INTRODUCTION:Specific sources for nonmedical prescription stimulant use (NMPSU) are linked to different rates of concurrent substance use (e.g., cannabis use) in adolescents and young adults. This study investigates whether NMPSU sources at age 17-18 (baseline) are linked to greater odds of NMPSU over young adulthood (19-30 years) and whether sources are consistent across development. METHODS:Data were from the 2007-2020 longitudinal Monitoring the Future panel study, with 1244 observations from 876 unique participants with any past-year NMPSU source data. NMPSU sources included given for free, theft, purchases, from one's own prescription, or other sources. Multiple source use was also captured. Analyses estimated NMPSU sources by age group (17-18 vs. 19-30) and NMPSU and source use at ages 19-30 based on NMPSU sources at ages 17-18. RESULTS:When compared to older adolescents, young adults were more likely to obtain stimulant medication from peers or family for free (adjusted odds ratio [aOR] = 1.58, 95% confidence interval (95% CI) = 1.10, 2.28), while NMPSU from one's own prescription (aOR = 0.39, 95% CI = 0.23, 0.65) and other source use (aOR = 0.38, 95% CI = 0.21, 0.69) were less common. Sources at ages 17-18 did not predict prevalence of past-year NMPSU at ages 19-30; similarly, sources were not consistent across the study period. CONCLUSIONS:NMPSU sources in late adolescence were not related to NMPSU in young adulthood, and sources were not consistent. Stimulant medication sources may be a better indicator of current risky behavior than of longer-term substance use.

Purpose: This study examined associations between sexual identity and both substance use and mental health outcomes via nationally representative data from adolescents and young adults, using a six-response sexual identity assessment.Methods: Data were from 11,328 adolescents (12-17 years) and 13,131 young adults (18-25 years) completing the 2023 National Survey on Drug Use and Health. Sexual identity had six-response options: heterosexual, lesbian/gay, bisexual, using a different term, unsure/don't know, and do not understand the question. Substance use variables included alcohol, cannabis, nicotine, prescription drug misuse, polysubstance use, and substance use disorder (SUD). Mental health variables included major depressive episodes, suicidal ideation, and serious psychological distress (measured only among young adults). Multivariable logistic regression models were fitted to examine whether substance use and mental health differed by sexual identity. Analyses adjusted for sociodemographics, occurred separately by age group and sex, and heterosexual individuals were the reference category.Results: Youth identifying as lesbian, gay, bisexual, unsure/don't know, or using a different term had significantly higher rates of all mental health concerns than their heterosexual peers, with 80% of adjusted odds ratios above 3.0. Substance use-sexual identity links were less consistent, although lesbian and bisexual females were more likely than heterosexual females to have past-year SUD. Individuals not understanding the sexual identity question had lower rates than their heterosexual peers on 15 of 36 outcomes (41.7%).Conclusion: Screening and indicated prevention for mental health concerns and SUD are needed for sexual minority youth, along with the development of culturally sensitive interventions.

This study explores hallucinogen use, comparing adults with and without a recent history of justice involvement. While past research finds that justice-involved adults are more prone to health problems and substance use behaviors, less attention has been paid to hallucinogen use. Using data from 2021 to 2024 National Survey on Drug Use and Health, we assessed the association between past-year justice involvement and hallucinogen use among U.S. adults. Logistic regression models include demographic characteristics, health-related measures, and other types of substance use. Results indicate that hallucinogen use continues to increase, particularly among adults with recent justice involvement. While both poor health and substance use behaviors were significantly associated with hallucinogen use, once other types of substance use were included in the analysis there was no longer a significant difference in hallucinogen use based on justice involvement. Lastly, we identified several differences in correlates of hallucinogen use among adults with and without justice involvement. Research on hallucinogens is important as some states have moved to decriminalize use and prevalence has increased in recent years. Given the increased risk for poor health and substance use among adults with criminal justice contact, research in this area is important.

