A spicy kind of high: a profile of synthetic cannabinoid users

'Spice' Use Motivations, Experiences, and Repercussions among Veterans of the United States Armed Forces

BACKGROUND AND OBJECTIVES

The potential for synthetic cannabinoids (SCs) to function as an alternative to marijuana without the same risk of a positive urinalyses led to claims of pervasive military SC use. Case studies confirm use among veterans, but no study has adequately explored SC use in the military using detailed interview data.

METHODS

Interviews (1-2 h) were conducted with 318 justice-involved veterans. Recruitment was attempted with all participants in eight veterans treatment courts in three U.S. states (54.9% of 579 eligible veterans). Interviews were transcribed and thematic analyses completed.

RESULTS

SC use was reported by 65 participants (21.3%). Major emergent themes indicated SCs were perceived as unpleasant, overly powerful, and a poor substitute for marijuana. Further, habitual use was rare as many chose not to reuse after initial negative experiences. Few indicated that the perception that SCs would not appear on routine military urinalyses enabled their use. Veterans were aware of the changing drug composition and feared "bad batches."

CONCLUSIONS

SCs were explicitly disliked both independently and relative to marijuana. Nine discussed avoiding positive military drug screens as a consideration, but negative initial experiences generally prevented progression to habitual use. Veterans did not view SCs as a suitable marijuana replacement. Fears that SCs are being used as a marijuana alternative among veterans subject to frequent drug testing appear unfounded. These interviews suggest that routine military drug testing did not motivate individuals to use SCs habitually as a marijuana replacement; however, veterans' negative interpretation of SC effects contributed to this outcome.

Characterisation of AMB-FUBINACA metabolism and CB1-mediated activity of its acid metabolite

PURPOSE

AMB-FUBINACA is a synthetic cannabinoid receptor agonist (SCRA) which is primarily metabolised by hepatic enzymes producing AMB-FUBINACA carboxylic acid. The metabolising enzymes associated with this biotransformation remain unknown. This study aimed to determine if AMB-FUBINACA metabolism could be reduced in the presence of carboxylesterase (CES) inhibitors and recreational drugs commonly consumed with it. The affinity and activity of the AMB-FUBINACA acid metabolite at the cannabinoid type-1 receptor (CB₁) was investigated to determine the activity of the metabolite.

METHODS

The effect of CES1 and CES2 inhibitors, and delta-9-tetrahydrocannabinol (Δ⁹-THC) on AMB-FUBINACA metabolism were determined using both human liver microsomes (HLM) and recombinant carboxylesterases. Radioligand binding and cAMP assays comparing AMB-FUBINACA and AMB-FUBINACA acid were carried out in HEK293 cells expressing human CB₁.

RESULTS

AMB-FUBINACA was rapidly metabolised by HLM in the presence and absence of NADPH. Additionally, CES1 and CES2 inhibitors both significantly reduced AMB-FUBINACA metabolism. Furthermore, digitonin (100 µM) significantly inhibited CES1-mediated metabolism of AMB-FUBINACA by ~ 56%, while the effects elicited by Δ⁹-THC were not statistically significant. AMB-FUBINACA acid produced only 26% radioligand displacement consistent with low affinity binding. In cAMP assays, the potency of AMB-FUBINACA was ~ 3000-fold greater at CB₁ as compared to the acid metabolite.

CONCLUSIONS

CES1A1 was identified as the main hepatic enzyme responsible for the metabolism of AMB-FUBINACA to its less potent carboxylic acid metabolite. This biotransformation was significantly inhibited by digitonin. Since other xenobiotics may also inhibit similar SCRA metabolic pathways, understanding these interactions may elucidate why some users experience high levels of harm following SCRA use.

