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Rigg KK, Kusiak ES, Rigg LK. Motivations for Misusing Opioids Among African Americans. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:240-249. [PMID: 38258821 DOI: 10.1177/29767342231214118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND A wide range of opioid misuse motives have been documented in the literature, including to relieve physical pain, feel good/get high, relax, manage feelings/emotions, sleep, and moderate the effects of other substances. Despite a rise in opioid misuse among African Americans over the last 2 decades, their motivations for misuse remain unclear. Much of the research on opioid misuse motivations either rely on samples with little racial diversity or do not stratify their findings by race. As a result, less is known about the specific reasons why African Americans engage in opioid misuse. The objective of this study, therefore, was to identify and explain the most common motives for misusing opioids among African Americans. Qualitative interview data are also presented to explain/contextualize the most prevalent motivations. METHODS This study used data from the Florida Minority Health Survey, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of African Americans. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida. RESULTS Analyses revealed that while some (33.9%) misused opioids for purposes of recreation/sensation seeking (eg, feel good/get high), the majority (66.1%) were attempting to self-treat perceived medical symptoms (eg, physical pain, anxiety/trauma, withdrawals, insomnia). CONCLUSIONS This study contributes to a better understanding of why some African Americans engage in opioid misuse and findings highlight the need for interventions to be trauma informed and address unmanaged physical pain among African Americans. Given that most studies on motivations are quantitative in nature, the study contributes to the literature by capturing the voices of African Americans who use drugs.
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Affiliation(s)
- Khary K Rigg
- Department of Mental Health Law & Policy, University of South Florida, Tampa, FL, USA
| | - Ethan S Kusiak
- Department of Mental Health Law & Policy, University of South Florida, Tampa, FL, USA
| | - Lindi K Rigg
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA
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Philbin MM, Greene ER, LaBossier NJ, Martins SS, McCrimmon T, Mauro PM. Age-related patterns of cocaine and methamphetamine use across the life course in the United States: Disparities by gender and sexual identity among adults. Addict Behav 2023; 137:107539. [PMID: 36343473 PMCID: PMC11018266 DOI: 10.1016/j.addbeh.2022.107539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Research showing substance use decreases over the life course has focused primarily on heterosexual adults. We examined how age-related patterns of cocaine and methamphetamine use vary by sexual identity and gender among a national sample. METHODS We included 191,954 adults aged 18-64 from the 2015-2019 National Survey on Drug Use and Health. We described the weighted prevalence of past-year cocaine and methamphetamine use and used logistic regressions to estimate relative odds of past-year cocaine and methamphetamine use by age, stratified by gender and sexual identity (heterosexual, gay/lesbian, bisexual). RESULTS Cocaine and methamphetamine use was highest among lesbian, gay, and bisexual (LGB) adults compared to their heterosexual counterparts. Gay/lesbian men and women and bisexual men were also more likely to use cocaine at later ages. Heterosexual adults ages 26-34 (adjusted odds ratio [aOR] = 0.73; confidence interval [CI] = 0.65-0.83) were less likely than those 21-25 to report past-year cocaine use, but there were no differences between those ages 26-34 and 21-25 among any LGB sub-group. Heterosexual (aOR = 1.62; CI = 1.28-2.04) and gay (aOR = 2.93; CI = 1.26-6.80), men ages 26-34 were more likely to report past-year methamphetamine use than their counterparts ages 21-25. There were no age-related differences in past-year methamphetamine use between bisexual men and gay/lesbian women. CONCLUSIONS Patterns of cocaine and methamphetamine use across the life course for LGB individuals differ from those of heterosexuals. This has implications for targeted prevention efforts to address stimulant use among minoritized populations.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Emily R Greene
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | | | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Tara McCrimmon
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
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Individual Experiences with Being Pushed to Limits and Variables That Influence the Strength to Which These Are Felt: A Cross-Sectional Survey Study. J 2022. [DOI: 10.3390/j5030024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In a 2021 survey, we found that “limit or suppression experiences” were related to a willingness to use enhancement technologies. However, the concept of “limit or suppression experiences” is vague and difficult to interpret in relation to neuroethics/enhancement. Thus, we aimed to better understand “limit or suppression experiences” and establish a robust philosophical concept of the topic. To do so, we exploratively investigated the concept to determine individual experiences with the presence or absence of sensing limits, investigate different ways in which limits can be sensed (factors of the sense of limits: “FSLs”), and identify factors that correlate with the strength of FSLs. Data from an Internet survey investigating respondents’ experiences with limits (1258 respondents) were analyzed using exploratory factor analysis and a linear regression model. Five variables were extracted as the FSLs. The highest regression coefficients were found between physical FSL and sports activities and between cognitive FSL and academics. The lowest regression coefficients were found between relational FSL and academics, sports activities, and arts and cultural activities. The results facilitate a detailed discussion of the motivations of enhancement users, and the extraction of the suppression experience opens new enhancement directions. Further normative and empirical studies are required.