In recent years there has been an increase in cannabis use among adults in the U.S., which corresponds with changes in state-level laws making cannabis available for medical/recreational use. While cannabis became available for medical use in Florida in 2014, it was not until a ban on smoking cannabis was lifted in 2019 that the number of patients began to increase. The data for the current study are the Florida Young Adult Cannabis Study and focus on 415 medical cannabis patients (MCP). We identified several significant differences between male and female MCP. Female MCP initiated regular cannabis use at a younger age and reported more frequent cannabis use. Female MCP were more likely to endorse self-treatment motives while male MCP were more likely to endorse recreational motives. As Florida is one of the largest and most diverse states in the U.S., research on MCP is needed to inform policy.

BACKGROUND:Medication sources for prescription opioid misuse in US adolescents and young adults may have changed, particularly related to the COVID-19 pandemic. We examined how opioid sources vary across age groups and cohorts and whether links between sources and substance use or mental health vary between age groups. METHODS:Cross sectional nationally representative survey data from the 2015-2019 and 2021-2022 National Survey on Drug Use and Health were used. Respondents were interviewed in their homes (2015-19) or via mixed household and web-based survey methods (2021-2022). Participants were 6045 14-25-year-old reporting past-year prescription opioid misuse. Mutually exclusive opioid sources were physicians, purchases, theft, and friends/family for free. Cross-tabulations estimated source prevalence by age, and logistic and negative binomial regression models evaluated links between sources (independent variable) and substance use, mental health, and sociodemographics (individual dependent variables). RESULTS:Theft declined significantly with age in the 2015-2019 cohort (12.4% to 4.7%), with some evidence of opioid source differences between 2015-2019 and 2021-2022. Those using purchases had the most past-month prescription opioid misuse days and the highest prevalence of substance use disorder from misuse (e.g., 23.4% of 2015-2019 young adults), other substance use, and mental health concerns; those using theft typically had the second highest rates, with the lowest rates often in the physician source group. CONCLUSION:We found age- and cohort-based differences in sources, and mechanisms underlying these differences warrant further study. Adolescents and young adults using purchases or theft to obtain opioids are important targets for identification and intervention.

BACKGROUND:Adolescent (12-17 years) and young adult (18-25 years) nonmedical use of prescription tranquilizer medication (ie, short-acting benzodiazepines) is linked to high rates of other substance use and psychopathology. Using probability-based US survey data, we sought to identify nonmedical tranquilizer use motive latent classes by age group and identified links between latent class membership and other substance use and mental health outcomes. METHODS:Data were from the 2015 to 2019 National Survey on Drug Use and Health (67 971 adolescents; 69 432 young adults), with motive data from 889 unweighted adolescents and 2819 unweighted young adults. Latent class analysis identified subgroups based on motives, accounting for the complex sampling, and with the most likely class membership assigned via a modal approach. Logistic regression linked latent class membership to substance use, mental health, and sociodemographic characteristics. RESULTS:Analyses revealed 5 adolescent latent classes: Relax (35.0%), Multi-Motive (26.3%), Experimenter (22.0%), Sleep (9.2%), and Emotional Coping (7.4%). There were also 7 young adult classes: Relax (30.2%), Sleep (18.8%), Multi-Motive/High (17.1%), Experimenter (13.9%), Emotional Coping/Relax (12.8%), Multi-Motive/Self-Treatment (4.8%), and Other Drug Enhancement (2.4%). Within those engaged in nonmedical use, the adolescent and young adult multi-motive classes with frequent endorsement of "to get high" had the highest odds of other substance use and mental health concerns. CONCLUSION:Latent class profiles based on nonmedical tranquilizer use motives differ between adolescents and young adults, though the Multi-Motive classes with frequent endorsement of "to get high" are in greatest need of identification and intervention.

