搜索结果：Drug and alcohol dependence reports

National trends indicate that drug-related deaths among Veterans have been increasing from 2010 to 2019. The present study involves a recent analysis of drug mortality data for a single large Veterans Affairs (VA) Healthcare System. The aims of the study included (1) the identification of VA patients with drug-related deaths, (2) patient characteristics and service utilization patterns of VA patients with drug-related deaths, and (3) the evaluation of existing internal tracking systems for monitoring drug-related deaths. This retrospective study matched VA enrollment records to San Diego County Medical Examiner (ME) data from January 2019 to June 2023. The records of individuals who died of a drug-related overdose in San Diego County were matched to VA medical records. Chart reviews were conducted to evaluate the extent to which intentional and accidental overdose events were documented in electronic medical records, and to examine demographic and clinical characteristics and healthcare utilization in Veterans who died by overdose. From January 2019 to June 2023 there were a total of 140 drug overdose deaths, 91.4 % were accidental (n = 128) and 8.6 % were intentional (n = 12). Prior to ME data matching, VA records captured 9.6 % of accidental drug overdoses (n = 15) and 100 % of intentional drug overdoses (n = 12). Fentanyl or fentanyl analogs were involved in 37.1 % (n = 52) of intentional and unintentional drug overdose deaths with the combination of fentanyl and methamphetamine being the next most specific common cause of death (n = 30; 21.4 %). In terms of VA healthcare utilization, in the year prior to their death, 63.6 % of Veterans accessed care. Among those 89 VA patients, they most commonly utilized the emergency department (75 %) and primary care (56.2 %). Among the 20 % of Veterans with opioid use disorder (OUD), in the year prior to their death, 39.3 % were dispensed a prescription for naloxone and 35.7 % were dispensed a medication for OUD. Comparing VA records to county ME records revealed that VA records missed over 80 % of drug-related overdose deaths-4 out of every 5 deaths. While accurate for intentional overdoses, accidental overdoses-which comprise the vast majority of drug overdose deaths-were missing over 90 % of the time. Given that drug toxicology results were consistent with county trends, this suggests that VA records severely underestimate drug overdose deaths. Approximately two-thirds of VA patients who died of drug overdose access VA and most were seen in the emergency department and over half in primary care-identifying these as important intervention targets for overdose prevention. Given the gaps in capturing drug overdose deaths, other healthcare systems looking to prevent overdose deaths, and especially other VA systems, may want to consider adopting similar methods to better capture and understand factors that impact drug overdose deaths among their patient populations.

Alcohol dependence (AD) includes tolerance to alcohol's analgesic effects and increased pain sensitivity during withdrawal (i.e., hyperalgesia). Further, the reciprocal relationship between alcohol use and pain sensitivity is hypothesized to contribute to the maintenance of AD through negative reinforcement (i.e., self-medication). The neuropeptide S (NPS) system, known to regulate stress, arousal, and pain pathways, may offer a therapeutic target to ameliorate AD-induced hyperalgesia. Given previous reports on the antinociceptive properties of NPS, we hypothesized that central administration of NPS could attenuate the heightened pain sensitivity observed in AD rats. Male (n = 11) and female (n = 7) Wistar rats were surgically implanted with an intracerebroventricular (ICV) cannula and assigned to either the AD or alcohol-naïve control group, matched in terms of their baseline thermal nociceptive thresholds. Pain sensitivity was tracked weekly using thermal (Hargreaves) and mechanical (robotic Von Frey, also known as the dynamic plantar aesthesiometer) assays to establish AD-induced hyperalgesia. After stable hyperalgesia emerged, rats received ICV NPS administrations (0, 0.1, or 1 nmol in 5 μL saline) 5 min prior to pain testing (Experiment 1: Hargreaves; Experiment 2: robotic Von Frey). In a follow-up experiment, three Von Frey methods (electronic, robotic, and manual) were compared to assess their efficacy in detecting AD-induced mechanical hyperalgesia. AD male and female rats developed significant hyperalgesia across both pain modalities. Central administration of NPS produced robust analgesia in a dose-dependent manner in both AD and alcohol-naïve control rats. No sex differences were observed in baseline nociception, AD-induced hyperalgesia, or NPS-induced analgesia. All three mechanical assays reliably detected AD-induced mechanical hyperalgesia, and the importance of adequate habituation procedures is discussed. These findings indicate that NPS exerts a robust analgesic effect in male and female rats. This effect appears independent of ethanol-exposure history but produces sufficient analgesia to alleviate pain sensitivity in hyperalgesic AD rats to/beyond the level of sensitivity in vehicle treated, alcohol-naïve controls. The NPS system may therefore represent a promising, non-addictive target for treating pain-related symptoms in alcohol dependence.