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Hazani HM, Naina Mohamed I, Muzaimi M, Mohamed W, Yahaya MF, Teoh SL, Pakri Mohamed RM, Mohamad Isa MF, Abdulrahman SM, Ramadah R, Kamaluddin MR, Kumar J. Goofballing of Opioid and Methamphetamine: The Science Behind the Deadly Cocktail. Front Pharmacol 2022; 13:859563. [PMID: 35462918 PMCID: PMC9021401 DOI: 10.3389/fphar.2022.859563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
Globally, millions of people suffer from various substance use disorders (SUD), including mono-and polydrug use of opioids and methamphetamine. Brain regions such as the cingulate cortex, infralimbic cortex, dorsal striatum, nucleus accumbens, basolateral and central amygdala have been shown to play important roles in addiction-related behavioral changes. Clinical and pre-clinical studies have characterized these brain regions and their corresponding neurochemical changes in numerous phases of drug dependence such as acute drug use, intoxication, craving, withdrawal, and relapse. At present, many studies have reported the individual effects of opioids and methamphetamine. However, little is known about their combined effects. Co-use of these drugs produces effects greater than either drug alone, where one decreases the side effects of the other, and the combination produces a prolonged intoxication period or a more desirable intoxication effect. An increasing number of studies have associated polydrug abuse with poorer treatment outcomes, drug-related deaths, and more severe psychopathologies. To date, the pharmacological treatment efficacy for polydrug abuse is vague, and still at the experimental stage. This present review discusses the human and animal behavioral, neuroanatomical, and neurochemical changes underlying both morphine and methamphetamine dependence separately, as well as its combination. This narrative review also delineates the recent advances in the pharmacotherapy of mono- and poly drug-use of opioids and methamphetamine at clinical and preclinical stages.
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Affiliation(s)
- Hanis Mohammad Hazani
- Department of Physiology, Faculty of Medicine, The National University of Malaysia, Cheras, Malaysia
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, The National University of Malaysia, Cheras, Malaysia
| | - Mustapha Muzaimi
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Wael Mohamed
- Basic Medical Science Department, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia
- Faculty of Medicine, Department of Clinical Pharmacology, Menoufia University, Shebin El-Kom, Egypt
| | - Mohamad Fairuz Yahaya
- Department of Anatomy, Faculty of Medicine, National University of Malaysia, Cheras, Malaysia
| | - Seong Lin Teoh
- Department of Anatomy, Faculty of Medicine, National University of Malaysia, Cheras, Malaysia
| | | | | | | | - Ravi Ramadah
- National Anti-Drugs Agency Malaysia, Selangor, Malaysia
| | - Mohammad Rahim Kamaluddin
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, The National University of Malaysia, Bangi, Malaysia
| | - Jaya Kumar
- Department of Physiology, Faculty of Medicine, The National University of Malaysia, Cheras, Malaysia
- *Correspondence: Jaya Kumar,
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Boileau-Falardeau M, Contreras G, Gariépy G, Laprise C. Patterns and motivations of polysubstance use: a rapid review of the qualitative evidence. Health Promot Chronic Dis Prev Can 2022; 42:47-59. [PMID: 35170930 PMCID: PMC8935897 DOI: 10.24095/hpcdp.42.2.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Polysubstance use-the use of substances at the same time or close in time-is a common practice among people who use drugs. The recent rise in mortality and overdose associated with polysubstance use makes understanding current motivations underlying this pattern critical. The objective of this review was to synthesize current knowledge of the reasons for combining substances in a single defined episode of drug use. METHODS We conducted a rapid review of the literature to identify empirical studies describing patterns and/or motivations for polysubstance use. Included studies were published between 2010 and 2021 and identified using MEDLINE, Embase, PsycINFO and Google Scholar. RESULTS We included 13 qualitative or mixed-method studies in our analysis. Substances were combined sequentially to alleviate withdrawal symptoms or prolong a state of euphoria ("high"). Simultaneous use was motivated by an intention to counteract or balance the effect(s) of a substance with those of another, enhance a high or reduce overall use, and to mimic the effect of another unavailable or more expensive substance. Self-medication for a pre-existing condition was also the intention behind sequential or simultaneous use. CONCLUSION Polysubstance use is often motivated by a desire to improve the experience based on expected effects of combinations. A better understanding of the reasons underlying substance combination are needed to mitigate the impact of the current overdose crisis.
