BackgroundMainstays of pharmacoepidemiology are large, representative, behavioral surveys, which focus on many drugs with few detailed behaviors. Smaller, targeted studies measure drug-specific patterns but without explicit generalizability assumptions; the evidence generated is narrow. ObjectiveIn this cross-sectional survey study, we outline an estimation framework based on data fusion and combine two surveys: a representative, anchor survey and an enriched survey about psychedelic drugs in the United States. Application of calibration weighting transports estimates from the enriched survey to the anchor survey. MethodsThe psychedelic-focused enriched survey was sampled twice from a commercial online panel of adults from April 19 to June 25, 2024, (n=2306; 40.4% female, 33.1 y median age) and January 24 to March 21, 2025 (n=2023; 39.6% female, 35.2 y median age). The anchor survey was sampled twice from a different online panel from March 13 to May 6 2024 (n=28,679 total; 2430 using psychedelics) and 14 August to 9 October 2024 (n=29,040 total; 2309 using psychedelics). Internal consistency (transport bias, the absolute difference between the weighted estimates from the anchor survey and weighted fused survey) and external validity (root-mean-square error, RMSE, of self-reported demographic, health, and substance use estimates to probability-based benchmarks) metrics were calculated. The methodology was applied to estimate reasons for using specific psychedelic drugs. ResultsWithout adjustments, the enriched surveys had lower percentages of male and White respondents, lower self-perceived health, and higher cigarette use. A total of 2048 weighting schemes were tested, with good internal consistency. Average transport biases with the final weighting scheme were: demographics, 0.09 percentage points; health characteristics, 0.35 percentage points; and substance use, 0.22 percentage points. Estimates after fusion were externally consistent with benchmarks. RMSE increased by 3.3% for demographic estimates (1.82 unweighted to 1.88 weighted); larger decreases were observed for health RMSE (7.30 to 3.38, 53.7% decrease) and for substance use RMSE (6.56 to 6.03, 8.1% decrease). Alcohol use substantially increased the RMSE, likely due to question differences (without alcohol, the RMSE decreased from 6.03 to 1.55). Using the fused dataset, recreational use of psilocybin (92.9%, 95% CI 91.1, 94.7), LSD (93.2%, CI 90.1, 96.4, and MDMA (93.3%, 91.0, 95.6) was more common than medical use (30.9%, CI 27.6, 34.2; 26.4%, CI 21.1, 31.7; and 21.1%, CI 17.5, 24.7, respectively). ConclusionsBuilding upon past data fusion research, this study fused two surveys for the purpose of surveillance. This methodology, termed the “fused survey design,” is a rigorous but accessible approach for surveilling rare behaviors like drug use, and we demonstrated constructs absent from anchor surveys may be measured with generalizable inference. This expands the surveillance epidemiology toolbox, giving researchers an actionable process to field enriched surveys with specialized questions that would be impractical to add to larger surveys due to space constraints and respondent fatigue.

There is still inconsistency in psychedelic research across the United States. There are gaps in our understanding of the psychedelic community's perception of topics including reasons for use and set/setting. The goal is to utilize these findings to produce better quantitative research, to ask the right questions of the right communities. This qualitative study organized focus groups from people who use psychedelics for: 1) recreational/spiritual and 2) mental health reasons. We conducted 10 focus groups with 29 people. The data were analyzed using Grounded Theory. A primary coder (JJ) inductively coded the transcribed audio recordings, and a secondary coder (CJ) deductively coded the data using JJ's codebook. Four themes emerged. We learned that people who use for recreational reasons often still use with purposive intent. Secondly, there is evidence of preparation and integration with their use. In those that use for mental health reasons, it was not uncommon to have a history of prior psychedelic use, and those individuals also had concerns about access to psychedelics for others who needed mental health treatment. These themes provide useful information for researchers to develop data collection tools for harm reduction and therapy techniques that are grounded in community perspectives and supportive literature.

This survey study examines the estimated increase in 12-month psilocybin use in Oregon and Colorado associated with decriminalization.

Racial and ethnic disparities in opioid overdose deaths in the US have widened in recent years, potentially driven by inequitable access to naloxone. This study evaluated engagement across the naloxone care cascade, a framework encompassing awareness, access, training, possession, and use of naloxone. Using a nationally representative US sample, we analyzed data from 57,719 adults who completed the 2024 Survey of Non-Medical Use of Prescription Drugs to characterize differences by race and ethnicity in the degree of contact with any component of the naloxone care cascade. Black, Hispanic, and Asian adults had significantly lower engagement across all steps of the cascade compared with White adults. These trends were similar among a subgroup of adults with recent illicit or nonmedical opioid use. Culturally tailored, equity-focused strategies are needed to address the systemic drivers of racial and ethnic disparities in naloxone engagement.

