The role of first use of inhalants within sequencing pattern of first use of drugs among Brazilian university students

Prescription opioid misuse among university students: A systematic review

Misuse of prescription opioids has substantially increased in the past decade among the general population, including among university students. Relative to the literature concerning opioid misuse among the general population, little information is available regarding the college student population. Objective: The purpose of the present study was to conduct a systematic review of the literature concerning the prevalence of prescription opioid misuse among the university student population. Results: The lifetime estimate for prescription opioid misuse among general populations of students ranged from 4% to 19.7%, with higher estimates for special student populations. Students most at risk for misuse of prescription opioids are those who report higher rates of psychological distress, depression, and suicidal thoughts and behaviors, and white, male students who use alcohol and illicit drugs. Conclusions: Findings from this study underscore the need for opioid prevention and intervention programs on university campuses.

Adolescent drug use initiation and transition into other drugs: A retrospective longitudinal examination across race/ethnicity

BACKGROUND

Understanding adolescent drug use mechanisms is critical for drug use prevention. Although some theories such as the gateway theory suggest that drug users gradually transition into using more addictive drugs, there is no consensus about such a hypothesis. One important factor that hinders the advancement of knowledge in this area is the scarcity of longitudinal studies examining the type of drugs adolescents initially use and the different pathways adolescents take to transition into using other drugs as they grow older.

METHODS

Using the pooled sample of adolescent dug users (14-17 years old; n = 10,644) from the National Survey on Drug Use and Health (2015-2018), we constructed longitudinal data on adolescents' illicit drug use history other than the use of tobacco and alcohol based on the age of drug initiation. This allowed us to investigate what drugs were initially used by adolescents, how the use of these drugs may have progressed into a new drug, and whether there were racial/ethnic differences in the initiation and progression. The retrospective longitudinal data analyses applied life table method and Cox regression models.

RESULTS

Two thirds of the adolescent drug users initiated their drug use trajectories with marijuana, one quarter with inhalants, and the remaining with hallucinogens, prescription drugs, and hard drugs. Adolescent drug users who initiated with different drugs showed unique trajectories to the use of a new drug. By year 8, the probability of using a new drug was about 40% and 70% to 80% for adolescents who initiated with inhalants and other drugs, respectively. The probability of using a new drug for adolescents who initiated with marijuana and inhalants accumulated stably over time, and its difference with that of other drug users diminished over time. The multivariate Cox regression models suggest the observed discrepancies generally held after controlling for covariates. There were also racial/ethnic differences in adolescent drug use initiation and progression, with Black/African American adolescents being the least likely to switch to the use of a new drug.

CONCLUSION

Adolescents' initial use of marijuana and inhalants may lead to substantial risks of using other drugs over time. It is therefore important to screen adolescent drug use comprehensively and provide early interventions to prevent an escalation to more detrimental drugs. The findings provide new evidence to support aspects of both the gateway and generalized risk drug use theories.

Alcohol and other drug use, and mental distress in the women’s universe

ABSTRACT Objective: to analyze the relationship between alcohol and other drug use, and mental distress among women. Method: an analytical cross-sectional study conducted with 369 women in Piauí State. Alcohol Use Disorders Identification Test, Non-Student Drugs Use Questionnaire and Self-Reporting Questionnaire and inferential statistics were used. Results: women with heavy alcohol consumption (zone IV - possible dependence) are 2.1 times more likely to have mental distress. Consuming tobacco increases the odds of distress 3.5%, tranquilizers 2.6 times and cannabis 4.5 times. There is a statistically significant and positive correlation between the Alcohol Use Disorders Identification Test score and the Self-Reporting Questionnaire (p = 0.000; r = 0.250). Conclusion: alcohol, tobacco, tranquilizers and cannabis use is associated with mental distress. The more intense the alcohol consumption, the more intense the mental distress. Therefore, it is necessary to track alcohol and other drug consumption, and mental distress in the routine care of women.