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Affiliation(s)
- Michèle Boileau-Falardeau
- Public Health Agency of Canada, Montréal, Quebec, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Geneviève Gariépy
- Public Health Agency of Canada, Montréal, Quebec, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Quebec, Canada
| | - Claudie Laprise
- Public Health Agency of Canada, Montréal, Quebec, Canada
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montréal, Quebec, Canada
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Philbin MM, Greene ER, Martins SS, LaBossier NJ, Mauro PM. Medical, Nonmedical, and Illegal Stimulant Use by Sexual Identity and Gender. Am J Prev Med 2020; 59:686-696. [PMID: 32981768 PMCID: PMC7577928 DOI: 10.1016/j.amepre.2020.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Major knowledge gaps regarding medical and nonmedical prescription stimulant use and illegal stimulant use (i.e., cocaine/crack/methamphetamine) by sexual identity and gender have implications for individuals' health and well-being. This study improves stimulant use measurement by differentiating the type of stimulant use and focusing on lesbian, gay, and bisexual subpopulations. METHODS Data were pooled for adults in the 2015-2017 National Survey on Drug Use and Health (n=126,463; analyzed in 2019). Gender-stratified logistic regression models examined associations between sexual identity and past-year illegal stimulant use. Gender-stratified multinomial logistic regression models estimated odds of (1) medical use only versus no past-year prescription stimulant use, (2) any nonmedical stimulant use versus no past-year use, and (3) any nonmedical stimulant use versus medical use only. RESULTS Illegal stimulant use varied by sexual identity (men: gay, 9.2%; bisexual, 7.5%; heterosexual, 3.2%; women: gay/lesbian, 3.2%; bisexual, 7.8%; heterosexual, 1.5%), as did nonmedical prescription stimulant use. Relative to same-gender heterosexuals, gay (AOR=2.61, 95% CI=2.00, 3.40) and bisexual (AOR=1.70, 95% CI=1.24, 2.33) men had higher odds of past-year illegal stimulant use, as did gay/lesbian (AOR=1.63, 95% CI=1.16, 2.28) and bisexual (AOR=2.70, 95% CI=2.23, 3.26) women. Sexual minorities reported higher odds of nonmedical prescription stimulant use than heterosexuals. Any nonmedical prescription opioid use was reported by 26.4% of people who reported nonmedical stimulant use and 27.0% of people who reported illegal stimulant use. CONCLUSIONS Lesbian, gay, and bisexual individuals had a higher prevalence of stimulant use than their heterosexual counterparts. This has important implications for health disparities, especially given the high levels of polysubstance use. Taking a multilevel approach is crucial to reduce stimulant-related harms for lesbian, gay, and bisexual individuals.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York.