BACKGROUND:Opioid misuse, including prescription opioid misuse, remains a significant public health concern impacting various ethnoracial groups in the United States, including non-Hispanic Black Americans. This study provides more recent evidence on prescription opioid misuse among Black Americans.METHODS:We used data from the 2019 National Survey on Drug Use and Health to examine the prevalence and determinants of prescription opioid misuse among Black American adults aged 18 and older. We compared these findings to non-Hispanic White American adults.RESULTS:The prevalence rate of past-year prescription opioid misuse was very similar among Black (3.4%) and White respondents (3.8%). Adjusted multivariate logistic regression analyses found no significant racial differences in prescription opioid misuse. Religious importance and rurality were negatively associated with misuse only among Black respondents. Depressive episodes, other drug use, age, and risk-taking behaviors were associated with prescription opioid misuse among both Black and White respondents.CONCLUSION:Black and White Americans remain at risk for prescription opioid-related problems. Religiosity and rurality require further investigation to understand how they may impact misuse among Black Americans.

OBJECTIVE:Adolescent (12-17 years) and young adult (18-25 years) prescription opioid misuse (POM) is linked to poor health outcomes. We investigated how POM motives vary across these ages and the potential links between motives and other substance use, mental health, and sociodemographic characteristics to help guide screening and prevention. METHODS:Pooled 2015-2019 US National Survey on Drug Use and Health data were used, with 137,858 participants. Cross-tabulations estimated prevalence of individual motives and motive category by age. Mutually exclusive motive categories were no past-year POM, pain relief only, pain/sleep/relax (ie, some combination of only these motives), and any non-self-treatment motives (eg, get high, experiment). Logistic regression models evaluated links between motive category and sociodemographic, mental health, and substance use (eg, alcohol, cannabis, nicotine, other prescription misuse) outcomes by age group, versus reference groups of no past-year POM or pain relief only. RESULTS:Pain relief was the most common POM motive (estimated at >50% at all ages), but POM for non-self-treatment motives was the most common category after 14 years. POM for non-self-treatment motives had the highest adjusted odds ratios (aORs) of all substance use and mental health characteristics (eg, past-year substance use disorder aORs of 6.11 in adolescents [95% confidence interval (CI), 4.23-8.85] and 4.81 [95% CI, 4.01-5.77] in young adults, versus the pain relief only reference). CONCLUSIONS:POM for any non-self-treatment motives is linked to the highest prevalence of other substance use and mental health concerns, whereas POM for pain relief also signals a need for substance use and mental health screening.

Purpose: To examine the impact of employment and health insurance on healthcare utilization while delineating criminal-legal system (CLS) contact by type. Methods: We examined pooled data (2015-2019) from the National Survey on Drug Use and Health to assess the association between type of CLS contact (i.e., arrest, probation, or parole) and healthcare utilization (i.e., emergency room visit, overnight hospital stays, or doctor visit) among adults aged 18 and older (N = 201,490). Results: Adults with any past-year CLS contact reported a higher prevalence of emergency room visits and hospital stays, but lower rates of doctor visits, compared to adults with no past-year CLS contact. Findings from logistic regression analyses highlight the importance of arrest. Among adults with past-year CLS contact, those with an arrest were more likely to report all forms of healthcare utilization compared to those on probation or parole. Lastly, findings clearly indicated that insurance was more strongly associated with healthcare utilization than employment. Discussion: The current research contributes to literature that examines health conditions and healthcare utilization across type of CLS contact. Understanding how barriers to healthcare utilization vary by type of CLS contact should enable community resources and support services to reduce health disparities in this vulnerable population.

This study examines trends in medical use, nonmedical use, diversion sources, and perceived procurement difficulty of prescription medications for nonmedical use among US adolescents.

