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Ataiants J, Wong CF, Odejimi OA, Fedorova EV, Conn BM, Lankenau SE. Medicinal cannabis use among young adults during California's transition from legalized medical use to adult-use: a longitudinal analysis. Am J Drug Alcohol Abuse 2024; 50:229-241. [PMID: 38407837 DOI: 10.1080/00952990.2024.2308098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024]
Abstract
Background: In 2016, California transitioned from legalized medical cannabis use to adult-use. Little is known about how this policy change affected medicinal cannabis use among young adults.Objectives: To identify longitudinal groups of medicinal cannabis users and concurrent changes in health- and cannabis use-related characteristics among young adults in Los Angeles between 2014 and 2021.Methods: Cannabis users (210 patients and 156 non-patients; 34% female; ages 18-26 at baseline) were surveyed annually across six waves. Longitudinal latent class analysis derived groups from two factors - cannabis patient status and self-reported medicinal use. Trajectories of health symptoms, cannabis use motives, and cannabis use (daily/near daily use, concentrate use, and problematic use) were estimated across groups.Results: Three longitudinal latent classes emerged: Recreational Users (39.3%) - low self-reported medicinal use and low-to-decreasing patient status; Recreational Patients (40.4%) - low self-reported medicinal use and high-to-decreasing patient status; Medicinal Patients (20.3%) - high self-reported medicinal use and high-to-decreasing patient status. At baseline, Medicinal Patients had higher levels of physical health symptoms and motives than recreational groups (p < .05); both patient groups reported higher level of daily/near daily and concentrate use (p < .01). Over time, mental health symptoms increased in recreational groups (p < .05) and problematic cannabis use increased among Recreational Patients (p < .01).Conclusions: During the transition to legalized adult-use, patterns of medicinal cannabis use varied among young adults. Clinicians should monitor increases in mental health symptoms and cannabis-related problems among young adults who report recreational - but not medicinal - cannabis use.
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Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Carolyn F Wong
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Omolola A Odejimi
- Department of Educational Psychology, Leadership and Higher Education, College of Education, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ekaterina V Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Bridgid M Conn
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Conn BM, Brammer WA, Choi S, Fedorova EV, Ataiants J, Lankenau SE, Wong CF. Mental and Physical Health-Related Cannabis Motives Mediate the Relationship between Childhood Trauma and Problematic Cannabis Use over Time among Emerging Adult Cannabis Users. Subst Use Misuse 2023; 59:193-207. [PMID: 37822106 PMCID: PMC10842029 DOI: 10.1080/10826084.2023.2267111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND While growing evidence has identified mental and physical health-related cannabis use motives as significant mechanisms between childhood trauma and problematic cannabis use (PCU) for emerging adults (EA), there is a need to understand the longitudinal stability of these pathways and how they impact PCU as cannabis users age into later adulthood. METHODS The current study extends an analysis examining the impact of childhood trauma (e.g., emotional abuse, sexual abuse) on multiple indicators of PCU through a range of cannabis use motives. 339 medical cannabis patient and non-patient EA users from the Los Angeles area were sampled at baseline (mean age = 21.23; SD = 2.48). The present analysis used four waves of follow-up data collected from 2016 to 2018 (W3, W4) and 2019-2020 (W5, W6). RESULTS Use of cannabis to cope with nausea, sleep, pain, and emotional distress mediated the relationships between some types of childhood abuse and PCU at W4, though most associations attenuated by later adulthood (W6). Specifically, greater emotional distress and nausea motives were associated with greater PCU in models of emotional abuse and neglect and sexual abuse, with emotional distress continuing to mediate at W6. Conversely, sleep and pain motives were associated with lower PCU in models for emotional neglect. CONCLUSIONS Mental and physical health-related motives reflect potential intervenable factors that predict PCU in emerging adulthood among EA cannabis users with histories of childhood trauma. Results highlight the importance of and value for assessing a wide range of motives and PCU outcomes to target and address areas for intervention.
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Affiliation(s)
- Bridgid M Conn
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Whitney A Brammer
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Susie Choi
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Ekaterina V Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Carolyn F Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
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3
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Khalemsky M, Khalemsky A, Lankenau S, Ataiants J, Roth A, Marcu G, Schwartz DG. Predictive Dispatch of Volunteer First Responders: Algorithm Development and Validation. JMIR Mhealth Uhealth 2023; 11:e41551. [PMID: 38015602 PMCID: PMC10716760 DOI: 10.2196/41551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 06/03/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Smartphone-based emergency response apps are increasingly being used to identify and dispatch volunteer first responders (VFRs) to medical emergencies to provide faster first aid, which is associated with better prognoses. Volunteers' availability and willingness to respond are uncertain, leading in recent studies to response rates of 17% to 47%. Dispatch algorithms that select volunteers based on their estimated time of arrival (ETA) without considering the likelihood of response may be suboptimal due to a large percentage of alerts wasted on VFRs with shorter ETA but a low likelihood of response, resulting in delays until a volunteer who will actually respond can be dispatched. OBJECTIVE This study aims to improve the decision-making process of human emergency medical services dispatchers and autonomous dispatch algorithms by presenting a novel approach for predicting whether a VFR will respond to or ignore a given alert. METHODS We developed and compared 4 analytical models to predict VFRs' response behaviors based on emergency event characteristics, volunteers' demographic data and previous experience, and condition-specific parameters. We tested these 4 models using 4 different algorithms applied on actual demographic and response data from a 12-month study of 112 VFRs who received 993 alerts to respond to 188 opioid overdose emergencies. Model 4 used an additional dynamically updated synthetic dichotomous variable, frequent responder, which reflects the responder's previous behavior. RESULTS The highest accuracy (260/329, 79.1%) of prediction that a VFR will ignore an alert was achieved by 2 models that used events data, VFRs' demographic data, and their previous response experience, with slightly better overall accuracy (248/329, 75.4%) for model 4, which used the frequent responder indicator. Another model that used events data and VFRs' previous experience but did not use demographic data provided a high-accuracy prediction (277/329, 84.2%) of ignored alerts but a low-accuracy prediction (153/329, 46.5%) of responded alerts. The accuracy of the model that used events data only was unacceptably low. The J48 decision tree algorithm provided the best accuracy. CONCLUSIONS VFR dispatch has evolved in the last decades, thanks to technological advances and a better understanding of VFR management. The dispatch of substitute responders is a common approach in VFR systems. Predicting the response behavior of candidate responders in advance of dispatch can allow any VFR system to choose the best possible response candidates based not only on ETA but also on the probability of actual response. The integration of the probability to respond into the dispatch algorithm constitutes a new generation of individual dispatch, making this one of the first studies to harness the power of predictive analytics for VFR dispatch. Our findings can help VFR network administrators in their continual efforts to improve the response times of their networks and to save lives.
