Polysubstance use profiles among electronic dance music party attendees in New York City and their relation to use of new psychoactive substances

BackgroundElectronic Dance Music (EDM) party attendees are often polysubstance users and are at high risk for use of new psychoactive substances (NPS). We sought to identify patterns of use of common illegal drugs among EDM party attendees, sociodemographic correlates, and use of NPS as a function of patterns of use of more common drugs to inform prevention and harm reduction.MethodUsing time-space-sampling, 1045 individuals aged 18–40 were surveyed entering EDM parties in New York City. We queried past-year use of common illegal drugs and 98 NPS. We conducted latent class analysis to identify polysubstance use profiles of use of eight common drugs (i.e., ecstasy, ketamine, LSD, mushrooms, powder cocaine, marijuana, amphetamine, benzodiazepines). Relationships between drug classification membership and sociodemographics and use of drugs within six NPS categories were examined.ResultsWe identified four profiles of use of common drugs: non-polysubstance use (61.1%), extensive polysubstance use (19.2%), moderate polysubstance use/stimulants (12.8%), and moderate polysubstance use/psychedelics (6.7%). Those in the moderate/psychedelic group were at higher odds of using NPS with psychedelic-type effects (2C, tryptamines, and other “new” psychedelics; Ps < 0.05). Extensive polysubstance users were at increased odds of reporting use of 2C drugs, synthetic cathinones (“bath salts”), tryptamines, other new (non-phenethylamine) psychedelics, new dissociatives, and synthetic cannabinoids (Ps < 0.05).ConclusionNPS preference is linked to the profile of use of common drugs among individuals in the EDM scene. Most participants were identified as non-polysubstance users, but findings may help inform preventive and harm reduction interventions among those at risk in this scene.     

“How do online and offline sampling compare in a multinational study of drug use and nightlife behaviour?”

BackgroundOnline sampling is widely used to recruit hard to reach samples such as drug users at nightlife events. We conducted the first study comparing differences in demographics, drug use and nightlife behaviour between an online sample of young adults engaging with the European nightlife scene, and an offline sample recruited at nightclubs and festivals in Europe.MethodsOnline participants who attended at least six nightlife events in the past 12 months were recruited using social media advertising (May-November 2017). Offline participants were recruited at nightclubs and festivals using a random intercept method (May-November 2017). Samples were compared with respect to age, gender, past year use of alcohol, cannabis, cocaine, ecstasy/MDMA and amphetamines, and past year attendance at nightclubs, licensed festivals, illegal festivals, pubs and house-parties.Results6153 online and 3529 offline participants were recruited. When adjusting for differences in age and gender, online participants were less likely to have used each drug and to have attended illegal festivals, pubs and house-parties in the past 12 months. The online sample also used each drug and attended each venue, with the exception of nightclubs, less frequently on average than offline participants. Adjusted odds ratios (range 0.37 to 1.39) and regression coefficients (range -0.84 to 0.07) indicate that the majority of observed differences between the samples were of a small effect size.ConclusionsEstimates of drug use and nightlife engagement are more conservative when using online sampling compared to venue based sampling. Observed differences were generally small in effect, indicating good overall representativeness when using online sampling in the European nightlife scene.     

Recreational drug use and use of drugs associated with chemsex among HIV-negative and HIV-positive heterosexual men and women attending sexual health and HIV clinics in England

BackgroundThere is little information on the prevalence of recreational drug use among UK heterosexual men and women, in particular on use of drugs associated with ‘chemsex’ within gay communities. The aim of this study was to examine among HIV-negative and HIV-positive heterosexual men and women in England: (i) the prevalence of recreational drug use (including use of drugs associated with chemsex), (ii) socio-economic/lifestyle correlates of drug use, and (iii) the association of drug use with sexual behavior measures and mental health symptoms.MethodsData are from the AURAH study of HIV-negative individuals attending sexual health clinics across England (2013–2014) and the ASTRA study of HIV-positive individuals attending HIV outpatient clinics in England (2011–2012). Prevalence of recreational drug use (past three months) and associations are presented separately among the four sample groups: HIV-negative (N = 470) and HIV-positive (N = 373) heterosexual men and HIV-negative (N = 676) and HIV-positive (N = 637) women.ResultsThe age standardized prevalence of any drug use was 22.9%, 17.1%, 15.3%, and 7.1% in the four sample groups respectively. In all groups, cannabis was the drug most commonly used (range from 4.7% to 17.9%) followed by cocaine (1.6% to 8.5%). The prevalence of use of drugs associated with chemsex was very low among HIV-negative participants (1.0% heterosexual men, 0.2% women) and zero among HIV-positive men and women. In age-adjusted analysis, factors linked to drug use overall and/or to cannabis and cocaine use specifically in the four sample groups included Black/mixed Caribbean and white (vs. Black/mixed African) ethnicity, lower level of education , cigarette smoking, and higher risk alcohol consumption. Associations of recreational drug use with measures of condomless sex, depression, and anxiety were observed in the four groups, but were particularly strong/apparent among women.ConclusionProviders need to be aware of cannabis and cocaine use and its potential link with sexual risk behavior and symptoms of depression and anxiety among heterosexual men and women attending sexual health and HIV clinics.     