Background While alcohol use and prescription drug misuse (PDM) are common among adolescents, there is relatively little research on coingestion. This is disquieting as polysubstance use has become a major contributing factor in drug overdose deaths among young people in the United States. Methods The current research uses multiple years of data from the National Survey on Drug Use and Health (2015–2019) to assess characteristics associated with coingestion among adolescents aged 12 to 17 years ( N = 57,352). Multinomial logistic regression analysis is used to identify characteristics associated with past 30-day PDM with and without alcohol coingestion. The primary objective is to determine how youth experiences with parents, involvement in conventional activities, religiosity, social support, and school status are associated with coingestion. Results Among adolescents who report past 30-day PDM, 18.6% coingest with alcohol and 77.5% of adolescents who coingest report at least one substance use disorder. Several youth experiences were significantly associated with opioid coingestion including increased conflict with parents (relative risk ratio [RRR], 1.27; 95% confidence interval [CI], 1.07–1.48), lower levels of religiosity (RRR, 0.72; 95% CI, 0.52–0.98), less social support (RRR, 0.36; 95% CI, 0.18–0.69), and not being in school (RRR, 3.86; 95% CI, 1.33–11.17). In addition, emergency department visits, depression, and other substance use behaviors were also significantly associated with coingestion. Conclusions Findings demonstrate a strong connection between coingestion and substance use disorder among US adolescents. The findings from the current study can inform prevention and intervention efforts by identifying youth experiences and health-related factors that are associated with coingestion.

BACKGROUND AND OBJECTIVES:To examine changes in United States past-year opioid, stimulant, and benzodiazepine prescription drug misuse (PDM) and poly-PDM by demographics.METHODS:Data were from the 2015-2019 National Survey on Drug Use and Health (N = 282,768), examining annualized PDM change by demographics.RESULTS:Opioid and poly-PDM significantly declined among those under 35 years, White, and multiracial residents.DISCUSSION AND CONCLUSIONS:Age and race/ethnicity are important moderators of recent PDM trends, warranting investigation of mechanisms.SCIENTIFIC SIGNIFICANCE:Results highlight ongoing PDM declines in younger groups but expand the literature by showing limited changes in adults 35 and older and non-opioid PDM.

Objective We examine the association between college education and the number of medications used/misused in the past year. We also consider the possibility of differential socioeconomic returns to health for racial/ethnic minorities. Methods The data come from the 2015-2019 National Survey on Drug Use and Health (n = 144,589). Results In accordance with human capital theory, we found that, in the full sample and white subsample, college education was associated with lower levels of polypharmacy, even with adjustments for financial insecurity, health, and lifestyle. Consistent with the diminished return theory, we observed that college education was mostly unrelated to polypharmacy among black and Hispanic individuals. While health commodity theory was supported among Asians, health disparity theory was confirmed among individuals of other races and ethnicities. Conclusion The most important implication of our study is that polypharmacy can be simultaneously structured by durable systems of social stratification, including education, race, and ethnicity.

A large portion of the U.S. population is justice-involved, an important at-risk population with poor physical/mental health outcomes and increased rates of substance use. Using the 2018 National Survey on Drug Use and Health, the current study assesses marijuana use across level of community-based justice involvement (i.e., arrest, probation, and parole) among adults. Given increasing rates of marijuana use and a relative lack of research, the current study addresses an important gap in the literature. Findings from logistic regression analysis show that adults who had been arrested or were on probation were more likely to use marijuana compared to adults with no justice involvement, while adults on parole were less likely to use marijuana than those on probation. This study offers evidence of differences in marijuana use across level of justice involvement, which may be attributable to other substance use behaviors, and has important implications for criminal justice practice.

INTRODUCTION:Criminal legal system (CLS) exposed adults experience higher rates of substance use, substance use disorder (SUD), and overdose. As most CLS exposed adults are not incarcerated, it is important to focus on CLS exposure across the carceral continuum. METHODS:This research used pooled data from adult respondents (N = 206,314) in the National Survey on Drug Use and Health (2015-2019). Survey weighted descriptive statistics and Poisson regression were used to estimate prevalence of polysubstance use (i.e., concurrent use) across CLS exposure types (i.e., arrest, probation, parole), identifying relevant correlates. RESULTS:The prevalence of polysubstance use was higher among CLS exposed adults, and nearly two-thirds of CLS exposed adults who used multiple types of substances indicated having an SUD. Comparing CLS exposure types, polysubstance use was less likely among adults on probation (IRR=0.89, 95%CI=0.84,0.94) or parole (IRR=0.82, 95%CI=0.76,0.87) compared to those arrested. Polysubstance use was also more likely among adults on probation (IRR=1.09, 95%CI =1.01,1.17) compared to those on parole. While some characteristics (i.e., age, ethnicity, SUD) were consistently associated with polysubstance use across types of CLS exposure, other characteristics (i.e., sexual identity, marital status, suicidal ideation) were not. CONCLUSIONS:There is heterogeneity in health risks as a function of CLS exposure type. Further research is needed to identify causal mechanisms and differences based on demographic characteristics. Given high levels of polysubstance use across CLS exposure types, a shift towards a more comprehensive approach in substance use epidemiology may facilitate building an evidence-base to maximize treatment related interventions to reduce polysubstance-involved overdoses.