Co-use of alcohol and opioid medications increases risk for sedation, respiratory depression, and overdose, yet remains common among patients prescribed opioids. The Alcohol Brief Intervention-Medication Therapy Management (ABI-MTM) intervention was developed for delivery by community pharmacists and demonstrated feasibility, acceptability, and preliminary reductions in co-use. Given possible pain-related motives for co-use, this exploratory secondary analysis assessed whether ABI-MTM affected pain symptomatology. This study utilized data from a randomized trial of 44 community pharmacy patients from 25 pharmacies prescribed opioids and who reported alcohol co-use. Participants were randomized to ABI-MTM or standard medication counseling (SMC). Pain intensity/interference were assessed at baseline, 2-, and 3-months using the Brief Pain Inventory-Short Form. Analyses included descriptive statistics, Cohen's d effect sizes, and mixed-effects models comparing pain across conditions and timepoints. Pain scores did not differ between groups (p > 0.05). For pain intensity, ABI-MTM and SMC showed similar baseline means (4.31 vs. 5.05), decreased modestly at 2-months (2.80 vs. 3.74), and returned to baseline levels at 3-months (4.21 vs. 4.83). Pain interference followed a comparable pattern, with ABI-MTM and SMC starting similarly (4.83 vs. 5.07), decreasing modestly at 2-months (3.19 vs. 3.87), and returning near baseline at 3-months (4.92 vs. 4.42). Effect sizes between group differences were small (Cohen's d≤0.33). Mixed-model analyses showed no significant treatment effects on pain intensity/interference across time (p > 0.05). This underpowered study found no evidence of pain differences between ABI-MTM and SMC, tentatively suggesting possible alcohol-opioid co-use improvements associated with the intervention without worsening pain.

The Canadian Student Alcohol and Drugs Survey is a biennial, repeat cross-sectional survey of grade 7-12 students in the Canadian provinces. This study examined cannabis-related behaviours at five timepoints before and after legalization of cannabis for non-medical purposes. Trends over time were examined using data from 2014-15 to 2023-24 (n&#x2009;=&#x2009;264,558). Binary logistic regression examined changes in cannabis use and related behaviours, including frequency; usual method of use; perceived risk and access; usual source; and motor vehicle behaviours. Data were stratified by sex and grade group (grade 7-9 vs. 10-12). Overall, there was no change in prevalence of past 12-month, past 30-day, or frequent cannabis use (p&#x2009;>&#x2009;0.05 for all); however, modest increases were observed among females and grade 7-9 students (p&#x2009;<&#x2009;0.05 for both). Vaping surpassed smoking as the most common method of consumption in 2023-24. Smoking and dabbing cannabis decreased over time, whereas vaping and eating cannabis increased (p&#x2009;<&#x2009;0.001 for all). Perceived risk of regularly smoking cannabis decreased (p&#x2009;<&#x2009;0.001), and perceived ease of cannabis access increased (p&#x2009;<&#x2009;0.001). The most common cannabis sources were social sources. There was no change in driving after using cannabis (p&#x2009;>&#x2009;0.05), whereas there was a recent increase in riding with a driver who had used cannabis (p&#x2009;<&#x2009;0.001). While legalization and regulation of cannabis for non-medical purposes was not associated with increases in overall cannabis use among students in Canada, increasing rates of use in females and younger students, and changes in perceptions of risk and accessibility require continued monitoring.

