Changes in the prevalence and correlates of cocaine use and cocaine use disorder in the United States, 2001–2002 and 2012–2013

To present nationally representative data on changes in the prevalences of 12-month cocaine use, cocaine use disorder (CocUD) and 12-month CocUD among 12-month cocaine users between 2001 and 2002 and 2012–2013. Data were derived from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012–2013 NESARC-III. Between 2001 and 2002 and 2012–2013, prevalences of 12-month cocaine use and DSM-IV CocUD significantly increased and 12-month CocUD among 12-month users significantly decreased. Increases in risk of cocaine use were seen across nearly all sociodemographic subgroups while increases in CocUD were observed among women, those in the oldest age group, Whites, individuals with the lowest incomes and highest education, and those residing in urban areas. Prevalence of CocUD among users significantly declined overall and among men, individuals aged 30–44 years old, the never-married, respondents with incomes between $20,000 and $34,000, and those residing in the Midwest. Increases in coca cultivation in Colombia in recent years together with increases in the purity of cocaine entering the U.S. portend more significant increases in the rates of cocaine use and CocUD in the U.S. along with increases in cocaine-related morbidity and mortality. The results of this study support the continued monitoring of cocaine use and CocUD in the U.S., especially in view of the narrowing of the gender gap and shifts in race-ethnic, age and socioeconomic differentials seen between 2001 and 2002 and 2012–2013.     

Patterns and correlates of polytobacco use in the United States over a decade: NSDUH 2002–2011

BackgroundFew studies have examined the patterns and correlates of polytobacco use among a large, nationally representative population over an extended period of time.MethodsThis study examined 10 years of data from the National Survey on Drug Use and Health (NSDUH) to establish time trends and correlates for exclusive and mixed use of cigarettes, smokeless tobacco (SLT), cigars, and pipes.ResultsResults show that rates of polytobacco use were essentially unchanged from 2002 to 2011 (8.7% to 7.4%), though some product combinations, including cigarettes and SLT, cigars and SLT, and use of more than two products have increased. In tobacco users under age 26, the proportion of polytobacco use increased, even as overall tobacco use declined. The factors associated with polytobacco use among tobacco users included sex, income, education, risk taking/seeking behaviors, and outward indicators of ‘risk-liability’.ConclusionsFindings provide a snapshot of trends of single and polytobacco product use as well as trends in combinations of product use. Longitudinal studies are needed to examine the sequence of individual patterns of tobacco product use and to identify whether polytobacco use results in greater nicotine dependence, increased exposure to harmful and potentially harmful constituents and/or greater risk of tobacco related disease.     

Cannabis use among women of reproductive age in the United States: 2002–2017

BackgroundIn this study of cannabis use in large nationally representative samples of United States (US) women aged 12–44 years, we evaluate variation by pregnancy month and by trimester. We also evaluate cannabis dependence, which might explain why some women continue using cannabis during pregnancy.MethodsLarge nationally representative samples drawn for the US National Surveys on Drug Use and Health included 12–44-year-old women asked about pregnancy month, cannabis use, and cannabis dependence (n = 381,199). For this research, we produced month-specific estimates across four-time intervals (2002–2005, 2006–2009, 2010–2013, 2014–2017).ResultsOverall from 2002 to 2017, estimates for non-pregnant women and for pregnant women in Trimester 1 indicate 7%–8% had used cannabis at least once in the 30 days prior to assessment. For pregnancy Month 1, the corresponding estimate is 11%, double Month 3 estimate of 5%. This degree of month-to-month variation is not seen for pregnant women in Trimesters 2 and 3, for whom estimates are 3% and 2%, respectively. Among women using cannabis during pregnancy, an estimated 19% have cannabis dependence, versus an expected value of 13% among non-pregnant women (p < .05).ConclusionEvidence of a possibly ameliorative pregnancy-associated reduction of cannabis use prevalence was seen by Month 3 during pregnancy. Cannabis dependence may help account for cannabis use early during pregnancy. Identification and outreach to reproductive age women with cannabis dependence might decrease prenatal cannabis exposure.     

