Background

The policing and criminalization of drug use are linked with negative health impacts among people who use illicit drugs and disproportionately impact racial/ethnic minorities in the United States. Recent drug policy reforms, including overdose Good Samaritan Laws, reduction of the crack cocaine sentencing disparity, and cannabis reforms, have aimed to reduce criminal legal involvement in this population. The present study examined the recent epidemiology of drug arrests in a national survey.

Methods

This study analyzed the National Survey on Drug Use and Health (NSDUH) public-use data from 2015-2019. The sample included 25,429 adults who reported using at least one illicit drug (excluding marijuana) in the past year. Multivariate logistic regression models were used to estimate the odds of drug-related arrest by year and sociodemographic, polysubstance use, and health characteristics.

Results

The sample was majority male (53.4%), aged 18-25 (50.2%), non-Hispanic White (64.7%), above two times the federal poverty level (54.6%), and in large metro areas (46.9%). About 7.51% had residential transience (moved three or more times in the past year), 52.9% had used more than one illicit drug, and 6.1% received any treatment for illicit drug use. After adjustment, past-year drug arrest was associated with being non-Hispanic Black (aOR=1.90, 95% CI= 1.30-2.80), residential transience (aOR=1.61, 95% CI= 1.20-2.33), living in nonmetro areas (aOR=1.47, 95% CI= 1.14-1.88), and polysubstance use (aOR=1.34, 95% CI= 1.23-1.49).

Conclusion

Despite recent reforms to reframe substance use as a public health challenge, no reduction in drug-related arrests was detected from 2015 to 2019. Significant racial disparities persisted, with Black participants twice as likely to be arrested for drugs than their white counterparts. This may have downstream implications for health disparities, particularly as overdose rates are currently increasing most steeply in Black communities. More resources are needed in prevention and intervention efforts to combat these disparities.

Background: The co-use of heroin and methamphetamine has become a growing public health challenge, with those engaging in polysubstance injection use at greater risk for worse physical and mental health outcomes than those who engage in single substance use. However, little effort has been made to characterize this population or their needs and preferences. Moreover, even less is known if there are differences in the characteristics, needs, and preferences between those who do and do not co-use.

Methods: We collected survey data from participants of a midwestern syringe services program (N = 50), including sociodemographics, substance use behaviors, basic needs, and harm reduction preferences. We calculated descriptive statistics to characterize the sample and then used bivariate analyses to examine for differences in the characteristics, needs, and preferences between those who do and do not co-use heroin and methamphetamine.

Results: Self-reported needs and preferences for additional harm reduction services were high among this sample. Participants who endorsed co-use of heroin and methamphetamine were more likely to be non-white (p < 0.05), unemployed or only working part-time (p < 0.05), re-use syringes after someone else (p < 0.05), and rate the place they lasted injected drugs as less safe (p < 0.05) compared to those use only heroin or methamphetamine. Those who endorsed co-use also had significantly higher levels of need for housing/shelter, food, job or job training, healthcare, substance use disorder medication and treatment, a support person to help get the services they need, bus passes/transportation, fentanyl test strips, and safer smoking supplies (p < 0.05).

Conclusions: Results suggest that people who co-use heroin and methamphetamine may have riskier substance use behaviors and higher levels of need for harm reduction services than those who do not co-use. More robust harm reduction efforts for people who engage in polysubstance use are warranted.

Background: According to national prevalence data, a fifth of the population have had a parent with alcohol problems. Further, more than 2 million American children have lived with at least one parent who had a substance use disorder. A parent or other family members’ alcohol or substance use can negatively impact children. We used qualitative data to investigate the short and long-term harms that children experience from a parent or other family members’ alcohol or drug use.

Methods: Family members of individuals with substance use disorders (SUDs) from 5 different US cities were recruited to participate in 10 focus groups completed in summer 2022. We used thematic analysis to explore child harms from focus group participants who experienced harms as a child or directly witnessed such harms to children.

