Cannabis use has been more prevalent among men than women and prior work has found differing impact of recreational cannabis laws (RCL) by age. We examined changes in the prevalence of past-year and past-month cannabis use, past-month daily cannabis use, and DSM-5-proxy cannabis use disorder (CUD) in the past-year before and after RCL enactment by gender alone and stratified by age using 2008-2017 repeated cross-sectional samples of the US National Survey on Drug Use and Health. Changes in cannabis outcomes were estimated using adjusted multi-level logistic regression with state random intercepts and two-way and three-way interactions between RCL, gender, and age group. Enactment of RCL was associated with higher increases in past-year (+3.2%; aOR= 1.30 [95%CI = 1.19 to 1.41]) and past-month (+2.3; 1.37 [1.24 to 1.51]) cannabis use in women than men (+2.1%; 1.15 [1.06 to 1.25] and +1.7%; 1.19 [1.08 to 1.30]). No increases in past-month daily cannabis use and past-year DSM-5 CUD among those using cannabis were observed after RCL enactment. There were no increases in any cannabis outcomes after RCL enactment among those 12-20 years old. RCL enactment may contribute to narrowing of the cannabis gender gap. Ongoing surveillance is essential to ensure that the social justice aims of legalization are achieved without negative public health consequences.

The impact of state-level medical cannabis laws (MCL) on individual-level opioid outcomes is inconclusive. We analyzed representative samples of U.S. adults ≥21 years reporting past-year non-medical prescription opioid (NMPO) use in the 2004-2014 National Surveys on Drug Use and Health. Multi-level mixed effects models estimated associations of state-level MCL with individual-level NMPO use frequency, categorized as occasional (1-12 days), regular (13-52 days), or frequent (53-365 days). Further analyses stratified by past-year cannabis use and disorder (no use, use only, DSM-IV cannabis use disorder). MCL was associated with increases in occasional use (2.1 percentage points, 95% CI: 0.5, 3.8) alongside reductions in regular (-0.6 percentage points, 95% CI: -1.1, -0.1) and frequent use (-1.5 percentage points, 95% CI: -2.7, -0.4). In stratified analyses, significant changes were observed only for adults with cannabis use disorder, including increases in occasional use (5.6 percentage points, 95% CI: 1.5, 9.6) and decreases in frequent use (-4.9 percentage points, 95% CI: -8.1, -1.8). The association of MCL with lower frequency of NMPO use was driven by individuals with cannabis use disorder, highlighting the importance of identifying tradeoffs of cannabis legalization as an intervention to reduce opioid-related harms.

In a sample of women living with HIV, we examined whether individual traits fear of negative evaluation and resilience moderate the internalization of poverty stigma that these women experience from others. We also examined the downstream effects of these processes on depression symptoms using moderated serial mediation analyses.

Despite increases in injection drug use, depression, and fatal overdose among young people (aged 18-30) during the last 15-20 years, and despite literature among other populations finding relationships between various types of stigma and mental health outcomes, to date, there have been no studies examining the relationship between substance use-related stigma and depression among young people who inject drugs (PWID), specifically. The present study examined baseline data from a longitudinal study of young (18-30-year-old) PWID and their risk network members of any age. Multiple linear regression was used to explore the relationship between substance use-related stigma and depression. Stigma was measured both as a composite score of all stigma types/domains, and separately as enacted, anticipated, and internalized stigma. Results are compared for the full sample and for the subsample of young PWID ( = 166). Greater levels of the composite measure of all stigma types were associated with greater levels of depression among both samples. While each of the three domains of stigma, measured separately, significantly predicted greater levels of depression among the full sample, only enacted stigma and anticipated stigma were significantly associated with depression among the subsample of young PWID. These findings suggest that to address mental health challenges among young PWID, in addition to providing mental health support and treatment, intervention efforts should focus on the direct reduction of stigma among the general population. Since internalized stigma does not significantly predict depression, working with young PWID to address internalized stigma is unlikely to be effective.