| | - Emily R Greene
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | | | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Valente PK, Bazzi AR, Childs E, Salhaney P, Earlywine J, Olson J, Biancarelli DL, Marshall BDL, Biello KB. Patterns, contexts, and motivations for polysubstance use among people who inject drugs in non-urban settings in the U.S. Northeast. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102934. [PMID: 32911318 PMCID: PMC7770041 DOI: 10.1016/j.drugpo.2020.102934] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/12/2020] [Accepted: 08/20/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Polysubstance use (i.e., using ≥2 psychoactive substances concomitantly) is associated with increased morbidity and mortality and complicates drug treatment needs among people who inject drugs (PWID). We explored patterns, contexts, motivations, and perceived consequences of polysubstance use among PWID in small cities and towns in the U.S. Northeast. METHODS Between October 2018 and March 2019, we conducted semi-structured interviews with 45 PWID living outside of the capital cities of Rhode Island and Massachusetts recruited online and through community-based organizations. Written transcripts were coded inductively and deductively using a team-based approach and analyzed thematically. RESULTS All participants reported recent polysubstance use, with most using five or more classes of substances in the past three months. Polysubstance use often followed long personal drug use histories (i.e., years or decades of occasional drug use). Reasons for polysubstance use included obtaining synergistic psychoactive effects as a result of mixing drugs (i.e., using drugs to potentiate effects of other drugs) and managing undesirable effects of particular drugs (e.g., offsetting the depressant effects of opioids with stimulants or vice-versa). Polysubstance use to self-medicate poorly managed physical and mental health conditions (e.g., chronic pain, anxiety, and depression) was also reported. Inadequately managed cravings and withdrawal symptoms prompted concomitant use of heroin and medications for opioid use disorder, including among individuals reporting cocaine or crack as their primary "issue" drugs. Polysubstance use was perceived to increase overdose risks and to be a barrier to accessing healthcare and drug treatment services. CONCLUSION Healthcare services and clinicians should acknowledge, assess, and account for polysubstance use among patients and promote harm reduction approaches for individuals who may be using multiple drugs. Comprehensive healthcare that meets the social, physical, mental health, and drug treatment needs of PWID may decrease the perceived need for polysubstance use to self-medicate poorly managed health conditions and symptoms.
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Ellen Childs
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Peter Salhaney
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Joel Earlywine
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Jennifer Olson
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Dea L Biancarelli
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA.
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Morgan E, Feinstein BA, Dyar C. Disparities in Prescription Opioid Misuse Affecting Sexual Minority Adults Are Attenuated by Depression and Suicidal Ideation. LGBT Health 2020; 7:431-438. [PMID: 33112701 DOI: 10.1089/lgbt.2020.0220] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: Heightened rates of prescription opioid misuse have been observed among sexual minority (SM) compared with heterosexual populations. In addition, depression and suicidal ideation are risk factors for misuse, and they are also elevated among SM populations. The purpose of this analysis was to examine whether depression and suicidal ideation attenuate disparities in prescription opioid misuse among SM adults. Methods: Data came from a publicly available, nationally representative data set, the National Survey on Drug Use and Health, 2015-2018. Among adults, survey-weighted logistic regression was used to assess the relationship between sexual orientation and past-year opioid misuse adjusting for demographics and either past-year major depressive episode or suicidal ideation. Probabilities of prescription opioid misuse were also assessed under counterfactual rates of depression and suicidal ideation. Analyses were stratified by sex. Results: Among participants in the analytic sample (N = 169,759; SM = 11,268), 9254 (5.5%) reported past-year prescription opioid misuse. The overall rate of opioid misuse decreased from 6.2% in 2015 to 4.6% in 2018. The association between sexual orientation and opioid misuse was attenuated downward for gay men, lesbian women, and bisexual individuals (men and women) after adjusting for either major depressive episode or suicidal ideation, but opioid misuse remained higher among most SM groups. In addition, rates of opioid misuse were found to be lower in counterfactual analyses with a nearly 2.5- and 4-fold decrease in depression and suicidal ideation among gay men and bisexual women, respectively. Conclusion: Efforts to reduce disparities in depression and suicidal ideation affecting SM individuals may reduce disparities in prescription opioid misuse affecting this population.