Results: Three themes of child harms emerged including acute effects, enduring effects, and parentification. Acute effects involved experiences of neglect such as lack of basic needs and emotional warmth. Enduring effects captured how these child harms can persist into adulthood affecting their own substance use and relationships as an adult. Parentification described the undue responsibility a child experiences (e.g., caring for siblings) because of a parent’s alcohol or drug use. Altogether, these themes highlighted the severity and burden of harms children may experience from a parent or family member with a SUD.

Conclusions: Focus group data from people with relevant lived experiences identified important areas for further research including the severity and long-term burden of child harms. Findings are also essential for informing policies and programs to reduce child harms from a parent or family members’ alcohol or drug use.

Background: Pre-pandemic data suggests that methamphetamine-related mortality and opioid co-involvement have been increasing in the United States (US). However, there was a staggering number of drug overdose deaths in the US in 2020 and 2021, particularly among males. An updated examination of sex-specific trends in methamphetamine-related mortality and the extent to which these deaths may be driven by the second (i.e., heroin) and third (i.e., fentanyl) waves of the opioid overdose crisis is warranted.

Methods: We leveraged final and provisional data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research multiple causes of death database to examine deaths involving methamphetamine and methamphetamine-related deaths that co-involved heroin and/or fentanyl among US residents aged 15 – 74 years. We plotted the age-adjusted methamphetamine mortality rates by sex and year and quantified the proportion of deaths with heroin/fentanyl co-involvement. Finally, we used joinpoint regression models to quantify sex-specific trends in methamphetamine mortality and the proportion of deaths with heroin and/or fentanyl co-involvement.

Results: From 1999 to 2021, the age-adjusted methamphetamine-related mortality rate increased 58.8-fold among males and 65.3-fold among females. The proportion of these deaths that co-involved heroin and/or fentanyl increased among both males (13.1% in 1999 to 61.5% in 2021) and females (7.7% in 1999 to 63.1% in 2021), with the greatest increases occurring over the last several years. Males had a higher age-adjusted mortality rate than females each year examined (p < 0.001), peaking at 19.74 deaths per 100,000 population among males in 2021 and 7.96 deaths per 100,000 population among females in 2021.

Conclusions: Increasing methamphetamine-related mortality among both males and females has been accompanied by a dramatic increase in the proportion of heroin and/or fentanyl co-involvement. Robust harm reduction efforts are needed to mitigate these increases, particularly for people who co-use stimulants and opioids.

Background: During the last decade in the United States, the public health focus has been on the opioid epidemic. Recently, however, there has been a shift in drug abuse patterns due to a rapid rise in stimulant use disorder. The increase in the use of stimulants during pregnancy presents a serious public health concern due to the harms associated with these substances.

Objectives: Analyzing Mississippi’s hospital discharge data for the 2016-2021 period, we evaluated the trends in stimulant use disorder during pregnancy. We also compared the characteristics of patients with simulant use disorder to those with other types of substance use disorders.

Methods: This was a cross-sectional study of pregnant Mississippi residents (12-49 years) hospitalized statewide. We created two groups: patients with stimulant use disorder (e.g., methamphetamine and prescription amphetamines) and those with other substance use disorders (e.g., opioid, cocaine, and cannabis). These categories were identified by using ICD-10-CM. We performed statistical analyses with SAS 9.4.

Results: During the study period, stimulant use disorder in pregnant patients skyrocketed by 106%, increasing from 110 cases in 2016 to 226 in 2021. Of the 921 pregnant patients with stimulant use disorder between 2016 and 2021, 81.7% were Caucasians, 65.0% were rural residents, and 75.8% were Medicaid-insured. Alarmingly, 67.1% of pregnant patients with stimulant use disorder had a diagnostic code for “drug use complicating childbirth.” Compared with pregnant patients suffering from other substance use disorders, those with stimulant use disorder were more likely to be Caucasians (81.7% vs. 39.2%, p < .001) and self-pay (11.9% vs. 4.00%, p <.001).