The History of MDMA as an Underground Drug in the United States, 1960–1979

MDMA (3,4-methylenedioxy-methylamphetamine, a.k.a. “ecstasy”) was first synthesized in 1912 and resynthesized more than once for pharmaceutical reasons before it became a popular recreational drug. Partially based on previously overlooked U.S. government documentation, this article reconstructs the early history of MDMA as a recreational drug in the U.S. from 1960 to 1979. According to the literature, MDMA was introduced as a street drug at the end of the 1960s. The first forensic detection of MDMA “on the street” was reported in 1970 in Chicago. It appears that MDMA was first synthesized by underground chemists in search of “legal alternatives” for the closely related and highly sought-after drug MDA, which was scheduled under the Controlled Substances Act (CSA) in 1970. Until 1974, nearly all MDMA street samples seized came from the U.S. Midwest, the first “hot region” of MDMA use. In Canada, MDMA was first detected in 1974 and scheduled in 1976. From 1975 to 1979, MDMA was found in street samples in more than 10 U.S. states, the West Coast becoming the major “hot region” of MDMA use. Recreational use of MDMA spread across the U.S. in the early 1980s, and in 1985 it was scheduled under the CSA.     

Trends in cigarette use,by serious psychological distress status in the United States, 1998–2013

ObjectivesThe study compared trends in current and heavy cigarette smoking between adults with and without serious psychological distress (SPD).MethodsThis study examined data from 480,024 adults aged 18 years or older in the 1998–2013 National Health Interview Survey (NHIS) public use files. SPD is defined as having a Kessler-6 score of 13 or higher in the past month. Trends in the prevalence of current smoking and heavy smoking for 2-year time periods were assessed among those with versus those without SPD using logistic regression; tests of interaction terms determined whether smoking trends differed by SPD status.ResultsThe prevalence of current smoking decreased over time among adults without SPD (adjusted odds ratio [AOR] = 0.97, 95% CI = 0.97–0.98), but remained stable among adults with SPD (AOR = 1.01, 95% CI = 0.99–1.03). Both groups had significant declines in heavy smoking over time; however, the rates of decline were greater among adults without versus with SPD (AOR = 0.87, 95% CI = 0.86–0.88 and AOR = 0.91, 95% CI = 0.88–0.94, respectively).ConclusionsThe prevalence of current smoking is not declining among adults with SPD, and the prevalence of heavy smoking is not declining as quickly among adults with SPD as compared with those without SPD. Smoking cessation efforts may need to target these populations and tailor programs accordingly.     

Trends in cannabis use among immigrants in the United States, 2002–2017: Evidence from two national surveys

Background and aimsFindings from recent studies suggest that, among the general population of adults, the prevalence of cannabis use has increased over the last decade in the United States (US). And yet, there is much we do not know regarding the trends in cannabis use among immigrants. We address this important shortcoming by examining data on immigrants vis-à-vis US-born individuals using two national surveys.MethodsWe examine trend data from the National Epidemiologic Study on Alcohol and Related Conditions (NESARC, 2001–2013) and the National Survey on Drug Use and Health's Restricted Data Analysis System (NSDUH, 2002–2017). Main outcomes were past year cannabis use and cannabis use disorder with survey adjusted prevalence estimates generated for immigrants and US-born individuals.ResultsIn the NESARC, significant increases in the past year prevalence of cannabis use were observed both among US-born (2001–2002: 4.53%, 2012–2013: 10.74%) and immigrant participants (2001–2002: 1.67%, 2012–2013: 3.32%). We also found significant increases among immigrants arriving before age 12 and among immigrants from Latin America and Europe. In the NSDUH, we observed a significantly higher prevalence of cannabis use in 2016–2017 (6.3%) when compared to 2002–2003 (4.4%).ConclusionsFindings make clear that cannabis use among US-born individuals has consistently been higher than that of immigrants since the early 2000s. However, while rates of cannabis use have declined among US-born adolescents in recent years, the prevalence of cannabis use has remained stable among immigrant adolescents. At the same time, cannabis use increased two-fold among both US-born and immigrant adults.     