Medication and substance use increases among people using cannabis medically during the COVID-19 pandemic

BackgroundThe ongoing COVID-19 pandemic strains the medical system, limiting access to healthcare services. Many people use cannabis medically for chronic health conditions and as a substitute for other medications. As such, changes in cannabis access associated with COVID-19 may result in increased non-cannabis drug use.MethodsWe recruited N = 353 individuals through Amazon Mechanical Turk who reported current medical cannabis use in April and May of 2020. We assessed the effects of the COVID-19 pandemic on patterns of medication and substance use, as well as on cannabis use patterns.ResultsOver half of participants either started using or increased use of medications or substances because of the COVID-19 pandemic, most commonly alcohol and sleep aids. Over a third of participants increased cannabis use while 25% decreased cannabis use. Approximately 40% of participants who increased or started use of medications/substances (other than cannabis) reported doing so because of changed access to medical cannabis.ConclusionThe reported increase in drug use among people using medical cannabis is concerning. Because the pandemic will likely continue for months (or even years), having a better understanding of why this is occurring is critical for developing effective harm-reduction strategies in this population.     

Polydrug use among 15- to 16-year olds: Similarities and differences in Europe

Aims: We describe types of polydrug use among school students across Europe and explore differences between high, medium and low drug prevalence countries.

Method: Analysis is based on survey data from over 70,000 15- to 16-year-old school students in 22 European countries. Polydrug use (defined as the use of two or more listed substances during the last 30 days) is compared across three country clusters based on drug prevalences by hierarchical cluster analysis. Affinity between substances is measured by pairwise associations and regression analysis was used to assess the differences in rate ratio across the country clusters.

Results: A third of all school students had consumed two or more substances. The most common combinations were: alcohol and cigarettes, followed by alcohol or cigarettes combined with cannabis, followed by alcohol or cigarettes, cannabis and at least one other illegal drug. Pairwise associations show that cannabis and cocaine users are more likely to use illegal drugs than the general student populations but least likely to do so in countries with high prevalence levels (p < 0.0005).

Conclusion: Consideration of country differences and objective measures for the concept of normalization could help to inform more holistic prevention initiatives that respond to country-specific contexts.     

A cotwin-control analysis of drug use and abuse/dependence risk associated with early-onset cannabis use

We assessed whether, after controlling for genetic and shared environmental influences, early cannabis use remains a significant predictor of other drug use, abuse, and dependence, and whether the risk for early-users is greater than that for later cannabis users. Data from a 1992 telephone diagnostic interview of 8169 male twins (M = 42.0 years at interview) who served in the U.S. military during the Vietnam-era were used to identify a subsample of 293 monozygotic (MZ) and dizygotic (DZ) twin pairs discordant for early cannabis use (before age 18). Using cotwin-control analyses, outcomes assessed were: lifetime illegal drug use (stimulant/cocaine, sedative, opiate, and hallucinogen/PCP), lifetime DSM-III-R illegal drug abuse/dependence, and lifetime DSM-III-R alcohol dependence. After controlling for covariates, early cannabis users were at greater risk than their later/never-using cotwins for 8 of 9 substance-related comparisons, including: using other illegal drugs (ORs: 2.71–4.09), having illegal drug abuse/dependence (ORs: 2.02–2.13), and developing alcohol dependence (OR = 2.36). When analyses were limited to pairs in which the cotwin used cannabis later, early and later-users only differed significantly on sedative, opiate, and hallucinogen use. After familial influences on early cannabis use were controlled for, cannabis use—regardless of the age of initiation—still conferred increased risk of other illegal drug use, drug abuse/dependence, and alcohol dependence. In contrast to previous research, there is limited evidence for increased risk associated with early-onset use in this sample of Vietnam-era veterans.     

