Introduction - Currently, Drug overdose is a major public health burden in the USA. The CDC statistics show that drug overdose is currently the leading cause of accidental death in the United States and is a major cause of emergency department visits leading to this public health crisis. In Connecticut, fatalities from unintentional drug overdose outnumber those from motor-vehicle accidents.

Methods – Data was retrieved from the State Unintentional Drug Overdose Reporting System (SUDORS) which is compiled by the Connecticut Department of Public Health and the CT medical examiner office statistics. Recent literature and other public databases were utilized in further assessment

Results – Analysis of the SUDORS data indicates a continual increase in the prevalence of drug overdose, with a 198.9% increase from the year 2015 to 2022. In 2022, there were 1,464 drug overdose fatalities in the state of Connecticut, 92% of which involved prescribed or illicit opioid. The drug overdose deaths in white/Caucasians were at least 4 times as common as African Americans, or Hispanics. In 2021/22, the drug overdose autopsies represented almost half of all the total autopsies performed by the CT medical examiner office.

Conclusions - Drug overdose is a major public health burden in the USA. The problem in Connecticut is significant and is a clear example of this public health crisis in the New England region. Opioids and fentanyl/fentanyl analogues overdose were the main substances observed in this cohort. We observed a significant fraction of cases with polysubstance detection raising concerns that comprehensive drug assessment should be done in the acute setting. Overall, this data is significant and will have implications for physician drug monitoring protocols as well as promotion of Medication for Opioid Use Disorder (MOUD) programs.

Background

Drug overdose deaths increased by over 50% between 2017 and 2021 in San Francisco, most due to fentanyl. Little is known about non-fatal overdoses (NFOD), which heralds future risk for overdose death and is a cause of morbidity in itself. We assessed NFOD and access to overdose prevention services among people who inject drugs (PWID) in San Francisco in 2022. In addition to opioids, NFOD included “overamps” from stimulants.

Method

Data were from the National HIV Behavioral Surveillance (NHBS), a cross-sectional survey among PWID conducted from June to December 2022. Logistic regression analysis identified factors associated with NFOD.

Results

Of 521 PWID, 23.0% experienced NFOD in the past 12 months. The odds of experiencing NFOD increased 2.13 times among unhoused PWID (vs. housed, p=0.010, 95%CI 1.20-3.78) and 2.21 times among PWID with low-income (vs. >$40,000 annual income, p=0.033, 95%CI 1.06-4.60). The most commonly reported substance injected among PWID who experienced NFOD were methamphetamine (40.8%), followed by heroin (33.3%). On average, PWID witnessed someone else overdose 26.7 times (SD=61.1) in the past 12 months. Most (73.9%) PWID received a naloxone kit and over half (62.1%) had used naloxone to reverse a witnessed overdose. However, less than half of PWID who experienced NFOD received overdose treatment (43.7%).

Conclusion

Data shows that stimulant use is highly prevalent among PWID who experienced NFOD. Since NFOD on stimulants is associated with subsequent opioid overdose death, public health surveillance will need to be more vigilant in monitoring stimulant use, especially among PWID who often experience homelessness and live below the poverty line. Future harm reduction interventions are needed to help PWID mitigate their risk of overdose from stimulants in addition to opioids.

Background

Treatment admissions for methamphetamine use disorder (MUD) have doubled in the past decade. Treatment outcomes remain poor as there is currently no medication treatment for MUD. Given high rates of relapse and treatment attrition, the FDA and NIDA recommend that clinical endpoints extend beyond abstinence. A reduction in methamphetamine use is associated with improved overall functioning and better health. This study used national treatment data to identify reductions in stimulant use and whether patterns are changing over time.

Methods

We used the Treatment Episode Dataset–Discharges (2017–2021; N=251,841) to identify outpatient clients with methamphetamine, other amphetamines, cocaine, or other stimulants indicated as the primary substance. Drug use patterns were defined as the frequency of use reported at admission and discharge, which included decreased use (daily to some use; daily to no use; some to no use), no change (daily; some use), or increased use. We used a generalized linear model to calculate the predicted probability of drug use frequency, with an interaction between the primary stimulant and year, and adjusted for covariates.