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Affiliation(s)
- Ethan Morgan
- Infectious Disease Institute, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
| | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
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Boyle SC, LaBrie JW, Omoto AM. Normative Substance Use Antecedents among Sexual Minorities: A Scoping Review and Synthesis. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2020; 7:117-131. [PMID: 34079845 DOI: 10.1037/sgd0000373] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although sexual minority stress remains the dominant perspective for understanding disproportionate substance use among lesbian, gay and bisexual (LGB) populations, social norms are among the most predictive and commonly targeted substance use antecedents in other high-risk groups. This scoping review seeks to bring clarity to the body of norms-focused alcohol, tobacco, and other drug (ATOD) research conducted with LGBs over the past 20 years, identify intervention implications, and present priority directions for future research. Fifty-two peer-reviewed studies published between June 1999 and June 2019 were identified from searches of PubMed, PsycInfo, and Medline databases using combinations of terms related to: social norms; sexual orientation or sexual minority status; and, the use of alcohol, tobacco, and other drugs. A far greater number of studies focused on actual ATOD norms than perceived ATOD norms or discrepancies between actual or perceived norms, illuminating the need for additional research focused on these levels of analysis. Taken together, this literature suggests that: (1) perceived ATOD norms are reliable predictors of LGBs' ATOD use; (2) actual ATOD use norms are low among LGBs participating in representative, population-based survey studies; and, (3) LGBs over-estimate the ATOD use of peers. Thus, intervention strategies including personalized normative feedback, psychoeducation, and social branding may hold promise in reducing LGBs substance use. However, additional research is needed to increase our understanding of injunctive ATOD norms, identify meaningful LGB reference groups, elucidate environmental influences on ATOD norms, and examine relationships between stigma experiences, perceived norms, and ATOD use.
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Affiliation(s)
- Sarah C Boyle
- Claremont Graduate University, Claremont, CA, 91711.,Loyola Marymount University, Los Angeles, CA, 90045
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Votaw VR, Geyer R, Rieselbach MM, McHugh RK. The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend 2019; 200:95-114. [PMID: 31121495 PMCID: PMC6639084 DOI: 10.1016/j.drugalcdep.2019.02.033] [Citation(s) in RCA: 209] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research. METHODS PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse. RESULTS The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment. CONCLUSIONS Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.
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Affiliation(s)
- Victoria R. Votaw
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, USA,Corresponding author: Victoria R. Votaw, Clinical Psychology Ph.D. Student Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, Albuquerque, NM 87131,
| | - Rachel Geyer
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - Maya M. Rieselbach
- Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA
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W Hawkins B, Armstrong HL, Kesselring S, Rich AJ, Cui Z, Sereda P, Howard T, Forrest JI, Moore DM, Lachowsky NJ, Hogg RS, Roth EA. Substance Use as a Mechanism for Social Inclusion among Gay, Bisexual, and Other Men Who Have Sex with Men in Vancouver, Canada. Subst Use Misuse 2019; 54:1945-1955. [PMID: 31142175 PMCID: PMC7055638 DOI: 10.1080/10826084.2019.1621901] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Previous research demonstrates that substance use preferences and social-sexual environments are highly interrelated for gay, bisexual, and other men who have sex with men (gbMSM). Objective: We conducted a qualitative study to explore the socio-cultural context of substance use among local gbMSM communities in Metro Vancouver, Canada. Methods: Twenty gbMSM were purposively sampled from the larger Momentum Health Study cohort, a sexual health study of gbMSM in Greater Vancouver. Participants were demographically diverse in terms of HIV serostatus, age, income, ethnicity, and area of residence within the city and neighboring suburbs. Community maps generated by participants during formative research served as prompts for semi-structured interviews which were audio recorded and transcribed verbatim. Thematic analysis identified three themes of common experience. Results: First, participants indicated that substance use is intrinsically social in Vancouver gbMSM communities and that it functions as both a means of social inclusion and exclusion. Second, a distinction was made between types of substances and the location and context of their use, with specific substances having particular uses and meanings. Third, analysis suggested that gbMSM change their substance use over the life course and that this is affected by shifting priorities as people age. Discussion: For Vancouver gbMSM communities, substance use serves several social-cultural functions and can simultaneously serve as both a potential facilitator and barrier for community connection. Future research and health programing should consider venue and context specific messaging and recognize the heterogeneity of substance use within the larger gbMSM population.