Reinforcing properties of oral Δ 9-tetrahydrocannabinol,smoked marijuana,and nabilone: Influence of previous marijuana use

The reinforcing properties of ⁹ (17.5 mg), a 1 g marijuana cigarette containing 1.83% ⁹-THC, a synthetic cannabis compound (Nabilone 2 mg orally), and their respective placebos were assessed with self-report and operant work-contingent choice procedures. Three groups of eight subjects were selected on the basis of a history of regular, intermittent, or occasional marijuana-smoking behavior. All subjects served as their own controls for each drug condition and studies were carried out under double-blind and double-dummy conditions in a controlled, residential research ward. Placebo responding did not vary as a function of history of marijuana use, but the past history of drug use had a significant influence on the reinforcing properties of cannabis compounds as well as the behavioral and physiological effects of these drugs. Regular marijuana users reported a significant increase in elation following marijuana smoking, but this was not associated with a significant increment in pulse rate. Intermittent and occasional marijuana smokers had significant increases in pulse rate, but no significant marijuana-induced elation. Nabilone and ⁹-THC produced a significant increase in pulse rate for all subject groups, but there was no significant increase in elation following ingestion of these compounds. Given a choice between the three drugs and three placebos, 18 of 23 subjects worked to obtain a marijuana cigarette in an operant work choice paradigm. These data indicate that smoked marijuana was significantly more reinforcing than all other cannabis compounds studied, regardless of past drug-use history.     

Is inhalant use a risk factor for heroin and injection drug use among adolescents in the United States?

PURPOSE: We examined whether inhalant use was associated with heroin and injection drug use (IDU) among adolescents aged 12 to 17 in the United States. METHODS: Data were drawn from the 2002/2003 administrations of the National Survey on Drug Use and Health (NSDUH). We conducted logistic regression analyses to estimate associations of inhalant use with heroin use, heroin injection, and IDU, respectively, among adolescent drug users (N=8161). RESULTS: Approximately 30.9% of adolescents had ever used at least one illicit drug. More than one-fifth (22.2%) of adolescents were past-year or recent drug users. Among past-year adolescent drug users, 1.4% had progressed to heroin use and 1.2% reported IDU. Adolescents who had used inhalants and marijuana were 2.8 and 2.9 times as likely as adolescents who had used marijuana but not inhalants to report heroin use and any IDU, respectively. Adolescents who had used inhalants or other drugs but not marijuana were unlikely to use heroin. However, inhalant users, irrespective of their marijuana use histories, had greater odds of IDU than drug users who had not used inhalants. Adolescent drug users who were females, school dropouts, whites, or delinquents had significantly increased odds of heroin use and IDU. Cigarette smoking before the age of 15 was strongly associated with heroin use, and a history of foster care placement was associated with IDU. CONCLUSIONS: This national study of American adolescents identifies several subgroups of recent drug users, such as females, school dropouts, and youth who have used inhalants and marijuana, which have substantially increased odds of heroin use and IDU. Screening, prevention, and treatment interventions targeted to these groups might reduce medical and social complications of heroin use and IDU.     

Abstention from Drug Use and Delinquency Increasing among Youth in the United States, 2002–2014

Background: Trends in abstaining from substance use and delinquency among adolescent's ages 12–17 in the United States was examined. Methods: Data was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic white, African American, and Hispanic respondents (n = 98,620) and spanning the years 2002–2014. Logistic regression was used to examine significance of trend year and correlates of low-risk and high-risk behavioral groups relative to abstaining. Results: Overall, the prevalence of abstaining was 47.56% between 2002 and 2014. Prevalence increased significantly among all adolescents from 44.85% in 2002 to 53.58% in 2014. Relative to abstainers nonabstaining youth were more likely to be male, and report lower household income, poorer grades, depression, and lower levels of parental affirmation and control. Conclusions: Findings indicate that there is a corresponding increase in abstaining mirroring the recent decreases found in adolescent drug use found in national surveys.     