Women who exchange sex and use opioids experience substantial post-traumatic stress disorder (PTSD) symptoms. Among veterans, PTSD increases the risk of concomitant opioid-benzodiazepine use, increasing overdose risk, but this relationship is underexplored in other at-risk populations. We examined correlates of non-medical benzodiazepine use among a cohort of women who exchange sex and use opioids daily (N=270) in Baltimore Maryland. PTSD symptom severity was measured by the full PCL-5 (possible range: 0-80, categorized by tertile as low, medium, high) and four symptom-specific subscales. The prevalence of benzodiazepine use was 27% and the median PCL-5 score was 34. In adjusted models, women with high PCL-5 scores were more likely to use benzodiazepines than those with low scores, overall and across subscales. Severe PTSD symptoms conferred elevated risk of concomitant opioid-benzodiazepine use, calling attention to the importance of addressing trauma in combating the opioid and overdose crises.

Alcohol and cannabis use are each associated with suicidal thoughts and behaviors and nonsuicidal self-injury (NSSI) in military veterans, but less is known with regard to concurrent use. The present study compared U.S. veterans ( = 1098; 78% male, 67% White) who in the past year engaged in hazardous drinking (HD only), cannabis use (CU only), or concurrent use (HD + CU), or used neither substance (comparison group), on past-year suicidal ideation, elevated risk for suicidal behavior, and past-year NSSI.

Substance use among street-involved children and youth (SICY) in low- and middle-income countries is common. Using data abstracted from program intake forms (2016-2022) for an intervention to reintegrate SICY with their communities, we assess which individual, family, and geographic characteristics are predictive of substance use, and specifically inhalant use and non-inhalant use among a sample of 227 SICY in Meru County, Kenya. Assessed determinants include age, geographic location of home community, years on street, family deprivation prior to street-migrating, motivation for street migrating, abuse experiences on the street, and activities on the street. Number of years lived on the street, experiencing abuse on the street, and citing peer-self relations as the reason for street migration were all associated with significantly higher odds of reporting substance use, and inhalant use specifically. Inhalant use was also significantly associated with peer socialization and specific street activities. Further research should explore the role of peer-self dynamics in substance use among SICY and how it can inform approaches to reintegrating children from street situations and sustaining their development in non-street environments.

To synthesize randomized controlled trial evidence on technology-based interventions' (TBIs) effectiveness for substance use among emerging adults (EA)/college students (CS).

Efforts to prevent opioid overdose mortality have rapidly expanded, including community-based distribution of naloxone to laypeople. In turn, responding to the opioid overdose crisis has increasingly fallen on the shoulders of community laypeople. Yet, little attention has been given to studying the mental health consequences of responding to an opioid overdose for community laypeople. This study examined emotion dysregulation as a risk factor for posttraumatic stress disorder (PTSD) stemming from opioid overdose responding among community laypeople.

This study examined differences in quit attempts, 1-month quit success, and vaping status at follow-up among a cohort of 3709 daily smokers with and without depression, anxiety, and regular alcohol use who participated in both the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) Surveys. At baseline, a survey with validated screening tools was used to classify respondents as having no, or one or more of the following: 1) depression, 2) anxiety, and 3) regular alcohol use. Multivariable adjusted regression analyses were used to examine whether baseline (2018) self-report conditions were associated with quit attempts; quit success; and vaping status by follow-up (2020). Results showed that respondents who reported depressive symptoms were more likely than those without to have made a quit attempt (aOR=1.32, 95% CI:1.03-1.70, =0.03), but were less likely to have quit (aOR=0.55, 95% CI:0.34-0.89, =0.01). There were no differences in quit attempts or quit success between those with and without self-reported anxiety diagnoses or regular alcohol use. Among successful quitters, respondents with baseline depressive symptoms and self-reported anxiety diagnoses were more likely than those without to report vaping at follow-up (aOR=2.58, 95% CI:1.16-5.74, =0.02, and aOR=3.35 95% CI:1.14-9.87, =0.03). In summary, it appears that smokers with depression are motivated to quit smoking but were less likely to manage to stay quit, and more likely to be vaping if successfully quit. As smoking rates are higher among people with mental health conditions, it is crucial for healthcare professionals to identify these vulnerable groups and offer tailored smoking cessation support and continued support during their quit attempt.