Results

The majority of the sample reported methamphetamine as their primary drug of use (67%), followed by cocaine (28%), other amphetamines (4%), and other stimulants (1%). Two-thirds (65%) demonstrated no change in how often they used drugs. Achieving abstinence decreased over the five years (28% in 2017 versus 17% in 2021), and this negative treatment response was most pronounced for methamphetamine clients (interaction p<0.01). A reduction in drug use without abstinence was rare (3%).

Conclusions

Reduced methamphetamine and stimulant use among treatment clients is not improving. MUD clients are the largest treatment group and their trends in reduced use are more worrisome than other stimulant types. New treatment approaches, such as novel therapeutics, are needed to improve outcomes among a growing population of MUD treatment clients.

Introduction

The effects of alcohol, nicotine and cannabis on sleep duration are an emerging area of interest along with poly-substance use among adults. Approximately 37% of US adults ages 25 to 44 reported decreased sleep duration, defined as less than 7 hours of sleep per night. Our research objective was to explore the association of alcohol, nicotine, and/or cannabis use with sleep duration.

Methods

Utilizing 2020 & 2022 BRFSS across 31 US states (N=209,137), we examined prevalence of self-reported alcohol, cannabis, and nicotine use with sleep duration. Using regression analysis, we examined (1) average sleep duration by substance use; (2) binary regression for getting <7 hrs of sleep daily by substance use; and (3) not meeting CDC sleep recommendations by substance use.

Results

Average sleep duration was 6 hours and 59 minutes, with 34.34% of adults reporting less than 7 hours of sleep. Daily alcohol, nicotine, and cannabis use was 5.93%, 14.76%, 6.15%, respectively. Daily cannabis use was associated with ~ 8 minutes less sleep and daily nicotine use was associated with ~16 minutes less sleep. Past 30-day co-substance use was reported by 6.34% for tobacco/nicotine & cannabis, 9.79% for cannabis & alcohol, and 12.17% for nicotine & alcohol, while 4.33% reported using all three. Co-use of nicotine & alcohol, as well as nicotine & cannabis, was associated with ~11 minutes less sleep on average. Lastly, poly-substance use of all was associated with ~12 minutes less sleep.

Discussion

Co/poly-use of alcohol, nicotine and cannabis appears to negatively affect sleep duration. This evidence draws attention to the need for further screening for use of these substances in those with decreased sleep duration. With co/poly-use being associated with lower sleep duration, future research examining this potential relationship is warranted.

Background: Many experience burdens from others’ use of alcohol, cannabis and other drug harms. We adapted a burden scale from caring for people with mental health conditions, for our US Alcohol and Drug Harm to Others Survey (ADHTOS).

Methods: A web survey of adults December 2023-January 2024 (preliminary n=6,145) using address-based sampling (n=2,067) and web panels (n=4,080), oversampled Black, Latinx and sexual/gender minority (SGM) participants. We assessed 7 burdens from others’ alcohol/drug use (e.g., neglected family needs, family frictions/arguments, emotional drained/exhausted) with 4-point scales (“1=not at all, 2=a little, 3=some, 4=a lot”). Analyses used a 4-level ordinal-burden scale from 7-item sum (dependent) in multinomial logistic regressions with ever experiencing harms from each substance, using SPSS V29.

Results: The single-factor burden scale had good reliability (alpha=.91). Two burden items, family friction/arguments and feeling emotionally drained/exhausted, were endorsed by 39-40% participants (10-13% “a lot”); 34% endorsed finding the stigma of another’s use upsetting (9% “a lot”). Fewer endorsed feeling trapped as caregivers (22%; 6% “a lot”), problems outside the family (27%; 4% “a lot”) and having to change plans (15%; 3% “a lot”). We analyzed associations between burden and ever experiencing four secondhand harms: assault, family/marital problems, felt threatened/afraid or emotionally hurt/neglected due to, separately, others’ use of alcohol, cannabis, or other drugs besides cannabis. For example, adjusting for age and gender (younger, women and SGM people: higher burden), ever feeling threatened/fearful, and emotionally hurt/neglected from others’ alcohol/drug use showed significant (p<.001) adjusted Odds Ratios in ordinal burden ranges 8-14 (aORs 1.5 & 2.0); 15-21 (2.1 & 4.9); and 22-28 (3.5 & 6.1), respectively; reference never=7.