New Psychoactive Substances: Awareness and Attitudes of Future Health Care Professionals in Serbia

This study was conducted in order to evaluate prospective health care professionals' (HCPs) awareness and attitudes regarding new psychoactive substances (NPSs) in the context of their future role in the prevention and treatment of NPS overdose and addiction. Correlates of NPS perception and use were also examined. This cross-sectional survey was performed on 490 students of the Faculty of Medicine, Novi Sad, Serbia, during 2017. NPS awareness was better in pharmacy students (IRR: 1.926, CI: 1.173-3.163, p = 0.010) than in medicine students-pharmacy students recognized 92.6% more NPS names than their peers studying medicine. Female students knew 36.5% less NPS names than their male colleagues (IRR: 0.635, CI: 0.399-1.013, p = 0.049). Number of NPS names students knew was rising by 15.9% with each age group-the higher the age, the larger the number of NPSs they were aware of (IRR: 1.159, CI: 1.025-1.310, p = 0.018). Students who had used marijuana knew 52.6% more NPS names than those who had never had experience with cannabis (IRR: 1.526, CI: 0.953-2.445, p = 0.049). Although a high number of future HCPs claimed to know what NPSs are, numerous misconceptions were noticed. Further educational efforts are necessary to improve their awareness and attitudes regarding NPSs.

Does cannabis testing in the military drive synthetic cannabinoid use? Self-reported use motivations among justice-involved veterans

BACKGROUND

Though synthetic cannabinoid receptor agonists (SCRAs) were controlled after being introduced as a 'legal high,' SCRAs likely remain appealing to individuals subject to routine drug screens as not all testing programs consistently include SCRAs. Military populations have been linked to SCRAs due to the unconfirmed supposition that testing protocols led many to substitute SCRAs for cannabis. This study aimed to explore SCRA use prevalence, correlates, and use motivations among veterans, with a particular focus on whether United States military personnel substituted SCRAs for cannabis to subvert testing protocols.

METHODS

All veterans appearing in one of eight civilian criminal courts in three U.S. states were invited to answer questionnaire items related to military service, court functionality, and substance use. Of the 579 veterans eligible, 54.9% chose to participate, yielding a cross-sectional sample of 318 veterans charged with a criminal offense by civilian authorities.

RESULTS

Sixty-five (21.3%) justice-involved veterans reported lifetime SCRA use. Use while within the military was reported by 15.0% of veterans enlisting after 2008. Only eight (12.3%) reported SCRAs were used as a substitute for cannabis. Boredom (36.9%), experimentation (27.7%), and social aspects of SCRA use (32.3%) were more commonly reported motives. Logistic regression models indicated that use of cannabis (aPR=2.06, p<.05), hallucinogens (aPR=2.50, p<.01), and SCRAs (aPR=2.49, p<.05) while in the military were risk factors for SCRA use after leaving the military, whereas older age at time of military exist was a protective factor (aPR=.87, p<.01) CONCLUSIONS: Drug testing programs within the military do not appear to have the unintended consequence of routing individuals to more risky drugs; however, SCRAs appear to have been an underappreciated problem within the military. Further, use extends beyond the military with many only initiating use after discharge, suggesting SCRA use may jeopardize the health of veterans post-service.

Sexual Orientation and Synthetic Cannabinoid Use: Examining the Role of Bullying Victimization

Bullying is a common experience among youths with many adverse consequences. Research indicates that those who identify as lesbian, gay, and bisexual experience bullying at greater levels than heterosexuals. Studies also indicate that sexual minorities are more likely to use alcohol and other drugs, including synthetic cannabinoids (SCs). This paper examines whether the relationship between sexual minority status and SC use is mediated by differential exposure to bullying victimization. Data from the 2015 and 2017 Youth Risk Behavior Study were used. Participants include 30,389 adolescents. Supplemental analyses were conducted with state and district data as those collection efforts incorporated additional bullying measures. Ianobucci's z_mediation was used to assess the relationships between sexual orientation, bullying victimization, and SC use. Results confirm the higher prevalence of bullying and SC use among LGBQ students. Multiple forms of bullying victimization (e.g., in-person, online, because of weight/appearance) mediate the relationship between sexual orientation and SC use. The greater prevalence of SC use within the LGBQ population is partially attributed to coping as a result bullying victimization.

