The American Journal of Drug and Alcohol Abuse

Background: The opioid crisis, driven by fentanyl use, continues to worsen in the US and there has been a lack of focus on nonfatal overdose and how pediatric populations are being affected. Objectives: We determined the prevalence of nonfatal pediatric fentanyl exposures and associated characteristics and delineated how such characteristics are associated with major (life threatening) outcomes. Methods: This repeated cross-sectional study examined characteristics of pediatric nonfatal fentanyl exposures (aged 0–19 years) reported to poison centers in 49 US states from 2015 through 2023. Results: 3,009 nonfatal pediatric exposures (41.5% female) were reported to poison centers—58.9% aged 13–19 and 41.1% aged 0–12. The number of exposures increased overall from 69 in 2015 to 893 in 2023 (a 1,194.2% increase, p < .001). Exposures increased by 924.3% among those aged 0–12 (p < .001) and by 1,506.3% among those aged 13–19 (p < .001). Ingestion-only use was the most prevalent route of administration by those aged 0–12 (76.9%) and 13–19 (54.1%). Prevalence of ingestion-only use increased from 44.1% of exposures in 2015 to 67.9% in 2023 (p < .001). The majority of patients aged 0–12 were exposed unintentionally (81.7%, vs. 1.0% among patients aged 13–19) while the majority of patients aged 13–19 misused or “abused” fentanyl (65.7% vs. 1.8%). The plurality of exposures (41.0%) resulted in a major (life-threatening) effect. Conclusions: Pediatric exposures to fentanyl are increasing and over one-third of cases are unintentional and/or had documented life-threatening effects. Prevention and harm reduction efforts need to include efforts for youth, particularly as counterfeit pills containing fentanyl flood the illicit market.

Background: Gabapentinoids are ligands of a brain calcium channel, which are approved for different indications, including epilepsy, neuropathic pain, or generalized anxiety disorder. Among gabapentinoids, pregabalin has been increasingly associated with a risk of pregabalin use disorder (PUD). To date, there is no recommended medical treatment for PUD. However, gabapentin, which has a lower abuse potential, could be used as a substitution therapy to reduce pregabalin withdrawal and craving. Objectives: To report on the experimental use of high dose of gabapentin among those with PUD. Methods: Case series of four patients (3 males and 1 female) with severe PUD (average daily doses ranging from 1,200 to 8,400 mg of pregabalin), in whom high dose of gabapentin was prescribed as a substitution treatment. Results: Upon gabapentin being administered as substitution therapy for pregabalin, all four patients experienced intense craving and distress. Despite receiving high doses of gabapentin, due to the observed levels of craving and distress, all four patients had to be rapidly switched back to pregabalin. Conclusions: Preliminary clinical findings suggest that gabapentin is unlikely to be a suitable, lower- risk alternative treatment for people with PUD. Additional examination of candidate medications, including other gabapentinoids, could be useful to identify an effective treatment for PUD.

Background: Adults who smoke cigarettes (AWS) who switch to electronic nicotine delivery systems (ENDS) are likely to reduce their health risks.Objectives: To explore ENDS-users' readiness to stop smoking (RTSS) when adopting ENDS, the prospective association of RTSS and switching away from smoking (past-30-day abstinence), and the role of frequency of JUUL use in switching.Methods: Analyses used data from a naturalistic 2-year longitudinal study of 17,393 AWS (55.4% male) who had purchased a JUUL Starter Kit.Results: Only 20% were planning to stop smoking within 7 days at baseline but had the highest likelihood of switching, 70% at Month-24 (vs. in a year or more: OR = 2.33; 95%CI = 2.13-2.55). Those planning to stop smoking within 30 days (24%), 6 months (24%) or a year or more (27%) had switch rates of 53 ~ 59% at Month-24; those who planned never to quit (6%) had 51% switch rates. Daily ENDS use was prospectively associated with the highest likelihood of subsequent switching (vs. infrequent: OR = 1.68; 95%CI = 1.60-1.77); frequent users (≥20 days/month) also had higher switch rates (OR = 1.22; 95%CI = 1.15-1.28). Descriptively, participants higher on RTSS were more likely to be daily or frequent users, but frequency of use neither interacted with RTSS, nor mediated its association with switching.Conclusions: Most ENDS adopters were not ready to stop smoking, and would not be candidates for cessation treatment. However, a majority - even of those never planning to quit - were abstinent from cigarettes two years later. ENDS may facilitate smoking abstinence in populations not reached by traditional cessation interventions.