The co-use of opioids and stimulants is associated with elevated health risks. This study examined patterns of injection drug use and cocaine use frequency among people who use opioids. Cross-sectional data were collected from community-recruited adults who use opioids in Baltimore, Maryland, between December 7, 2022 and January 26, 2025. Participants were categorized into four groups based on injection status and cocaine use frequency. Multinomial logistic regression examined factors associated with group membership, calculating relative risk ratios (RRR) and adjusted relative risk ratios (aRRR) with 95&#x2009;% confidence intervals. Of 777 participants (60.7&#x2009;% male, 71.6&#x2009;% Black, median age 52), 29.2&#x2009;% reported past-month injection drug use. Daily/almost daily use was reported for heroin/fentanyl (79.5&#x2009;%), crack cocaine (43.2&#x2009;%), and powder cocaine (9.3&#x2009;%). Four distinct drug use patterns emerged: not inject/lower frequency cocaine use (42.0&#x2009;%), inject/lower frequency cocaine use (9.3&#x2009;%), not inject/higher frequency cocaine use (28.8&#x2009;%), and inject/higher frequency cocaine use (19.9&#x2009;%). Factors significantly associated with injecting and higher frequency cocaine use group membership included: overdose history (aRRR=2.58, 95&#x2009;% CI=1.52-4.38), withdrawal behavior with high overdose risk (aRRR=1.29, 95&#x2009;% CI=1.14-1.46), and using in multiple locations (aRRR=1.09, 95&#x2009;% CI=1.02-1.18). Nearly one-fifth of people who use opioids reported both injection drug use and high-frequency cocaine use, and greater frequency of cocaine use was associated with higher overdose risk. Targeted interventions addressing polysubstance use patterns, social networks, and environmental factors are urgently needed to reduce harm among this high-risk population.

Drug checking services are becoming increasingly popular. Despite the significant variability in fentanyl concentrations observed in the unregulated opioid supply, quantifying fentanyl concentrations using community drug checking technologies remains challenging. This study reports the development of the first machine learning model to classify and quantify multiple fentanyl analogues in community drug checking samples, using data from British Columbia, Canada. Drug checking samples from harm reduction sites using Fourier-transform infrared spectroscopy were forwarded for laboratory analysis at Health Canada's Drug Analysis Service. Using gold-standard quantitative nuclear magnetic resonance results, we developed a machine learning pipeline to classify and quantify fentanyl and fluorofentanyl in unregulated drug samples. Over a nearly six-year period, 131,096 drug checks occurred at British Columbia harm reduction sites and 2032 unique drug samples were forwarded for laboratory analysis. A total of 974 training samples were used, each containing varying amounts of fentanyl or fluorofentanyl. Model performance depended on sample composition: ridge regression produced the most accurate fentanyl estimates in absence of fluorofentanyl, while random forest performed better in mixed-analogue samples. A screening model allowed us to combine these into a hybrid pipeline, improving estimates for both fentanyl (mean average error=3.74; R2=0.94) and fluorofentanyl (mean average error=1.22; R2=0.97). Our study shows that machine learning models for fentanyl quantification can be used to augment traditional community drug checking technologies. However, any practical use as a point-of-care tool should be accompanied by clear communication of uncertainty to ensure predictions support, rather than unintentionally undermine, harm reduction goals.