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Affiliation(s)
- Michael Khalemsky
- Department of Management, Hadassah Academic College, Jerusalem, Israel
| | - Anna Khalemsky
- Department of Management, Hadassah Academic College, Jerusalem, Israel
| | - Stephen Lankenau
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Janna Ataiants
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Alexis Roth
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - David G Schwartz
- The Graduate School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
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Fedorova EV, Mitchel A, Finkelstein M, Ataiants J, Wong CF, Conn BM, Lankenau SE. Pre-Post Cannabis Legalization for Adult Use: A Trend Study of Two Cohorts of Young Adult Cannabis Users in Los Angeles. J Psychoactive Drugs 2023:1-11. [PMID: 37997888 DOI: 10.1080/02791072.2023.2282515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023]
Abstract
Cannabis was legalized for adult use in California in 2016 for individuals 21 and older. Among 18-20-years-olds, who can possess cannabis legally as medical cannabis patients (MCP) but not as non-patient cannabis users (NPU), the impact of adult use legalization (AUL) on cannabis and other substance use is unknown. Two cohorts of 18-20-year-old cannabis users (MCP and NPU) were surveyed, one in 2014-15 (n = 172 "pre-AUL") and another in 2019-20 (n = 139 "post-AUL"), using similar data collection methods in Los Angeles, California. Logistic and negative binomial regressions estimated cohort and MCP differences for cannabis and other drug use outcomes based on past 90-day use. In both pre- and post-AUL cohorts, MCP were more likely to self-report medical cannabis use (p < .001) while the post-AUL cohort reported greater use of edibles (p < .01), but fewer mean days of alcohol (p < .05) and cigarette (p < .01) use in multivariate models. Notably, frequency of cannabis use (days or hits per day) did not significantly differ between the pre- and post-AUL cohorts, except for greater use of edibles, despite potentially greater access to cannabis.
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Affiliation(s)
- Ekaterina V Fedorova
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Allison Mitchel
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Maddy Finkelstein
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Janna Ataiants
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Carolyn F Wong
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Division of Adolescent Medicine, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Division of Research on Children, Los Angeles, CA, USA
| | - Bridgid M Conn
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Division of Adolescent Medicine, Los Angeles, CA, USA
| | - Stephen E Lankenau
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA
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Fedorova EV, Wong CF, Conn BM, Ataiants J, Lankenau SE. COVID-19 Vaccine Uptake and Attitudes Within Two Cohorts of Younger Adult Cannabis Users. J Drug Issues 2023; 53:422-430. [PMID: 38603185 PMCID: PMC9527554 DOI: 10.1177/00220426221131488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is crucial to understand COVID-19 vaccine uptake and attitudes among young adult cannabis users given the lowest vaccination rates among young adults and negative association between cannabis use and willingness to get vaccinated. 18-21-year-old and 26-33-year-old cohorts of cannabis users, recruited in California, were surveyed about the COVID-19 vaccine uptake/attitudes between March-August 2021. Cannabis use/demographic differences were investigated by vaccination status. Vaccine attitudes data were categorized and presented descriptively. 44.4% of the older and 71.8% of the younger cohorts were vaccinated. Non-Hispanic Black/African American race/ethnicity, lack of health insurance, and medicinal orientation towards cannabis use were negatively associated with vaccine receipt within the older cohort. For both cohorts, top reasons for vaccine hesitancy and rejection were concerns about speed of development, potential side effects, natural immunity, and lack of trust of vaccines. Our results highlight greater vaccine hesitance/rejection and need for targeted interventions among mid-20's-early-30's cannabis users.
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Affiliation(s)
- Ekaterina V. Fedorova
- Department of Community Health and
Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Carolyn F. Wong
- Department of Pediatrics, Keck School of
Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Adolescent Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Division of Research on Children, Youth,
and Families, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Bridgid M. Conn
- Department of Pediatrics, Keck School of
Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Adolescent Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Janna Ataiants
- Department of Community Health and
Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Stephen E. Lankenau
- Department of Community Health and
Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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DiGuiseppi GT, Fedorova EV, Conn B, Lankenau SE, Davis JP, Ataiants J, Wong CF. Understanding Changes in Social Cannabis Use among Young Adults During the COVID-19 Pandemic: A Social Network Analysis. Cannabis 2023; 6:20-33. [PMID: 37287728 PMCID: PMC10212261 DOI: 10.26828/cannabis/2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction As the COVID-19 pandemic has caused historic morbidity and mortality and disrupted young people's social relationships, little is known regarding change in young adults' social cannabis use following social distancing orders, or other factors associated with such changes before and during the pandemic. Methods 108 young adult cannabis users in Los Angeles reported on their personal (egocentric) social network characteristics, cannabis use, and pandemic-related variables before (July 2019 - March 2020) and during the COVID-19 pandemic (August 2020 - August 2021). Multinomial logistic regression identified factors associated with increasing or maintaining the number of network members (alters) participants used cannabis with before and during the pandemic. Multilevel modeling identified ego- and alter-level factors associated with dyadic cannabis use between each ego and alter during the pandemic. Results Most participants (61%) decreased the number of alters they used cannabis with, 14% maintained, and 25% increased. Larger networks were associated with a lower risk of increasing (vs. decreasing); more supportive cannabis-using alters was associated with a lower risk of maintaining (vs. decreasing); relationship duration was associated with a greater risk of maintaining and increasing (vs. decreasing). During the COVID-19 pandemic (August 2020 - August 2021), participants were more likely to use cannabis with alters they also used alcohol with and alters who were perceived to have more positive attitudes towards cannabis. Conclusions The present study identifies significant factors associated with changes in young adults' social cannabis use following pandemic-related social distancing. These findings may inform social network interventions for young adults who use cannabis with their network members amid such social restrictions.