Frequent or chronic cannabis use can have negative effects on the adolescent and young adult (AYA) brain and psychosocial development. This study investigated the psychosocial impact of frequent cannabis use in a prospective study of sexually active female AYA patients. Participants completed questionnaires at three separate visits over a period of one year. A total of 545 AYA women were included in our analysis. Most (94%) identified as individuals of color, including 37% as non-Black Hispanic, 16% as Hispanic Black, and 41% as non-Hispanic Black. Multivariable regression analyses showed that using cannabis 20 or more times in the prior month was significantly associated with a higher likelihood of being suspended (OR=2.71, 95%CI:1.48, 4.57; p<.001), as well as with increased number of depressive symptoms (β=0.48, 95%CI:0.23-0.75; p<.001) and delinquent behaviors (β=0.81, 95%CI:0.56-1.06; p<.001). Cross-lagged models showed that frequent cannabis use was associated with increased depressive symptoms six months later (β=0.09, p<.05), and higher levels of delinquency six months (β=0.20, p<.001) and 12 months later (β=0.12, p<.05). This study demonstrated that frequent cannabis use was prospectively associated with negative psychosocial outcomes for AYA women of color, including depression and delinquency.

Injection drug use is the primary driver of the human immunodeficiency virus HIV epidemic in Iran. We characterized people who inject drugs (PWID) living in Iran who had never received opioid agonist therapy (OAT) and examined barriers to OAT uptake. We recruited 2,684 PWID with a history of drug injection in the previous 12 months using a respondent-driven sampling approach from 11 geographically dispersed cities in Iran. The primary outcome was no lifetime uptake history of OAT medications. The lifetime prevalence of no history of OAT uptake among PWID was 31.3%, with significant heterogeneities across different cities. In the multivariable analysis, younger age, high school education or above, no prior incarceration history, and shorter length of injecting career was significantly and positively associated with no history of OAT uptake. Individual-level barriers, financial barriers, and system-level barriers were the main barriers to receiving OAT. PWID continue to face preventable barriers to accessing OAT, which calls for revisiting the OAT provision in Iran.

We aimed to identify interventions for college students' harmful cannabis use in the United States (U.S.) and determine whether (and what type of) additional randomized clinical trials (RCTs) are needed. We conducted a scoping review of RCTs of individual-focused cannabis interventions for U.S. college students. Database searches yielded 13 RCTs-seven interventions were effective. Effective interventions typically comprised one session, representing various modalities and intervention types (e.g., personalized feedback interventions [PFIs]; brief motivational interventions [BMIs]), and reduced frequency of cannabis use or consequences in the target population across variable follow-up periods. Single-session PFIs and BMIs that engage subgroups reporting cannabis-related consequences may be effective. There is a need for a tool like the College Alcohol Intervention Matrix, but focused on cannabis prevention, to increase the dissemination and uptake of effective, evidence-based strategies. Researchers are called on to fill gaps and strengthen content within a possible College Cannabis Intervention Matrix.

Tobacco-cannabis co-use is more common than exclusive cannabis use, and is linked to more severe tobacco and cannabis health consequences. We assessed trends and predictors of tobacco-cannabis co-use and their link to future substance use problems and severity among Black and Hispanic adolescent and young adult (AYA) females living in New York City.

To provide a model for using Multidimensional Growth Mixture Models to identify trajectories of polyuse through investigating transitions between conjoint substance use trajectories from adolescence into young adulthood and examining potential moderators that may promote transitions into healthier substance use trajectories in adulthood.

