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.

OBJECTIVE:Major changes in opioid prescribing have created a need to understand long-term patterns of medical prescription opioid use and its associations with substance-related consequences. This study aimed to identify trajectories of medical use of prescription opioids during middle adulthood (ages 35-60) and examine associations of such trajectories with nonmedical prescription opioid use and substance use disorder symptoms. METHODS:Twenty-seven cohorts of 31,094 adults were followed longitudinally via self-administered surveys during midlife. Latent profile analysis was used to create trajectory profiles based on frequency of medical prescription opioid use between ages 35 and 60. RESULTS:An estimated 37.3% of adults reported at least one episode of medical prescription opioid use during midlife, and four trajectories were identified: infrequent use (27.1% of all adults); multiple peaks at ages 35, 45, and 60 (3.7%); multiple peaks at ages 40 and 55 (2.9%); and frequent use at all ages (3.7%). The prevalence and adjusted odds ratio (AOR) of experiencing multiple substance use disorder symptoms were significantly higher among adults with frequent use at all ages (60.5%, AOR=2.1); multiple peaks at ages 35, 45, and 60 (51.1%, AOR=1.7); multiple peaks at ages 40 and 55 (48.9%, AOR=1.5); and infrequent use (41.1%, AOR=1.4), relative to a population control group. CONCLUSIONS:Most adults with frequent long-term medical use of prescription opioids reported multiple substance use disorder symptoms. Screening for nonmedical use and substance use disorders before prescribing opioids and ongoing monitoring for substance use disorders are critical, particularly among adults requiring frequent or long-term recurrent medical use of prescription opioids.

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.

OBJECTIVES:To assess the US lifetime and past-year prevalence of kratom Mitragyna speciosa use and its associations with mental health and DSM-5 substance use disorder (SUD). METHODS:This study examined cross-sectional survey data collected from 169,408 non-institutionalized individuals aged 12 and older in US households between 2021 and 2024. Measures included kratom use, nonmedical use of cannabis, prescription drugs (opioids, sedatives/tranquilizers, stimulants), other drugs, mental health indicators (serious psychological distress, DSM-5 major depression, suicidal ideation), and DSM-5 SUD. RESULTS:Between 2021 and 2024, lifetime and past-year kratom use were highest among adults aged 21 to 34, 3.40% (95% CI: 3.17-3.65) and 1.01% (95% CI: 0.91-1.13), respectively. Among people who reported prior-to-past-year kratom use, most reported past-year cannabis (65.7%; 95% CI: 60.4-70.3) and had a past-year SUD (52.8%; 95% CI: 50.1-55.4), whereas an estimated 37.8% (95% CI: 37.2-47.3) experienced serious psychological distress. Similar results were observed for those who reported past-year kratom use. Multivariate logistic regression analysis revealed prior-to-past-year and past-year kratom use was associated with increased adjusted odds of past-year SUD (AOR: 4.36; 95% CI: 3.89-4.88 and AOR: 4.81; 95% CI: 3.99-5.80, respectively). Similar results were found for other substance use, DSM-5 major depression, and suicidal ideation. CONCLUSIONS:Over 5 million people in the United States used kratom in their lifetime, with the highest use at ages 21-34 years. Kratom use is increasing and strongly associated among individuals who use cannabis, have a DSM-5 SUD, and experience serious psychological distress. These findings reinforce a profile of individuals who use kratom, many with behavioral health symptoms, and need evidence-based treatment warranting consideration in clinical and policy efforts.