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Affiliation(s)
- Blake W Hawkins
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia , Vancouver , British Columbia , Canada
| | - Heather L Armstrong
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - Sarah Kesselring
- Population Data BC, University of British Columbia , Vancouver , British Columbia , Canada
| | - Ashleigh J Rich
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - Zishan Cui
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Paul Sereda
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Terry Howard
- Community Advisory Board, Momentum Health Study , Vancouver , British Columbia , Canada
| | - Jamie I Forrest
- Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - David M Moore
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - Nathan J Lachowsky
- School of Public Health & Social Policy, University of Victoria , Victoria , British Columbia , Canada.,Centre for Addictions Research BC , Victoria , British Columbia , Canada
| | - Robert S Hogg
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,Faculty of Health Sciences, Simon Fraser University , Burnaby , British Columbia , Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria , Victoria , British Columbia , Canada
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Li DH, Janulis P, Mustanski B. Predictors of correspondence between self-reported substance use and urinalysis screening among a racially diverse cohort of young men who have sex with men and transgender women. Addict Behav 2019; 88:6-14. [PMID: 30099289 PMCID: PMC6291201 DOI: 10.1016/j.addbeh.2018.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 11/28/2022]
Abstract
It is unknown if estimates of illicit drug use among young men who have sex with men and transgender women (YMSM/TW) may be biased due to historical distrust of research or reliable due to more accepting norms for use. Research is needed to examine the validity of drug use self-reports among YMSM/TW. Data came from an ongoing longitudinal study of YMSM/TW aged 16-29 living in Chicago (analytic N = 1029). Baseline urinalysis screens for marijuana, ecstasy, amphetamine, methamphetamine, cocaine, benzodiazepine, and opiate metabolites were compared to self-reported use within different recall periods using measures of concordance. Generalized estimating equations logistic regressions were conducted on three waves of data to identify predictors of disclosing past-6-month use of marijuana and non-marijuana drugs. Past-6-month self-reported use of all non-marijuana substances was <15%. There was excellent agreement between self-reported and drug-tested marijuana use. For other substances, sensitivities within the urinalysis detection window were <0.5 but increased with longer recall periods. Black participants had lower odds of disclosing non-marijuana drug use. Gender minority participants had lower odds of disclosing marijuana use. Participants with a history of arrest had higher odds of disclosing both marijuana and non-marijuana drug use. Wave and year of first research participation were non-significant, suggesting no systematic bias or increasing honesty associated with longer research participation. Programs that rely on self-identification of non-marijuana illicit substance use may be missing a substantial portion of drug-using YMSM/TW. Future epidemiological studies should work to reduce social desirability biases and include biomarker-based drug screenings to increase validity.
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Affiliation(s)
- Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | - Patrick Janulis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Li DH, Turner BC, Mustanski B, Phillips GL. Sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents: Prevalence and correlates. Addict Behav 2018; 77:143-151. [PMID: 29017108 PMCID: PMC5701833 DOI: 10.1016/j.addbeh.2017.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/14/2017] [Accepted: 09/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Sexual minority adolescents (SMA) may be at disproportionate risk for misusing prescription psychotropic medications compared to their heterosexual peers. However, generalizable studies specific to this age group are lacking. The current study aimed to describe the prevalence of sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents as well as to examine key correlates of misuse. METHOD Using data from the National Youth Risk Behavior Survey, we conducted stepwise multivariable weighted logistic regressions, sequentially controlling for demographics, experiences of victimization, mental health, and other illicit substance use. RESULTS Adjusting for grade and race/ethnicity, female SMA and gay and unsure males had significantly elevated odds of ever misusing a prescription drug compared to heterosexual adolescents (ORs from 1.7-2.5). Most sexual orientation disparities among females remained significant with the addition of victimization and mental health covariates but attenuated completely after controlling for other illicit drug use. The effect for unsure males attenuated when victimization variables were included, but the effect for gay males remained significant through the final model. Controlling for other illicit drug use, mental health variables remained significant correlates for females whereas only forced sex was significant for males. CONCLUSION These results suggest experiences of victimization and mental health partially account for the disparities in prescription drug misuse between SMA and heterosexual adolescents, and their effects may differ by sex. A combination of structural, individual coping, and universal drug prevention approaches should be used to make the largest impact on reducing these disparities.