Although many adolescents and young adults experiment with drugs, a subset may develop a drug use disorder (DUD). Few studies have used machine learning to identify risk and protective factors associated with DUDs, and to the best of our knowledge, none have been conducted with a high-risk youth sample or incorporated explanatory analyses to understand how such factors influence model predictions. We sought to address these gaps by estimating a random forest to identify salient risk and protective factors that differentiate youth with a DUD from their peers who use drugs but do not meet diagnostic criteria for a DUD. We extend traditional supervised learning methods by conducting explanatory model analyses to unpack what the model learned from the data, allowing for better interpretation of how influential factors may affect DUD risk at both the sample and case levels. Cross-sectional data were analyzed from a sample of 600 youth aged 14-24 with past 6-month illicit drug use (59&#x2009;% male, 58&#x2009;% Black; 57&#x2009;% meeting DUD criteria). Global assessments revealed that risk factors aligned with deviance proneness and stress/negative affect were associated with higher likelihoods of a DUD, whereas academic achievement and later drug use initiation were associated with lower likelihoods. Local assessment methods highlighted how these broad predictive patterns can be applied to individual risk and protective factor profiles to inform precision-based preventive strategies. Overall, these analytic approaches and findings may help inform the development of indicated preventive interventions for DUDs in adolescent and young adult populations.

Non-Hispanic Black adults ages 55 and older experienced the sharpest increases in drug overdose mortality from the mid-2010s onwards. We aimed to elucidate longitudinal patterns of rising overdose mortality among this population and identify key substances driving this trend. We analyzed national death records from CDC's WONDER database (1999-2023) to examine unintentional drug overdose death rates across racial/ethnic and age groups, focusing on non-Hispanic Black adults ages 55 and older. We examined trends by substance type and census region (i.e., Northeast, Midwest, South and West), and introduced a metric named contribution ratio (CR)-defined as the ratio of the change in overdose mortality involving a specific substance to the overall change in drug overdose mortality-to quantify the contributions of different substances to the increase in overdose mortality. Since 2015, drug overdose mortality among non-Hispanic Black adults ages 55 and older increased more than among younger Black adults, older adults of other racial/ethnic groups, and younger adults of all racial/ethnic groups, many of whom experienced more modest increases during this period. By 2019, this group had the highest overdose death rate nationwide. CR analyses showed that cocaine and its co-involvement with fentanyl contributed most to the mortality increases among this population. Regional patterns varied, with methamphetamine-related deaths emerging in the U.S. West. Overdose mortality involving cocaine without opioid co-involvement rose steadily among older non-Hispanic Black adults across all regions, potentially reflecting heightened age-related vulnerability. The rapid rise in overdose mortality among non-Hispanic Black adults ages 55 and older-largely associated with cocaine with and without fentanyl-signals an urgent public health crisis requiring targeted interventions.

Kava (Piper methysticum), a central nervous system depressant derived from a plant in the pepper family native to the Pacific Islands, is traditionally consumed in religious, cultural, political, and social ceremonies. In the United States, kava emerged in the late 1990s and has experienced renewed growth and product diversification since the 2010s, with increasing availability of concentrated extracts and ready-to-drink beverages. These commercial products are commonly marketed as healthy alternatives to alcohol, sold near college campuses, and increasingly being combined with kratom, a psychoactive botanical with opioid-like effects, raising safety concerns. Data on kava-related use during January 2000-December 2025 that resulted in a report to the National Poison Data System (i.e., kava exposure report) were analyzed to assess trends by users' demographic characteristics, exposure type, and outcomes. Kava-related exposure reports declined sharply after a 2002 Food and Drug Administration advisory on kava-associated severe liver injury but have risen steadily since 2011, reaching 203 reported exposures in 2025. Reports primarily involved adults aged &#x2265;20 years, but demographic characteristics have changed over time. During 2000-2001, reports primarily involved females and included more children aged &#x2264;12 years, whereas exposure reports since 2013 have predominantly involved men; reports involving children have been rare. Since 2017, reports involving combined use of kava and kratom have increased, reaching 30% (61) of all kava reports in 2025. These increases have coincided with higher rates of serious reported clinical outcomes in recent years (32% in 2025 compared with 12% in 2000). These data indicate a resurgence of overall kava exposure reports to poison centers, as well as an increase in kratom-related kava reports, which has coincided with higher rates of serious clinical outcomes. The findings in this report suggest the need for enhanced surveillance for, clinical awareness of, and public education regarding commercial products containing kava.