Discussion: People affected by others’ AOD use showed substantial burden from others’ use of alcohol, cannabis, other drugs, and combinations.

Conclusions: Results can inform interventions and policies to mitigate burdens associated with others’ use of substances.

Background: Alcohol and tobacco co-use have health implications including increased risk for heart disease and certain cancers, and difficulty in quitting either substance. There are gaps on our understanding of the risk factors for co-use, and due to the complexity of both behaviors, different definitions of alcohol and tobacco use could impact the population deemed as having co-use behaviors.

Methods: NSDUH 2019 data (N=56,136) was used to explore alcohol and tobacco co-use by creating four unique variables of alcohol and tobacco use. Alcohol use was coded as non-drinking, drinking, and heavy drinking, with one variable defining heavy drinking using average drinks per week, and the other also including binge drinking as heavy drinking. Tobacco use was coded as cigarette only use or any tobacco product use. These variables were then used to describe the prevalence of co-use by gender and age.

Results: Among men, the prevalence of heavy drinking increased from 20.2% to 29.2% when binge drinking was included in the definition of heavy drinking; for women, the prevalence increased from 26.3% to 30.8%. The prevalence of non-heavy drinking was highest for men compared to women, but women had a greater proportion of heavy drinkers using either definition of heavy drinking. Among men, 49.0-53.0% were defined as cigarette co-users depending on the definition of heavy drinking; 54.5-58.8% were defined as any tobacco co-users. For women, the prevalence of cigarette co-use was 47.0-50.1% and any tobacco co-use was 41.2-45.5%. Co-use was most prevalent among 18-25 year-olds (34.8-37.4%) and lowest among those 50 and older (10.3-10.8%).

Conclusions: While the prevalence of heavy drinking was higher in women, co-use was more common in men and younger people, regardless of the definition of co-use. Future research is needed to better understand the correlates of co-use in the population with varying definitions of co-use.

Crude and retrospective measurement impedes the validity of prior findings suggesting people who use substances are at elevated risk of “unintended” pregnancy.

Between 2019-2023, 2,015 non-pregnant individuals, recruited from 23 clinics in 5 southwestern states, reported pregnancy preferences quarterly over one year using the validated Desire to Avoid Pregnancy (DAP) scale. We investigated associations between substance use and DAP using multi-level linear mixed effects models. We examined differential attainment of pregnancy preferences (e.g., becoming pregnant or avoiding pregnancy, as desired over time) by substance use with cox proportional hazard models (with DAP categorized as low, midlevel, or high).

Participants reported baseline heavy alcohol (45%), cannabis (31%), tobacco (13%), and illicit drug (3%) use. Daily cannabis and illicit drug use, but not alcohol use, were associated with higher DAP scores among non-pregnant participants (respectively, coef = 0.21, 95% CI: 0.13, 0.28; coef = 0.34, 95% CI: 0.20, 0.48). 284 participants reported incident pregnancies. Associations between DAP and pregnancy differed by alcohol but not drug use. Those most wanting to avoid pregnancy were at increased pregnancy risk if they reported heavy drinking (aHR = 1.50, 95% CI: 1.14, 1.97); those most open to pregnancy had similar pregnancy rates regardless of alcohol use (aHR=0.84, 95% CI: 0.62, 1.14).

Heavy alcohol use was associated with lower attainment of pregnancy preferences for those most wanting to avoid pregnancy. With attention to reproductive autonomy and full-spectrum pregnancy preferences, the DAP scale could help existing interventions better support people with heavy alcohol consumption in achieving reproductive autonomy.

Background: Drug overdose deaths have continued to increase, and the proportion of synthetic opioids has become more significant. There is a need to understand spatiotemporal differences and clustering of overdose death rates.

Objectives: We aim to understand the spatial and temporal distribution and clustering of fentanyl-involved and non-fentanyl-involved overdose death rates between 2016 and 2023 in Cook County, Illinois. We also seek to assess the potential impact of COVID-19 on drug overdose death rates.

