"Something that actually works": Cannabis use among young people in the context of street entrenchment

Use of Cannabis for Medical or Recreational Purposes Among US Young Adults: Correlates and Implications for Problematic Use and Interest in Quitting

Objective

Recreational and medical cannabis use has increased, particularly among young adults, but little is known regarding who uses for these purposes or how purpose of use is associated with problematic use.

Methods

We analyzed Fall 2019 survey data among 1,083 US young adults (ages 18-34) reporting past 6-month cannabis use. Multivariable regression analyses examined: 1) characteristics of those using for only/primarily medical purposes, primarily recreationally, and only recreationally vs. equally for medical and recreational purposes (referent; multinomial logistic); and 2) reasons for use in relation to cannabis use disorder symptoms (linear) and driving under the influence of cannabis (DUIC; binary logistic).

Results

37.1% used only recreationally, 23.5% primarily recreationally, 21.5% equally for both, and 17.8% medically. Compared to those using equally for medical and recreational purposes, those using only/primarily medically had fewer friends who used cannabis; those using primarily recreationally were younger, more educated, less likely used tobacco, and reported fewer ACEs. Those using only recreationally were younger, more likely male, less likely to report an ADHD diagnosis or past-month alcohol or tobacco use, and reported fewer friends who used cannabis, ACEs, and depressive symptoms. Using equally for medical and recreational purposes (vs. all other cannabis use subgroups) correlated with greater use disorder symptoms and DUIC.

Conclusions

Using cannabis equally for medical and recreational purposes may pose particularly high-risk, given the association with greater mental health concerns and problematic use. Understanding use profiles and how young adults interpret and distinguish medical and recreational use is critical.

The social-structural contexts of cannabis consumption and harm reduction among young Nigerian women

BACKGROUND

Young women remain under-represented in the research literature on young people's cannabis use. This study explored cannabis use and harm reduction practices of young Nigerian women.

METHODS

The study draws on 19 in-depth interviews conducted with young women aged 21-35 years who were recruited through time-location sampling in Uyo, Nigeria. Interview transcripts were subjected to thematic coding and analysis.

RESULTS

Accounts highlighted a rapid progression from occasional consumption during hang-outs to regular and heavy consumption for most participants. Frequent and heavy cannabis use, shaped by trauma, stress and mental health problems linked to participants' marginal social locations, established a context of risk for health harms. The participants sought to reduce harms by attempting to reduce frequency and quantity of cannabis consumed, often with limited success. They also micro-dosed to monitor drug effects, avoided mixing cannabis with more potent drugs, sought out cannabis strains with lower THC as well as consuming privately to reduce social harms such as violence and police arrest associated with using in street milieus. On the other hand, cannabis consumption was seen as helping to reduce harms by providing a relatively safer and less addictive alternative to drugs such as heroin and pharmaceutical opioids, preventing high-risk sexual exchanges often associated with opioid withdrawal among women, and relieving pain.

CONCLUSIONS

Cannabis was consumed recreationally at first, and harmful consumption patterns developed from using cannabis to treat the psychological symptoms of structural inequalities. The analysis supports the social-structural production of drug-related harms, foregrounding the importance of structural-level interventions for creating an enabling environment for safer consumption.

A randomized controlled trial of a brief motivational interviewing-based group intervention for emerging adults experiencing homelessness: 12-Month effects on substance use and sexual risk behavior

INTRODUCTION

Few brief evidence-based risk reduction programs for emerging adults experiencing homelessness focus on the interrelated problems of substance use and sexual risk behavior. This study examines outcomes from a 12-month evaluation of AWARE, a brief Motivational Interviewing (MI)-based group risk reduction intervention for this population.

METHODS

In a cluster randomized crossover trial, N = 276 18-25-year-olds received AWARE or usual care at drop-in centers serving homeless youth in Los Angeles County. We evaluated intervention effects on substance use and condomless sex (primary outcomes), as well as drinking consequences and protective strategies, number of casual partners, self-efficacy, and motivation for change (secondary outcomes).

