forum data

Background

Despite recent rises in fatal overdoses involving multiple substances, there is a paucity of knowledge about stimulant co-use patterns among people who use opioids (PWUO) or people being treated with medications for opioid use disorder (PTMOUD). A better understanding of the timing and patterns in stimulant co-use among PWUO based on mentions of these substances on social media can help inform prevention programs, policy, and future research directions. This study examines stimulant co-mention trends among PWUO/PTMOUD on social media over multiple years.

Methods

We collected publicly available data from 14 forums on Reddit (subreddits) that focused on prescription and illicit opioids, and medications for opioid use disorder (MOUD). Collected data ranged from 2011 to 2020, and we also collected timelines comprising past posts from a sample of Reddit users (Redditors) on these forums. We applied natural language processing to generate lexical variants of all included prescription and illicit opioids and stimulants and detect mentions of them on the chosen subreddits. Finally, we analyzed and described trends and patterns in co-mentions.

Results

Posts collected for 13,812 Redditors showed that 12,306 (89.1%) mentioned at least 1 opioid, opioid-related medication, or stimulant. Analyses revealed that the number and proportion of Redditors mentioning both opioids and/or opioid-related medications and stimulants steadily increased over time. Relative rates of co-mentions by the same Redditor of heroin and methamphetamine, the substances most commonly co-mentioned, decreased in recent years, while co-mentions of both fentanyl and MOUD with methamphetamine increased.

Conclusion

Our analyses reflect increasing mentions of stimulants, particularly methamphetamine, among PWUO/PTMOUD, which closely resembles the growth in overdose deaths involving both opioids and stimulants. These findings are consistent with recent reports suggesting increasing stimulant use among people receiving treatment for opioid use disorder. These data offer insights on emerging trends in the overdose epidemic and underscore the importance of scaling efforts to address co-occurring opioid and stimulant use including harm reduction and comprehensive healthcare access spanning mental-health services and substance use disorder treatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12954-022-00628-2.

A Scoping Review of Gender, Sex and Sexuality Differences in Polysubstance Use in Adolescents and Adults

BACKGROUND

Polysubstance use is a common, problematic behavior that increases risk of harm to self and others. Research suggests that rates may vary based on gender, sex and sexuality. Understanding the current state of this literature may inform prevention and treatment of polysubstance use, leading to reduced public health burden.

OBJECTIVES

This review aimed to synthesize research on gender, sex and sexuality differences in polysubstance use in adults and adolescents.

METHODS

A scoping review was conducted using all EBSCO databases, PubMed and Google Scholar to identify articles examining the effects of gender, sex and sexuality on polysubstance use. Polysubstance use was defined broadly as the use of any combination of substances over any time period and included licit (alcohol, tobacco) and illicit substances, concurrent and simultaneous use, from lifetime to daily use and use at any frequency. Studies were considered if they were published in peer-reviewed journals between January 1990 and October 2020 and were written in English. Publicly available data sources were also utilized to fully capture prevalence data that has not been published elsewhere.

RESULTS

Findings were mostly inconsistent and often conflicting. Only two findings were generally consistent: adult men were overall more likely to report polysubstance use than adult women, and sexual and gender minorities report more frequent polysubstance use than non-minorities.

CONCLUSIONS

Research has been unable to clearly elucidate differences in polysubstance use prevalence and patterns according to gender, sex and sexuality. Several recommendations are offered to advance future research and address limitations of current research.

Poor Sleep in Community-Dwelling Polysubstance Users: Association With Khat Dependence, Metacognition, and Socio-Demographic Factors

Purpose

Poor sleep and cognitive deficits are often associated with increased drug use. However, no study has addressed the relationship between poor sleep, substance dependence, and metacognitive deficit in polysubstance users.

Methods

This was a cross-sectional study with a simple random sampling involving community-dwelling polysubstance users (n = 326, age = 18-43 years) in Mizan, Ethiopia. Participants completed a brief sleep questionnaire, severity of dependence on khat (SDS-Khat), a brief meta-cognition questionnaire, and a socio-demographic survey.

Results

Majority (56.4%) of the polysubstance users had sleep disturbance. Chronic health conditions [adjusted odds ratio (AOR) = 2.52, 95% confidence interval (CI) 1.31-4.85], chronic conditions in the family (AOR = 2.69, 95% CI 1.40-5.20), illiterate-primary level of educational status (AOR = 2.40, 95% CI 1.30-4.04), higher SDS-Khat score (AOR = 1.39, 95% CI 1.13-1.72), and lower meta-cognition score (AOR = 0.90, 95% CI 0.84-0.97) predicted poor sleep in the polysubstance users. Moreover, low metacognition score and high SDS score also predicted additional sleep disturbances like chronic sleep insufficiency, lethargy and restlessness after nighttime sleep, socio-occupational dysfunctions, and daytime disturbances in polysubstance users.

Conclusion

Poor sleep, severe khat dependence, and metacognitive deficits are common in community polysubstance users. Moreover, poor sleep is associated with higher khat dependence, lower metacognitive ability, lower educational status, and the presence of chronic conditions in polysubstance users or their families.