Patterns of Simultaneous Polysubstance Use in Canadian Rave Attendees

The aim of this study was to examine rave-related polydrug drug use and to determine if patterns of substance use were associated with previous rave attendance. One hundred and eighty-six rave attendees (50% female) representing a wide range of ages (16 to 47 years; mean = 23.5, sd = 5.15) and levels of rave attendance experience (1 to 400 events) completed structured interviews in Montreal, Canada between November 2002 and September 2003 about their rave attendance patterns and their use of various licit and illicit substances at the most recently attended event. On average, participants reported using 2.5 different psychoactive substances (excluding tobacco) at the most recent event attended. Cannabis, alcohol, MDMA (ecstasy), amphetamine, cocaine, ketamine, and GHB were the most frequently reported substances, and details about their orders of administration, dosages, and patterns of co-administration are presented and discussed. The total lifetime number of raves attended by participants varied considerably (mean = 48.6; sd = 69.7; median = 25), and there was a positive correlation between the number events attended and number of substances used at the most recent event attended (p < 0.001). Analyses revealed that individuals reporting the use of ketamine, GHB, and/or cocaine at the most recent event had attended significantly more events than nonusers even when controlling for various demographic variables. A subset of respondents (n = 27) completed a second interview to determine the reliability of their responses. Results indicated that respondents could reliably recall details about which drugs were used, the total doses administered, as well as order of drug administration.     

Patterns of simultaneous polysubstance use in Canadian rave attendees

The aim of this study was to examine rave-related polydrug drug use and to determine if patterns of substance use were associated with previous rave attendance. One hundred and eighty-six rave attendees (50% female) representing a wide range of ages (16 to 47 years; mean=23.5, sd=5.15) and levels of rave attendance experience (1 to 400 events) completed structured interviews in Montreal, Canada between November 2002 and September 2003 about their rave attendance patterns and their use of various licit and illicit substances at the most recently attended event. On average, participants reported using 2.5 different psychoactive substances (excluding tobacco) at the most recent event attended. Cannabis, alcohol, MDMA (ecstasy), amphetamine, cocaine, ketamine, and GHB were the most frequently reported substances, and details about their orders of administration, dosages, and patterns of co-administration are presented and discussed. The total lifetime number of raves attended by participants varied considerably (mean=48.6; sd=69.7; median=25), and there was a positive correlation between the number events attended and number of substances used at the most recent event attended (p<0.001). Analyses revealed that individuals reporting the use of ketamine, GHB, and/or cocaine at the most recent event had attended significantly more events than nonusers even when controlling for various demographic variables. A subset of respondents (n=27) completed a second interview to determine the reliability of their responses. Results indicated that respondents could reliably recall details about which drugs were used, the total doses administered, as well as order of drug administration.     

Opioids,stimulants, and depressant drugs in fifteen Mexican Cities: A wastewater-based epidemiological study

BackgroundMonitoring drug use in México is a challenge due to emerging drugs and rapid changes in consumption patterns. The temporal and geographical patterns of cocaine, methamphetamine, amphetamine, MDMA, cannabis, heroin, ketamine, and fentanyl were examined in Mexican cities using wastewater-based epidemiology (WBE).Methods105 daily composite wastewater samples were collected from sewage treatment plants in fifteen Mexican cities. We quantified drug residues using liquid chromatography–high-resolution mass spectrometry, and estimated drug use by back-calculation of drug loads.ResultsWe identified ten drug target residues in at least one sample across cities. Drugs with the highest median levels were cannabis, methamphetamine, and cocaine. The median range of cannabis for one week was between 147 and 20,364 mg/day/1000inhab across cities, whereas methamphetamine ranged between 5 and 3,628 mg/day/1000inhab. Cocaine was found in levels between 2 and 370 mg/day/1000inhab. The highest levels of methamphetamine and amphetamine were observed in the US border cities of Tijuana and San Luis Río Colorado. The presence of heroin, MDMA, ketamine, and fentanyl was stronger during weekends, while cannabis, cocaine, and amphetamine were found throughout the week.ConclusionThis study provides the first report of fentanyl, norfentanyl, and ketamine in wastewater in Mexico. The results indicate an increased presence of drugs on known drug traffic routes, demonstrating that WBE can help identify areas of high drug use and assist governments in developing policies to reduce drug use and harm in the communities.     