Background: It is necessary to understand drinking motives to inform tailored interventions counteracting high-risk alcohol use and alcohol use disorder. Research suggests that, during the COVID-19 pandemic, drinking to cope with the current situation (i.e. coping motive) increased. This was alarming since the coping motive is a predictor of alcohol use and alcohol-related problems.Objective: In the current study, we aimed to elucidate whether this COVID-19-induced increase in coping-motivated alcohol use outlasted the COVID-19 pandemic in the USA, Great Britain, Mexico, Spain, and Germany. We provide a 2023 post-COVID-19 update on alcohol use and drinking motives.Methods: In spring 2023, 1032 participants recruited via Prolific (48% female) across the five countries completed a cross-sectional online survey, including the Alcohol Use Disorder Identification Test (AUDIT) for alcohol use patterns and the Drinking Motives Questionnaire-Revised (DMQ-R) for drinking motives.Results: Across all five countries, 20-30% of the participants exceeded the AUDIT cutoff score for high-risk alcohol use. The ranking of all four motives for alcohol use was cross-nationally consistent: Social > Enhancement > Conformity > Coping.Conclusion: Compared to most research before the pandemic, with a Social > Enhancement > Coping > Conformity motive ranking, and research during COVID-19, with an Enhancement > Coping > Social > Conformity motive ranking, our data suggests that post-COVID drinking to socialize and to enhance one's own mood, are again the most important motives to drink alcohol. Furthermore, it seems like the increase in the coping motive found in research during the pandemic, did luckily not persist but conversely, post- compared to pre-COVID, the conformity motive seems more important than coping motive.

Background: Unplanned drinking episodes are empirically and conceptually linked with adverse outcomes, though recent research suggests planned drinking episodes may be riskier. Mixed findings may be due to unplanned drinking being operationalized as a dichotomous representation of the phenomenon (e.g. was drinking planned or unplanned) rather than continuous (e.g. the number of drinks beyond one's intended limit). Examining a continuous representation of the number of unplanned drinks consumed (i.e. consumed minus intended drinks) would permit a more nuanced evaluation of unplanned drinking and may be more predictive of consequences.Objectives: The present study aimed to describe the occurrence of unplanned drinking and disentangle the role of dichotomous vs. continuous operationalizations in predicting consequences.Methods: Participants were 104 (81.7% female; Mage = 20.75, SD = 1.99) undergraduate drinkers recruited through a psychology subject pool. Participants completed an online baseline survey followed by 14 brief, daily online surveys. Daily reports yielded an analytic sample of 325 drinking episodes.Results: Results indicated that most drinking episodes were planned but underestimated in quantity (i.e. consumption exceeded intentions). Only the continuous estimate of unplanned drinking was associated with negative consequences after controlling for dichotomous unplanned drinking (b = 0.25, IRR = 1.28).Conclusions: Results shed light on the need for a more nuanced operationalization of unplanned drinking behaviors, as current research utilizing a dichotomous lens may not be fully capturing the risky phenomenon. Results suggest that unplanned drinking, particularly related to consuming more drinks than intended, may be a useful indicator of problematic drinking.

Background: The emergence of new psychoactive substances (NPSs) poses a serious global health threat. Although various groups of psychostimulants exist, this study specifically investigated two lesser-studied substances, 4,4'-dimethylaminorex (4,4'-DMAR) and escaline.Objective: To assess liability to substance use disorder (SUD), as evidenced via preclinical models, of the two psychostimulants.Methods: 4,4'-DMAR and escaline were evaluated, in mice, for their potential to exhibit rewarding and reinforcing effects, and for causing central dopaminergic activity. The climbing behavior test investigated whether the substances acted as dopaminergic agents and to determine the dose range for further evaluation. The rewarding and reinforcing effects of these substances were evaluated via the conditioned place preference (CPP) and self-administration (SA) tests.Results: The results showed that both test substances significantly increased climbing behavior at 1 mg/kg (p < .01). Mice treated with 0.1 and 1 mg/kg 4,4'-DMAR (p < .05) and with 1 mg/kg escaline (p < .01) exhibited increased duration of time spent in the substance-paired compartment in the CPP test compared to those treated with vehicle. Further, the frequency of infusions from the 5th to 7th sessions was significantly increased at 1 mg/kg/infusion of 4,4'-DMAR (p < .001) and at 0.01 and 0.1 mg/kg/infusion of escaline (p < .01) compared to controls.Conclusion: The findings suggest that 4,4'-DMAR and escaline have dopaminergic activity, exert reinforcing and rewarding effects, and may cause SUD. The findings can inform relevant authorities about the need to regulate these two new compounds.