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Affiliation(s)
- Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States.
| | - Blair C Turner
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Gregory L Phillips
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
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Li DH, Mustanski B. Prevalence and Correlates of Prescription Drug Misuse Among a Racially Diverse Sample of Young Sexual Minority Men. LGBT Health 2018; 5:95-104. [PMID: 29360421 DOI: 10.1089/lgbt.2017.0125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Sexual minority men (SMM) are at greater risk than heterosexual men for misusing prescription psychotropic medications. However, community prevalence estimates of prescription drug misuse among young SMM are lacking. The current study described lifetime and past-6-month stimulant, painkiller, and depressant/tranquilizer misuse in a large, racially diverse sample of 967 SMM aged 16-29 in Chicago, Illinois, and investigated demographic and other substance use associations. METHODS Data came from the baseline visit of the RADAR longitudinal cohort study. Associations were examined using bivariate and multivariable logistic regression. RESULTS A quarter of the sample reported ever misusing any prescription drug, and 14.2% reported recent misuse. Lifetime class-specific misuse was 16.9% for stimulants, 11.0% for painkillers, and 11.4% for depressants/tranquilizers; recent misuse was 8.0%, 5.7%, and 6.2%, respectively. In multivariable analysis, Non-Hispanic black participants had lower odds of lifetime stimulant and depressant/tranquilizer misuse and recent stimulant misuse than non-Hispanic white participants, and bisexual participants had greater odds of lifetime and recent painkiller and depressant/tranquilizer misuse than gay participants. Generally, using other substances was associated with greater odds of prescription drug misuse. Having ever been prescribed a psychotropic medication was associated with higher odds of lifetime painkiller misuse after controlling for covariates. CONCLUSION These results provide critical information on a growing public health problem among young SMM. Future research should explore why differential rates of misuse exist across subgroups. New interventions emphasizing the risk of prescription drugs, discouraging drug sharing, and bolstering refusal and coping skills should be developed and evaluated.
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Affiliation(s)
- Dennis H Li
- 1 Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University , Chicago, Illinois.,2 Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Brian Mustanski
- 1 Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University , Chicago, Illinois.,2 Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
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Feinstein BA, Moody RL, John SA, Parsons JT, Mustanski B. A three-city comparison of drug use and drug use before sex among young men who have sex with men in the United States. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2017; 30:82-101. [PMID: 30381785 PMCID: PMC6205241 DOI: 10.1080/10538720.2018.1408519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
High rates of drug use have been documented among young men who have sex with men (YMSM). However, updated prevalence data are needed to understand current trends, especially for drug use before sex. We used baseline data from an HIV prevention trial to examine demographic differences in drug use (in general and before sex) among YMSM in Atlanta, Chicago, and NYC. Marijuana was the most commonly used drug, but alkyl nitrites ("poppers"), cocaine, and Ecstasy were also common. Drug use was more prevalent among older and White YMSM, and it was similar between cities, except use of poppers was higher in NYC. Our data generally support national prevention efforts.