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Affiliation(s)
| | - Ekaterina V. Fedorova
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention
| | - Bridgid Conn
- Children’s Hospital Los Angeles, Division of Adolescent and Young Adult Medicine
- University of Southern California, Keck School of Medicine, Department of Pediatrics
| | - Stephen E. Lankenau
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Janna Ataiants
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention
| | - Carolyn F. Wong
- Children’s Hospital Los Angeles, Division of Adolescent and Young Adult Medicine
- University of Southern California, Keck School of Medicine, Department of Pediatrics
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Khurana S, Fedorova EV, Kaur H, Mitchell A, Kosdon S, Ataiants J, Conn B, Wong CF, Lankenau SE. “I Feel Validated”: Participation in a Medical Cannabis Program in the Context of Legalized Recreational Use. Journal of Drug Issues 2022. [DOI: 10.1177/00220426221097924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined the effects of California’s 2016 law legalizing cannabis for recreational use among young adult medical cannabis patients (MCP) and non-patient users (NPU). Three groups of young adult cannabis users ( n = 30) were qualitatively interviewed in Los Angeles between 2020-21: current MCP ( n = 3), who always had a medical cannabis recommendation, NPU ( n = 6), who never had a recommendation, and MCP-to-NPU ( n = 21), who had a recommendation in the past. MCP remained MCP due to greater acceptance of cannabis and lower prices afforded to MCP. MCP-to-NPU and NPU remained NPU due to increased acceptance of cannabis use within their community, greater legal security, and no compelling need for a medical cannabis recommendation. Price increases drove many to purchasing cannabis from unregulated black-market dispensaries. The legalization of cannabis for recreational use led to decisions to transition out of MCP status, destigmatization of cannabis use, increased prices of cannabis, and increased sourcing of cannabis from the black-market.
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Affiliation(s)
- Saranya Khurana
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, Philadelphia, PA, USA
- Drexel University, College of Medicine, Department of Psychiatry, Philadelphia, PA, USA
| | - Ekaterina V. Fedorova
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, Philadelphia, PA, USA
| | - Harjot Kaur
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, Philadelphia, PA, USA
| | - Allison Mitchell
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, Philadelphia, PA, USA
| | - Sari Kosdon
- Children’s Hospital Los Angeles, Division of Adolescent Medicine, Los Angeles, CA, USA
| | - Janna Ataiants
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, Philadelphia, PA, USA
| | - Bridgid Conn
- Children’s Hospital Los Angeles, Division of Adolescent Medicine, Los Angeles, CA, USA
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, USA
| | - Carolyn F. Wong
- Children’s Hospital Los Angeles, Division of Adolescent Medicine, Los Angeles, CA, USA
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, USA
- Children’s Hospital Los Angeles, Division of Research on Children, Youth, & Families, Los Angeles, CA, USA
| | - Stephen E. Lankenau
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, Philadelphia, PA, USA
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Ataiants J, Mazzella S, Roth AM, Robinson LF, Sell RL, Lankenau SE. Multiple Victimizations and Overdose Among Women With a History of Illicit Drug Use. J Interpers Violence 2022; 37:NP1588-NP1613. [PMID: 32536256 PMCID: PMC7808297 DOI: 10.1177/0886260520927501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The experiences of violence and overdose are highly prevalent among women who use illicit drugs. This study sought to ascertain whether multiple victimizations during adulthood increase the frequency of women's overdose. The sample comprised 218 women recruited at Philadelphia harm reduction sites during 2016-2017. Victimization was assessed as exposure to 16 types of adulthood violence. Three measures were constructed for multiple victimizations: continuous and categorical polyvictimization, and predominant violence domain. Negative binomial regression estimated the incidence rate ratio (IRR) of lifetime overdoses from multiple victimizations. Lifetime history of opioid use (88.6%) and drug injection (79.5%) were common. Among overdose survivors (68.5%), the median of lifetime overdoses was 3. The majority of participants (58.7%) were victims of predominantly sexual violence, 26.1% experienced predominantly physical abuse/assault, and 3.7% were victims of predominantly verbal aggression/coercive control. Participants reported a mean of seven violence types; the higher-score category of polyvictimization (9-16 violence types) comprised 41.7% of the total sample. In multivariable models, one-unit increase in continuous polyvictimization was associated with 4% higher overdose rates (IRR: 1.04, 95% confidence interval [CI]: [1.00, 1.08]). Compared to women who were not victimized (11.5%), those in the higher-score category of polyvictimization (IRR: 2.01; 95% CI: [1.06, 3.80]) and exposed to predominantly sexual violence (IRR: 2.10, 95% CI: [1.13, 3.91]) were expected to have higher overdose rates. Polyvictimization and sexual violence amplified the risk of repeated overdose among drug-involved women. Female overdose survivors need to be screened for exposure to multiple forms of violence, especially sexual violence. Findings underscore the need to scale-up victimization support and overdose prevention services for disenfranchised women.
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Voronkov M, Nikonov G, Ataiants J, Isakulyan L, Stefanut C, Cernea M, Abernethy J. Modifying naloxone to reverse fentanyl-induced overdose. Int J Pharm 2022; 611:121326. [PMID: 34848365 DOI: 10.1016/j.ijpharm.2021.121326] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/04/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
Developing an effective antidote for fentanyl-induced overdose (OD) is an unmet medical need that requires both lipophilicity comparable to fentanyl and fast onset of overdose reversal. We synthesized and evaluated a bioreversible derivative of naloxone (NX-90) in silico, in vitro and in vivo to yield a robust reversal of fentanyl-induced OD in rats. All monitored reflexes along with the heart rate (HR) and respiratory rate (RR) were fully restored faster in the NX-90 groups than in naloxone groups on equimolar bases when given intranasally. In NX-90 treated rats RR over the time of observation (RR AUC) was significantly higher at all respective doses with no re-narcotization observed. Apart from the enhanced pharmacodynamics profile, NX-90 was found to have lower circulating levels of naloxone, clean profile in in vitro selectivity panels, as well as Ames and CYP450 counter screens. Finally, we demonstrated a robust release of the parent naloxone in brain matrix, as well as lower peripheral naloxone levels after NX-90 iv administration. With the demonstrated pharmacological profile superior yet congruent to naloxone we nominated NX-90 for preclinical development as an effective intranasal fentanyl antidote.