Methods. A stepwise spatial analytical approach was used to analyze overdose death rates data collected by the Cook County Medical Examiner’s Office that involved fentanyl and non-fentanyl (prescription opioids, heroin, and cocaine). First postal-code-level incidence rates of overdose deaths for each drug were illustrated in maps. Next, inverse distance weighted interpolation was used to estimate incidence rates in areas with no observations. In the last steps, global and local clustering of incidence rates were measured using the Moran’s I method.

Results: The incidence rates of overdose deaths involving fentanyl have increased until 2022 and slightly decreased in 2023, while the rates involving heroin and prescription opioids have decreased after 2020. The hot spot clusters for fentanyl-involved overdose deaths expanded from the Chicagoland area to the Western part of Chicago before COVID-19 and then to the Southern areas after 2020. The geographical distribution of non-fentanyl substance-related deaths was similar, but the number of hot spots was fewer.

Conclusions: Fentanyl has not affected all areas of the county equally. Regions with higher fentanyl involvement, along with other substances, may indicate numerous cases of unintended fentanyl exposure. It is critical to prioritize closer monitoring of the drug supply chain and implementing harm reduction interventions in these areas.

Background

Substances-use related ED encounters were overall increasing in Westchester County in the past year, but it is unclear whether the increasing was significant or not, and what substances related visits contributed to such increase. The SUDs capture all related diagnosis even if it is not the main reason for the ED visits. Among patients aged 12 or older residing in Westchester County, we examined temporal trends in all ED encounters and substance use related encounters during the past year.

Methods

We conducted a retrospective analysis of 291,794 eligible encounters identified by electronic query between February 1, 2023 and February 29, 2024. Of these, 13,987 encounters involved SUD signals. Aggregated by month, SUD encounters percentages were SUD encounters over all encounters. Commonly used substances percentages were the number of alcohol, nicotine and other substance related encounters over SUD encounters in each month. Trends were fitted by linear regression. All statistical analyses were performed with R.

Results

There was significant increasing trend at a slop of 0.15 in the monthly percentage of SUD encounters (95% CI 0.08–0.23, p <0.001). Among those monthly SUD encounters, the percentage of Nicotine encounters had a significant increase at a slop of 2.6 (95% CI 1.65–3.44, p <0.001). No significant trend in the percentage of Alcohol encounters were observed. The percentage of the substances other than Alcohol and Nicotine had a significant decrease at a slop of -1.3 (95% CI -1.79 – -0.72, p <0.001).

Conclusions

The significant increase in the proportion of SUD encounters relative to overall encounters was driven largely by the increase trend in the encounters related to Nicotine despite decrease trends in Alcohol and other substances respectively. More attention on patients having complaints of Nicotine consuming or Nicotine related diagnosis in Westchester County is needed for further surveillance in the coming year.

Marijuana and tobacco co-use is common among female substance users. The purpose of the study was to (1) examine the recent prevalence of past month marijuana and tobacco co-use among women, and (2) identify the significant factors that differentiate marijuana and tobacco co-users from non-users. We used 11,832 U.S. women aged 18-44 who responded to the 2021 National Survey on Drug Use and Health. We calculated the weighted prevalence and chi-squared test to compare sociodemographic factors. We identified the risk factors of marijuana and tobacco co-use by using a weighted multinomial logistic regression reporting the adjusted odds ratio and 95% confidence intervals. Statistical significance was determined at p < 0.05. Tobacco-only users were more prevalent than co-users, which were 13.4%, followed by 9.4% among the respondents. The demographic and substance use related factors significantly differed from single users, co-users, and non-users. Being Hispanic (AOR ranging from 0.32 to 0.47) compared to Non-Hispanic White, having a college graduate (AOR ranging from 0.18 to 0.34) compared to lower than high school, having a higher income level compared to less than $20,000, being married compared to never married, being pregnant compared to non-pregnant, and ever used a pain reliever compared to non-users were protective factors for marijuana only and marijuana and tobacco co-users. The prevalence and risk factors related to marijuana and tobacco use varied by sociodemographic factors among reproductive aged women. To prevent marijuana and tobacco co-use by reproductive-aged women, the approach of poly-substance prevention is essential.