Prevalence and risk factors associated with psychostimulant use among Black individuals: A meta-analysis and systematic review

Changes in Synthetic Opioid-Involved Youth Overdose Deaths in the United States: 2018-2022

BACKGROUND AND OBJECTIVE

Youth overdose deaths have remained elevated in recent years as the illicit drug supply has become increasingly contaminated with fentanyl and other synthetics. There is a need to better understand fatal drug combinations and how trends have changed over time and across sociodemographic groups in this age group.

METHODS

We used the National Vital Statistics System's multiple cause of death datasets to examine trends in overdose deaths involving combinations of synthetic opioids with benzodiazepine, cocaine, heroin, prescription opioids, and other stimulants among US youth aged 15 to 24 years from 2018 to 2022 across age, sex, race and ethnicity, and region.

RESULTS

Overdose death counts rose from 4652 to 6723 (10.85 to 15.16 per 100 000) between 2018 and 2022, with a slight decrease between 2021 and 2022. The largest increases were deaths involving synthetic opioids only (1.8 to 4.8 deaths per 100 000). Since 2020, fatal synthetic opioid-only overdose rates were higher than polydrug overdose rates involving synthetic opioids, regardless of race, ethnicity, or sex. In 2022, rates of synthetic-only overdose deaths were 2.49-times higher among male youths compared with female youths and 2.15-times higher among those aged 20 to 24 years compared with those aged 15 to 19 years.

CONCLUSIONS

Polydrug combinations involving synthetic opioids continue to contribute to fatal youth overdoses, yet deaths attributed to synthetic opioids alone are increasingly predominant. These findings highlight the changing risks of the drug supply and the need for better access to harm-reduction services to prevent deaths among youth.

Racism in Education among Black Youth in Canada and its Association with Depression, Anxiety, Stress, and Post-Traumatic Stress Disorder

Racial discrimination in educational settings remains a significant barrier to equitable learning environments and is toxic for the mental health of Black youth in Canada. This study employed a mixed-methods multi-study approach to document the rates, dynamics, and mental health impacts of racial discrimination in education experienced by Black youths aged 14 to 24. Quantitative data were collected from two large samples (N = 558 and N = 914) to measure racial discrimination in education, stress, anxiety, depression, and post-traumatic stress disorder (PTSD). Additionally, qualitative data from semi-structured interviews with 32 youths provided deeper insights into their racial discrimination's experiences in educational settings. Over 40% of participants reported racial discrimination in education, which was significantly associated to elevated symptoms of anxiety, depression, stress, and PTSD. In both quantitative datasets, experience of racial discrimination in education moderated the association between resilience and internalized mental health problems (β = .53, p = .037, β = .34, p = .015, respectively). Racial discrimination in education lowers the protective role of resilience against internalized mental health problems. Thematic analysis of qualitative data uncovered key themes, including pervasive assumptions of low academic potential for Black students by authority figures, lack of appropriate intervention by educators and administrators when racial discrimination occurred, and ongoing enablement of a racist environment within schools. These findings underscore a critical need for systemic reform in Canadian schools and universities to prevent racism and address its mental health impacts. Implementing culturally responsive policies and antiracist interventions can foster safer, more inclusive educational environments, supporting well-being and academic success of Black Canadians youth.

"I Been Taking Adderall Mixing it With Lean, Hope I Don't Wake Up Out My Sleep": Harnessing Twitter to Understand Nonmedical Prescription Stimulant Use among Black Women and Men Subscribers

Black women and men outpace other races for stimulant-involved overdose mortality despite lower lifetime use. Growth in mortality from prescription stimulant medications is increasing in tandem with prescribing patterns for these medications. We used Twitter to explore nonmedical prescription stimulant use (NMPSU) among Black women and men using emotion and sentiment analysis, and topic modeling. We applied the NRC Lexicon and VADER dictionary, and LDA topic modeling to examine feelings and themes in conversations about NMPSU by gender. We paid attention to the ability of natural language processing techniques to detect differences in emotion and sentiment among Black Twitter subscribers given increased mortality from stimulants. We found that, although emotion and sentiment outcomes match the directionality of emotions and sentiment observed (i.e., Black Twitter subscribers use more positive language in tweets), this belies limitations of NRC and VADER dictionaries to distinguish feelings for Black people. Even still, LDA topic models showcased the relevance of hip-hop, dependence on NMPSU, and recreational use as consequential to Black Twitter subscribers' discussions. However, gender shaped the relevance of these topics for each group. Greater attention needs to be paid to how Black women and men use social media to discuss important topics like drug use. Natural language processing methods and social media research should include larger proportions of Black, Hispanic/Latinx, and American Indian populations in development of emotion and sentiment lexicons, otherwise outcomes regarding NMPSU will not be generalizable to populations writ large due to cultural differences in communication about drug use online.