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Affiliation(s)
| | | | - Janna Ataiants
- Drexel University, Philadelphia, PA 19104, United States
| | | | - Cristina Stefanut
- University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca 400372, Romania
| | - Mihai Cernea
- University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca 400372, Romania
| | - John Abernethy
- Serodopa Therapeutics Inc., Gainesville, FL 32601, United States
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10
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Scheidell JD, Ataiants J, Lankenau SE. Miscarriage and Abortion Among Women Attending Harm Reduction Services in Philadelphia: Correlations With Individual, Interpersonal, and Structural Factors. Subst Use Misuse 2022; 57:999-1006. [PMID: 35277115 PMCID: PMC9101319 DOI: 10.1080/10826084.2022.2046100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Reproductive health research among women who use drugs has focused on pregnancy prevention and perinatal/neonatal outcomes, but there have been few investigations of miscarriage and abortion, including prevalence and associated factors. Methods: Using cross-sectional data from a sample of non-pregnant women receiving harm reduction services in Philadelphia in 2016-2017 we examined lifetime miscarriage and abortion (n = 187). Separately for both outcomes, we used modified Poisson regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for associations with each correlate. We also explored correlates of reporting both miscarriage and abortion. Results: Approximately 47% experienced miscarriage, 42% experienced abortion, and 18% experienced both. Miscarriage correlates included: prescription opioid misuse (e.g., OxyContin PR 1.82, 95% CI 1.23, 2.69); 40% increase in prevalence associated with housing instability, 50% increase with survival sex, and two-fold increase with arrest. Abortion correlates included: mental health (e.g., depression PR 2.09, 95% CI 1.18, 3.71), stimulant use (e.g., methamphetamine PR 1.83, 95% CI 1.22, 2.74), and drug injection (PR 1.76, 95% CI 1.03, 3.02); partner controlling access to people/possessions, physical and emotional violence; and a two-fold increase associated with survival sex and arrest. Experiencing both reproductive outcomes was correlated with mental health, opioid and simulant use, housing instability, survival sex, and arrest. Conclusion: Miscarriage and abortion was common among women with history of drug misuse suggesting a need for expanded access to family planning, medication-assisted therapy, and social support services, and for the integration of these with substance use services. Future research in longitudinal data is needed.
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Affiliation(s)
- Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
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Fedorova EV, Wong CF, Conn BM, Ataiants J, Iverson E, Lankenau SE. COVID-19’s Impact on Substance Use and Well-Being of Younger Adult Cannabis Users in California: A Mixed Methods Inquiry. Journal of Drug Issues 2021; 52:207-224. [PMID: 35382397 PMCID: PMC8919106 DOI: 10.1177/00220426211052673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Few qualitative studies have examined the impact of COVID-19 on cannabis and alcohol use, and overall well-being among cannabis users. Cannabis users (aged 26-32) were surveyed quantitatively (n=158) and interviewed qualitatively (n=29) in April 2020–May 2021 in Los Angeles. 63.3% of the quantitative sample reported increasing use of either cannabis (29.1%) or alcohol (15.2%) or both (19.0%) following the COVID-19 outbreak. Qualitative data revealed that increases in cannabis and alcohol use were largely attributed to changes in employment and staying at home resulting in fewer impediments and boredom. Themes of loneliness and utilization of various coping strategies were more pronounced among those who increased cannabis and/or alcohol use. For some, increases in cannabis/alcohol use were temporary until participants adjusted to “a new normal” or embraced more adaptive coping strategies. Results suggest monitoring cannabis/alcohol use trends and identifying coping strategies to reduce the pandemic’s impact on substance use and mental health.
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Affiliation(s)
- Ekaterina V. Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Carolyn F. Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Adolescent Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Division of Research on Children, Youth, & Families, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Bridgid M. Conn
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Adolescent Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Ellen Iverson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Adolescent Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Stephen E. Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
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12
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Voronkov M, Ataiants J, Cocchiaro B, Stock JB, Lankenau SE. A vicious cycle of neuropathological, cognitive and behavioural sequelae of repeated opioid overdose. Int J Drug Policy 2021; 97:103362. [PMID: 34314956 DOI: 10.1016/j.drugpo.2021.103362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/03/2021] [Accepted: 06/23/2021] [Indexed: 01/15/2023]
Abstract
In the midst of an escalating U.S. opioid crisis, the immediate focus of public health interventions is on fatal overdose prevention. Few studies, however, have sought to examine the long-term health consequences of exposure to repeated nonfatal opioid overdose. We reviewed recent literature to examine three corresponding downstream health outcomes of repeated overdose: a) neurodegenerative processes; b) cognition and memory; and c) overdose risk behaviours. We found a remarkable congruency among available biochemical and cognitive data on how nonfatal overdose precipitates various pathological feedforward and feedback loops that affect people who use opioids for years to come. We found however that downstream behavioural implications of neurodegenerative and cognitive sequelae are less studied despite being most proximal to an overdose. Findings point to a vicious cycle of nonfatal overdose leading to neurodegeneration - closely resembling Alzheimer Disease - that results in cognitive decline that in turn leads to potentially reduced adherence to safe drug use behaviours. The collected evidence not only brings into the focus the long-term health consequences of nonfatal overdose from the perspectives of biology, neuroscience, and public health, but also creates new cross-disciplinary context and awareness in the research and public health community that should benefit people at risk.