Applying network analysis to investigate substance use symptoms associated with drug overdose

BACKGROUND

Drug overdose deaths have been increasing over the last several decades. While single substance classes, such as opioids, have been implicated in this rise, less is known about the contributions of polysubstance use (PSU) and other combinations of specific substances and symptoms that may be a risk factor for drug overdose.

METHODS

Symptoms of alcohol, cannabis, and other drug use disorders, as well as co-substance use indicators, were assessed and then examined via network analysis in a sample of young adults (N = 1540). Features of the estimated symptom network were investigated, including topology and node centrality, as well as bridge centrality, which further examines node centrality while accounting for the nodes belonging to discrete communities.

RESULTS

Individual symptoms were more strongly associated with other symptoms within the same substance class than across substance classes. Tolerance and withdrawal symptoms were the most central items in the network. However, when accounting for symptoms belonging to discrete substance classes, drug overdose emerged as a strong bridge symptom, among others.

CONCLUSIONS

As a strong bridge symptom, drug overdose had many connections with a variety of substances and symptoms, which might suggest that risk for drug overdose may be a function of overall substance use severity. Altogether, examining alcohol and substance use symptoms using a network analytic framework provided novel insights into the role PSU might play in conferring risk for drug overdose.

Heroin and fentanyl overdose deaths among cases age 50+ in the National Poison Data System, 2015-2020

CONTEXT

Illicit opioid use and heroin treatment admissions among individuals age 50+ have increased. Little research has, however, examined correlates of illicit opioid overdose deaths in this age group before or during the COVID-19 pandemic or the healthcare services used in these cases.

METHODS

The sample included illicit opioid (heroin, fentanyl, or other synthetic, nonpharmaceutical opioids) poisoning cases age 50+ (N = 5576) in the National Poison Data System (NPDS), 2015-2020. Using descriptive statistics and logistic regression models, we report changes in overdose death rates during the study period and associations of death with healthcare service use, naloxone administration, and clinical and demographic characteristics.

RESULTS

The 6-year average overdose death rate from illicit opioids among those age 50+ was 2.9%, increasing from 1.4% in 2015 to 4.0% in 2019 and 3.6% in 2020. Logistic regression results showed that exposure year was not a significant factor in the odds of overdose death; however, odds were significantly higher among cases that were not managed at any healthcare facility (HCF) (adjusted odds ratio [AOR] = 4.60, 95% confidence interval [CI] = 3.19-6.63) and lower among those who received naloxone therapy (AOR = 0.64, 95% CI = 0.45-0.92). The odds of death were also higher among cases involving exposure at own or another's home and co-use of prescription opioids, alcohol, and other illicit drugs.

CONCLUSIONS

Although the NPDS did not show increases in illicit opioid overdose death rates among cases age 50+ in 2020 compared to 2019, overdose deaths were greater among cases that were not managed at HCF and did not receive naloxone therapy. Many appear to have died before they received any intervention to prevent death. Improved access to healthcare services and social support and access to naloxone therapy for older adults with opioid use problems are needed.

Co-exposure of cannabinoids with amphetamines and biological, behavioural and health outcomes: a scoping review of animal and human studies

RATIONALE

The growing prevalence of psychostimulant (including amphetamine) use and associated health harms, with limited treatment options, present a global challenge. There is an increasing availability and medical applications of cannabinoids, and growing interest in their therapeutic potential for addictive disorders.

OBJECTIVES

The objective of this study is to review available data regarding cannabis/cannabinoid co-use or exposure on amphetamine-related outcomes.

METHODS

Towards the present scoping review, we systematically searched four databases (Medline, Web-of-Science, CINAHL Plus and PsycInfo) using cannabis/cannabinoid and amphetamine text-terms identifying peer-reviewed, English-language studies published in 2000-2020 involving multiple methods approaches among both human and animal study samples, assessing the association of co-use/administration of cannabis/cannabinoids products with non-medical amphetamines on biological, behavioural or health outcomes.

RESULTS

Twenty-five articles were included. Pre-clinical studies (n = 15) found mostly protective effects of single or repeated cannabinoids administration on rodents in amphetamine addiction models, amphetamine-induced models of human mental disorders (e.g. schizophrenia) and amphetamine-induced neurotoxicity. Human studies (n = 10) were more heterogeneously designed (e.g. cross-sectional, case-control, longitudinal) and assessed natural ongoing cannabis and methamphetamine use or dependence, showing mostly enhanced harms in a diversity of outcomes (e.g. mental health, methamphetamine use, cognition).

CONCLUSIONS

While human studies suggest cannabis use as an adverse risk factor among non-medical amphetamine users, pre-clinical studies suggest therapeutic potential of cannabinoids, especially cannabidiol, to alleviate amphetamine addiction and harms, including treatment outcomes. Given increasing psychostimulant harms but lack of care options, rigorous, high-quality design studies should aim to translate and investigate pre-clinical study results for potential therapeutic benefits of cannabinoids for amphetamine use/abuse in human subjects.