RESULTS

AWARE participants self-reported reductions in their alcohol use and negative consequences from drinking, and an increase in use of drinking protective strategies. AWARE participants also reported an initial decrease in drug use other than marijuana, followed by a slight uptake later on, as well as an initial increase in importance of cutting down on other drug use followed by a decrease. Control group participants did not show change in these outcomes. Among those who reported casual sex partners at both baseline and 12-month surveys, exploratory analyses indicated that AWARE participants had a 29 % decline in condomless sex with casual partners compared to a 6 % decline for control group participants.

CONCLUSIONS

Findings build on our pilot work by demonstrating that AWARE has long-term benefits on drinking among emerging adults experiencing homelessness. Further work should seek to strengthen its long-term effectiveness in reducing drug use in this population.

Cannabis use to manage opioid cravings among people who use unregulated opioids during a drug toxicity crisis

BACKGROUND

Accumulating evidence has indicated that cannabis substitution is often used as a harm reduction strategy among people who use unregulated opioids (PWUO) and people living with chronic pain. We sought to investigate the association between cannabis use to manage opioid cravings and self-reported changes in opioid use among structurally marginalized PWUO.

METHODS

The data were collected from a cross-sectional questionnaire administered to PWUO in Vancouver, Canada. Binary logistic regression was used to analyze the association between cannabis use to manage opioid cravings and self-reported changes in unregulated opioid use.

RESULTS

A total of 205 people who use cannabis and opioids were enrolled in the present study from December 2019 to November 2021. Cannabis use to manage opioid cravings was reported by 118 (57.6%) participants. In the multivariable analysis, cannabis use to manage opioid cravings (adjusted Odds Ratio [aOR] = 2.13, 95% confidence interval [CI]: 1.07, 4.27) was significantly associated with self-reported reductions in opioid use. In the sub-analyses of pain, cannabis use to manage opioid cravings was only associated with self-assessed reductions in opioid use among people living with moderate to severe pain (aOR = 4.44, 95% CI: 1.52, 12.97). In the sub-analyses of males and females, cannabis use to manage opioid cravings was only associated with self-assessed reductions in opioid use among females (aOR = 8.19, 95% CI: 1.20, 55.81).

CONCLUSIONS

These findings indicate that cannabis use to manage opioid cravings is a prevalent motivation for cannabis use among PWUO and is associated with self-assessed reductions in opioid use during periods of cannabis use. Increasing the accessibility of cannabis products for therapeutic use may be a useful supplementary strategy to mitigate exposure to unregulated opioids and associated harm during the ongoing drug toxicity crisis.

An answered call for aid? Cannabinoid clinical framework for the opioid epidemic

BACKGROUND

The opioid crisis continues in full force, as physicians and caregivers are desperate for resources to help patients with opioid use and chronic pain disorders find safer and more accessible non-opioid tools.

MAIN BODY

The purpose of this article is to review the current state of the opioid epidemic; the shifting picture of cannabinoids; and the research, policy, and current events that make opioid risk reduction an urgent public health challenge. The provided table contains an evidence-based clinical framework for the utilization of cannabinoids to treat patients with chronic pain who are dependent on opioids, seeking alternatives to opioids, and tapering opioids.

CONCLUSION

Based on a comprehensive review of the literature and epidemiological evidence to date, cannabinoids stand to be one of the most interesting, safe, and accessible tools available to attenuate the devastation resulting from the misuse and abuse of opioid narcotics. Considering the urgency of the opioid epidemic and broadening of cannabinoid accessibility amidst absent prescribing guidelines, the authors recommend use of this clinical framework in the contexts of both clinical research continuity and patient care.

Use of Cannabis as a Harm Reduction Strategy Among People Who Use Drugs: A Cohort Study