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Affiliation(s)
| | - Janna Ataiants
- Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA.
| | - Benjamin Cocchiaro
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffry B Stock
- Department of Molecular Biology, Princeton University, Princeton, NJ 08544, USA
| | - Stephen E Lankenau
- Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
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13
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Fedorova EV, Ataiants J, Wong CF, Iverson E, Lankenau SE. Changes in Medical Cannabis Patient Status before and after Cannabis Legalization in California: Associations with Cannabis and Other Drug Use. J Psychoactive Drugs 2021; 54:129-139. [PMID: 34044753 DOI: 10.1080/02791072.2021.1926604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
It is unknown how patterns of cannabis and other drug use changed among young adult cannabis users as they became, exited or stayed medical cannabis patients (MCPs) after California legalized cannabis for adult use in 2016. A cohort of 18-26 year-old cannabis users was recruited in Los Angeles in 2014-15 (64.8% male; 44.1% Hispanic/Latinx). Based on wave 1 (pre-legalization) and wave 4 (post-legalization) MCP status, four transition groups emerged: MCP, Into MCP, Out of MCP and NPU (non-patient user). Relationships between self-reported medical cannabis use, transition group membership, and cannabis/other drug use outcomes were examined. Changes in cannabis practices were consistent with changes in MCP status. Cannabis days, concentrate use, self-reported medical cannabis use and driving under influence of cannabis were highest among MCP, increased for Into MCP, and decreased for Out of MCP in wave 4. A majority of drug use outcomes decreased significantly by wave 4. Self-reported medical cannabis use was associated with more frequent cannabis use but less problematic cannabis and other drug use. Future studies should continue to monitor the impact of policies that legalize cannabis for medical or recreational use, and medical motivations for cannabis use on young adults' cannabis and other drug use.
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Affiliation(s)
- Ekaterina V Fedorova
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Carolyn F Wong
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Division of Research on Children, Youth, & Families, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ellen Iverson
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
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14
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Ataiants J, Reed MK, Schwartz DG, Roth A, Marcu G, Lankenau SE. Decision-making by laypersons equipped with an emergency response smartphone app for opioid overdose. Int J Drug Policy 2021; 95:103250. [PMID: 33887699 DOI: 10.1016/j.drugpo.2021.103250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/19/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Targeted naloxone distribution to potential lay responders increases the timeliness of overdose response and reduces mortality. Little is known, however, about the patterns of decision-making among overdose lay responders. This study explored heuristic decision-making among laypersons equipped with an emergency response smartphone app. METHODS UnityPhilly, a smartphone app that connects lay responders equipped with naloxone to overdose victims, was piloted in Philadelphia from March 2019 to February 2020. Participants used the app to signal overdose alerts to peer app users and emergency medical services, or respond to alerts by arriving at overdose emergency sites. This study utilised in-depth interviews, background information, and app use data from a sample of 18 participants with varying histories of opioid use and levels of app use activity. RESULTS The sample included 8 people who used opioids non-medically in the past 30 days and 10 people reporting no opioid misuse. Three prevailing, not mutually exclusive, heuristics were identified. The heuristic of unconditional signalling ("Always signal for help or backup") was used by 7 people who valued external assistance and used the app as a replacement for a 911 call; this group had the highest number of signalled alerts and on-scene appearances. Nine people, who expressed confidence in their ability to address an overdose themselves, followed a heuristic of conditional signalling ("Rescue, but only signal if necessary"); these participants had the highest frequency of prior naloxone administrations. Eleven participants used the heuristic of conditional responding ("Assess if I can make a difference"), addressing an alert if they carried naloxone, were nearby, or received a signal before dark hours. CONCLUSION The deployment of specific heuristics was influenced by prior naloxone use and situational factors. Success of overdose prevention interventions assisted by digital technologies may depend on the involvement of people with diverse overdose rescue backgrounds.
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Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA.
| | - Megan K Reed
- Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut St, College Bldg, Suite 706, Philadelphia, PA 19107, USA
| | - David G Schwartz
- Information Systems Division, Graduate School of Business, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Alexis Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA
| | - Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor, 105 S. State Street, Ann Arbor, MI 48109, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA
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15
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Fedorova EV, Wong CF, Ataiants J, Iverson E, Conn B, Lankenau SE. Cannabidiol (CBD) and other drug use among young adults who use cannabis in Los Angeles. Drug Alcohol Depend 2021; 221:108648. [PMID: 33676073 PMCID: PMC8462788 DOI: 10.1016/j.drugalcdep.2021.108648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cannabidiol (CBD) is purportedly a promising therapeutic agent to provide relief for a variety of medical conditions with mild or no psychoactive effects. However, little is known about young adults who use cannabis and CBD-dominant products, and associations between CBD use and other drug use. METHODS Young adults (aged 24-32) who currently used cannabis (n = 239) were surveyed in Los Angeles in March 2019 through March 2020. The sample was divided into CBD-dominant (at least 1:1 CBD:THC ratio) and THC-dominant product users. We described CBD forms, reasons and conditions for CBD use and examined between-group differences in sociodemographic characteristics, cannabis practices, health and other drug use. RESULTS CBD-dominant users were more likely to be female, use cannabis at lower frequency and amount (except for edible/drinkable/oral products), self-report medical motivation for cannabis use, use cannabis for pain and report more health problems. Oil, flower, topicals and sprays/drops/tinctures were the most prevalent CBD forms. Psychological problems and pain were commonly reported conditions and medical reasons for CBD use. CBD-dominant users were more likely to report illicit drug use, where psilocybin use was markedly different between the two groups. CONCLUSIONS CBD use was associated with health histories and motivations linked to pain and psychological problems. Positive association between CBD use and illicit drug use may indicate self-medication for psychological conditions. Future studies should evaluate the effectiveness of various CBD forms and dose regimens for treatment of pain and psychological problems, and as a potential intervention for decreasing other drug use and associated harms.