Suicidal Ideation, Planning, and Attempts Among Synthetic Cannabinoid Users Across Different Demographic Subgroups

Background: Case studies have linked synthetic cannabinoid (SC) use to suicide risk both during and following acute psychoactive effects. No study has explored whether a meaningful relationship exists between SC use and suicidal ideation, planning, and attempts within a generalizable sample. Aims: This work attempted to determine whether SC use is significantly associated with suicidal thoughts, planning, or attempts and whether the association between SC use and suicide may be stronger in certain demographic groups. Method: Cross-sectional self-report data from the Youth Risk Behavior Surveillance System were utilized. Logistic regression models were explored within a sample of 29,384 adolescents. Results: A clear connection emerged between SC use and suicidal thoughts and attempts. SC use and suicide risk were strongly related within the lesbian, gay, and bisexual and African Americans populations, even after controlling for depressive symptoms. Limitations: The study was cross-sectional and respondents may have underreported substance use or suicidal thoughts. Conclusion: Whether SC use has an impact on suicidal ideation directly, indirectly, or if it is simply a co-occurring phenomenon, it may serve as a flag of enhanced risk. Physicians must remain cognizant of the SC-suicide risk connection, particularly among African American and/or lesbian, gay, or bisexual patients.

Why Switch? - Motivations for Self-Substitution of Illegal Drugs

Self-substitution is the conscious switch from one drug to another for reasons such as price, availability, desired effect, or perceived benefit of the substitute drug. Purpose/Objectives: This study aimed to describe drug use patterns and motivations associated with substitution. We examined correlates of lifetime substitution among individuals with substance use disorder. Methods: A cross-sectional study of 771 treatment-enrolled individuals. We used self-report for determining the lifetime prevalence, correlates, and motivations for substitution. Results: Of the 771 respondents, 570 (73.9%) reported ever substituting their preferred substance. The main incentives for substitution were availability (23.7%) and curiosity (20.2%). Among heroin or cannabis preferers, improved effects or less adverse effects of the substitute drug, self-medication, and managing withdrawal symptoms were significant substitution incentives. Increased odds for substitution were observed for past 12 months use of cannabis (OR = 1.51, CI = 1.06-4.52), prescription opioids (OR = 2.86, CI = 1.81-4.52), novel psychoactive substances (OR = 2.68, CI = 1.64-4.36), and repeated admission (OR = 1.50, CI = 1.05-2.14). Older age at onset-of-use was negatively associated with substitution (OR = 0.95, CI = 0.93-0.98). Conclusions: Self-substitution of one substance for another is a highly prevalent behavior among treatment-enrolled patients with substance use disorder. Clinicians caring for substance use disorder patients should be aware of substitution patterns involving the use of highly potent substances, which constitutes a risk to patients. Results underscore the benefit of substitution patterns analyses, as they reveal important information on the characteristics of persons who use drugs and their motivations.

Exploring the Relationships between Sexual Orientation and Gender Identity and Youth Synthetic Cannabinoid Use

Purpose: Existing studies have identified sexual minorities as being at enhanced risk for reporting synthetic cannabinoid (SC) use. It is unclear whether this association is the result of those that identify as a minority due to sexual orientation being more likely to use SCs, due to those that identify as transgender using SCs more, or both. Deconstructing this relationship will allow for targeted clinical advice and public health campaigns. Methods: Data from the 2015 and 2017 Youth Risk Behavior Study are utilized. In total, 31,279 youth were asked about their gender identity, sexual orientation, and SC use history. Bivariate analyses and logistic regression models were completed to explore relevant associations. Results: Identifying as lesbian, gay, bisexual, or questioning was linked to SC use and continuing SC use. Similarly, identifying as transgender was linked to SC use and continuing use. Regression analyses showed no significant interactive effect; identifying as both LGBQ and transgender does not have a compounding effect on use likelihood. Conclusions: Both sexual orientation and gender identity contribute to the relationship between sexual minority status and SC use noted in extant literature. This relationship is hypothesized to be tied to increased exposure to discrimination, victimization, and social isolation. Thus, efforts to directly counsel LGBTQ patients about the dangers associated with SC use are warranted as well as social policy reforms to better protect and support members of the LGBTQ community.