Conclusions: Over the six years studied, hospitalizations with stimulant use disorder during pregnancy increased rapidly in Mississippi. To reduce this trend, the state needs to introduce urgent educational and preventive measures, while physicians should exercise caution when prescribing amphetamines to women of childbearing age.

Background

Deleterious effects of independent alcohol, tobacco, and cannabis use on health and wellbeing have been widely documented, even as more states are allowing adult recreational cannabis use. Heightened use of these substances in individuals reporting mental distress is also known. Concurrent use of all three (polysubstance use) could synergistically increase risk for poor outcomes. Identifying population sub-groups at higher likelihood for polysubstance or dual combination use could inform public health interventions. This study sought to identify population-at-risk of polysubstance use; and quantified the relationship between polysubstance use and frequent mental distress (FMD) among New York adults.

Methods

Data from the 2021 Behavioral Risk Factor Surveillance System were utilized. Alcohol and cannabis use were defined by 1 or more days reported use; current smoking was defined using CDC methodology. FMD was dichotomized as “yes” and “no,” defined as >14 days and <14 days in past month when mental health was not good, respectively. Descriptive statistics and regression analyses were conducted using a statistical software.

Results

Past month use was 53.1% and 12.8% for alcohol and cannabis respectively, while 11.9% were current smokers. For dual use, 6.8% used alcohol and tobacco, 9.5% used alcohol and cannabis, while 3.5% used tobacco and cannabis. Only 2.4% used all three substances within past month but differed by sub-groups: 3.3% males versus 1.6% females; highest in 25-34 years old (5.4%); 7.6% in unemployed vs 2.1% in employed individuals; and higher in medium-sized metro areas. In adjusted analysis, frequent mental distress was associated with polysubstance use (aOR=2.58, 95% CI:1.54–4.30).

Conclusions

Findings demonstrate risk of polysubstance use varied across the New York adult population. This could have applications for brief screening interventions and public health education and policy. Additional studies could explore population differences in polysubstance compared to dual and single substance use during similar FMD experiences.

INTRODUCTION:

Substance abuse is a rapidly growing epidemic in the United States. Racial/ethnic health inequities and systematic racism play an important role in the substance use trend and likelihood of early initiation of substance abuse.

METHODS:

We analyzed all admissions aged 12years and above who accessed care for substance use treatment in the US as recorded in the 2018 Treatment Episode Data Set-Admissions (TEDS-A).We used multivariable logistic regression models to assess the association between race/ethnicity and age at first use after adjusting for confounding.

RESULT:

We found that out of the 2,060,509 admissions, majority were White (67%), followed by Blacks/African American (20%), Alaskan native/American Indian (3%) and Asian/Pacific Islander/Native Hawaiian (1%). About fourteen percent reported being of either Hispanic or Latino ethnicity.

Most of the Alaskan natives/ American Indians (61%) started substance use before 18 years of age (p<0.001). Logistic regression analysis of age at first use before controlling for confounding showed that the highest odds of early substance use was reported for Alaskan natives/ American Indians (OR-1.68). This was followed by Hispanic or Latino ethnicity (OR-1.16) and Black /African American (OR-1.03), while White was protective (OR-0.98). After adjusting for confounding, Black/ African American was protective (OR-0.95) while White had increased in the odds of early initiation of substance use (OR-1.09).

CONCLUSION:

The findings from this analysis that Black/African Americans had a higher risk of early initiation of substance use in univariate analysis and a lower risk after multivariable analysis as compared to Whites may be reflective of the role of structural racism and inequity in early initiation of substance use among those who later develop substance use disorders.

These findings have implications for focusing on individual and community-level risk factors as well as addressing the macro-level risk factors related to the manifestation of structural violence in the US.

Background: Drug overdose deaths are currently classified using the International Classification of Disease, Tenth Revision (ICD-10) codes. These codes are not inclusive of new or emerging specific substances. Considering the process to both finalize deaths and expand the ICD-10 series is slow, understanding alternative methods for fatal drug overdose identification is necessary for public health response and prevention.