Background: To examine the persistence of substance use disorder (SUD) symptoms and medical use of prescription benzodiazepines and opioids in midlife (ages 40-55) as a function of SUD symptom severity at age 35. Methods: Multiple national cohorts of US adults were followed longitudinally from ages 35 to 55 in the Monitoring the Future Longitudinal Panel study. The prevalence of multiple SUD symptoms (ie, two or more SUD symptoms) and medical use of prescription benzodiazepines and opioids at ages 40-55 as a function of SUD symptom severity (0, 1, 2-3, 4-5, 6+ symptoms) at age 35 were estimated. Multivariable logistic regression models assessed the longitudinal associations between SUD symptom severity at age 35 and the odds of multiple SUD symptoms and medical use of prescription benzodiazepines and opioids at ages 40-55 using Generalized Estimating Equations analyses, controlling for relevant covariates. Outcomes: Among adults with severe SUD symptoms at age 35 (≥6 symptoms), over 80% had persistent multiple SUD symptoms and half (50%) reported medical use of prescription benzodiazepines or opioids in midlife (ie, at ages 40-55). The prevalence and adjusted odds of multiple SUD symptoms and medical use of prescription benzodiazepines or opioids at ages 40-55 increased in a stepwise fashion based on SUD symptom severity at age 35. Interpretations: Screening for SUD symptom severity is needed in midlife given the high persistence of multiple SUD symptoms. More attention is warranted to assess the balance of benefits and harms of prescribing benzodiazepines and opioids in adults with persistent and severe SUD symptom profiles.

OBJECTIVES:To assess associations between symptomatic polysubstance use and symptom severity during adolescence and later substance use disorder (SUD) symptoms in midlife. METHODS:Multi-cohorts of nationally representative US adolescents in 12th grade (N=12,025; baseline cohort years 1976-2002) were followed longitudinally to age 55 (follow-up years 1993-2019). Poisson regression models were fitted longitudinally, accounting for repeated measures, panel attrition, and covariates. RESULTS:An estimated 8.9% (95% CI=8.3%-9.5%) of US adolescents had moderate-to-severe SUD symptoms involving multiple substances (ie, 4+ SUD symptoms for 2+ substances). The bivariate and multivariate relationships between SUD symptom severity and multiple SUDs at baseline and subsequent SUD symptoms in midlife (ages 35-55) indicated a positive near-linear association. Over two-thirds of adolescents with moderate-to-severe SUD symptoms involving multiple substances had multiple SUD symptoms in midlife (68.6%, 95% CI=63.0%-73.7%). Most adolescents with moderate-to-severe SUD symptoms of one substance and those with fewer SUD symptoms involving multiple substances (ie, 1-3 SUD symptoms for 2+ substances) persisted with multiple SUD symptoms in midlife (57.2%, 95% CI=53.2%-61.0% and 56.4%, 95% CI=51.4%-61.4%, respectively). Adolescents with moderate-to-severe SUD symptoms involving multiple substances had substantially greater odds of SUD symptoms in midlife relative to asymptomatic adolescents (aRR=2.80, 95% CI=2.49-3.15). CONCLUSIONS:Most US adolescents with symptomatic polysubstance use or moderate-to-severe SUD symptoms persisted with multiple SUD symptoms in midlife. Adolescent symptomatic polysubstance use is associated with a more severe developmental course in midlife than those with the same SUD symptom burden concentrated within a single substance, therefore, early comprehensive screening and intervention strategies are needed.

INTRODUCTION:Peer workers-nonclinical service providers with lived experience of recovery-are a growing sector of the substance use workforce whose professional practices are intertwined with their own personal recovery pathways. While research has documented stigma toward harm reduction among peers and the ways peers' attitudes affect their interactions with clients, little is known about effective strategies to prepare peers to serve people in non-abstinent recovery. This study used Delphi methodology to develop expert recommendations for training peers to provide non-abstinent recovery support. METHODS:A national panel of experts, including certified peers, peer supervisors, service recipients, and researchers, was surveyed using real-time Delphi software (N = 72). Delphi statements captured experts' recommendations for target outcomes and training methods on a 5-point scale, supported with open-ended comments. The real-time format allowed for independent anonymous responses followed by immediate review of group consensus and comments. For each Delphi statement, an interquartile range of ≤1.25 served as the consensus threshold. RESULTS:The experts reached consensus on 16 of 20 Delphi statements regarding training outcomes (n = 7/10, e.g., peers should educate clients about safer drug use strategies) and methods (n = 9/10, e.g., training should include role play activities). Where consensus was not achieved (e.g., peers should initiate conversations about medications for opioid use disorder), desired training outcomes varied significantly by experts' attitudes toward harm reduction, professional background, and racial-ethnic identity. CONCLUSION:These findings provide a framework for the first empirically developed training for peers to improve the provision of non-abstinent recovery support. A national panel of experts in harm reduction and recovery services clarified peers' roles and responsibilities and recommended theory-informed strategies to develop peer competencies. Differences in recommendations by personal and professional backgrounds may indicate the need for tailored training protocols.