It is unknown how many people in the US have had pharmacogenetic (PGx) testing and whether people want to be tested. We conducted a nationally representative survey of the general US adult population to determine the prevalence of adults that have had PGx testing using a validated confidential online survey, the Non-Medical Use of Prescription Drugs Program. A weighted logistic regression was used to test health characteristics associated with PGx testing and determine those who desire to be tested. The analysis included 29 146 individuals who completed the survey, which represents approximately 260 000 000 adults in the US. The prevalence of US adults who have been PGx tested is 6.6% [95% confidence interval (CI): 6.2-7.0]. Only 32.2% (95% CI: 31.5-32.9), an estimated 79 million individuals, desired PGx testing. Adults who had or want PGx testing were more likely to be female, have higher education, be students, current or former members of the military, use medications, and have a mental health disorder. The prevalence of adults who have been PGx tested remains low in the US. There are knowledge gaps about the benefits of PGx testing that must be bridged to increase implementation.

BACKGROUND:Off-label prescribing of ketamine to treat psychiatric disorders has been increasing, as has recreational use and availability of illicit ketamine. It is important to examine trends in ketamine-related poisonings to inform public health efforts. METHODS:We examined data from poisonings (exposures) involving ketamine reported to Poison Centers in the US between 2019 and 2023 (n = 1519). Annual trends were examined for number of exposures and characteristics of exposures, and we delineated correlates of major (life-threatening) adverse effects and death compared to less severe outcomes. RESULTS:The number of reported ketamine exposures increased from 205 in 2019 to 414 in 2023. Most cases involved ketamine ingestion (57.2 %), and a plurality involved misuse or "abuse" (36.2 %) and moderate effects (44.8 %). The percentage of cases involving suspected suicide attempts doubled from 12.7 % in 2019 to 25.9 % (a 103.9 % increase; P < 0.001); ingestion use increased from 46.0 % to 65.2 % (a 41.7 % increase; P < 0.001), and cases involving ketamine in liquid form decreased from 65.1 % to 41.2 % (a 36.7 % decrease; P < 0.001). Cases with major effects or death decreased from 23.4 % in 2019 to 15.6 % in 2023 (a 33.2 % decrease; P = 0.039). A major event or death was experienced by 18.6 % of cases, but prevalence was lower for those who inhaled ketamine (aPR=0.49, 95 % CI:0.29-0.85) compared to those who did not inhale. DISCUSSION:Poisonings involving ketamine are at their highest in reporting history. Both medical and recreational ketamine use and related adverse events need to be monitored, especially as off-label prescribing of take-home oral formulations appears to be increasing.

Objectives. To characterize present-day polysubstance use patterns in the general adult population. Methods. From a 2022 nationally representative survey in the United States, we defined polysubstance use as last 12-month use of 2 or more drugs (n = 15 800). Latent class analyses included medical (as indicated) and nonmedical (not as directed) use of prescription opioids, stimulants, benzodiazepines, and antidepressants; recreational use of cannabis, psilocybin or mushrooms, other psychedelics, cocaine, methamphetamine, and illicit opioids; and concomitant use with alcohol, cannabis, prescriptions, or recreational drugs. Results. The national prevalence of polysubstance use was 20.9% (95% confidence interval = 20.5%, 21.3%), broken down into the following 4 latent classes: (1) medically guided polysubstance use (11.5% prevalence, 6.1% substance use disorder [SUD]): prescribed drug use, some cannabis, and no concomitant use; (2) principal cannabis use variety (4.0% prevalence, 31.9% SUD): high probability of cannabis use with various drugs concomitantly used; (3) self-guided polysubstance use (3.4% prevalence, 14.5% SUD): nonmedical use of prescriptions and concomitant use; and (4) indiscriminate coexposures (2.1% prevalence, 58.9% SUD): concomitant drug use with indiscriminate drug preference. Conclusions. Different polysubstance profiles show adults with untreated SUDs, and there are 2 previously unrecognized classes. Prevention and treatment strategies addressing polysubstance use should take a personalized perspective and tailor to individuals' use profile. (Am J Public Health. 2025;115(5):747-757. https://doi.org/10.2105/AJPH.2024.307979).