Limited research has been conducted to understand possible relationships that exist between IPH and access to DV services. The current study adds to the literature by expanding traditional measures of DV services to capture presence, as well as access, and examines the impact on female IPH victimization across 67 Florida counties between 2005 and 2015. Using exposure reduction arguments, we shed light on factors associated with female victim IPH rates and support previous research findings showing a continuation in the disparity of IPH rates between urban and rural areas within county boundaries. We also demonstrate the importance of accessible shelter and safe homes in combating IPV and IPH rates.

Purpose: Although we know that sexual minority populations, particularly bisexual individuals, tend to be at increased risk for substance use, less research has focused on prescription drug misuse (PDM). The current study is the first to assess differences in motivations for PDM by sexual identity and sex. This is important as research has established a link between certain motivations and adverse outcomes. Methods: This study used data from multiple years of the National Survey on Drug Use and Health (2015-2018). Respondents who reported past-year PDM were asked follow-up questions to identify motivations for PDM. We ran several weighted cross-tabulations to estimate the prevalence and 95% confidence intervals for motivations for PDM by sexual identity (i.e., heterosexual, lesbian or gay, and bisexual) for males and females separately. When chi-square tests were significant, post hoc comparisons using design-based multivariable regressions were conducted. Results: Prevalence rates for both PDM and substance use disorder associated with prescription drugs were higher among sexual minority adults than heterosexual adults. With regard to motives, bisexual females were more likely to endorse recreational motives (i.e., to get high) for prescription opioids, tranquilizers, and stimulants than heterosexual females. Gay males were more likely to endorse self-treatment motives (e.g., to relax, to lose weight) than both bisexual and heterosexual males. Conclusion: High prevalence rates and endorsement of recreational motives identify bisexual females as an important at-risk population. It is important for clinicians to consider how prevention, treatment, and intervention strategies focused on PDM may be improved to best target this unique population.

Abstract Objectives Although older adult prescription drug misuse (PDM) is associated with concerning consequences, stimulant PDM and poly- PDM involving multiple medication classes each remain understudied. Our objectives were to examine PDM and poly-PDM prevalence by medication class in US older adults and to identify the mental health, SUD, and health-related quality-of-life correlates of poly-PDM. Method Data were from adults 50 and older completing the National Epidemiologic Survey on Alcohol and Related Conditions-III, (N = 14,667). Prevalence of PDM and poly-PDM by medication class was estimated. Logistic regression established odds of four SUD diagnoses, five psychopathology diagnoses and lifetime suicide attempts; linear regression evaluated health-related quality-of-life by PDM/poly-PDM status. Results Past-year PDM abstinence increased with age (50–54 years: 80.5%; 80 and older: 96.0%), while poly-PDM declined; past-year stimulant PDM was rare (≤0.6%), except when combined with opioid and tranquilizer/sedative PDM. Compared to no past-year PDM, both past-year opioid-only PDM and opioid-involved poly-PDM were associated with poorer health-related quality-of-life and greater odds of psychopathology and SUD, with the highest odds in poly-PDM. Conclusion The presence of any opioid-involved PDM in older adults highlights screening for SUD, psychopathology, and other medical conditions, with the most significant intervention needs likely in those with opioid-involved poly-PDM.