Risk estimates for starting tobacco,alcohol, and other drug use in the United States: Male–female differences and the possibility that ‘limiting time with friends’ is protective

Background

A specific facet of parental monitoring is known as ‘limiting time with friends’ (LTF). Here, we aim to learn whether LTF-associated differences in adolescent risk of starting to use tobacco, alcohol, and other drugs now might be as large as observed male–female risk differences.

Methods

Data are from the US National Surveys on Drug Use and Health, with annual large scale nationally representative samples of community-dwelling civilian age 12 years and older, conducted 2002–2009. Focus is on 12–17-year-old participants, assessed via computerized self-interviews. Risk differences are estimated for all 12–17 year olds, males and females separately, and in relation to the LTF facet of parenting.

Results

Contingency table analyses disclose a female excess risk of initiating use of tobacco, alcohol, cocaine, opioids, and EMIRD, with male–female risk differences ranging from 0.1% (cocaine) to 1.6% (alcohol). LTF-associated risk differences were of similar magnitude for young people whose parents ‘always’ limit time with friends versus those with parents who are more relaxed about the LTF facet of parenting [e.g., RD = 0.4% (cocaine); 1.5% (alcohol)].

Conclusions

Not just for tobacco, but also for other drugs, there now is female excess risk of extra-medical drug use. Drug-by-drug, observed LTF-associated risk differences are about the same size as the female excess risk. This evidence provides a rationale to sustain focus on the LTF facet of parenting if the goal is to enhance prevention of precocious drug involvement and to delay its onset until later in the adolescent or adult years.     

Who becomes cannabis dependent soon after onset of use? Epidemiological evidence from the United States: 2000–2001

In this paper we estimate the risk of becoming cannabis dependent within 24 months after first use of cannabis and examine subgroup variation in this risk. The study estimates are based on the National Household Survey on Drug Abuse conducted during 2000-2001, with a representative sample of U.S. residents ages 12 and older (n=114,241). A total of 3352 respondents were found to have used cannabis for the first time within a span of up to 24 months prior to assessment. An estimated 3.9% of these recent-onset users developed a cannabis dependence syndrome during the interval since first use (median interval duration approximately 12 months). Excess risk of cannabis dependence was found for those with cannabis onset before late-adolescence, those with family income less than US dollars 20,000, and those who had used three or more drugs before the first use of cannabis (i.e., tobacco, alcohol, and other drugs). While these findings generally support previous study results, this study's focus on recent-onset users more closely approximates prospective and longitudinal research on the incidence (risk) of becoming cannabis dependent soon after onset of cannabis use, removing the influence of users with long-sustained or persistent cannabis dependence developed years ago.     

Trends and drug-related correlates in residential mobility among young adults in the United States, 2003–2016

IntroductionYoung adulthood, typically conceptualized as stretching from the late teens to the mid-twenties, is a period of elevated risk for residential mobility (i.e., moving or changing residences frequently) and drug involvement. However, our understanding of the trends and drug-related correlates of residential mobility among young adults remains limited.MethodsWe analyzed national trend data from the National Survey on Drug Use and Health (2003–2016) on residential mobility and drug involvement among young adults (N = 230,790) in the United States. For tests of trend, we conducted logistic regression analyses with survey year specified as a continuous independent variable and residential mobility as the dependent variable (no/yes), controlling for sociodemographic factors.ResultsThe prevalence of residential mobility was stable among females, but decreased significantly—a 20% reduction in the relative proportion of respondents—among males during the study period (AOR = 0.98, 95% CI = 0.97–0.99). Male and female young adults reporting residential mobility were significantly more likely to report involvement in all drug-related outcomes examined, but effects were larger among females for drug selling and drug-related arrests.DiscussionStudy findings show that a substantial minority of young adults experience residential mobility and that, while rates are declining among young men, the experience of mobility is connected with risk for drug involvement, particularly among females. Mobility may be an important target for drug prevention/intervention efforts, but further research is needed to provide insight into how mobility and drug involvement are connected in the lives of young adults.     

