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

Background

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.

Methods

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.

Results

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.

Conclusions

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.