Comprehensive analysis of synthetic cannabinoids and metabolites in oral fluid by online solid-phase extraction coupled to liquid chromatography-triple quadrupole-mass spectrometry

The class of novel psychoactive substances known as synthetic cannabinoids (SC) includes illicit compounds that are sprayed on plant material and smoked or sold as liquids to be vaporized in e-cigarettes. In toxicological analysis of SC, fast analytical methods are needed for the detection and confirmation of parent drugs and metabolites at very low levels. While various analytical methods have been developed for SC in blood and urine, few are available for alternative matrices such as oral fluid (OF). There are numerous advantages to using OF as a sample matrix for SC analysis, including non-invasive collection, lesser risk of adulteration, and presence of both parent drug and metabolites. Here we report a validated online solid-phase extraction (online SPE) method coupled to LC-QqQ-MS for rapid confirmation and quantitation of 72 structurally diverse SC parent drugs and metabolites in OF with 2.5 min of preconcentration time and a total elution time of < 10 min. The use of online SPE for sample pretreatment facilitates rapid and consistent processing and greatly increases sample throughput. The method was fully validated according to relevant guidelines (ANSI/ASB Standard 036). Bias and precision values were within ± 20% for all compounds in human OF matrix. Method detection and quantitation limits ranged from 0.4 to 3.8 ng/mL and from 1.1 to 11.6 ng/mL, respectively. Recovery, matrix effects, process efficiency, carryover, and stability were also within acceptable limits for the majority of compounds. Successful application of the method was demonstrated using blank human OF fortified with SC in addition to a set of authentic OF specimens previously tested by another laboratory. Graphical abstract.

Multiple drug use disorder diagnoses among drug-involved hospitalizations in the United States: Results from the 2016 National Inpatient Sample

BACKGROUND

Having more than one drug use disorders (DUDs) is an increasing public health concern, but it has been understudied. The goal of this study is to investigate the prevalence and patterns of coexisting DUD diagnoses among inpatient hospitalizations due to DUD in the United States.

METHODS

Data were from the 2016 National Inpatient Sample and included hospitalizations with a principal DUD diagnosis for patients aged ≥18 years (i.e., drug-involved hospitalizations, unweighted n = 31,707). The DUD diagnosis profile was categorized into three groups: single, two, and three or more DUD diagnoses. Generalized ordered logit models were used to examine correlates of DUD diagnosis groups.

RESULTS

Among drug-involved hospitalizations, approximately 50.1 % had multiple coexisting DUD diagnoses (2 DUD diagnoses, 32.1 %; ≥3 DUD diagnoses, 18.0 %). Particularly, opioid use disorder accounted for 58.6 % of drug-involved hospitalizations. Among specific opioid-involved hospitalizations, about 51.2 % had multiple DUD diagnoses. The most common secondary DUD diagnoses among opioid-involved hospitalizations included cocaine (21.7 %), cannabis (18.5 %), and sedatives (18.1 %). Adjusted analyses showed that being aged 18-25 years (vs. ≥ 26), living in areas with the lowest quartile of household income (vs. highest), and having a secondary diagnosis of mental disorders or tobacco/alcohol use disorder were associated with increased odds of having multiple DUD diagnoses in the total sample and in the opioid subsample.

CONCLUSIONS

Findings suggest that healthcare providers should increase the awareness of multiple DUDs while treating patients with DUD, especially those with opioid use disorder. More research is needed to better characterize treatment needs for patients with multiple DUDs.

The Arrest and Synthetic Novel Psychoactive Drug Relationship

Novel psychoactive drugs (NPDs), an emerging class of dangerous substances, generally mimic the actions of commonly abused substances such as marijuana, stimulants, hallucinogens, and opiates, but are formulated, marketed, and used either to sidestep legal restrictions or to avoid positive drug screens. Synthetic cannabinoids such as Spice and K2 along with synthetic stimulants often referred to as “bath salts” have recently entered U.S. markets. The current study explores the relationship between being arrested and using NPDs per self-report survey data obtained from 2,349 students at a large university in the Southeastern United States. Respondents indicated whether they had used synthetic psychoactive drugs, reported demographic characteristics, and whether they had been arrested for a number of offenses. Results from logistic regression and propensity score matching models indicate that those who have been arrested are also more likely to use NPDs.