BackgroundGiven the opioid overdose crisis, surveillance of evolving opioid use patterns is critical to the effective deployment of mitigation strategies. The National Survey on Drug Use and Health (NSDUH) provided the first annual US estimate of illicitly manufactured fentanyl (IMF) use in 2022. However, as a household survey, NSDUH may not capture the full extent of population heroin and IMF use. We compare estimates of past-year heroin and IMF use and correlates of use in NSDUH and the Survey of Non-Medical Use of Prescription Drugs (NMURx) survey which employ an alternate sampling strategy.MethodsWe conducted a cross-sectional analysis of the 2022 NSDUH and NMURx. NSDUH samples respondents using a probability-based approach targeting community-dwelling individuals, while NMURx samples respondents using an opt-in, online survey panel. US adults ages 18 years and older were included. The main outcomes were differences in the weighted percentage of population reporting past-year use of heroin, IMF, and either heroin or IMF between the surveys. Secondary outcomes were the patterns of association of past-year heroin or IMF use with comorbid substance use, treatment utilization, and demographic characteristics between the surveys. Data were analyzed March to June 2024.ResultsNSDUH (n = 47,100 respondents) had a lower proportion of respondents who identified as non-Hispanic White and graduated college, and a higher proportion with past week employment than NMURx (N = 59,041 respondents). Past-year use of heroin, IMF, and either heroin or IMF were lower in the NSDUH than the NMURx. NSDUH estimated 0.52% (95% CI: 0.40%, 0.69%) %) of the US population used either heroin or IMF in the past year compared to 1.05% (95% CI: 0.97%, 1.14 0) in NMURx. In regression models, stimulant and benzodiazepine use were consistently associated with increased heroin or IMF use across both surveys.Conclusions and relevanceThe estimated prevalence of heroin or IMF use was nearly 50% higher in the NMURx compared to NSDUH. These results highlight the importance of using complementary surveillance approaches to obtain accurate estimates of the prevalence and patterns of heroin or IMF use.

Despite efforts to reduce abuse, opioids remain a societal concern. Coronavirus disease 2019 (COVID-19) brought new challenges, and research is needed to understand its impact on opioid abuse in the population. Three data sources were used to investigate trends in misuse and abuse of XTAMPZA® ER compared to extended-release (ER) and single-entity immediate-release (SE-IR) oxycodone from 2019Q3 through 2022. Changes in trends over 6-month intervals were investigated using linear spline models with a breakpoint at 2020Q3 to measure the impact of COVID-19. Poison center call rates for misuse or abuse of ER and SE-IR oxycodone showed significant changes during COVID-19 (both p < 0.001), reversing trends and significantly decreasing (201327.56 percent change and -12.91 percent change, respectively). In contrast, XTAMPZA ER trend rates showed no change during COVID-19, remaining fairly stable. The odds of abuse of ER oxycodone among those entering opioid use disorder treatment significantly changed during COVID-19 (p = 0.025), resulting in a stabilization of the trend. For SE-IR oxycodone, no change was observed in the decreasing trend (-12.88 percent change during COVID-19). XTAMPZA ER had no significant change during COVID-19 (p = 0.200) and appeared stable. Since 2021Q3, among the general adult population, the prevalence of past-year nonmedical use of XTAMPZA ER was rare (0.04 percent), as was the case for other oxycodone products (<1 percent). Overall, there is no evidence that oxycodone misuse and abuse worsened during COVID-19 in these populations, and XTAMPZA ER was consistently lower than other oxycodone products. Low rates and improving trends in oxycodone misuse and abuse may signify an ongoing reduction in prescription opioid contributions to the opioid crisis.