Survey of substance use among adolescent drug offenders referred from juvenile courts in Taiwan: Clinical epidemiology of single versus multiple illicit substance use

BACKGROUND

Substance use during adolescence might cause substantial health burden. Little is known regarding profiles of multiple illicit substance users compared to single illicit substance users in adolescent population in Taiwan.

METHODS

We enrolled 106 adolescent illicit drug users who received addiction treatment referred by juvenile courts in Taiwan between September, 2016 and September, 2021. We divided them into two groups: single versus multiple illicit drug users, and further compared their socio-demographic characteristics, psychiatric and substance comorbidities. The independent t test or Mann-Whitney U test was used for continuous variables and Pearson's chi-square test for nominal variables. Multivariate logistic regression was used to examine the suicide and violence risk among adolescents.

RESULTS

71.7% of participants were multiple illicit drug users while 28.3% of them were single drug users. Multiple illicit substance users were more likely to use methamphetamine (p = 0.005), ketamine (p < 0.001), new psychoactive substance (NPS) (p < 0.001), MDMA (p = 0.003), and nitrous oxide (p < 0.001) compared to single illicit substance users. In addition, multiple illicit drug users were more likely to have ADHD (p = 0.030), major depressive disorder (p = 0.050), and lifetime suicidal attempts (p = 0.048) compared to single illicit drug users. In further analysis (NPS vs. traditional drugs), we found NPS users tended to use larger numbers of illicit drugs (p < 0.001) and were more likely to have substance-induced psychotic disorder (p = 0.008), ADHD (p = 0.011), suicidal attempts (p = 0.020).

CONCLUSION

Our findings highlight the distinct profiles of multiple illicit drug users compared to single illicit drug users among adolescent population. High suicidality and high psychiatric comorbidities in multiple illicit drug users call for special need for suicide screening and a more integrated care incorporating psychiatric and substance treatment.

Longitudinal analysis of the prevalence and correlates of heavy episodic drinking and self-reported opioid use among a national cohort of patients with HIV

BACKGROUND

Heavy episodic drinking (HED) is a risk factor for opioid-related overdose and negatively impacts HIV disease progression. Among a national cohort of patients with HIV (PWH), we examined sociodemographic and clinical correlates of concomitant HED and self-reported opioid use.

METHODS

We used data collected from 2002 through 2018 from the Veterans Aging Cohort Study, a prospective cohort including PWH in care at eight US Veterans Health Administration sites. HED was defined as consuming six or more drinks at least once in the year prior to survey collection. We examined the relationship between HED and self-reported opioid use and created a 4-level composite variable of HED and opioid use. We used multinomial logistic regression to estimate odds of reporting concomitant HED and self-reported opioid use.

RESULTS

Among 3702 PWH, 1458 (39.4%) reported HED during the study period and 350 (9.5%) reported opioid use. In the multinomial model, compared to reporting neither HED nor opioid use, lifetime housing instability (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.01 to 2.35), Veterans Aging Cohort Study Index 2.0 (a measure of disease severity; aOR 1.14, 95% CI 1.02 to 1.28), depressive symptoms (aOR 2.27, 95% CI 1.42 to 3.62), past-year cigarette smoking (aOR 3.06, 95% CI 1.53 to 6.14), cannabis use (aOR 1.69, 95% CI 1.09 to 2.62), and cocaine/stimulant use (aOR 11.54, 95% CI 7.40 to 17.99) were independently associated with greater odds of concomitant HED and self-reported opioid use. Compared to having attended no college, having some college or more (aOR 0.39, 95% CI 0.26 to 0.59) was associated with lower odds of concomitant HED and self-reported opioid use.

CONCLUSIONS

Among PWH, concomitant HED and self-reported opioid use are more common among individuals with depressive symptoms and substance use, structural vulnerabilities, and greater illness severity. Efforts to minimize opioid-related risk should address high-risk drinking as a modifiable risk factor for harm among these groups.

Resting state functional connectivity in alcohol users and co-users of other substances

Polysubstance use (PSU) is the use of more than one psychoactive substance simultaneously or independently, and occurs in roughly half of individuals who seek treatment for substance use. The current study sought to use resting state functional connectivity (rs-FC) to examine functional connectivity in participants who report using multiple or single substances. Participants were drawn from a larger neuroimaging study. From there, participants were placed into one of three groups based on their frequency of alcohol, tobacco, cannabis, and illicit drug use. The final sample consisted of 82 participants. We observed three clusters that differed significantly between the three groups; one within the salience network and two within the temporal network. Tri+ users were found to have a lesser amount of rs-FC in these regions (compared to the other two groups) and dual users were found to have a greater amount of rs-FC within these regions. Findings indicate that use of three or more substances may significantly impact rs-FC within the salience and temporal networks, and that those who use alcohol+cannabis have significantly greater rs-FC than those who use alcohol+tobacco. Research is needed to examine larger samples of PSU for comparisons across specific substance combinations.