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Affiliation(s)
- Ekaterina V. Fedorova
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
| | - Carolyn F. Wong
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Research on Children, Youth, & Families, 4650 Sunset Blvd., MS #2, Los Angeles,
CA 90027, United States
| | - Janna Ataiants
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
| | - Ellen Iverson
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United
States
| | - Bridgid Conn
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States
| | - Stephen E. Lankenau
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
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16
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Ataiants J, Fedorova EV, Wong CF, Iverson E, Gold JI, Lankenau SE. Pain Profiles among Young Adult Cannabis Users: An Analysis of Antecedent Factors and Distal Outcomes. Subst Use Misuse 2021; 56:1144-1154. [PMID: 33882778 PMCID: PMC8249053 DOI: 10.1080/10826084.2021.1910707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pain is a primary reason for medical cannabis use among young adults, however little is known about the patterns of pain in this group. This study identified pain profiles among young adult cannabis users and examined related antecedents and distal outcomes. METHODS Past 30-day cannabis users aged 18-26, both medical cannabis patients and non-patients, were enrolled in Los Angeles in 2014-2015. A latent class analysis was used to identify pain classes based on history of chronic pain conditions and recent non-minor pain. The study assessed the predictors of membership in pain classes and examined the association of classes with recent mental health characteristics, cannabis use motives and practices. RESULTS Three classes were identified: Low pain (56.3%), Multiple pain (27.3%), and Nonspecific pain (16.4%). In adjusted models, lifetime insomnia was associated with membership in Multiple pain and Nonspecific pain classes versus the Low pain class. Medical cannabis patients and Hispanics/Latinos were more likely to belong to the Multiple pain class than the other classes. Regarding recent outcomes, the Multiple pain and Nonspecific pain classes were more likely than the Low pain class to use cannabis to relieve physical pain. Additionally, the Multiple pain class had a higher probability of psychological distress, self-reported medical cannabis use, consuming edibles, and using cannabis to sleep compared to one or both other classes. CONCLUSION Findings suggest that young adult cannabis users can be separated into distinct groups with different pain profiles. The Multiple pain profile was associated with medically-oriented cannabis use motives and practices.
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Affiliation(s)
- Janna Ataiants
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ekaterina V Fedorova
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA
| | - Carolyn F Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Ellen Iverson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jeffrey I Gold
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Psychiatry & Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Anesthesiology Critical Care Medicine, The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Stephen E Lankenau
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA
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17
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Marcu G, Schwartz DG, Ataiants J, Roth A, Yahav I, Cocchiaro B, Khalemsky M, Lankenau S. Empowering communities with a smartphone-based response network for opioid overdoses. IEEE Pervasive Comput 2020; 19:42-47. [PMID: 33568966 PMCID: PMC7869836 DOI: 10.1109/mprv.2020.3019947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In a Philadelphia neighbourhood where opioid overdoses are frequent, neighbors used a smartphone app to request and give help for a victim of suspected overdose. A one-year study demonstrated the feasibility of this approach, which empowered the local community to save lives and even respond to overdoses faster than emergency medical services.
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18
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Ataiants J, Mazzella S, Roth AM, Sell RL, Robinson LF, Lankenau SE. Overdose response among trained and untrained women with a history of illicit drug use: a mixed-methods examination. Drugs (Abingdon Engl) 2020; 28:328-339. [PMID: 34321719 DOI: 10.1080/09687637.2020.1818691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Little is known about differences in bystander behavior among people who use drugs, trained and untrained in opioid overdose prevention. We examined three types of recommended overdose response - a 911 call, rescue breathing/CPR, and naloxone administration-among Philadelphia-based, predominantly street-involved women with a history of illicit drug use. The study utilized a convergent mixed methods approach integrating data from 186 quantitative survey responses and 38 semi-structured qualitative interviews. Quantitative findings revealed that compared to untrained women, trained women were more likely to administer naloxone (32.9% vs. 5.2%) and use two recommended responses (20.0% vs. 9.5%). No significant differences were found between the two groups in calling 911 or using rescue breathing/CPR. Qualitative findings indicated that barriers to enacting recommended overdose response were either structural or situational and included the avoidance of police, inability to carry naloxone or phone due to unstable housing, and perceived lack of safety on the streets and when interacting with strangers. Our study demonstrated that overdose training improved the frequency of naloxone administration among this sample of predominantly street-involved women. Future efforts need to focus on avoiding intrusive policing, scaling-up naloxone refill sites, and providing secondary naloxone distribution via drug user networks.
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Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Randall L Sell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lucy F Robinson
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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19
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Schwartz DG, Ataiants J, Roth A, Marcu G, Yahav I, Cocchiaro B, Khalemsky M, Lankenau S. Layperson reversal of opioid overdose supported by smartphone alert: A prospective observational cohort study. EClinicalMedicine 2020; 25:100474. [PMID: 32954238 PMCID: PMC7486335 DOI: 10.1016/j.eclinm.2020.100474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Rapid naloxone administration is crucial in reversing an opioid overdose. We investigated whether equipping community members, including people who use opioids (PWUO), with a smartphone application enabling them to signal and respond to suspected overdose would support naloxone administration in advance of Emrgency Medical Services (EMS). METHODS This observational cohort study of opioid overdose intervention used a dedicated smartphone app, UnityPhilly, activated by volunteers witnessing an overdose to signal other nearby volunteers in Philadelphia (March 2019 - February 2020). Alerted volunteers chose to respond, or declined to respond, or ignored/missed the alert. Witnessing volunteer was connected to 9-1-1 through a semi-automated telephone call. The primary outcome was layperson-initiated overdose reversal before EMS arrival, and a secondary outcome was hospital transfer. This study is registered with ClinicalTrials.gov, NCT03305497. FINDINGS 112 volunteers, including 57 PWUO and 55 community members, signaled 291 suspected opioid overdose alerts. 89 (30⸱6%) were false alarms. For 202 true alerts, the rate of layperson initiated naloxone use was 36⸱6% (74/202 cases). Most naloxone-use cases occurred in the street (58⸱11% (43/74)) and some in home settings (22⸱98% (17/74)). The first naloxone dose was provided by a nearby volunteer responding to the alert in 29⸱73% (22/74) of cases and by the signaling volunteer in 70⸱27% (52/74) of cases. Successful reversal was reported in 95⸱9% (71/74) of cases. Layperson intervention preceded EMS by 5 min or more in 59⸱5% of cases. Recovery without hospital transport was reported in 52⸱7% (39/74) of cases. INTERPRETATION Our findings support the benefits of equipping community members, potentially witnessing suspected opioid overdose, with naloxone and an emergency response community smartphone app, alerting EMS and nearby laypersons to provide additional naloxone. FUNDING Funding provided by NIH through NIDA, grant number: 5R34DA044758.
