142nd APHA Annual Meeting and Exposition

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Synthetic cannabinoids, cathinones, and illicitly synthesized opioids: Use prevalence, risk perception, and risk reduction behaviors among people who use internet drug discussion forums

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Traci Green, PhD, MSc , Inflexxion, Inc, Newton, MA
Maya Doe-Simkins, MPH , Prescribetoprevent.org, Chicago, IL

Data about illicitly synthesized opioid, cannabinoid and cathinone use often relies upon poison control calls or emergency department visits, reflecting only negative experiences. Little is known about behavior of users, perceived risks of use, and endemic risk reduction behaviors.


Users of an online drug discussion forum were invited to complete a survey in winter 2013.  Descriptive statistics summarized prevalence and risk perception.  Respondents reported cannabinoid and cathinone use risk reduction techniques in open text responses which were thematically grouped by time (pre-, during, post- use) and domain (self, drug, environment), guided by the Haddon Matrix.


Among 695 respondents, lifetime use of illicitly synthesized opioids (n=174, 25%), cannabinoids (n=274, 40%) and cathinones (n=219, 31.5%) was high. Past year prescription opioid use was associated with illicitly synthesized opioid (38.7% vs. 16.6%, p<0.001) and cannabinoid (46.2% vs. 36.1%, p<0.01), but not cathinone use (33.1% vs. 30.5%, p=0.48). Illicitly synthesized desomorphine (compared to heroin) was perceived as the most risky followed by cannabinoids (compared to marijuana), illicitly synthesized fentanyl (compared to heroin), and cathinones (compared to methamphetamine). E-cigarettes and pharmaceutical opioids were considered safer than tobacco and heroin, respectively. Risk reduction techniques for cathinones focused on self and drug, both pre- and during use; techniques for cannabinoids focused almost exclusively on the drug and during use.


Illicitly synthesized opioid, cannabinoid, and cathinone use is common among forum users, despite perceived relative risks. Future research should quantify risks of use and evaluate effectiveness of identified risk reduction techniques for these substances.

Learning Areas:

Public health or related research

Learning Objectives:
Compare the difference in use of illicitly synthesized opioids, cannabinoids, and cathinones among groups with different drug use behavior. Discuss divergence of risk perception and drug consumption behaviors for illicitly synthesized opioids, cannabinoids, and cathinones among internet drug forum users. Describe risk reduction behaviors undertaken to reduce the risk of canabinoid and cathinone use.

Keyword(s): Drug Abuse, Internet

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a drug abuse epidemiologist with experience conducting online and community-based participatory research among people who use drugs. The foci of my federally funded research are prescription drug and illicit drug abuse and misuse.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Inflexxion drug abuse research Employment (includes retainer)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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