Interventions that support family members or concerned significant others (CSOs) of people with alcohol or drug dependence can enhance recovery, strengthen family functioning, and reduce recurrence rates. Yet factors influencing successful implementation of CSO-focused online programs, especially in rural Australia remain poorly understood. This study explored the implementation experiences of clinicians delivering online Community Reinforcement and Family Training (CRAFT). This exploratory descriptive qualitative study involved semi-structured interviews with seven clinicians who delivered CRAFT. Data were analysed thematically using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. CRAFT was perceived as well-structured, feasible, and compatible with routine clinical practice, enhancing clinicians' confidence and enabling CSOs to develop skills in self-care, positive communication, problem-solving, and supporting healthy behaviours among loved ones. Successful implementation depended on clinician enthusiasm, flexible delivery modes (online as well as in-person), tailored content, and ongoing feedback, while challenges included CSO emotional overwhelm, competing responsibilities, limited digital literacy, and insufficient alcohol and drug services for loved ones. Socio-cultural factors, including reluctance to discuss alcohol or substance dependence, also limited engagement. Clinicians intended to retain key program components in practice but time constraints, telehealth limitations, and rural service gaps hindered sustained integration. Suggested improvements included cultural adaptation and structured opportunities for family-service collaboration. Online CRAFT is a promising, practice-ready intervention for supporting and empowering rural families affected by alcohol and drug use. Its integration into health services will depend on addressing workforce capacity, digital access, and rural service inequities, alongside policy-level commitment to family-focused programs. ACTRN12623000796684 (registered 26 July 2023).

Opioid agonist therapy (OAT) is the gold standard of treatment for opioid dependence and a cornerstone of Swiss drug policy. The Swiss Association for the Medical Management in Substance Users (SAMMSU) cohort was established to monitor health trends and improve care for OAT patients across Switzerland. Baseline and follow-up data collected from eight centres between 2014 and 2024 were analysed descriptively, including demographic and psychosocial characteristics, substance use history, prescribed OAT, co-medications, and somatic and psychiatric comorbidities. During the study, the SAMMSU cohort included 1&#x202f;502 participants. Median individual age at registration was 44.3 years, rising to a cohort median of 50.9 years by the end of 2024; 75.7&#x2009;% of participants were male. Lifetime heroin use was reported by 97.2&#x2009;%, with 73.2&#x2009;% having a history of intravenous drug use. Ongoing illicit and intravenous drug use declined over time, while prescribed OAT shifted from methadone to long-acting morphine and diacetylmorphine. The most prevalent lifetime somatic comorbidities were hepatitis C (56.5&#x2009;%), (pre)hypertension (18.6&#x2009;%), musculoskeletal disorders (13.8&#x2009;%), and needle abscesses (13.7&#x2009;%). Psychiatric disorders - primarily affective (34.8&#x2009;%), personality (23.2&#x2009;%), and anxiety disorders (18.0&#x2009;%) - contributed to multimorbidity and a high prevalence of polypharmacy (49.2&#x2009;%). There were 120 deaths, mainly from malignancy, overdose, and liver failure, with a median age at death of 51.6 years. SAMMSU cohort trends corroborate the effectiveness of OAT in reducing illicit drug use and underscore the need for OAT services to evolve from an addiction-focused model to comprehensive chronic care for an ageing and highly vulnerable population.