Methods: We used 2019-2021 Tennessee death certificate and toxicology data from the State Unintentional Drug Overdose Reporting System (SUDORS) to evaluate a text search method for identifying fatal drug overdoses. This method was assessed to determine if it could correctly categorize drug overdose deaths (all drug, opioids, heroin, fentanyl, cocaine, psychostimulants), as well as identify overdoses involving specific substances (xylazine, ketamine, and nitazene). Both sensitivity and specificity tests were calculated to determine the method’s validity.

Results: For 2019-2021, there were 247,257 Tennessee residents who died; 8,935 were drug overdoses. When comparing the text search method to ICD-10 codingall broad categories were highly specific (greater than 99%) and sensitivity ranged from 96.6% (cocaine-involved) to 98.4% (all drug). By year sensitivity did not vary drastically; however, all categories except fentanyl saw a decline in sensitivity in 2020 followed by a slight increase in 2021. Identifying specific substances-involved with toxicology data was more difficult. All 3 substances searched for had high (>99.8%) specificity and lower sensitivity (nitazene-93.6%, xylazine-82.1%, ketamine-44%).

Conclusions: Text search methods for identifying drug overdose deaths involving broad categories of substances and specific substances may be an alternative method to the traditional ICD-10 codes or toxicology results. While novel substances identified from text search had lower sensitivity, the presence of these key words on a death certificate can give public health officials a way to be more proactive in monitoring and quantifying emerging substances unable to be reported by traditional methods.

Background: Adolescent substance use is heavily influenced by youth, peer, and parental substance use attitudes. Less is known about how these attitudes influence polysubstance (use of >1 substance) use. The purpose of this study was to examine the relationship of youth, peer, and family substance use attitudes in combination on both substance use and polysubstance use, and to assess whether attitudes about the use of specific substances have a stronger relationship to specific types of polysubstance use.

Methods: Longitudinal data was collected from an urban high school in northeastern United States. At baseline, demographics (sex, race/ethnicity) and student-reported youth, peer, and family attitudes were assessed. At wave 2, past-30 days substance use (alcohol, cannabis, cigarettes, and e-cigarettes) and all polysubstance use combinations were generated. GEE logistic regression models accounting for panel data by grade level were used to quantify risk of polysubstance use by combined substance use attitudes, adjusting for baseline student sex and race/ethnicity.

Results: At baseline, the sample was 51% girls (n=288), and 63% Hispanic (n=318). At follow-up, 79% of the sample (n=439) did not engage in substance use, 12% (n=67) engaged in the use of one substance, and 8.5% (n=47) engaged in polysubstance use. Youth, peer, and parental attitudes that were less restrictive toward alcohol, cannabis, and electronic vapor product were found to consistently predict any type of polysubstance use regardless of the specific combination of polysubstance use reported. However, attitudes toward cigarette use were not predictive of polysubstance use.

Conclusion: Least restrictive attitudes in multiple contexts – youth, peers, parents – toward substance use significantly predict most forms of polysubstance use, thus identifying a potential target for adolescent polysubstance use prevention.

Background: Many Indigenous communities across Turtle Island (now known as North America) are creating innovative responses to supporting community members through Indigenous harm reduction programming. To date, much of this effort remains unnoticed and uncaptured.

Methods: We completed a scoping review of academic and “grey” literature (i.e., community reports, toolkits and videos) surrounding Indigenous harm reduction. Our search strategy focused on articles that included Alaska Native/American Indian, substances use, harm reduction and demonstrated issues and/or solutions (new or existing).

Results: Results will include a description of current approaches and best practices incorporating Indigenous harm reduction. We will also explain how findings from this scoping review can support Indigenous communities in learning from each other to address ongoing inequities in substance use related health outcomes.

Conclusions: Inequities in overdose related deaths and substance use related consequences among Indigenous Peoples are widely cited and increasingly of concern. Yet, far less attention has been given to the ways in which Indigenous communities lead innovations in harm reduction approaches to honor our relatives and save lives. This presentation will demonstrate how Indigenous communities are creating opportunities for support through high quality, innovative, community-based care that supports people who use drugs “where they are at”.