INTRODUCTION:Fentanyl-related deaths involving stimulants have increased in the U.S., but little is known about nonfatal overdoses involving use. This study examined national trends in nonfatal fentanyl-related exposures involving co-use of cocaine or methamphetamine. METHODS:In this cross-sectional analysis, data from U.S. poison centers were used to estimate annual trends in reported exposures involving fentanyl and stimulant use from 2015 to 2023. Cases included patients aged ≥13 with exposures involving intentional misuse or "abuse" of fentanyl where nonfatal adverse effects occurred (n=13,173). Co-exposure trends were examined, and multivariable logistic regression models were used to estimate how region and medical outcome severity were associated with (1) fentanyl-cocaine use (versus fentanyl, no cocaine use) and (2) fentanyl-methamphetamine use (versus fentanyl, no methamphetamine use). RESULTS:Between 2015 and 2023, among fentanyl-related exposures, cocaine use increased from 1.3% to 10.0% (669.2% increase, p<0.001) and methamphetamine use increased from 1.5% to 10.8% (620.0% increase, p<0.001). Exposures in the Northeast were associated with higher odds of cocaine co-use, while exposures in the Midwest, South, and West were associated with higher odds of methamphetamine co-use. Compared to those with less severe effects, those with a major (life-threatening) effect had higher odds of cocaine co-use, but lower odds of methamphetamine co-use. CONCLUSIONS:Similar to drug-related mortality trends, nonfatal fentanyl poisonings involving co-use of cocaine or methamphetamine increased in recent years and became increasingly widespread. Differences in experience of life-threatening adverse effects linked to different stimulants suggests varying risk according to which stimulant is involved.

STUDY OBJECTIVE:Oregon and Colorado have legalized possession of natural psychedelic drugs. We assessed if travel to use psychedelics in decriminalized states is occurring and compared the use patterns of travelers with nontravelers. METHODS:The National Survey Investigating Hallucinogen Trends is a cross-sectional behavioral survey fielded from April to June 2024 to every US state. The survey asks whether individuals used a psychedelic drug in the last 12 months and whether they traveled outside of their home state to do so. RESULTS:A total of 2,124 people indicated use of psychedelic drugs in the preceding 12 months; 32.3% (n=687) traveled to take psychedelic drugs to at least one place; 13.9% (n=295) traveled to Colorado, 9.4% (n=199) traveled to Oregon, and 12.5% (n=265) traveled outside the United States. Travelers, compared with nontravelers, were more likely to have current anxiety or depression symptoms and were more likely to have attributed an emergency department or urgent care visit in the past 12 months to psychedelic drug use. Travelers were more likely to treat medical symptoms (23.4% versus 17.5%), use in psychedelic/healing centers (38.9% versus 11.9%), and at a ceremonial site (43.1% versus 13.0%) compared with nontravelers. CONCLUSION:Those traveling to use psychedelics were more likely to treat a mental health disorder and have a psychedelic attributable emergency department visit than nontravelers. Emergency physicians in legalized and nonlegal states must be aware that travel to use psychedelic drugs is common because risks of adverse outcomes while traveling and returning home may accompany travel to use.

ABSTRACTPurposeTo assess whether exposure to an extended‐release (ER) oxycodone with abuse deterrent properties (ADF) reduced tampering of oxycodone in a real‐world, postmarket setting to address the thinking behind Category 4 labeling by the FDA.MethodsData from an observational cross‐sectional study of the general adult population (2022) was used under a causal framework to estimate the confounding‐adjusted odds of tampering oxycodone after exposure to two types of ADF ER oxycodone. The tampering behaviors of those who used only single entity immediate‐release (SE‐IR) oxycodone was used as a comparison. The tampering outcome was defined as use by snorting, smoking, or injecting any oxycodone (ER or SE‐IR). A directed acyclic graph was used to identify covariates. Average treatment effect among the treated was estimated using inverse propensity score weighting combined with survey weights in a regression.ResultsIn 2022, 0.14% and 3.0% among the general population reported using the two ER oxycodone groups, while 2.4% used SE‐IR oxycodone. Propensity score analyses with both comparators (common support > 98%) balanced demographic, health, and drug use covariates. After adjustment for selection and confounding bias, among those who used ER oxycodone group 1 the odds ratio of tampering with any form of oxycodone was elevated but not statistically significant (2.25; 95% CI: 0.94, 5.39). The odds ratio of tampering by users of ER oxycodone group 2 was significantly elevated (1.90; 95% CI: 1.08, 3.19).ConclusionsTampering of ER oxycodone products by individuals was rare. We found evidence suggestive of elevated odds of tampering behaviors with use of an ADF ER oxycodone.