Background: The state of Washington legalized cannabis for adult use in 2012 and retail stores began to open in 2014 with 31 stores, rising to 447 in 2020. Prior studies have evaluated impacts of legalization on state-level mortality from suicide, motor vehicle accidents and opioid poisonings with mixed findings.Objectives: To estimate relationships between county cannabis retail store density and county mortality rates from suicide, motor vehicle accidents, opioid poisoning, homicide and accidental poisonings.Methods: County mortality data for Washington state (39 counties) from individual death records for the years 2009-2020 used ICD-10 Multiple Cause of Death Files. County-level cannabis retail store counts in Washington were based on cannabis license and sales data. Fixed effect Poisson regression models predicted county-level yearly mortality rates for 2009-2020.Results: Deaths from 2009-20 in Washington were 12,933 (77% men) from suicide, 6761 (71% men) from motor vehicle accidents, 8858 (62% men) from opioid poisoning, 2408 (73% men) from homicide and 11,873 (64% men) from accidental poisonings. Store counts per 10,000 population were negatively associated with accidental poisonings (incidence rate ratio (IRR) of 0.83 (0.73-0.93)) and opioid mortality rates with (IRR of 0.83 (0.70-0.99)). No significant effects were found for motor vehicle accidents, homicide or suicide.Conclusions: County cannabis retail store density in Washington was associated with reduced accidental poisoning and opioid mortality while suicide and motor vehicle accident mortality rates did not appear to change. Results do not support any harmful effects on mortality from cannabis store expansion in Washington counties.

Background: A high number of adolescents and young adults engage in opioid misuse and/or meet criteria for opioid use disorder (OUD). Youth also experience worse treatment outcomes when compared to adult counterparts.Objectives: This scoping review aimed to identify and summarize existing interventions designed to increase engagement of youth across the OUD care cascade, as well as describe clinical and research implications.Methods: Peer-reviewed literature was searched using PubMed, PsycInfo, and Web of Science. Studies were eligible if they presented outcomes of an intervention focused on engaging adolescents and young adults (ages 12-25 years) in the OUD care cascade and were published in English.Results: Nine articles met inclusion criteria that described interventions for adolescents and young adults across engagement, initiation, and retention in the OUD care cascade. Several strategies were used in interventions, including behavioral health and integrated health services, contingency management, meaningful family involvement, assertive outreach, and provider trainings/consultation. Only one intervention has been tested with a randomized control trial.Conclusions: Due to small sample sizes and lack of control groups, findings from existing intervention studies do not indicate which strategies are most effective. Further research is urgently needed to develop and evaluate effective interventions for youth with OUD. Providers working with youth should implement services to meet youth's individual needs. Providers should consider utilizing integrated services and referrals to behavioral health, involving family in treatment, and use of contingency management and assertive outreach. Continuing education for providers on OUD treatment and developmental concerns is also crucially needed.

Background: Young sexual and gender minority (SGM) men experience disproportionate risk of drug-related harms. Improving access to drug checking services (DCS), where people can receive information about the contents of their illicit drugs, is critical to facilitate safer drug use among this population. However, no research to date has explored their perspectives on DCS.Objectives: To explore perspectives on DCS among young SGM men in Metro Vancouver, Canada.Methods: Semi-structured interviews were conducted with 50 young (ages 18-30) SGM men living in Metro Vancouver in 2018. Interviews were audio-recorded, transcribed verbatim, and coded. Themes were identified using inductive-deductive approaches and interpreted by drawing on the Risk Environment Framework.Results: Two key themes emerged. First, participants generally had limited awareness and experience with DCS. Nevertheless, given concerns over the increasingly toxic drug supply, they perceived benefits to getting their drugs tested, including reducing their risk of overdose. Second, participants identified social (e.g. anti-drug stigma), policy/legal (e.g. drug criminalization), and physical (e.g. lack of services outside of downtown Vancouver) barriers in the current context of DCS. To improve access, participants encouraged the expansion of DCS in community settings (e.g. bars) and through community-based approaches (e.g. integration within community sexual health programming) tailored for young SGM men.Conclusion: Despite low levels of awareness and experience with DCS, young SGM men demonstrated a strong interest in accessing these services. Efforts to adapt and scale up DCS need to account for the social, policy/legal, and physical contexts that shape the lives of young SGM men.

Background: Kratom is a plant with alkaloids acting at opioid, serotonergic, adrenergic, and other receptors. Consumers report numerous use motivations.Objectives: To distinguish subgroups of kratom consumers by kratom-use motivations using latent-class analysis.Methods: From July to November 2022, we utilized convenience sampling and surveyed regular kratom consumers (n = 395, 38.1 years (SD 11.2), 54.9% male, 81.3% White) regarding demographics, lifetime and past-year substance use and preferences, substance use disorder history, healthcare barriers, kratom-use motivations, and general health. We used latent-class analysis to identify subgroups by use motivation and calculated conditional probabilities (Pc) for variables in each class.Results: A four-class model best fit our data. The largest class (32.4%) was characterized by the use of kratom for self-treatment of chronic pain (Pc = .91). The smallest class (19.2%) also reported using kratom for self-treatment, but usually as a long-term replacement for other substances (Pc = .75). The other two classes (24.8% and 23.5%) reported using kratom for management of anxiety (Pc = .87-.95) and depressive symptoms (Pc = .61-.89) and for recreation (Pc = .56- .86). These were distinguished from one another by probability of at least moderate kratom use disorder (Pc = .17 vs. .53), with greater probability observed in the class with greater anxiety (Pc = .13 vs. .50) and depressive (Pc = .34 vs. .82) symptom severity and more likely recreational use motivation (Pc = .56 vs. .86).Conclusion: Kratom consumers can be classified by their use motivations. As with other psychoactive substances, the range of motivations is consistent with the range of likely effects. It is not yet clear whether some motivations might indicate the risk of problems.