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Affiliation(s)
- David G. Schwartz
- Information Systems Division, Graduate School of Business, Bar-Ilan University, Ramat-Gan, Israel
- Corresponding author.
| | - Janna Ataiants
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Alexis Roth
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Inbal Yahav
- Coller School of Management, Tel-Aviv University, Tel-Aviv, Israel
| | - Benjamin Cocchiaro
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Khalemsky
- Information Systems Division, Graduate School of Business, Bar-Ilan University, Ramat-Gan, Israel
| | - Stephen Lankenau
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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20
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Ataiants J, Roth AM, Mazzella S, Lankenau SE. Circumstances of overdose among street-involved, opioid-injecting women: Drug, set, and setting. Int J Drug Policy 2020; 78:102691. [PMID: 32086154 PMCID: PMC7302961 DOI: 10.1016/j.drugpo.2020.102691] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Current discourses about the causes of the overdose crisis largely focus on the harmful effects of drugs. Prior research, however, indicates that drug use experience is shaped by complex interactions of drugs with physiological and mental "sets" of people who use drugs and the wider social and physical "setting." Zinberg's "drug, set, and setting" theoretical framework was applied to identify patterns in circumstances leading up to women's overdose. METHODS In-depth semi-structured interviews were conducted with 29 opioid-injecting street-involved women, clients of a Philadelphia harm reduction program. Qualitative analysis with deductive and inductive coding was utilized to examine transcripts for theory-driven and emerging themes. RESULTS Ten out of 29 women attributed their overdose to "drugs," reporting the unpredictable quality of street opioids, concurrent use of benzodiazepines, or chasing the "high." Thirteen women reported "set" as a type of circumstance where their emotional states were affected by a "good" or "bad" day, leading them to unusual drug consumption practices. Six women described "setting" type of circumstances where their overdose was preceded by a recent change in context, such as release from prison, which prompted unsafe drug use to address physiological or psychological dependence on drugs. CONCLUSION While all overdoses result from the pharmacological action of drugs, some overdoses were triggered by circumstances occurring in women's set or setting. Overdose prevention policies should embrace not only individual-level behavioral interventions, but also structural measures to address stress, social isolation, and risky drug use contexts that plague the lives of street-involved women who inject opioids.
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Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA.
| | - Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA
| | - Silvana Mazzella
- Prevention Point Philadelphia, 2913 Kensington Ave, Philadelphia, PA 19134, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA
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21
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Lankenau SE, Tabb LP, Kioumarsi A, Ataiants J, Iverson E, Wong CF. Density of Medical Marijuana Dispensaries and Current Marijuana Use among Young Adult Marijuana Users in Los Angeles. Subst Use Misuse 2019; 54:1862-1874. [PMID: 31154889 PMCID: PMC6681649 DOI: 10.1080/10826084.2019.1618332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: While tobacco and alcohol studies have focused on density of outlets as a determinant of consumption, research has begun examining the effects of medical marijuana (MM) dispensaries on marijuana use. Objectives: Examine the relationship between density of MM dispensaries and frequency of marijuana use among young adult medical marijuana patients (MMP) and nonpatient users (NPU). Methods: Young adult marijuana users (n = 329) aged 18- to 26-year old were sampled in Los Angeles in 2014-2015 and separated into MMP (n = 198) and NPU (n = 131). In 2014, 425 operational MM dispensaries were identified within the City of Los Angeles. Sequential multilevel Poisson random effect models examined density of MM dispensaries per square mile and 90 d marijuana use among MMP and NUP at the ZIP code level while controlling for demographic, behavioral, and community characteristics. Results: Density of MM dispensaries was not related to 90 d use of marijuana (days of use or hits per day) among either MMP or NPU. MMP reported significantly greater days of marijuana use in the past 90 d compared to NPU but no differences were found for hits per day. African-Americans reported significantly greater hits per day compared to whites. Hispanics reported significantly fewer hits per day compared to non-Hispanics. Conclusion: Concentration of MM dispensaries surrounding young adult marijuana users in Los Angeles was unrelated to days of marijuana use irrespective of having a MM recommendation or not. Rather, individual factors related to consumer choices and behaviors were more important in determining recent marijuana use among MMP and NPU.
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Affiliation(s)
- Stephen E. Lankenau
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104
| | - Loni Philip Tabb
- Drexel University, Dornsife School of Public Health, Department of Epidemiology and Biostatistics, 3215 Market Street, Philadelphia, PA 19104
| | - Avat Kioumarsi
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104
| | - Janna Ataiants
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY 10010
| | - Ellen Iverson
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, CA 90027
- Children’s Hospital Los Angeles, Division of Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027
| | - Carolyn F. Wong
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, CA 90027
- Children’s Hospital Los Angeles, Division of Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027
- Children’s Hospital Los Angeles, Division of Research on Children, Youth, & Families, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027
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22
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Richie-Zavaleta AC, Villanueva A, Martinez-Donate A, Turchi RM, Ataiants J, Rhodes SM. Sex Trafficking Victims at Their Junction with the Healthcare Setting-A Mixed-Methods Inquiry. ACTA ACUST UNITED AC 2019; 6:1-29. [PMID: 32190715 DOI: 10.1080/23322705.2018.1501257] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
U.S.-born citizens are victims of human trafficking typically exploited through sex trafficking. At least some of them interact with healthcare providers during their trafficking experience; yet a majority goes unidentified. Although protocols and training guides exist, healthcare providers often do not have the necessary skills to identify and assist victims of sex trafficking. Understanding where victims seek care and barriers for disclosure are critical components for intervention. Thus, this study interviewed survivors of sex trafficking to ascertain: a) healthcare settings visited during trafficking, b) reasons for seeking care, and c) barriers to disclosing victimization. An exploratory concurrent mixed-methods approach was utilized. Data were collected between 2016-2017 in San Diego, CA and Philadelphia, PA (N = 21). Key findings: 1) Among healthcare settings, emergency departments (76.2%) and community clinics (71.4%) were the most frequently visited; 2) medical care was sought mainly for treatment of STIs (81%); and 3) main barriers inhibiting disclosure of victimization included feeling ashamed (84%) and a lack of inquiry into the trafficking status from healthcare providers (76.9%). Healthcare settings provide an opportunity to identify victims of sex trafficking, but interventions that are trauma-informed and victim-centered are essential. These may include training providers, ensuring privacy, and a compassionate-care approach.