Stimulant-opioid co-use has surged in the United States, with methamphetamine use among people who use opioids increasing 82.6&#x2009;% from 2015 to 2017. This trend contributes to rising overdose deaths, marking a "fourth wave" of the opioid epidemic. This study examined how opioid dependence and withdrawal affect the reinforcing effects of opioids and stimulants. Male Sprague-Dawley rats (8-12 per group) were trained to self-administer fentanyl (3.2&#xb5;g/kg/inf), cocaine (0.32mg/kg/inf), or methamphetamine (0.1mg/kg/inf) under fixed ratio (FR) schedules. Opioid dependence was established through escalating twice-daily morphine injections (10-40mg/kg) over four days, then maintained with daily doses of 40mg/kg morphine. Rats exhibited stable signs of withdrawal (somatic signs, weight loss, hyperalgesia) following 20h but not 12h of morphine deprivation. Demand curves were generated by progressively increasing work requirements (FR 3, 5, 10, 18, 32, 56, 100, etc.) across sessions conducted 12 (morphine dependent) or 20 (morphine withdrawn) hours after morphine or saline (non-dependent controls). Morphine withdrawal (20-hour deprived group) increased demand for fentanyl but decreased demand for cocaine and methamphetamine. Morphine dependence (12-hour deprived group) had minimal effects, but did reliably decrease demand for cocaine. Morphine dependence increased demand intensity (Q0) only for the small dose of fentanyl; all other conditions were unaffected. These results demonstrate that opioid withdrawal increases motivation for opioid use while reducing motivation for stimulants, particularly at higher costs. Understanding these dynamics is crucial for developing effective polysubstance treatments addressing both opioid dependence and stimulant co-use.

Alcohol-related attentional bias (AB) is a central mechanism in alcohol use disorder (AUD), yet its temporal dynamics and measurement reliability remain debated. This study investigated the psychometric properties and temporal characteristics of AB in a clinical sample using a multimodal approach. Patients with AUD (N&#x2009;=&#x2009;49) completed a visual-probe task at short (200&#x2009;ms) and long (2000&#x2009;ms) stimulus-onset asynchronies (SOAs). Reaction times (RT) and eye-tracking (ET) indices were evaluated, including dwell time, fixation count, and first fixation landing position, with internal reliability assessed specifically for AB indices (difference scores) and correlations across modalities. RT-based AB-indices showed moderate split-half reliability at short and good reliability at long SOAs. ET-base AB indices of dwell time and fixation count demonstrated good reliability. Contrary to some prior studies, multimodal measures were interrelated, with significant correlations between dwell time and RT-based AB indices at both SOAs. RTs revealed a biphasic pattern via a significant approach bias at 200&#x2009;ms and avoidance at 2000&#x2009;ms. However, ET indices showed no significant effects for dwell time or fixation count. AB correlated with momentary craving, which was generally low in this clinical sample, but not with AUD severity. No significant differences were observed based on alcohol type preference. Manual RTs captured the dynamic pattern of the approach-avoidance time course of AB. Findings support a state-dependent perspective, suggesting AB reflects a fluid motivational state rather than a stable trait. Overall, the results indicate that AB indices can be measured with acceptable reliability, supporting further investigation of attentional processes in AUD.

During the COVID-19 pandemic, policies and practices were adopted to increase access to medications for opioid use disorder (MOUD), an evidence-based treatment that has lower utilization rates in rural areas compared to urban regions. However, limited attention has been given to rural-urban differences in MOUD use associated with pandemic policy and practice changes. We examine associations between the pandemic, rurality, and MOUD use in residential and outpatient treatment programs in the United States. Using 2018-2022 Treatment Episode Data Set Admissions (TEDS-A) data from residential short-term (RST), residential long-term (RLT), and outpatient treatment centers, we explored bivariate associations between MOUD as part of a treatment plan as the outcome variable and rurality and the pandemic as key independent variables. We then employed logistic regression, adjusting for multiple factors to analyze base and moderation models. Findings indicated MOUD use increased across all treatment modalities in the post-COVID period with the strongest association in RLT treatment (OR = 2.298). In all treatment modalities, rurality reduced the strength of the positive relationship between the pandemic and MOUD use (interaction term ORs ranged from .441 to .91). Rural areas experienced a sharp drop in MOUD use from 2021 to 2022 in RLT and outpatient treatment. Gains in the use of MOUD post-pandemic appeared short-lived in rural areas, ultimately widening urban-rural disparities. Providers, policymakers, and other stakeholders should work together to sustain policies and practices that promote MOUD, particularly in rural areas.