Background: While social support benefits those in treatment for opioid use disorder, it is unclear how social support impacts patient outcomes.Objectives: This study examines how support person attitudes toward buprenorphine and their communication about substance use are associated with the well-being of patients receiving buprenorphine treatment.Methods: We analyzed cross-sectional baseline data from 219 buprenorphine patients (40% female) and their support persons (72% female). Patients were recruited from five community health centers and asked to nominate a support person. Patient outcomes included symptoms of depression, anxiety, impairment due to substance use, and perceived social support. Support persons predictors included their attitudes toward buprenorphine from four statements (e.g. "Buprenorphine is just replacing one drug for another") and communication using two items (e.g. comfort and effectiveness discussing substance use).Results: More stigmatizing attitudes, such as believing patients should quit on their own without medication, were associated with increased patient substance use-related impairment (F = 4.53, p = .01). Effective communication was associated with lower patient depression (F = 10.15, p < .001), anxiety (F = 4.73, p = .001), lower impairment (F = 6.46, p < .001), and higher perceived social support (F = 3.68, p = .007).Conclusions: This study highlights how support person attitudes and communication dynamics significantly affect the mental health and impairment of individuals receiving buprenorphine treatment. Interventions that reduce stigma and promote effective communication between patients and their loved ones could enhance treatment outcomes and overall well-being among patients with OUD.

Background: There has been a dramatic rise in alcohol consumption and alcohol use disorder (AUD) among women. Recently, the field has made substantial progress toward better understanding sex and gender differences in AUD. This research has suggested accelerated progression to AUD and associated health consequences in women, a phenomenon referred to as "telescoping."Objective: To examine evidence for the telescoping hypothesis from a biopsychosocial perspective.Methods: This narrative review examined and integrated research on biological, psychological, and socio-environmental factors that may contribute to the development and progression of AUD in women.Results: Biopsychosocial research has revealed sex- and gender-specific risk factors and pathways to AUD onset and progression. Biological sex differences render females more vulnerable to alcohol-related toxicity across various biological systems, including the brain. Notably, sex and gender differences are consistently observed in the neural circuitry underlying emotional and stress regulation, and are hypothesized to increase risk for an internalizing pathway to AUD in women. Psychological research indicates women experience greater negative emotionality and are more likely to use alcohol as a means to alleviate negative emotions compared with men. Socio-environmental factors, such as familial and peer isolation, appear to interact with biological and psychological processes in a way that increases risk for negative emotionality and associated alcohol use in women.Conclusion: There appears to be a complex interplay of biopsychosocial factors that increase risk for AUD onset and progression in women through an internalizing pathway. Developing targeted interventions for women with AUD that specifically target internalizing processes is critical.

Background: Drug use among men is a significant public health concern in China, with compulsory drug treatment centers being the primary approach. Police officers in these centers play a crucial role in shaping the interactions and experiences of men who use drugs (MWUD). However, little research exists on the attitudes of police officers toward MWUD in China.Objectives: This qualitative study aimed to explore the attitudes of police officers toward MWUD and drug rehabilitation approaches in China.Methods: Semi-structured individual interviews were conducted among 23 police officers recruited from two compulsory drug treatment centers in Jiangsu Province, China. Of the participants, two were females and 21 were males. Thematic analysis was employed to analyze the data.Results: Three key themes emerged: 1) Multifaceted perspectives on MWUD. Participants viewed MWUD as offenders, victims, and patients. 2) Dynamic interactions with MWUD. Relationships were characterized as either adversarial or supportive, influenced by participants' personalities, experiences, beliefs, workload, and psychological training. 3) Advocating for punitive measures in drug rehabilitation. While the participants generally favored strict penalties for MWUD, they acknowledged the value of community-based rehabilitation. Concerns about social stigma, privacy, motivation, and the costs of voluntary rehabilitation tempered their support.Conclusions: The study highlights the importance of raising awareness and challenging bias among police officers. It emphasizes the need for psychological training to enhance their capacity to provide humane care and foster positive interactions with MWUD. Additionally, ensuring access to affordable, accessible, and stigma-free voluntary rehabilitation is crucial for effective drug rehabilitation efforts.