Psychiatric and substance use disorders frequently coexist and require co-management, yet little is known about the prevalence of psychiatric disorders among patients maintained on medications for opioid use disorder (MOUD) in Ukraine. We analyzed baseline data from a cluster-randomized trial of an integrated model of depression diagnosis and treatment among MOUD patients in Ukraine to determine prevalence and correlates of depression and bipolar disorder in this population. From a randomly selected sample of 1345 patients on MOUD at 12 sites in Ukraine, screening for moderate/severe depression (PHQ-9) and bipolar disorder (MDQ) yielded high prevalence of 50% (95% CI 42-58%) and 12% (95% CI 8-16%), respectively. Correlates of depression included recent drug injection, worse physical health, shorter duration on MOUD, higher methadone dosages, and stigma levels, being unmarried and having low trust in physicians. Bipolar disorder was correlated with alcohol use disorder and prior incarceration. The high burden of mental health disorders among patients prescribed MOUD in Ukraine calls for the urgent implementation of models to address co-occurring disorders, including those using integrated care strategies.

Social media use has been associated with depression in youth. It remains unclear how individual differences in social media use and depression relate to other health-related behaviors such as physical activity, green space exposure, cannabis use, and eveningness. We aimed to examine these associations and network structure with the Green/Screen Study, a Canadian cohort of 425 adults (82.5% female) aged 18-25 years who completed three online questionnaires between May 2021 and January 2022. Longitudinal analyses showed sex differences in the association of social media use with depression. Although social media use was positively associated with depression after adjusting for other health-related behaviors, it did not predict an increase in depressive symptoms over time. Shorter time intervals and more detailed measures of social media use may be needed to capture social media context- and usage-specific associations with depression.

Fentanyl use in the Midwest is rising, and there is data to suggest that this is a particular area of concern among sexual and gender minorities assigned male at birth (SGM-AMABs). However, little is known about intentional and non-intentional use among this population. The goal of this study was to document rates of fentanyl use and associated indicators (e.g., mode of administration) among a cohort of SGM-AMABs.

We examined socioeconomic variations in the association of off-premises Sunday alcohol sales bans and alcohol consumption and alcohol-attributable mortality in the United States. We analyzed associations between Sunday sales ban presence and alcohol consumption patterns, allowing for a differential effect by education in fixed-effects regression models using data from the 2000-2019 Behavioral Risk Factor Surveillance System. Mortality data from the National Vital Statistics System (2000-2019) were analyzed in interrupted time-series analysis to test the effect of lifting the Sunday sales ban in Minnesota (07/01/2017) on alcohol-attributable mortality. Regression analyses indicated lower alcohol consumption when Sunday sales bans were in place, with an overall stronger effect on those with high education. The repeal of the Minnesota ban resulted in a significant mortality increase, especially among individuals with high education. While overall effective, off-premises Sunday alcohol sales bans appear inadequate to address socioeconomic inequalities in the alcohol-attributable health burden.

Heavier drinking and depression are common mental health concerns in the USA, yet few studies have sought to understand transdiagnostic risk factors for both. Two health-focused risk factors are impulsive personality traits and sleep duration, but research typically separates the two, precluding additive and interactive relations. The current study sought to test a theoretical model where risk conferred from impulsive traits is heightened when individuals have reduced sleep. Public-access data from the National Longitudinal Study on Adolescent to Adult Health (Add Health) were used to test study hypotheses. Participants reported on impulsive traits (i.e., lack of premeditation, sensation seeking), sleep duration, depression, and drinking across three waves spanning adolescence, emerging adulthood, and adulthood. Multilevel models distinguished risk processes at the between- vs. within-person level. At the between-person level, sensation seeking predicted drinking whereas premeditation predicted depression. Additionally, within-person deviations in both traits were associated with drinking, whereas within-person deviations in premeditation were associated with depression. Sleep duration was protective against outcomes at both levels. However, main effects were qualified by interactions at both levels, such that having below average sleep duration heightened the effects of premeditation at the between-person level, whereas within-person decreases in sleep heightened the effects of sensation seeking at the within-person level. Findings support a theoretical model where poor sleep exacerbates risk conferred from impulsive traits. Risk conferred from impulsive traits diverged based upon level of analysis, suggesting that global and just-in-time interventions may benefit from targeting specific impulsive traits as well as sleep.