A preliminary evaluation of synthetic cannabinoid use among adolescent cannabis users: Characteristics and treatment outcomes

Little is known regarding the use of synthetic cannabinoids (SC), particularly use among adolescent substance users who may be at higher risk. The present exploratory study seeks to describe SC use and subjective effects among cannabis-using adolescents as well as compare the characteristics of cannabis users who do and do not use SC. Exploratory analyses evaluated cannabis treatment outcomes among SC users and non-users. Participants enrolled in a randomized, controlled intervention for cannabis-using high school students aged 14-19 (N=252) completed questionnaires regarding their use of SC and other substances. Those who used SC in the past 60days reported subjective effects of SC, consequences, and SC use disorder symptoms. Baseline characteristics, alcohol and other drug use, and treatment outcomes of SC users were compared to participants who never tried SC. Within this sample 29% had tried SC, and 6% used SC recently. Although most reported use at a relatively low rate, 43% of recent SC users reported SC use-disorder symptoms. Positive and negative subjective effects of SC were endorsed, with positive subjective effects reported more often. SC use was associated with more cannabis use, but not more alcohol or other (non-SC and non-cannabis) drug use. SC users did not differ from non-users on cannabis treatment outcomes. This exploratory study described SC use, and compared characteristics and treatment outcomes among SC users and non-users. Negative subjective effects of SC were reported as occurring less often, but SC use was associated with use disorder psychopathology. SC use was associated with more problematic cannabis use at baseline, but was not associated with use of other substances or differences in treatment outcome.

How Strong is the "Fake ID Effect?" An Examination Using Propensity Score Matching in Two Samples

BACKGROUND

Underage college students who obtain and use false identification (fake ID) are at risk for negative outcomes. However, it is currently unclear how uniquely the fake ID itself serves as a vehicle to subsequent harm (i.e., the "fake ID effect") over and above general and trait-related risk factors (e.g., deviant peers, low self-control).

METHODS

To investigate whether the "fake ID effect" would hold after accounting for phenotypic risk, we utilized propensity score matching (PSM) in a cross-sectional sample of 1,454 students, and a longitudinal replication sample of 3,720 undergraduates. Individuals with a fake ID were matched with individuals without a fake ID, in terms of a number of trait-based and social risk factors. These matched groups were then compared on 5 problematic outcomes (i.e., frequent binge drinking, alcohol-related problems, arrests, marijuana use, and hard drug use).

RESULTS

Findings showed that "fake ID effects" were substantially-although not fully-diminished following PSM. The "fake ID effect" remained strongest for alcohol-related arrests. This may relate to issues of enforcement and students' willingness to engage in deviant behavior with a fake ID, or it may be a function of combined processes.

CONCLUSIONS

Overall, the findings suggest that interventions should not only be aimed at reducing the fake ID-related alcohol access specifically, but should also be aimed more generally toward at-risk youths' access to alcohol. Future research might examine whether fake IDs have their strongest potency as moderators of the effects of risky traits-such as impulsiveness-on drinking outcomes.

Synthetic Cannabinoid Use and Descriptive Norms among Collegiate Student-Athletes

Synthetic cannabinoids have gained popularity over the past decade, especially among young adults, due to sharing similar psychoactive properties with Tetrahydrocannabinol (THC). A limited number of studies have examined synthetic cannabinoid use among college students but none have examined use exclusively by collegiate student-athletes. The objective of this study was to examine synthetic cannabinoid use among collegiate student-athletes. In the spring of 2013, 3,276 freshmen and transfer collegiate student-athletes from 47 NCAA Division I, II, and III institutions participated in a web-based survey on substance use. Bivariate logistic regression was used to analyze the relationship between collegiate student-athlete characteristics, substance use, and descriptive norms with lifetime use of synthetic cannabinoids. Sixty-two individuals (1.9%) reported lifetime use of synthetic cannabinoids, and 3 (0.1%) reported past-30-day use. Males, current drinkers, and athletes who used hookah and marijuana in the past 30 days were more likely to use synthetic cannabinoids. Peer use of synthetic cannabinoids was estimated to be higher than actual use, and such overestimation was positively associated with personal use of synthetic cannabinoids. Our findings suggest that campaigns addressing normative beliefs should be implemented on college campuses to prevent synthetic cannabinoid use among college students and collegiate student-athletes.