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Affiliation(s)
- Brian A. Feinstein
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL 60611
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, 625 N Michigan Ave Suite 2700, Chicago, IL 60611
| | - Raymond L. Moody
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), 365 Fifth Ave, New York, NY 10016
- Center for HIV/AIDS Educational Studies & Training, 142 W 36 St, 9 Floor, New York, NY 10018
| | - Steven A. John
- Center for HIV/AIDS Educational Studies & Training, 142 W 36 St, 9 Floor, New York, NY 10018
| | - Jeffrey T. Parsons
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), 365 Fifth Ave, New York, NY 10016
- Center for HIV/AIDS Educational Studies & Training, 142 W 36 St, 9 Floor, New York, NY 10018
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave, New York, NY 10065
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL 60611
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, 625 N Michigan Ave Suite 2700, Chicago, IL 60611
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Aarstad-Martin S, Boyraz G. Posttraumatic Stress, Risky Drinking, and Prescription Drug Misuse in Trauma-Exposed College Students. JOURNAL OF LOSS & TRAUMA 2017. [DOI: 10.1080/15325024.2017.1360590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Güler Boyraz
- Department of Psychology and Behavioral Sciences, Louisiana Tech University, Ruston, LA
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Motta-Ochoa R, Bertrand K, Arruda N, Jutras-Aswad D, Roy É. "I love having benzos after my coke shot": The use of psychotropic medication among cocaine users in downtown Montreal. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 49:15-23. [PMID: 28826127 DOI: 10.1016/j.drugpo.2017.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 03/21/2017] [Accepted: 07/10/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cocaine abuse is a major public health issue due to its role in the HIV and hepatitis C virus (HCV) epidemics in North America. A significant area of concern among people who use cocaine (PWUC), injected or smoked, is their frequent misuse of prescription drugs, particularly psychotropic medication (PM), such as tranquilizers, sedatives, stimulants, and antipsychotics. This paper aims to describe and understand practices of PM use among PWUC in downtown Montreal. METHOD Ethnographic methods including participant observation and semi-structured interviews were used in an iterative manner. RESULTS Two thirds of the 50 participants were male. They ranged in age from 20 to 60 and most were homeless. A significant proportion of them reported polydrug use patterns that included frequent concomitant opioid use (heroin and/or prescription opioids (PO)). Benzodiazepine-based tranquilizers and the atypical antipsychotic quetiapine were the most frequently used PM. Routes of PM administration were oral, nasal and, to a lesser degree, intravenous. Five main PM use practices were identified: 1) "downers" from cocaine high (benzodiazepines and quetiapine); 2) enhancers of heroin/PO effects (benzodiazepines); 3) reducers or suppressors of heroin/PO withdrawal symptoms (benzodiazepines); 4) enablers of a different type of "trip" (benzodiazepines); and 5) treatment for mental and physical problems (benzodiazepines and quetiapine). CONCLUSION PM use practices showed several complementary functions that PM fulfill in a context of polydrug use. The soothing and stimulating effects of PM reinforce the patterns of drug use among participants, posing various risks including overdose, HIV/HCV transmission, PM dependence and accidents. The results highlight the need for clinicians to assess clients' substance use patterns when prescribing PM and to question PWUC about PM use. The findings also underline certain unmet service needs in relation to overdose, HIV/HCV and mental health prevention/treatment among cocaine users.
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Affiliation(s)
- Rossio Motta-Ochoa
- Addiction Unit, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-LeMoyne, Office 200, Longueuil, Quebec, J4K 0A8, Canada.
| | - Karine Bertrand
- Addiction Unit, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-LeMoyne, Office 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Nelson Arruda
- Addiction Unit, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-LeMoyne, Office 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Didier Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada; Department of Psychiatry, Université de Montréal, Université de Montréal, Pavillon Roger-Gaudry, Faculté de médecine, Département de psychiatrie, C.P. 6128, succursale Centre-ville Montréal, Québec, H3C 3J7, Canada
| | - Élise Roy
- Addiction Unit, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-LeMoyne, Office 200, Longueuil, Quebec, J4K 0A8, Canada; Institut national de santé publique du Québec, 190, boulevard Crémazie Est Montréal, Québec, H2P 1E2, Canada
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Rönkä S, Katainen A. Non-medical use of prescription drugs among illicit drug users: A case study on an online drug forum. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 39:62-68. [DOI: 10.1016/j.drugpo.2016.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 08/26/2016] [Accepted: 08/29/2016] [Indexed: 12/24/2022]
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Bluthenthal RN, Kral AH. Next steps in research on injection initiation incidence and prevention. Addiction 2015; 110:1258-9. [PMID: 26173157 DOI: 10.1111/add.13001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ricky N Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alex H Kral
- Behavioral and Urban Health Program, RTI International, San Francisco, CA, USA
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