The National Overdose Response Service (NORS) is a Canadian mobile or virtual overdose response hotline intended to prevent drug overdose deaths but has unexpectedly received mental health related calls, including adverse mental health events. Our study aimed to examine these occurrences and caller characteristics predictive of adverse mental health outcomes. Using the NORS call dataset, we conducted a descriptive representation of mental health occurrences and mental health emergencies along with correlative statistics. We found that NORS had received 2518 mental health calls, with 28 (1.1%) being adverse events. Men, rural callers, polyroute substance consumption and history of overdosing were found to have increased odds of having an adverse mental health event, while being from Quebec, using non-standard consumption routes and using the line between 50 and 99 times were found to decrease odds. This supports the utility of overdose prevention hotlines to also support people experiencing adverse mental health situations and reduce harm for individuals with mental health and/or substance use disorders.

This study examines the process of implementing One-at-a-Time (OAAT; i.e., single-session) therapy into child and youth addiction and mental health services in New Brunswick. The implementation process was retrospectively mapped onto implementation science frameworks. Providers were recruited to participate in research associated with the system change, and completed surveys to assess readiness for implementation. Client satisfaction and system-outcomes were measured through surveys and system indicators, respectively. Key implementation considerations included age of consent for services, implementation within an integrated service delivery model, and mapping the client journey to conceptualize changes in service delivery. Providers ( = 214) felt that OAAT therapy was acceptable and appropriate to implement into practice, and would lead to observable short-term outcomes. During the implementation (April-December 2022), 2266 sessions were delivered, resulting in a 62% waitlist reduction. Most clients who completed the satisfaction survey ( = 518) reported benefit. This study elucidates the successful implementation of OAAT therapy for children and youth, and can serve as a heuristic for comparable practice change initiatives.

This study assessed independent and interaction effects of the frequency of cannabis use, high-risk alcohol use, and depressive symptomology on motivation and attempts to quit cigarette smoking among adults who regularly smoked. Cross-sectional data are from the 2020 International Tobacco Control Four Country Smoking and Vaping Survey and included 7044 adults (ages 18 + years) who smoked cigarettes daily in Australia ( = 1113), Canada ( = 2069), England ( = 2444), and the United States (USA) ( = 1418). Among all respondents, 33.1% of adults reported wanting to quit smoking "a lot," and 29.1% made a past-year quit attempt. Cannabis use was not significantly associated with either outcome (both  ≥ 0.05). High-risk alcohol use was significantly associated with decreased odds of motivation to quit ( = 0.02) and making a quit attempt ( = 0.004). Depressive symptomology was associated with increased odds for both outcomes (both  < 0.001). There were no significant 2- or 3-way interactions between cannabis use, alcohol consumption, and depressive symptomatology. Overall, just over a quarter of adults who smoked daily reported making a recent quit attempt, and most were not highly motivated to quit. Longitudinal research should investigate whether there are linkages between cannabis use, risky alcohol consumption, and/or depression on successful long-term smoking cessation.

Arizona observed a sharp increase in opioid overdose deaths between 2017 and 2021. Our objective was to better understand the relationship between behavioral/ social characteristics and self-reported opioid misuse among Arizona adults.

Canada is experiencing an ongoing overdose crisis, driven by a toxic unregulated drug supply. Integrated safer supply pilot programs offer pharmaceutical alternatives, coupled with comprehensive support services, to individuals using unregulated drug supply who are at high risk of overdose. We collected data from December 2020 to January 2023 on clients receiving safer opioid supply from five frontline service providers in Toronto, Canada, using interviewer-administered questionnaires. We assessed the incidence rate ratio of self-reported overdose comparing pre- and post-enrolment in the programs and examined changes in the prevalence of social and substance use outcomes post-enrolment. Forty-one participants were recruited, of whom 26 were followed up for a median of eight months (interquartile range, 5.0-11.7). The incidence rate ratio of overdose comparing post-enrolment to pre-enrolment was 0.20 (95% confidence interval, 0.09-0.43). Participants reported several positive social and substance use outcomes at follow-up, including a reduction in reliance on the unregulated supply and reduced criminal activity. Future implementation of integrated safer opioid supply pilot programs with larger sample sizes and rigorous epidemiological designs could help further illustrate the potential impacts of these programs in reducing overdose rates in Canada.