Background:Sexual minority (SM; e.g., lesbian, gay, bisexual) young adults report elevated substance use, yet few studies examine whether disparities extend to use newly-reported during young adulthood using behaviorally specific measures of daily use and co-use. Methods:We analyzed Monitoring the Future Longitudinal Panel data (2019-2021; N = 12,173; 14.9% SM). Primary analyses used multivariable logistic regression to estimate incident-use odds during young adulthood among respondents reporting no lifetime alcohol and/or cannabis use at age 18. Outcomes included incident alcohol use, cannabis use, daily cannabis use, and past-30-day alcohol-cannabis co-use, defined as use of both substances in the past 30 days. Secondary analyses estimated prevalence and odds of past-30-day alcohol use, past-2-week binge drinking, past-30-day cannabis use, daily cannabis use, and co-use by sex and sexual identity. Results:Gay males had the highest observed past-30-day alcohol use (80.8%) and binge drinking (42.1%), while bisexual females had significantly higher binge drinking (37.6%), past-30-day cannabis use (47.8%), daily cannabis use (19.2%), and co-use (40.9%) than heterosexual females. Lesbian females and bisexual males showed elevated prevalence, with more limited incidence elevations. Incident-use models showed elevated odds of newly-reported cannabis use and co-use among gay males and bisexual females; bisexual females also showed elevated odds of newly-reported alcohol use and daily cannabis use. Contrasts between SM subgroups were generally nonsignificant. Conclusions:Incident-use disparities among SM young adults, particularly gay males and bisexual females, indicate that elevated substance use is not solely carried forward from adolescence. Young adulthood is therefore an important window for subgroup-specific intervention.

PURPOSE:We aimed to classify youth using a longitudinal, multidimensional construct of gender, and examine associations of gender subgroups with substance cognitions and substance use. METHODS:We used data from the Adolescent Brain Cognitive Development study (N = 11,868 youth ages 9-10 years at baseline [2016-2018] through the year 4 follow-up [ages 13-14 years, 2020-2022]) to conduct latent class models using measures of gender identity, felt gender, gender expression, and gender non-contentedness. We used multivariable logistic regression to assess associations of gender classes with curiosity to use, intention to use, and use of alcohol, nicotine/tobacco, and cannabis, respectively, adjusting for sociodemographic factors. RESULTS:A four-class model was selected based on model fit: transgender (2.5%), questioning (9.0%), naïve (36.3%), and cisgender (52.1%). Youth in the questioning and transgender classes were more likely to report curiosity to use alcohol, nicotine/tobacco, and cannabis (adjusted odds ratio [aOR] range 1.68-2.45, p < 0.001) and intention to use alcohol and nicotine/tobacco (questioning youth; aOR range 1.69-1.88, p < 0.01) or nicotine/tobacco and cannabis (transgender youth; aOR range 2.66-3.14, p < 0.001) but not actual use of alcohol, nicotine/tobacco, and cannabis, whereas members of the naïve class were less likely to report curiosity to use alcohol, nicotine/tobacco, and cannabis, intention to use cannabis, and use of alcohol, nicotine/tobacco, and cannabis (aOR range 0.48-0.81, p < 0.001), relative to cisgender youth. CONCLUSION:These findings suggest that a more nuanced understanding of gender among preadolescent youth and their heterogeneous risk for substance use is critical for the development of early prevention services. The timing of prevention efforts may be ideal during this developmental period.