Introduction: While substance use contributes to a substantial burden of disease, access to evidence-based harm reduction interventions remains limited or inaccessible. Preliminary research suggests that some individuals use cannabis to reduce the harms associated with their use of other substances, including opioids and stimulants. This study examines factors associated with the self-reported use of cannabis for harm reduction among people who use drugs (PWUD). Methods: We drew data from three prospective, community-recruited cohorts of PWUD in Vancouver, Canada, between June 2016 and May 2018. Multivariable generalized linear mixed-effects modeling was used to examine factors associated with the primary outcome of "use of cannabis for harm reduction," defined as self-reported use of cannabis to substitute for other substances, treat withdrawal, or come down off other drugs. Results: One thousand nine hundred thirty-six participants contributed 5706 observations. In adjusted analyses, daily methamphetamine use (adjusted odds ratio [AOR]=1.43, 95% confidence interval [CI]: 1.09-1.89), experiencing barriers to accessing addiction treatment (AOR=1.92, 95% CI: 1.21-3.03), and enrollment in addiction treatment modalities other than opioid agonist therapy (AOR=1.64, 95% CI: 1.17-2.29) were positively associated with using cannabis for harm reduction. Older age was negatively associated (AOR=0.97, 95% CI: 0.95-0.98). Among 1281 (66.2%) participants who use cannabis, daily cannabis use and obtaining cannabis from unregulated dispensaries were also independent correlates of using cannabis for harm reduction. Discussion and Conclusions: Individuals who were more likely to use cannabis for harm reduction reported difficulty accessing addiction treatment or used substances, such as methamphetamines, where effective treatments are limited. These findings highlight the need to better understand the potential harm-reducing impacts of cannabis among PWUD in these scenarios.

Digital interventions for substance use disorders in young people: rapid review

BACKGROUND

Young people are disproportionately more likely than other age groups to use substances. The rise in substance use and related harms, including overdose, during the Covid-19 pandemic has created a critical need for more innovative and accessible substance use interventions. Digital interventions have shown effectiveness and can provide more engaging, less stigmatizing, and accessible interventions that meet the needs of young people. This review provides an overview of recent literature on the nature of recently published digital interventions for young people in terms of technologies used, substances targeted, intended outcomes and theoretical or therapeutic models employed.

METHODS

Rapid review methodology was used to identify and assess the literature on digital interventions for young people. An initial keyword search was conducted using MEDLINE the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA) and PROSPERO for the years 2015-2020, and later updated to December 2021. Following a title/abstract and full-text screening of articles, and consensus decision on study inclusion, the data extraction process proceeded using an extraction grid developed for the study. Data synthesis relied on an adapted conceptual framework by Stockings, et al. that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment) for any type of substance.

RESULTS

In total, the review identified 43 articles describing 39 different digital interventions. Most were early interventions (n = 28), followed by prevention interventions (n = 6) and treatment interventions (n = 5). The identified digital technologies included web-based (n = 14), game-based (n = 10), mobile-based (n = 7), and computer-based (n = 5) technologies, and virtual reality (n = 3). Most interventions targeted alcohol use (n = 20) followed by tobacco/nicotine (n = 5), cannabis (n = 2), opioids (n = 2), ketamine (1) and multiple, or any substances (n = 9). Most interventions used a personalized or normative feedback approach and aimed to effect behaviour change as the intended outcome. Interestingly, a harm reduction approach guided only one of the 39 interventions.

CONCLUSIONS

While web-based interventions represented the most common type of technology, more recently developed immersive and interactive technologies such as virtual reality and game-based interventions call for further exploration. Digital interventions focused mainly on alcohol use, reflecting less concern for tobacco, cannabis, co-occurring substance use, and illicit drug use. Specifically, the recent exacerbation in the opioid crisis throughout North American underlines the urgent need for more prevention-oriented digital interventions for opioid use. The uptake of digital interventions among youth also depends on the incorporation of harm reduction approaches.

A scoping review of psychiatric conditions associated with chronic pain in the homeless and marginally housed population

The present review sought to examine and summarise the unique experience of concurrent pain and psychiatric conditions, that is often neglected, within the population of homeless individuals. Furthermore, the review examined factors that work to aggravate pain and those that have been shown to improve pain management. Electronic databases (MEDLINE, EMBASE, psycINFO, and Web of Science) and the grey literature (Google Scholar) were searched. Two reviewers independently screened and assessed all literature. The PHO MetaQAT was used to appraise quality of all studies included. Fifty-seven studies were included in this scoping review, with most of the research being based in the United States of America. Several interacting factors were found to exacerbate reported pain, as well as severely affect other crucial aspects of life that correlate directly with health, within the homeless population. Notable factors included drug use as a coping mechanism for pain, as well as opioid use preceding pain; financial issues; transportation problems; stigma; and various psychiatric disorders, such as post-traumatic stress disorder, depression, and anxiety. Important pain management strategies included cannabis use, Accelerated Resolution Therapy for treating trauma, and acupuncture. The homeless population experiences multiple barriers which work to further impact their experience with pain and psychiatric conditions. Psychiatric conditions impact pain experience and can work to intensify already adverse health circumstances of homeless individuals.