Prevalence and forms of cannabis use in legal vs. illegal recreational cannabis markets

BackgroundRecreational or ‘non-medical cannabis’ has been legalized in several US states, and was legalized federally in Canada in October 2018. There is little comparative data on product use across jurisdictions, particularly with respect to the types of cannabis products used, which differentially impact health.MethodsData are from Wave 1 of the International Cannabis Policy Study, collected from Aug 27–Oct 7, 2018. Respondents (n = 27,024) aged 16–65 completed an online survey measuring patterns of cannabis use, quantities and routes of administration. Respondents were recruited from Canada (n = 9976) and US states that had (n = 7362) and had not (n = 9686) legalized non-medical cannabis (‘legal’ and ‘illegal’ states, respectively).ResultsPrevalence of at least daily, weekly, and monthly cannabis use were significantly higher in US ‘legal’ states (11.3%, 18.2%, 25.0%, respectively) than US ‘illegal’ states (7.4%, 11.6%, 16.8%, respectively; p<0.001) and Canada (8.9%, 14.1%, 19.0%, respectively; p ≤ 0.01). Dried herb was the dominant form of cannabis reported by past 12-month users across all jurisdictions (77.7%–80.8%). Although the amount of dried herb used per year did not differ by jurisdiction (range: 210.3–229.4 g), those in US ‘legal’ states were significantly more likely to use dried herb daily or weekly than were those in ‘illegal’ states and Canada (p<0.001). Use of cannabis concentrates, vaped oils, edibles, and drinks was more prevalent among US ‘legal’ states than ‘illegal’ states and Canada (p ≤ 0.001). Vaping dried herb was more common in both legal and illegal US jurisdictions than in Canada (p<0.05), whereas Canadians were more likely to smoke dried herb with tobacco (p<0.001).ConclusionThe prevalence of cannabis use—and use of products such as cannabis concentrates, edibles and drinks—was higher in US states that had legalized cannabis. Additional longitudinal research is required to determine whether these differences reflect causal effects of legalization or pre-existing secular trends.     

Tobacco, alcohol, cannabis and other illegal drug use among young adults: the socioeconomic context

Background

Low socioeconomic position predicts risk of substance abuse, yet few studies tested the role of preexisting familial and individual characteristics.

Methods

Data come from the TEMPO (Trajectoires Epidémiologiques en Population) study (community sample in France, 1991–2009, n = 1103, 22–35 years in 2009) set up among offspring of participants of an epidemiological study (GAZEL). Past 12-month substance use was assessed in 2009 by self-completed mail survey: regular tobacco smoking, alcohol abuse (AUDIT), cannabis use, problematic cannabis use (CAST), other illegal drug use. Socioeconomic position was defined by educational attainment, occupational grade, employment stability and unemployment. Covariates included demographics (age, sex, relationship status, parenthood), family background (parental income, parental tobacco smoking, parental alcohol use), and juvenile characteristics (psychological problems, academic difficulties) measured longitudinally.

Results

35.8% of study participants were regular smokers, 14.3% abused alcohol, 22.6% used cannabis (6.3% had problematic cannabis use) and 4.1% used other illegal drugs. Except for alcohol abuse, substance use rates were systematically higher in individuals with low, rather than intermediate/high, socioeconomic position (age and sex-adjusted ORs from 1.75 for cannabis use to 2.11 for tobacco smoking and 2.44 for problematic cannabis use). In multivariate analyses these socioeconomic disparities were decreased, but remained statistically significant (except for illegal drugs other than cannabis).

Conclusions

Tobacco smoking, alcohol, cannabis and polysubstance use are common behaviors among young adults, particularly those experiencing socioeconomic disadvantage. Interventions aiming to decrease substance abuse and reduce socioeconomic inequalities in this area should be implemented early in life.     

Predictors of using social media to purchase drugs in New Zealand: Findings from a large-scale online survey

BackgroundThere are increasing reports of social media being used to buy and sell illegal drugs internationally. Studies of social media drug markets to date have largely involved general explorations of social media drug transactions in select countries. Social media drug markets may operate differently for different drug types and in different country contexts.AimsTo identify predictors of the use of social media to purchase cannabis, methamphetamine, LSD and ecstasy/MDMA in New Zealand using a large-scale online survey sample.MethodsThe annual New Zealand Drug Trends Survey (NZDTS), an online convenience survey promoted via targeted Facebook™ campaign, was completed by 23,500 respondents aged 16+. Logistic regression models were fitted to identify demographic, drug use and drug market predictors of reporting the use of social media to purchase cannabis, methamphetamine, LSD and ecstasy/MDMA.ResultsFifty-one percent of the sample had purchased cannabis, methamphetamine, ecstasy/MDMA or LSD in the past six months, of which 22% had done so via social media (n = 2,650). Cannabis was the drug type most purchased from social media among drug purchasers (24%), followed by ecstasy/MDMA (13%). Sixty percent of social media purchasers had used Facebook™, 48% Snapchat™, and 20% Instagram™. The leading advantages of social media purchasing were “high convenience” (74%), and “fast transaction speed” (43%). Younger age was a significant predictor of social media purchasing for all drug types (particularly among 16–17 year olds). Purchasing from someone identified as a “drug dealer” was a predictor of social media purchasing among respondents for all drug types.ConclusionSocial media drug markets may have significant implications for drug purchasing by youth through providing greater access to supply and breaking down age-related barriers between social supply and commercial drug markets. Our findings highlight the importance of incorporating social media platforms into youth drug prevention and harm minimisation strategies.     