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Affiliation(s)
- Arduizur Carli Richie-Zavaleta
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Augusta Villanueva
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Ana Martinez-Donate
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Renee M Turchi
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Shea M Rhodes
- Institute to Address Commercial Sexual Exploitation, Villanova University Charles Widger School of Law, Villanova, PA, USA
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23
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Ataiants J, Cohen C, Riley AH, Tellez Lieberman J, Reidy MC, Chilton M. Unaccompanied Children at the United States Border, a Human Rights Crisis that can be Addressed with Policy Change. J Immigr Minor Health 2019; 20:1000-1010. [PMID: 28391501 DOI: 10.1007/s10903-017-0577-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In recent years, unaccompanied minors have been journeying to the United States (U.S.)-Mexico border in great numbers in order to escape violence, poverty and exploitation in their home countries. Yet, unaccompanied children attempting to cross the United States border face treatment at the hands of government representatives which violates their inherent rights as children. The result is a human rights crisis that has severe health consequences for the children. Their rights as children are clearly delineated in various, international human rights documents which merit increased understanding of and recognition by the U.S. government. This paper calls for the improvement of policies and procedures for addressing the rights of unaccompanied immigrant children; it provides specific, rights-based recommendations which work together to safeguard the rights of the child at the U.S. southwestern border.
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Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA. .,Behavioral Sciences Training Program, Rory Meyers College of Nursing, New York University, 250 Park Avenue South, 6th Fl., New York, NY, 10003, USA.
| | - Chari Cohen
- Hepatitis B Foundation, Philadelphia, PA, USA
| | - Amy Henderson Riley
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Jamile Tellez Lieberman
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA
| | | | - Mariana Chilton
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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24
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Reed M, Kioumarsi A, Ataiants J, Fedorova EV, Iverson E, Wong CF, Lankenau SE. Marijuana sources in a medical marijuana environment: dynamics in access and use among a cohort of young adults in Los Angeles, California. Drugs (Abingdon Engl) 2019; 27:69-78. [PMID: 31949332 DOI: 10.1080/09687637.2018.1557595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
While a range of sources exist for marijuana users to acquire marijuana for medical or personal use, prior research on marijuana sources primarily focused on single sources. In this analysis, we longitudinally examined characteristics of multiple sources selected by marijuana users, motivations to use sources, and how a blend of marijuana sources accommodated users' needs. Young adult marijuana users (n=60) in Los Angeles, CA, where marijuana has been legal for medical use since 1996, completed two annual qualitative interviews on marijuana use practices and sources between 2014 and 2016. Approximately two-thirds were medical marijuana patients and one-third were non-patient users. Participants reported acquiring marijuana from the following primary sources across two interviews: dispensaries and delivery services, private sellers in the illicit market, friends and family, and marijuana events/conferences. While patients with legal medical access to marijuana typically purchased marijuana from dispensaries or delivery services, they often supplemented from other illicit sources. Non-patients often accessed marijuana through dispensary diversion but also other sources. As patients became non-patients and vice versa during the study period, source type changed too. Broad access to marijuana via legal and illicit sources in this sample is indicative of societal trends towards normalization of marijuana use.
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Affiliation(s)
- Megan Reed
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104
| | - Avat Kioumarsi
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104
| | - Janna Ataiants
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104.,Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY 10010
| | - Ekaterina V Fedorova
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104
| | - Ellen Iverson
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, CA.,Children's Hospital Los Angeles, Division of Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027
| | - Carolyn F Wong
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, CA.,Children's Hospital Los Angeles, Division of Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027.,Children's Hospital Los Angeles, Division of Research on Children, Youth, & Families, 4650 Sunset Blvd., MS #2, Los Angeles, CA
| | - Stephen E Lankenau
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104
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25
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Lankenau SE, Ataiants J, Mohanty S, Schrager S, Iverson E, Wong CF. Health conditions and motivations for marijuana use among young adult medical marijuana patients and non-patient marijuana users. Drug Alcohol Rev 2017; 37:237-246. [PMID: 28434211 DOI: 10.1111/dar.12534] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/18/2016] [Accepted: 12/30/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION While marijuana has been legal for medical purposes in California since 1996, little is known about the health histories of young adult medical marijuana patients who are a significant proportion of medical marijuana patients. We examined whether young adult medical marijuana patients reported health conditions and motivations for use that were consistent with medical use of marijuana in California. METHODS Young adults (N = 366) aged 18 to 26 years were sampled in Los Angeles in 2014-2015 and segmented into medical marijuana 'patients' (n = 210), marijuana users with a current recommendation, and non-patient users or 'non-patients' (n = 156), marijuana users who never had a medical marijuana recommendation. Differences between patients and non-patients regarding self-reported health histories and past/current motivations for marijuana use were expressed as unadjusted risk ratios. RESULTS Compared with non-patients, patients were significantly more likely to report a range of lifetime health problems, such as psychological, physical pain and gastrointestinal. In the past 90 days, patients were significantly more likely to report motivations for marijuana use than non-patients concerning sleep, anxiety, physical pain and focusing. Psychological and pain problems were the most common health conditions reported to receive a medical marijuana recommendation. Patients were significantly less likely than non-patients to report any privacy concerns about obtaining a medical marijuana recommendation. CONCLUSIONS Patients were significantly more likely to report a range of health conditions and motivations associated with medical use than non-patients. A great majority of patients reported obtaining a medical marijuana recommendation for health problems in accordance with the California law. [Lankenau SE, Ataiants J,Mohanty S, Schrager S, Iverson E, Wong CF.Health conditions and motivations for marijuana use among young adultmedical marijuana patients and non-patient marijuana users. Drug Alcohol Rev 2017;00:000-000].
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Affiliation(s)
- Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA.,Rory Meyers College of Nursing, New York University, New York, USA
| | - Salini Mohanty
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Sheree Schrager
- Children's Hospital Los Angeles, Division of Hospital Medicine, Los Angeles, USA
| | - Ellen Iverson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA.,Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Carolyn F Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA.,Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, USA.,Division of Research on Children, Youth, & Families, Children's Hospital Los Angeles, Los Angeles, USA
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