Suicide Ideation, Distress, and Peer Perceptions as Predictors of Substance Use

BACKGROUND

Substance use and suicide ideation are common behaviors that often overlap among college students. However, clues about their temporal relationship, as well as moderating factors (e.g., distress, peer perceptions of substance use), are understudied. Indeed, those with a history of suicide ideation may use avoidance coping (including substance use) to manage distress, underscoring the possibility of substance use as a response to suicide ideation, an oft-stressful experience in and of itself. Further, as a low sense of belongingness confers risk for suicide ideation, distress may increase compliance with perceived cultural norms, thus increasing substance use behavior. This study examined the effect of the suicide ideation-distress-peer perception interaction on substance use.

METHOD

Participants were 3,608 undergraduate students across eleven college campuses. Measures of past month substance use frequency, general distress, peer perceptions of substance use, and past year suicide ideation were utilized.

RESULTS

Suicidal ideation was associated with e-cigarette, marijuana, and illicit drug use. There were main effects of suicide ideation (on e-cigarette and marijuana use) and peer perceptions of substance use (on tobacco, alcohol, e-cigarette, and marijuana use), but not distress, on past 30-day substance use. Further, the three-way interaction of suicide ideation, distress, and peer perceptions of substance use predicted frequency of past month tobacco and illicit drug use.

CONCLUSIONS

Suicide ideation may be temporally linked to use of specific substances. Peer perception and distress may strengthen the suicide ideation-substance use relationship. These factors should be carefully considered when treating individuals with substance use.

Improving Harm Reduction Services: A Qualitative Study on the Perspectives of Highly Marginalized Persons Who Inject Drugs in Montreal

Harm reduction (HR) is an alternative to the moralization of drug use and a pragmatic public health approach aimed at minimizing harms associated with use. This study sought to gain the perspectives of persons who inject drugs (PWID) on the adequacy of services provided by HR organizations in Montreal. Twenty-two semi-structured interviews and two focus groups were conducted with 30 participants. Some of the key advantages of HR perceived by participants include access to injection equipment, psychosocial support, and reduced social isolation. However, many wanted more opportunities for social insertion and greater value to be placed on their knowledge and life experiences (e.g., experiential knowledge of the street scene, drug use, sex work, or homelessness). This study suggests that PWID who access HR services in Montreal are interested in paid work opportunities in environments that promote power sharing, and activities that are conducted and managed by and for them.

Attitudes to Cannabis Use and Public Prevention Information Among Young Adults: A Qualitative Interview Study With Implications for Prevention Practice

Background

Cannabis use carries an increased risk of ill health and social problems, especially when initiated at a young age. Drug use is influenced by individual beliefs, knowledge, and attitudes, which are, in turn, governed by social and environmental factors. In recent years, a less restrictive attitude toward cannabis has been observed in many countries, with concerns about increased cannabis use among young people. The aim of the current study was to gain a deeper understanding of young adults' attitudes toward cannabis use and public prevention information about cannabis.

Methods

A qualitative interview study was conducted among 32 anonymous informants aged 18-29 years in the Stockholm region. Participants were recruited through purposeful sampling, and semi-structured in-depth interviews were conducted using a digital video calling platform. A qualitative content analysis of the interviews was performed to generate categories and codes for cannabis use and attitudes toward prevention information.

Results

Both cannabis users and abstainers perceived some risks with cannabis; however, for many users, the positive effects appeared to outweigh any expected harm. Furthermore, the existing public information was perceived as less credible because of an excessive focus on harm. The informants expressed a desire for neutral facts about the effects of cannabis, delivered by credible senders. Moreover, they felt that prevention information should be delivered by individuals whom young people look up to or with whom they can identify, for example, people with authority or famous people such as influencers. The informants also underlined the importance of dialogue with the target group and taking young people's experiences into account when providing information about cannabis.

Conclusion

Current risk awareness associated with cannabis use among young adults is insufficient to prevent them from using cannabis. Public prevention information should preferably combine a fact-based focus on risks with recognition of cannabis' short-term desired effects, delivered by credible senders with authority or those with whom young people can identify.