Providing antiracist cognitive-behavioral therapy: Guidelines, tools, and tips

This article addresses gaps in cognitive-behavioral therapy (CBT) when it comes to integrating racial issues that affect racialized patients' mental health. Traditional adaptations of CBT focused on social, religious, and linguistic challenges but neglected the critical aspects of interpersonal, institutional and systemic racism, internalized racism and complex racial trauma. This oversight has resulted in less effective outcomes for racialized individuals. The article proposes clear, applicable guidelines for clinicians to provide anti-racist CBT interventions. They cover clinical self-development, re-design the CBT triangular (thoughts, feelings, behaviors) theoretical framework, provide practical tools and tips to facilitate antiracist CBT interventions. Clinicians are encouraged to engage in self-assessment to understand their own racial biases and develop competencies to address racial issues and dynamics in therapy. CBT theoretical framework is re-envisioned to include environmental factors that impact the lives of racialized people, acknowledging the pervasive effects of racism on mental and physical health. The article also highlights the importance of creating a culturally safe therapeutic environment for racialized children, adolescents, and families, and emphasizes the need for specialized training to effectively serve these groups. The proposed guidelines aim to transform CBT practice, increase confidence of racialized individuals in mental health care, and ultimately decolonize CBT interventions.

Venous thromboembolism in Black COVID-19 patients in a minority context compared to White, Asian and other racialized patients: A systematic review and meta-analysis

IMPORTANCE

COVID-19 has disproportionately affected racialized populations, with particular impact among individuals of Black individuals. However, it is unclear whether disparities in venous thromboembolic (VTE) complications exist between Black individuals and those belonging to other racial groups with confirmed SARS-CoV2 infections.

OBJECTIVE

To summarize the prevalence and moderators associated with VTE among Black COVID-19 patients in minoritized settings, and to compare this to White and Asian COVID-19 patients according to sex, age, and comorbid health conditions (heart failure, cancer, obesity, hypertension).

DESIGN SETTING, AND PARTICIPANTS

A systematic search of MEDLINE, Embase, CINAHL and CENTRAL for articles or reports published from inception to February 15, 2023.

STUDY SELECTION

Reports on VTE among Black individuals infected with SARS-CoV2, in countries where Black people are considered a minority population group.

DATA EXTRACTION AND SYNTHESIS

Study characteristics and results of eligible studies were independently extracted by 2 pairs of reviewers. VTE prevalence was extracted, and risk of bias was assessed. Prevalence estimates of VTE prevalence among Black individuals with COVID19 in each study were pooled. Where studies provided race-stratified VTE prevalence among COVID19 patients, odds ratios were generated using a random-effects model.

MAIN OUTCOMES AND MEASURES

Prevalence of VTE, comprising of deep vein thrombosis and pulmonary embolism.

RESULTS

Ten studies with 66,185 Black individuals reporting the prevalence of COVID-19 associated VTE were included. Weighted median age of included studies was 47.60. Pooled prevalence of COVID-19 associated VTE was 7.2 % (95 % CI, 3.8 % - 11.5 %) among Black individuals. Among individuals with SARS-CoV2 infections, Black population had higher risks of VTE compared to their White (OR = 1.79, [95 % CI 1.28-2.53], p < .001) or Asian (OR = 2.01, [95 % CI, 1.14-3.60], p = .017) counterparts, or patients with other racial identities (OR = 2.01, [95 % CI, 1.39, 2.92]; p < .001).

CONCLUSIONS AND RELEVANCE

Black individuals with COVID-19 had substantially higher risk of VTE compared to White or Asian individuals. Given racial disparities in thrombotic disease burden related to COVID-19, medical education, research, and health policy interventions are direly needed to ensure adequate disease awareness among Black individuals, to facilitate appropriate diagnosis and treatment among Black patients with suspected and confirmed VTE, and to advocate for culturally safe VTE prevention strategies, including pre-existing inequalities to the COVID-19 pandemic that persist after the crisis.

Integrative data analysis of clinical trials network studies to examine the impact of psychosocial treatments for black people who use cocaine: Study protocol

BACKGROUND

Cocaine overdose death rates among Black people are higher than that of any other racial/ethnic group, attributable to synthetic opioids in the cocaine supply. Understanding the most effective psychostimulant use treatment interventions for Black people is a high priority. While some interventions have proven effective for the general population, their comparative effectiveness among Black people remains unknown. To address this gap, our NIDA-funded Clinical Trials Network (CTN) study (0125), will use Integrative Data Analysis (IDA) to examine treatment effectiveness across 9 CTN studies. This manuscript describes the study protocol for CTN-0125.

METHODS

Of the 59 completed randomized clinical trials in the CTN with available datasets, nine met our inclusion criteria: 1) behavioral intervention, 2) targeted cocaine use or use disorder, 3) included sub-samples of participants who self-identified as Black and 4) included outcome measures of cocaine and psychostimulant use and consequences. We aim to 1) estimate scale scores of cocaine use severity while considering study-level measurement non-invariance, 2) compare the effectiveness of psychosocial treatments for psychostimulant use, and 3) explore individual (e.g., concomitant opioid use, age, sex, employment, pre-treatment psychiatric status) and study-level moderators (e.g., attendance/retention) to evaluate subgroup differences in treatment effectiveness.

CONCLUSION

The NIDA CTN provides a unique collection of studies that can offer insight into what interventions are most efficacious for Black people. Findings from our CTN-0125 study have the potential to substantially inform treatment approaches specifically designed for Black people who use psychostimulants.

Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States

OBJECTIVE

Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample.

METHODS

Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents.

RESULTS

About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use.

CONCLUSION

Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.