The fourth wave of the overdose epidemic in the United States (US) is characterized by deaths involving fentanyl with stimulants. Understanding patterns of substance use as novel drugs continue to emerge is critical to inform overdose prevention. Among people with a history of injection drug use in Baltimore, MD, we examined opioid-stimulant use by route and the association of injection with non-fatal overdose and xylazine use. We included 1132 participants in the AIDS Linked to the IntraVenous Experience cohort with a study visit in 2023-2024. We characterized participants by self-reported past-six-month use of any opioid and any stimulant by route using descriptive statistics. Adjusted associations were estimated using targeted minimum loss-based estimation. Most participants were Black (68&#x2009;%), male (67&#x2009;%), and older (median: 56 years). 53&#x2009;% reported using both opioids and stimulants; these participants were more likely to report using other substances, non-fatal overdose, depressive symptoms, and homelessness. Among participants using both, those injecting both were more likely to report non-fatal overdose and xylazine use than those using by non-injection (overdose: PD = 22.3&#x2009;%, 95&#x2009;% CI= 17.2&#x2009;%-27.5&#x2009;%; xylazine: PD = 13.3&#x2009;%, 95&#x2009;% CI = 4.7&#x2009;%-21.9&#x2009;%). We provide one of the most comprehensive summaries of substance use during the fourth wave in Baltimore, a city with the highest rate of fatal overdose in the US during the study period. Use of multiple substances was common, and many participants reported injection. Overdose prevention should be targeted to those injecting both drugs as this pattern had heightened overdose risk.

To examine next-day cognitive performance and subjective drug effects after smoking cannabis and to assess associations between performance and cannabinoid concentrations in blood and oral fluid. In this observational study, healthy adults who regularly used cannabis (mean age 30 years; n&#x2009;=&#x2009;65) smoked a legally purchased pre-rolled "joint" at night and were tested the next day, 12-15&#xa0;h later. Healthy adults with no past-month cannabis use served as a matched control group (mean age 30; n&#x2009;=&#x2009;65). Participants completed cognitive tasks (verbal free recall [VFR], Trail Making Test [TMT]), subjective effects questionnaires (including visual analogue scales [VAS]), and provided blood and oral fluid samples for quantification of delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and metabolites. Linear regression models compared groups across cognitive/subjective outcomes, while Pearson correlations assessed associations between cannabinoid concentrations and performance. There were no significant group differences on any cognitive measure. The cannabis group had significantly elevated VAS ratings (e.g., feeling a drug effect, &#x394;mean=12.54, p&#x2009;<&#x2009;0.01) compared to controls. Within the cannabis group, smoking infused (higher-THC-content) "joints" and higher %THC cannabis were associated with poorer verbal recall performance (e.g., %THC correlated with delayed verbal recall, r&#x2009;=&#x2009;-0.36, p&#x2009;<&#x2009;0.01). Higher blood THC and THC-COOH concentrations correlated with poorer VFR and slower TMT performance, whereas blood 11-OH-THC and oral fluid THC correlated with TMT performance only (all p&#x2009;&#x2264;&#x2009;0.03). There was no measurable next-day cognitive differences between groups, despite some subjective intoxication in the cannabis group. Nonetheless, higher THC potency and elevated cannabinoid concentrations were associated with poorer verbal memory and processing speed, suggesting potential next-day impairment with high-THC products.