Comparison of outcome expectancies for synthetic cannabinoids and botanical marijuana

BACKGROUND

Although initially developed for medical purposes, synthetic cannabinoids have also been consumed for recreational purposes.

OBJECTIVE

To evaluate whether agreement with positive and negative outcome expectancies differed for synthetic cannabinoids versus botanical marijuana, and assess reported reasons for using synthetic cannabinoids.

METHOD

Using a web-based recruitment and data collection procedure, 186 adults who had used both synthetic cannabinoids and botanical marijuana and 181 adults who had used botanical marijuana but not synthetic cannabinoids, completed measures of outcome expectancies and other relevant questionnaires.

RESULTS

A significant interaction revealed that participants who had used both synthetic cannabinoids and botanical marijuana indicated lower agreement with positive expectancies for synthetic cannabinoids, and higher agreement with positive expectancies for botanical marijuana, than did those participants who used only botanical marijuana. There was no interaction between type of drug and use history on agreement with negative expectancies, and participants agreed more strongly with negative outcome expectancies for synthetic cannabinoids than for botanical marijuana whether they had used one or both types of these drugs. The most frequently provided reasons for using synthetic cannabinoids included availability, perceived legality, cost, curiosity, and social interaction.

CONCLUSION

Given growing public acceptance of recreational and medical marijuana, coupled with negative perceptions and increasing regulation of synthetic cannabinoid compounds, botanical marijuana is likely to remain more available and more popular than synthetic cannabinoids.

Synthetic cannabinoids: the dangers of spicing it up

Cannabinoids are the most commonly used illegal substances in the world. Spice and K2 are synthetic cannabinoid (SC) products that contain a mixture of herbs and plant matter combined with synthetic compounds similar to tetrahydrocannabinol, the psychoactive component of cannabis. Because the effects of Spice and K2 are similar to cannabis, many users are smoking these products as legal substitutes despite package labeling that they are not designed for human consumption. These SC products appeal to users because they are easily accessible and not readily detected in standard urine drug screens. The active components in SC products are highly potent and poorly characterized. Use of these agents has been associated with serious psychological and physiological side effects. Because abuse of SC products has become a national public health issue, nurses should be aware of the effects of SC compounds and must take a lead role in educating patients about the dangers of their use.

Deception and Drug Acquisition: Correlates of "Success" Among Drug-Seeking Patients

PURPOSE

Most research examining patient-based drug diversion neglects to assess physician deception directly. We attempt to determine if motives for deception are linked to success, and, similarly, if any health, demographic, or substance use history characteristics of the patients are predictive of being able to successfully deceive a physician.

METHODS

Stratified random sampling was utilized to obtain a sample of 2349 young adults. Respondents completed a survey detailing their substance use histories and whether they had ever deceived a physician for medication. Ninety-three of these respondents reported attempting to deceive a physician for a medication and compose the analytic sample for the study.

RESULTS

Of the 93 young adults who reported having attempted to deceive a physician for pharmaceuticals (4.0% of the general sample), 64 (68.8%) were successful. This included 24 only seeking medications for their own use, 9 only for financial purposes, and 31 with both motives. Respondents who reported recreationally using pharmaceuticals in the past were more likely to report successful attempts at obtaining a prescription compared with respondents without a history of abuse. With respect to demographic characteristics of the respondents, only race/ethnicity distinguished between successful attempts and failure.

CONCLUSIONS

Although a rare occurrence in the overall sample, significant correlates of successful deception did emerge. Respondents motivated to obtain a prescription in order to sell it to others were overwhelmingly likely to succeed in their pursuit to deceive as compared with respondents who sought prescriptions for their own abuse. Successful deceivers were also more likely to have been legitimately prescribed medication in the past. Successful respondents were more likely to be Caucasian than any other race/ethnicity.

K2 and Spice use among a cohort of college students in southeast region of the USA

BACKGROUND

K2 and Spice consist of an herbal blend of plant matter and chemical synthetic cannabinoids. These substances emerged in the early 2000s as a popular alternative to marijuana among youth and young adults.