We describe binge drug injection in a longitudinal cohort study of people who inject drugs (PWID) in Montreal, Canada (eligibility: age ≥ 18, past-6-month injection drug use; follow-up: 3-monthly interviews). Bingeing was defined as injecting large quantities of drugs over a limited period, until participants ran out or were unable to continue, in the past 3 months. We recorded substances and circumstances typically involved in binge episodes. Eight hundred five participants (82% male, median age 41) provided 8158 observations (2011-2020). Thirty-six per cent reported bingeing throughout follow-up. Binges involved a diverse range of substances and social contexts. Cocaine was involved in a majority of recent binges (73% of visits). Injection of multiple drug classes (24% of visits) and use of non-injection drugs (63% of visits) were common, as were opioid injection (42%) and injecting alone (41%). Binge drug use may thus be an important yet overlooked trigger of overdose and other harms among PWID. This understudied high-risk behavior warrants further research and public health attention.

To examine illicit substance use across young adulthood and explore the extent to which social skills moderate the relationship between use and harm. 1,404 (761 women) from the Australian Temperament Project (est. 1983) participated across young adulthood (age 19-20, 23-24, and 27-28 years). Measures included self-reported illicit substance use/harm and social skills (i.e., assertion, empathy, responsibility, and self-control). The number and type of illicit substances used changed across young adulthood. Greater illicit substance use was associated with peer (OR = 4.96) and partner use (OR = 3.60). Moderation analyses suggested the risk relationship between the number of illicit substances used and harm was lower in those with high levels of assertion/self-control (OR = 2.34, OR = 2.60) compared to low levels (OR = 4.43, OR = 3.72). Evidence based programmes designed to strengthen individual social skills for young adults may play a role in protecting against the adverse effects of illicit substance use.

Polysubstance use is prevalent among individuals on opioid agonist treatment (OAT), yet past studies have focused primarily on distinct substances and their association with OAT retention. Data was collected from two prospective cohorts between 2005 and 2020 in Vancouver, Canada. Among 13,596 visits contributed by 1445 participants receiving OAT, we employed repeated measures latent class analysis using seven indicators and identified four longitudinal substance use classes. Using marginal structural Cox modeling, we found that compared to the primarily crack use class, the two opioid and stimulant use classes carried a higher risk of OAT discontinuation, while the primarily cannabis and crack use class had a lower OAT discontinuation risk. Our findings highlight the need for integrated treatment strategies to manage the co-use of opioids and stimulants during receipt of OAT and suggest future research should explore the potential of cannabis as a harm reduction strategy or adjunctive treatment to OAT. Word count: 150/150.

This study aimed to examine the relationship between externalizing behaviors, substance use, and sexual risk among adolescent girls and young women (AGYW) in Cape Town, South Africa, who experience social disadvantage characterized by poverty and school dropout. We analyzed baseline data from 500 AGYW in a cluster-randomized trial who had dropped out of school. Multivariate logistic regression models explored associations between self-reported criminal behaviors and other status offenses, heavy episodic drinking, polydrug use, and condomless sex. Engagement in status offenses was associated with heavy episodic drinking (OR = 3.56, 95% CI: 2.05-6.20), while crimes against other people were associated with polydrug use (OR = 1.65, 95% CI: 1.03-2.63). Drug-related illegal behavior was associated with polydrug use (OR = 7.78, 95% CI: 3.53-8.69) and reduced odds of condom use during last sexual episode, after adjusting for drug use (OR = 0.56, 95% CI: 4.00-5.15). As externalizing behaviors are prevalent among this sample of AGYW and associated with greater likelihood of problem substance use and condomless sex, interventions to improve the physical and mental well-being of AGYW should assess for and address engagement in criminal and status offenses.