Navigating treatment in the shadow of the overdose crisis: Perspectives of youth experiencing street-involvement across British Columbia

Objective

Youth experiencing street-involvement are particularly vulnerable to substance use-related harms. Since an overdose public health emergency was declared in British Columbia (BC) in 2016, there have been concerted efforts to expand youths' access to integrated mental health and substance use treatment across the province. The present study sought to explore how youth were navigating this rapidly evolving treatment landscape.

Methods

Focus groups were conducted with youth experiencing street-involvement in three BC cities, followed by a summit event in Vancouver. Audio recordings were transcribed verbatim and coded thematically alongside observational field notes. All activities were undertaken in collaboration with a Youth Advisory Council.

Results

Across BC, youth expressed desires to achieve aspects of what some called a "normal life" following treatment, which required having "somewhere to go next." In the absence of desirable housing and adequate income, youth were often left with the crushing sense that, despite their efforts, treatment would not ultimately help them to "get somewhere better." Negative experiences in treatment settings were also shaped by the files that "followed" youth across care settings, inappropriate information sharing between providers, and an overemphasis on pharmacotherapies (namely, opioid agonist therapies and psychotropic medications).

Conclusion

Our findings point to the inability of existing services and systems to address entrenched marginalization and chronic instability, and underscore the importance of relationship-, trust-, and future-building to providing treatment and care to youth. Young people must be empowered with control over their treatment trajectories, including decision-making surrounding pharmacotherapies and information sharing.

Harm reduction calls to action from young people who use drugs on the streets of Vancouver and Lisbon

Vancouver, Canada, and Lisbon, Portugal, are both celebrated for their world-leading harm reduction policies and programs and regarded as models for other cities contending with the effects of increasing levels of drug use in the context of growing urban poverty. However, we challenge the notion that internationally celebrated places like Lisbon and Vancouver are meeting the harm reduction needs of young people who use drugs (YPWUD; referring here to individuals between the ages of 14 and 29). In particular, the needs of YPWUD in the context of unstable housing, homelessness, and ongoing poverty—a context which we summarize here as “street involvement”—are not being adequately met. We are a group of community and academic researchers and activists working in Vancouver, Lisbon, and Pittsburgh. Most of us identify as YPWUD and have lived and living experience with the issues described in this comment. We make several calls to action to support the harm reduction needs of YPWUD in the context of street involvement in and beyond our settings.

The generative potential of mess in community-based participatory research with young people who use(d) drugs in Vancouver

Community-based participatory research (CBPR) is increasingly standard practice for critical qualitative health research with young people who use(d) drugs in Vancouver, Canada. One aim of CBPR in this context is to redress the essentialization, erasure, and exploitation of people who use(d) drugs in health research. In this paper, we reflect on a partnership that began in 2018 between three university researchers and roughly ten young people (ages 17–28) who have current or past experience with drug use and homelessness in Greater Vancouver. We focus on moments when our guiding principles of shared leadership, safety, and inclusion became fraught in practice, forcing us in some cases to re-imagine these principles, and in others to accept that certain ethical dilemmas in research can never be fully resolved. We argue that this messiness can be traced to the complex and diverse positionalities of each person on our team, including young people. As such, creating space for mess was ethically necessary and empirically valuable for our CBPR project.

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.

Co-exposure of cocaine and cannabinoids and its association with select biological, behavioural and health outcomes: A systematic scoping review of multi-disciplinary studies

Cocaine use entails severe health- and social-related harms globally. Treatment options for cocaine dependence are highly limited. Benefits of cannabinoids for addiction have been documented, making it opportune to examine existing data on the possible outcomes associated with cannabinoids and cocaine co-use. We conducted a systematic scoping review following the PRISMA guidelines of peer-reviewed, English-language studies published from 2000 to 2021 in four databases (Medline, Web-of-Science, CINAHL Plus, and PsycInfo), assessing the co-exposure of cannabis/cannabinoids with cocaine on behavioural, biological or health outcomes. Both quantitative and qualitative, as well as humans and pre-clinical animals' studies (n=46) were included. Pre-clinical studies (n=19) showed mostly protective effects of cannabidiol (CBD) administration on animal models of addiction (e.g., cocaine-craving, -relapse, and -withdrawal) and cocaine-toxicity. Tetrahydrocannabinol (THC) had more inconsistent results, with both protective and counter-protective effects. Human studies (n=27) were more heterogeneous and assessed natural ongoing cannabis and cocaine use or dependence. Quantitative-based studies showed mostly enhanced harms in several outcomes (e.g., cocaine use, mental health); two available clinical trials found no effect upon CBD administration on cocaine-related treatment outcomes. Qualitative data-based studies reported cannabis use as a substitute for or to alleviate harms of crack-cocaine use. While pre-clinical studies suggest a potential of cannabinoids, especially CBD, to treat cocaine addiction, the few trials conducted in humans found no benefits. Cannabis co-use by cocaine users commonly presents a risk factor, entailing enhanced harms for users. More rigorous, controlled trials are still necessary to investigate cannabinoids' potential considering pre-clinical findings and reported benefits from specific drug users.