BACKGROUND:The opioid crisis in the United States is a complex issue with interconnected factors that lead to opioid misuse and opioid-involved mortality. This study assessed the relative importance of different risk factor domains in predicting fatal opioid-involved mortality that occurred after hospital encounters involving opioids. METHODS:A machine learning model was developed by integrating multiple data sources, including hospital records, death records, and societal data. The model allowed simultaneous examination of risk factors across individual drug and non-drug related factors, hospital factors, and societal factors. RESULTS:429,005 patients with opioid-related encounters in 2014 were assessed, where 56.6% were female and the mean age was 44.98. Among deaths that had specific drugs listed for both the hospital encounter and the death, 51.7% of hospital encounters progressed to a more potent opioid at death. Community factors cumulatively had similar importance as individual drug-related factors in predicting opioid-involved deaths and were relatively more important in predicting opioid-involved mortality compared to non-drug involved mortality. In predicting opioid-involved mortality, non-drug related individual-level predictors accounted for 45.1% of the importance. Community factors accounted for 27.9% of the importance and drug-related individual factors accounted for 22.5%. In contrast, community factors accounted for only 16.5% of the importance when predicting non-opioid-involved mortality. PRACTICE IMPLICATIONS:Rather than suggesting community factors outweigh individual factors, our results highlight individual vulnerability may be amplified or mitigated by broader environmental factors. Interventions targeting larger social determinants of health may be strongly influential in reducing drug-involved mortality. This study demonstrated a quantitative evaluation of the different domains of risk factors and highlighted the importance of considering societal and community factors in a holistic approach to preventing opioid-involved mortality.

AIMS:Gabapentin is not a federally controlled substance, yet multiple states have implemented gabapentin-specific policies in response to non-medical use (NMU). This study aims to compare prevalence of gabapentin NMU by state policy type and examine the association between gabapentin NMU and gabapentin-related state policy types. METHODS:Data come from the Survey of Non-Medical Use of Prescription Drugs, which employed an online cross-sectional survey in the U.S. in 2021. Weighted, estimated prevalence of gabapentin NMU was compared by gabapentin state policy type: a) Schedule V controlled substance with mandated Prescription Drug Monitoring Program (PDMP) reporting; b) unscheduled, but PDMP reporting is required; and c) no policy. Additionally, weighted logistic regression analysis was performed to reveal the association between past 12-month gabapentin non-medical use and gabapentin-related state policies. RESULTS:Gabapentin NMU was most prevalent in states where it is a controlled substance alongside mandatory PDMP reporting (prevalence 1.72% [1.41, 2.04]) compared to lower rates among states with mandatory PDMP reporting alone (1.43% [1.20, 1.67]) and states with no gabapentin policy (1.30% [1.18, 1.42]). Results of Tabel 4 show gabapentin NMU was significantly associated with past 12-month pain (OR: 3.80 [3.18, 4.53]), substance use treatment (OR: 2.89 [2.15, 3.89]), and receiving medication for opioid use disorder (OR: 1.95 [1.28, 2.97]). CONCLUSIONS:These findings represent the first apparent estimates of prevalence of gabapentin NMU in the U.S. and underscore the need for continued research on the effects of gabapentin state policies, including impacts on individuals, the ongoing opioid crisis, and NMU and diversion.

Background: The opioid crisis, driven by fentanyl use, continues to worsen in the US and there has been a lack of focus on nonfatal overdose and how pediatric populations are being affected.Objectives: We determined the prevalence of nonfatal pediatric fentanyl exposures and associated characteristics and delineated how such characteristics are associated with major (life-threatening) outcomes.Methods: This repeated cross-sectional study examined characteristics of pediatric nonfatal fentanyl exposures (aged 0-19 years) reported to poison centers in 49 US states from 2015 through 2023.Results: 3,009 nonfatal pediatric exposures (41.5% female) were reported to poison centers-58.9% aged 13-19 and 41.1% aged 0-12. The number of exposures increased overall from 69 in 2015 to 893 in 2023 (a 1,194.2% increase, p < .001). Exposures increased by 924.3% among those aged 0-12 (p < .001) and by 1,506.3% among those aged 13-19 (p < .001). Ingestion-only use was the most prevalent route of administration by those aged 0-12 (76.9%) and 13-19 (54.1%). Prevalence of ingestion-only use increased from 44.1% of exposures in 2015 to 67.9% in 2023 (p < .001). The majority of patients aged 0-12 were exposed unintentionally (81.7%, vs. 1.0% among patients aged 13-19) while the majority of patients aged 13-19 misused or "abused" fentanyl (65.7% vs. 1.8%). The plurality of exposures (41.0%) resulted in a major (life-threatening) effect.Conclusions: Pediatric exposures to fentanyl are increasing and over one-third of cases are unintentional and/or had documented life-threatening effects. Prevention and harm reduction efforts need to include efforts for youth, particularly as counterfeit pills containing fentanyl flood the illicit market.