This study examines the associations between childhood parental death and parental substance-related problems and DSM-5 substance use disorders (SUDs), suicide attempt, and mental health discorders (mood, anxiety, post truamatic stress) in adulthood.. Using data from the National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36,309), we compared four mutually exclusive groups who experienced the following before age 18: parental death and no parental substance use problems; parental substance use problems and no parental death; both parental death and parental substance use problems; and neither parental death nor substance use problems. We examined differences in adverse childhood experiences (ACEs), suicidality, and six DSM-5 SUD and mental health disorders. Parental death and parental substance-related problems were treated as exposures rather than included in the ACEs measure. Parentally-bereaved individuals who experienced parental substance-related problems reported significantly greater number of ACEs (M = 5.34) compared to all other groups. Parentally-bereaved individuals who experienced parental substance-related problems had greater odds of a suicide attempt and all six DSM-5 SUD and mental health disorder outcomes (aOR range = 2.06–3.59) compared to parentally-bereaved individuals without parental substance-related problems. They also had greater odds of a suicide attempt and four DSM-5 SUD and mental health disorders (aOR range = 1.19–1.46) compared to those who experienced parental substance use problems and no parental death. Some differences were attenuated in models adjusting for ACEs; however, differences remained for six of the seven outcomes. Individuals who experienced parental death and parental substance-related problems have increased risk for suicidality, DSM-5 SUD, and mental health disorders which may warrant additional trauma-informed mental health care in bereavement services.

Aims: Early substance use onset and family history of substance-related problems (FH+) have independently been linked to higher rates of substance use disorder (SUD) but have not been examined together to predict Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) SUD. This study examines the associations between early substance use onset and the development of later DSM-5 SUD among FH+ individuals versus those without a history (FH−). Design: National prevalence estimates were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, which used structured diagnostic interviews in U.S. adults ( N = 36,309 from 2012–2013). Methods: We examined four DSM-5 SUDs (alcohol, cannabis, prescription drugs, and any substance) as a function of family history and age of substance use onset using logistic regressions adjusting for sociodemographics, mental health, and substance use history. Results: A higher percentage of FH+ than FH− individuals who began substance use at or before 13 years of age developed a DSM-5 SUD (68.0% vs. 35.4%). Multivariate logistic regression analyses indicated that the adjusted odds of developing a DSM-5 SUD were reduced by 16% with each year substance use was delayed (adjusted odds ratio = 0.84, 95% confidence interval = 0.83–0.86). The adjusted odds of SUD were 2.69 times greater in those with the highest family history density of substance-related problems versus FH− individuals (95% confidence interval = 2.03–3.58). Conclusions: Early substance use onset was a significant predictor of DSM-5 SUD, especially for FH+ individuals. The findings highlight the importance of screening and preventive intervention efforts for addiction nursing practice to prevent or delay substance use onset, especially for FH+ U.S. youth.

OBJECTIVES:This study examined DSM-5 stimulant use disorder (StimUD) symptom severity, stimulant craving, and clinical characteristics associated with different stimulant types. METHODS:Nationally representative cross-sectional data from the 2021-2022 National Survey on Drug Use and Health (N = 117,103) was analyzed to determine the past-year prevalence and adjusted odds of DSM-5 StimUD symptom severity, stimulant craving, psychological distress, suicidality, and major depressive episodes among individuals who used crack cocaine, methamphetamine, non-crack cocaine, nonmedical prescription stimulants (NPSU), or polystimulants (≥2 stimulants). RESULTS:Past-year DSM-5 StimUD was most prevalent and severe among individuals who used crack cocaine, methamphetamine-only, or polystimulants, versus non-crack cocaine-only and NPSU-only. Stimulant craving was the most prevalent DSM-5 StimUD symptom, highest among those reporting polystimulant use (56.6%), followed by methamphetamine-only (51.2%), crack cocaine (48.0%), non-crack cocaine-only (18.6%), and NPSU-only (16.6%). Stimulant craving showed a dose-response association with more frequent use. Polystimulant use was associated with the highest rates of psychological distress, suicidal ideation, suicide attempt, and major depressive episodes. In controlled analyses, adjusted odds of impaired control, social impairment, risky use, pharmacologic indicators, and craving were greater among those using crack cocaine, methamphetamine-only, and polystimulants, relative to NPSU-only. Individuals reporting non-crack cocaine use-only had lower odds of psychological distress [AOR = 0.63 (95% CI = 0.44-0.92)] and major depressive episodes [AOR = 0.61 (95% CI = 0.40-0.91)] compared with NPSU-only. CONCLUSIONS:Individuals using different stimulant types differ in DSM-5 StimUD symptoms, craving, and other clinical characteristics, especially those engaged in crack cocaine, methamphetamine, and polystimulant use. Health care professionals should consider these differences when treating individuals who use stimulants.