Use of Cannabis for Harm Reduction Among People at High Risk for Overdose in Vancouver, Canada (2016-2018)

Objectives. To characterize the prevalence and reasons for the use of cannabis as a strategy to reduce the harms arising from other substances.Methods. We drew data about recent cannabis use and intentions from 3 prospective cohort studies of marginalized people who use drugs based in Vancouver, Canada, from June 2016 to May 2018. The primary outcome was "use of cannabis for harm reduction," defined as using cannabis for substitution for licit or illicit substances such as heroin or other opioids, cocaine, methamphetamine, or alcohol; treating withdrawal; or coming down off other drugs.Results. Approximately 1 in 4 participants reported using cannabis for harm reduction at least once during the study period. The most frequent reasons included substituting for stimulants (50%) and substituting for illicit opioids (31%).Conclusions. The use of cannabis for harm reduction is a common strategy among people who use drugs in our setting. Further research into the factors associated with this strategy is needed. Better characterization of the risks and benefits of substitution strategies, including for opioids and stimulants, may prompt new treatment options for PWUD.

"It's Crazy What Meth Can Help You Do": Lay Beliefs, Practices, and Experiences of Using Methamphetamine to Self-Treat Symptoms of Opioid Withdrawal

BACKGROUND

Across the U.S., methamphetamine use is expanding among people who use illicit opioids (PWUIO). Motives for methamphetamine use must be contextualized within the experiences of PWUIO, who may use methamphetamine not only to achieve euphoria, but also as a tactic of self-management. The overall aim of this study is to contextualize lay beliefs, practices, and experiences of methamphetamine use as a form of self-treatment of symptoms related to chronic opioid use among PWUIO in the Dayton Metro Area of Southwest Ohio, an epicenter of the ongoing opioid crisis.

METHODS

This paper draws on two phases of interviews conducted with 38 individuals who use both heroin/fentanyl and methamphetamine. This paper primarily analyzes qualitative data but includes supplementary information from the structured interview component. Qualitative interview sections were transcribed in their entirety and thematically analyzed.

RESULTS

Participants described learning about methamphetamine as a tactic to treat opioid withdrawal symptoms through social networks and through personal experimentation. Many participants suggested that methamphetamine was helpful in relieving exhaustion, alleviating some acute physical symptoms of opioid withdrawal, and providing a psychological distraction, although some admitted that methamphetamine use could incur additional health risks. To effectively use methamphetamine as a tactic of self-treatment, participants emphasized the importance of timing and dosing.

DISCUSSION

Among PWUIO in the Dayton area, methamphetamine use as a tactic to self-manage opioid withdrawal must be studied in relation to historical and evolving patterns of illicit opioid use and associated risks. More research is needed to understand the long-term health impacts of this emergent practice of polydrug use.

Adolescents, Street, Drugs and Psychoactive Substances: A Study on Risk and Protection

Abstract The article describes the consumption of psychoactive substances (PSs) by street-involved children and adolescents (SCA) in three Brazilian state capitals and examines adverse life events due to drug involvement. The longitudinal study included 108 SCA (9-18 years old, both sexes), grouped according to the main reason for going to the street: drugs, caregivers, escape, work and freedom. It also discusses the impact of drugs, trafficking and the place that this theme has occupied in public policies, social interventions and the life trajectory of these participants, through a case study. It is intended that these data can support the operation of interventions and the formulation of public policies that guarantee integral protection.