Cannabis and cue-induced craving in cocaine-dependent individuals: A pilot study

BackgroundCannabis consumption is common among cocaine users; however, little is known about its effect on cocaine craving. The objective of this study was to assess whether cannabis co-use is associated with lower cue-induced cocaine craving in non-treatment-seeking cocaine-dependent individuals.MethodsData from twenty-eight cocaine-dependent men were analyzed in this pilot study. Cocaine-dependent subjects (n = 12) were compared with cocaine-dependent subjects who also abused or were dependent on cannabis (n = 16). After at least 72 h of cocaine abstinence, verified using the Timeline Followback and a drug screening test, subjects participated in a functional magnetic resonance imaging session during which neutral and drug cue video sequences were presented. Each sequence comprised four video blocks alternating with resting blocks. We report here subjective craving measures that were collected using the Visual Analog Scale, administered before and after each video block as per standard craving measurement paradigms.ResultsCocaine craving was successfully induced, with no significant difference in cue-induced craving between the two groups. However, post-hoc analyses revealed a significant increase in pre-video cocaine craving scores over time among individuals with cannabis use disorders.ConclusionWe could not highlight significant differences in cocaine craving induction between groups, but we observed a possible deficit in craving decay in the cocaine and cannabis group. In light of this finding, methodology of craving assessment in non-treatment-seeking users, particularly when different substances are combined, should possibly include outcomes linked to craving decay. Studies examining the association between cocaine craving decay and other outcome measures, such as relapse, are also warranted.     

Summary of adverse drug events for hydroxychloroquine,azithromycin, and chloroquine during the COVID-19 pandemic

ObjectiveGiven the increased use of hydroxychloroquine (HCQ), chloroquine (CQ), and azithromycin (AZM) during the early months of the coronavirus disease 2019 (COVID-19) pandemic, there is a need to evaluate the associated safety concerns. The objective of this study was to summarize the adverse drug events (ADEs) associated with HCQ, CQ, and AZM use during the national COVID-19 emergency and compare the results with known adverse reactions listed in the drugs’ package inserts.MethodsA cross-sectional study design was used. The publicly available Food and Drug Administration Adverse Event Reporting System quarterly data extract files from January 1, 2020 to June 30, 2020 were downloaded. A disproportionality analysis was conducted using the proportional reporting ratio to identify possible ADE signals. A Poisson regression was used to assess if the number of ADE reports for the 3 drugs increased over time.ResultsThere was a statistically significant increasing trend in the reported ADEs for both HCQ (P < 0.001) and AZM (P < 0.001). Before the declaration of the national emergency, there were 592 reported drug-ADE pairs for the 3 drugs compared with 2492 drug-ADE pairs reported after March 13, 2020. These 2492 drug-ADE pairs represented 848 ADEs across the 3 drugs, of which 114 (13.4%) were identified as potential signals including 55 (48.2%) that were not listed in the prescribing information.ConclusionsOur results showed that the reported ADEs for HCQ and AZM have increased during the COVID-19 pandemic. Differences were observed in both the type of and frequency of the highest reported ADEs for the 3 selected drugs before and after the national emergency declaration. Although causation cannot be determined from ADE reports, further investigation of some reports may be warranted. Our results highlight the need for pharmacovigilance and education of health care professionals on the safety of these drugs when being used for COVID-19 prophylaxis or treatment.     

The Influence of Age and Gender on Party Drug Use Among Young Adults Attending Dance Events,Clubs, and Rock Festivals in Belgium

A random sample of visitors of dance events, clubs, and rock festivals in Belgium (Flanders) was selected to complete an anonymous survey regarding their use of “party” drugs (alcohol, cannabis, xtc, cocaine, and amphetamines) and patterns of going out. The results of 670 respondents recruited in 2005 are reported and compared with 2003 for gender and age. Drug use in these nightlife settings is higher than in the general population. In younger age groups, the illegal drug use increases, but it decreases in older age groups. This might be linked to more responsibilities. Men still use drugs more often than women, but the gender differences seem to decrease. The changing role of women in society could be an explanation for this evolution. Limitations and implications of this research are discussed.