Swedish physicians have conflicting obligations when managing harmful alcohol use. They are responsible for identification and treatment, while also being legally required to report unfit driving licence holders. B-Phosphatidylethanol (PEth) is a reliable and specific biomarker for alcohol use and a useful tool in the assessment. We explored general practitioners' experiences of using PEth in the context of their legal obligation to report patients with certain alcohol-related disorders to the Swedish Transport Agency. Individual interviews were conducted with physicians (n = 20) from 10 primary healthcare centres with different patterns of PEth utilisation. Interview data were analysed using qualitative content analysis. Results encompassed three categories: 1. Struggling to implement the regulations: difficulties in assessing driving fitness when PEth test results indicated high alcohol intake; 2. Managing reactions and roles: physicians struggled to balance legal obligation while maintaining a confidential physician-patient relationship; 3. Navigating dilemmas arising from implementing the regulations: regulations were burdensome to apply and diverse strategies emerged, where some physicians refrained from PEth testing and others avoided reporting. Some relied on standardised management approaches or used the obligation to report as a motivating factor for patients to reduce their alcohol use. The results reveal that difficulties in complying with the legal obligation to report unfit drivers prevent the systematic use of PEth, obstructing the identification of harmful alcohol use and dependence. Clearer guidance on the implementation of the driving licence regulations and the clinical use of PEth are necessary to support physicians in handling this complex issue.

Nitazenes, benzimidazole synthetic potent opioid &#x3bc;-receptor agonists, have been implicated in increased risk for opioid toxicity. Subtypes of nitazenes, including protonitazene, have been recently detected in multiple overdose cases in Australia. We describe a case report of protonitazene dependence, inpatient withdrawal management and induction onto opioid dependence treatment. A 22-year-old man with no significant medical history presented to a metropolitan emergency department in opioid withdrawal after regular vaping of a product sold as cannabinoids. He required higher than expected buprenorphine doses and other standard treatment including diazepam and olanzapine to manage opioid withdrawal. Blood and urine samples taken in the emergency department later tested positive for protonitazene. Analysis of the vaping liquid was only positive for protonitazene. He was discharged for outpatient follow-up to later receive a 300&#x2009;mg subcutaneous buprenorphine monthly injection. This case describes the clinical presentation of dependence, withdrawal and buprenorphine induction for opioid dependence due to chronic protonitazene vaping. Future research may help guide optimal doses of buprenorphine to manage nitazene withdrawal. Vaping devices have increased in popularity, especially amongst youth, which poses public health risks to the community if adulterated with other substances. Detection of nitazenes currently requires specialised laboratories. Protonitazene withdrawal management was complex in this case report. Youth are at risk of harms in vaping products adulterated with other substances, including nitazenes. State-wide toxicosurveillance programs, such as the NSW PRISE program, are essential for coordinating detection, clinical management and community awareness of nitazenes.

Racism-based police violence (RPV) is an emerging public health concern. However, limited research has examined the relationship between RPV exposure and substance use, particularly among Black or African American and Hispanic emerging adults aged 18-29 years. This study assessed associations between lifetime RPV exposure across three domains (direct victimization, witnessing in person, and media-based exposure) and past 30-day and 12-month alcohol and cannabis use in this population. A cross-sectional survey was conducted from August to October 2023 using a national nonprobability internet sample recruited via Qualtrics. The analytic sample included 936 Black or African American (48&#x2009;%) and Hispanic (52&#x2009;%) emerging adults. Negative binomial and logistic regression models were used to examine associations. Higher levels of RPV exposure were significantly associated with increased alcohol and cannabis use. RPV-Victim exposure was the strongest predictor of alcohol use, including past 30-day (IRR = 1.02, 95&#x2009;% CI: 1.00-1.05) and 12-month (OR = 1.04, 95&#x2009;% CI: 1.01-1.07) use. RPV-Witness exposure was most strongly associated with cannabis use, including past 30-day (IRR = 1.02, 95&#x2009;% CI: 1.00-1.03) and 12-month (OR = 1.03, 95&#x2009;% CI: 1.01-1.06) use. A dose-response pattern was observed across increasing levels of RPV exposure. RPV exposure is a significant correlate of alcohol and cannabis use among Black or African American and Hispanic emerging adults. Findings suggest that perceived racialized policing is a significant risk factor for substance use and warrants further investigation as a potential structural determinant, highlighting it as an important target for public health interventions.