Prevalence,correlates, and trends in tobacco use and cessation among current,former, and never adult marijuana users with a history of tobacco use, 2005–2014

BackgroundApproximately 70% of current (past 30-day) adult marijuana users are current tobacco users, which may complicate tobacco cessation. We assessed prevalence and trends in tobacco cessation among adult ever tobacco users, by marijuana use status.MethodsData came from the National Survey on Drug Use and Health, a cross-sectional, nationally representative, household survey of U.S. civilians. Analyses included current, former, and never marijuana users aged ≥ 18 reporting ever tobacco use (cigarette, cigar, chew/snuff). We computed weighted estimates (2013–2014) of current tobacco use, recent tobacco cessation (quit 30 days to 12 months), and sustained tobacco cessation (quit > 12 months) and adjusted trends in tobacco use and cessation (2005–2014) by marijuana use status. We also assessed the association between marijuana and tobacco use status.ResultsIn 2013–2014, among current adult marijuana users reporting ever tobacco use, 69.1% were current tobacco users (vs. 38.5% of former marijuana users, p < 0.0001, and 28.2% of never marijuana users, p < 0.0001); 9.1% reported recent tobacco cessation (vs. 8.4% of former marijuana users, p < 0.01, and 6.3% of never marijuana users, p < 0.001), and 21.8% reported sustained tobacco cessation (vs. 53.1% of former marijuana users, p < 0.01, and 65.5% of never marijuana users, p < 0.0001). Between 2005 and 2014, current tobacco use declined and sustained tobacco cessation increased among all marijuana use groups.ConclusionsCurrent marijuana users who ever used tobacco had double the prevalence (vs. never-marijuana users) of current tobacco use, and significantly lower sustained abstinence. Interventions addressing tobacco cessation in the context of use of marijuana and other substances may be warranted.     

From counselor skill to decreased marijuana use: Does change talk matter?

Client language about change, or change talk, is hypothesized to mediate the relationship between counselor fidelity in motivational interviewing (MI) and drug use outcomes. To investigate this causal chain, this study used data from an MI booster delivered to alternative high school students immediately after a universal classroom-based drug abuse prevention program. One hundred and seventy audio-recorded MI sessions about substance use were coded using the motivational interviewing skill code 2.5. Structural equation modeling showed that percentage of change talk on the part of the client mediated three of the four relationships between MI quality indicators and marijuana outcomes, while percentage of reflections of change talk showed a main effect of counselor skill on marijuana outcomes. Findings support change talk as an active ingredient of MI and provide new empirical support for the micro-skills of MI.     

Drug use over the youth–adult transition in a west of Scotland cohort: Prevalence,pathways and socio-demographic correlates

Among a west of Scotland cohort surveyed at ages 15 (1987), 18, 23 and 30, lifetime prevalence (ever use) of any drugs rose from 9% at 15 to 58% at 23, thereafter increasing little; past year (‘current’) use peaked at age 23 (35%). Cannabis-only rates increased most between ages 15 and 18; ‘hard’ drug use increased steadily with age. There was considerable transitory use, particularly among cannabis-only users and those initiating later. Neither initiation nor use of cannabis only or other drug(s) was raised among those of lower background social class. However, cannabis-only initiation between 18 and 23 years was most likely among those from non-manual backgrounds who had left school later and were in full time education at 18. Initiation of other drug(s) between 18 and 23 also showed some evidence of this ‘student effect’. Measures which fail to distinguish different types of drug use, or the use of broad age bands, may obscure such relationships.     