OBJECTIVES

This study sought to identify rates and correlates of K2 and Spice at college entry and first use during college.

METHODS

In Fall 2010, 3146 students at 11 colleges in North Carolina and Virginia were recruited to participate in a longitudinal cohort survey. The cohort was invited to participate in a total of six surveys over their college career. Random-effects logistic regression models were used to identify factors associated with lifetime K2 and Spice use at college entry and first use during college, adjusting for clustering within schools and sample weights.

RESULTS

Weighted lifetime prevalence of K2 and Spice use at college entry was 7.6%. An additional 6.6% of students reported first use during college. By the cohort's fourth year, 17.0% reported lifetime K2 and Spice use. While lifetime prevalence increased, past 6-month prevalence decreased substantially over time. K2 and Spice use at college entry was associated with sensation seeking; hookah, marijuana, and illicit drug use; and low religiosity. First use during college was associated with having a father with less than a four-year degree; alcohol and hookah use.

CONCLUSION

Universities should ensure that prevention efforts address current substance use, including K2/Spice, and that treatment options are available for first year students who use substances.

Predictions instead of panics: the framework and utility of systematic forecasting of novel psychoactive drug trends

BACKGROUND

Countless novel psychoactive substances have been sensationally described in the last 15 years by the media and academia. Though some become significant issues, most fail to become a substantial threat. The diversity and breadth of these potential problem substances has led policymakers, law enforcement officers, and healthcare providers alike to feel overwhelmed and underprepared for dealing with novel drugs.

OBJECTIVE

Inadequacies in training and preparation may be remedied by a response that is more selective and more proactive. The current manuscript seeks to clarify how to most efficiently forecast the "success" of each newly introduced novel psychoactive substance in order to allow for more efficient decision making and proactive resource allocation.

METHODS

A review of literature, published case reports, and legal studies was used to determine which factors were most closely linked to use of a novel drug spreading. Following the development of a forecasting framework, examples of its use are provided.

RESULTS

The resulting five-step forecast method relies on assessments of the availability of a potential user base, the costs--legal and otherwise--of the drug relative to existent analogues, the subjective experience, the substance's dependence potential and that of any existent analogue, and ease of acquisition. These five factors should serve to forecast the prevalence of novel drug use, but reaction should be conditioned by the potential for harm.

CONCLUSIONS

The five-step forecast method predicts that use of acetyl fentanyl, kratom, Leonotis leonurus, and e-cigarettes will grow, but that use of dragonfly and similar substances will not. While this forecasting approach should not be used as a replacement for monitoring, the use of the five-step method will allow policymakers, law enforcement and practitioners to quickly begin targeted evaluative, intervention, and treatment initiatives only for those drugs with predicted harm.

Innovative alcohol use: assessing the prevalence of alcohol without liquid and other non-oral routes of alcohol administration

BACKGROUND

Though case studies, media reports, and anecdotal evidence point to creative forms of alcohol use such as "eyeballing," inhalation through vaporizers and other "alcohol without liquid" (AWOL) devices, and "slimming" as a growing trend, no empirical study has assessed the veracity of these claims. The present study attempts to debunk, confirm, or alter the popular perception that young adults are administering alcohol in novel ways.

METHODS

A self-report paper survey was administered to 2349 young adults selected for inclusion using a stratified random sampling technique. Respondents were asked to indicate all of the ways in which they had administered alcohol and presented options ranging from traditional oral consumption from a cup, can, or bottle to innovative techniques referenced by medical reports and news outlets. The prevalence of each form of innovative use was reported and explored.

RESULTS

Innovative alcohol use was very rare in the sample. Only 25 of 2349 participants (1.1%) had engaged in one or more of the creative methods of alcohol consumption. Among these individuals, most reported either using an AWOL device and/or administering alcohol anally. Vaginal administration and "eyeballing" were only reported by three and one respondents, respectively.

CONCLUSIONS

It appears that innovative alcohol use is more than an urban legend but that innovative use, even among a population with high rates of alcohol and drug use, is rare. Regardless, physicians and emergency medical personnel need to be aware of and prepared for dealing with innovative alcohol use.