INTRODUCTION:Recently, U.S. youth of color reported greater use of alcohol, tobacco, and cannabis than White youth. Increased levels of discrimination in recent years may have added to the chronic burden associated with increased use among youth of color. Little is known about this relationship, especially among youth who initiate substance use earlier in adolescence. This study assessed the prevalence of substance susceptibility (willingness and curiosity) and use (alcohol, tobacco, and cannabis) among youth by race/ethnicity and ethnic discrimination's role in this relationship. METHODS:Data from the national panel of 11,868 U.S. youth in the Adolescent Brain Cognitive Development study (baseline through fourth year follow-up; 2016-2022), which assessed these relationships beginning at ages 9-10 years, were analyzed in 2024-2025. Prevalence of lifetime substance susceptibility and use were quantified by race/ethnicity. Multivariable longitudinal analyses tested whether discrimination was connected to substance susceptibility and lifetime use and whether that relationship differed by race/ethnicity. RESULTS:Black youth reported lower lifetime alcohol and tobacco use, lower curiosity toward alcohol and tobacco, and higher willingness to try alcohol than White youth. Hispanic youth reported higher willingness to try alcohol. Asian youth reported lower lifetime tobacco use. Higher levels of ethnic discrimination were consistently associated with greater odds of susceptibility and use among all racial/ethnic groups in this study. CONCLUSIONS:Results show that youth of color report lower substance use; however, ethnic discrimination may account for some of the recent increased national trends in substance use among youth of color through its impact on their increased susceptibility to use substances.

Introduction: The aim of this study was to assess the association between past 30-day cigarette smoking, nicotine use with an e-product device (e.g., vape), cannabis smoking, cannabis use with an e-product device, and other forms of cannabis use and past-year respiratory symptoms in a nationally representative sample of people aged >= 12 years in the U.S. during 2021. Methods: Data from Wave 6 (2021) of the Population Assessment of Tobacco and Health Study, a national probability sample of adolescents (aged 12-17 years; n=5,652) and adults (aged >= 18 years; n=30,516), were used. Logistic regression was used to assess the association of past 30-day cigarette smoking, nicotine use with an e-product, cannabis smoking, cannabis use with an e-product, and other forms of cannabis use with past-year respiratory symptoms (a past-year respiratory symptom index was constructed and ranged from 0 to 9; an index of 2+ was flagged as having functionally important respiratory impairment). Results: The odds of a past-year respiratory index score of 2+ was greater among respondents who indicated either past 30-day cigarette or cannabis smoking than among respondents who did not use any nicotine or cannabis during the past 30 days. Past 30-day nicotine and cannabis use with an e-product device was not associated with a respiratory symptom index of 2+. The combination of past 30-day cigarette smoking and cannabis smoking had one of the strongest associations with experiencing a respiratory index score of 2+ among dual users of nicotine and cannabis. Conclusions: Past 30-day cigarette smoking and cannabis smoking were associated with higher odds of functionally important respiratory impairment. In addition, this study provides robust evidence regarding the potential respiratory harms of single or dual nicotine and cannabis smoking as it relates to respiratory health. AJPM Focus 2025;4(1):100291. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).