Prevalence and associated demographic characteristics of exposure to multiple metals and their species in human populations: The United States NHANES, 2007–2012

Lead (Pb), cadmium (Cd), mercury (Hg), and arsenic (As) are among the top 10 pollutants of global health concern. Studies have shown that exposures to these metals produce severe adverse effects. However, the mechanisms underlying these effects, particularly joint toxicities, are poorly understood in humans. The objective of this investigation was to identify and characterize prevalent combinations of these metals and their species in the U.S. NHANES population to provide background data for future studies of potential metal interactions. Exposure was defined as urine or blood levels ≥ medians of the NHANES 2007–2012 participants ≥6 years (n = 7408). Adjusted-odds ratios (adj-OR) and 95% confidence intervals were determined for covariates (age, gender, and race/ethnicity, cotinine and body mass index). Species-specific analysis was also conducted for As and Hg including iAs (urinary arsenous acid and/or arsenic acid), met-iAs (urinary monomethylarsonic acid and/or dimethylarsinic acid), and oHg (blood methyl-mercury and/or ethyl-mercury). For combinations of As and Hg species, age- and gender-specific prevalence was determined among NHANES 2011–2012 participants (n = 2342). Data showed that approximately 49.3% of the population contained a combination of three or more metals. The most prevalent unique specific combinations were Pb/Cd/Hg/As, Pb/Cd/Hg, and Pb/Cd. Age was consistently associated with these combinations: adj-ORs ranged from 10.9 (Pb/Cd) to 11.2 (Pb/Cd/Hg/As). Race/ethnicity was significant for Pb/Cd/Hg/As. Among women of reproductive age, frequency of oHg/iAs/met-iAS and oHg/met-iAs was 22.9 and 40.3%, respectively. These findings may help prioritize efforts to assess joint toxicities and their impact on public health.     

The epidemiology of intentional non-fatal self-harm poisoning in the United States: 2001–2004

Introduction

Suicide attempts through intentional poisoning are an important public health concern. This investigation sought to determine the different US incident rates of poisonings (with intent to do self-harm) by race, sex, and gender.

Methods

We used data from the National Electronic Injury Surveillance System — All Injury Program (NEISS-AIP) to describe differences in incidence rates of non-fatal, self-harm poisonings evaluated in US emergency departments (ED) from 2001 to 2004. WISQARS defines self-harm as “either confirmed or suspected from injury or poisoning resulting from a deliberate act inflicted on oneself with the intent to take one’s own life or harm oneself.”

Results

From 2001 to 2004, there were 976,974 (95% Confidence Interval (CI) 772,884 – 1,181,065) non-fatal self-harm poisonings reported in US Emergency Departments. Young white females between 15 to 19 years of age were at highest risk with an incidence rate of 248 per 100,000 (95% CI 180 – 315). Females had higher rates of self-harm poisonings than males: the rate for females was 101 per 100,000 (95% CI 81 – 123); the rate for males was 66 per 100,000 (95% CI 51 – 81), p < 0.001. Whites had slightly higher rates than blacks, and significantly higher rates than Hispanics: whites rates were 71 per 100,000 (95% 51 – 91); black rates were 65 per 100,000 (95% CI 35 – 96), and Hispanic rates were 23 per 100,000 (95% 10 – 37). There was a significant increase in the incidence rate from 2002 to 2003 (p < 0.001). Incident rates decreased for females and males older than 19 years of age (p < 0.001 for males and females).

Conclusion

Recently, the incidence of self-harm poisoning has risen considerably. It rose from 75 (CI 53–98) per 100,000 in 2002 to 94 (CI 74–115) per 100,000 in 2003; incidence remained relatively steady in 2004. Whites have higher incidence rates than blacks and significantly higher incidence rates than Hispanics. Females are at higher risk than males, and adolescent white females are at highest risk. An understanding of the demographic factors associated with self-harm poisoning may provide useful information to improve prevention and treatment strategies.