Pattern of Methamphetamine Use and the Time Lag to Methamphetamine Dependence

OBJECTIVES

Use of methamphetamine (MA) commonly co-occurs with the use of other substances. The present study aims to examine substance initiation patterns of other substances, including alcohol, nicotine, inhalants, and cannabis (OTH), in MA users and its consequence on the time lag of MA dependence.

METHODS

Sociodemographic, environmental, and clinical data were obtained from MA users at a Thai substance treatment center. The Semi-Structured Assessment for Drug Dependence and Alcoholism was employed to diagnose drug dependence.

RESULTS

Of 991 MA users, 52.6% were males, and the average age was 26.8 ± 7.1 years. The mean age of first MA use (18 years) was greater than the mean age of first use of alcohol (17 years), nicotine (16 years), and inhalants (15 years) (P < 0.001), but was comparable with the mean age at the first use of cannabis (P > 0.05). Family history of MA use and nicotine dependence were associated with early MA onset. Participants who used MA as their first drug (MA>OTH) were more likely to be female and less likely to smoke intensely and to be exposed to severe traumatic events than those who used MA later than other substances (OTH>MA). The time lag from age at onset of MA use to MA dependence was shorter in OTH>MA than in MA>OTH (3 vs 5 years; χ = 5.7, P = 0.02, log-rank test).

CONCLUSIONS

A higher proportion of women was observed in MA>OTH than in OTH>MA. The use of other substances before MA increases the individual's vulnerability in shortening the interval between age at onset of MA use and MA dependence in a substance treatment cohort.

Denise Kandel's classic work on the gateway sequence of drug acquisition

During the early 1970s Denise Kandel and her colleagues documented an 'invariant sequence' in initiation of drug use: starting with alcohol and tobacco, progressing to cannabis and then to other illicit, or 'harder' drugs. This observation, which became known as the 'gateway sequence' of drug use, has been influential in policy debates but remains highly contentious, with the area of greatest controversy focusing upon whether cannabis use increases risk causally for initiation of other illicit drugs. While numerous studies have replicated Kandel's initial findings (sequence of onset) and reported that associations between cannabis use and the use of other illicit drugs remain after controlling for potentially confounding factors, the mechanisms underlying these observed associations remain hotly debated. In particular, it is possible that the observed associations are non-causal but reflect the influence of confounding factors which influence both early-onset drug use and subsequent progressions. However, research employing a range of techniques to address this issue has been unable to discount the possibility that associations between earlier and subsequent drug use reflect causal processes. This paper reviews Kandel's ongoing contributions to this field, which span 45 years, and discusses both the influence of her work and the controversy that it has aroused.

In-transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern

INTRODUCTION AND AIMS

Given a scenario of intense discussion about the legal situation of cannabis users worldwide, this paper aims to investigate the role of cannabis within a drug use sequencing pattern.

DESIGN AND METHODS

Data came from a representative sample of college students from 27 Brazilian capitals (n = 12 711). We analysed the patterns of transition from/to the first use of cannabis to/from the first use of alcohol, tobacco and seven other illegal drugs. Survival analysis methods were used to analyse age of onset data on all potential drug pairs. Drugs that were not specified as the target drug pair tested in each survival model were included as time-varying covariates in all models.

RESULTS

We found significant transitions from alcohol [adjusted hazard ratio (aHR) = 1.41, 95% confidence interval (CI) 1.15-1.73, P < 0.001] and inhalants (aHR = 1.56, 95% CI 1.26-1.93, P < 0.001) to cannabis. Moreover, we found significant transitions from cannabis to alcohol (aHR = 2.40, 95% CI 1.47-3.91, P < 0.001), cocaine (aHR = 7.47, 95% CI = 4.26-13.09, P < 0.001), prescription opioids (aHR = 2.16, 95% CI 1.29-3.63, P < 0.01) and tranquilisers (aHR = 1.51, 95% CI 1.11-2.06, P < 0.01).

DISCUSSION AND CONCLUSIONS

Overall, our findings point to a strategic role of cannabis within drug first use sequence pattern. We had an important and unexpected finding-the bi-directional relationship between alcohol and cannabis. In addition, the first use of cannabis still precedes the first use of cocaine and non-medical use of tranquilisers and prescription opioids. [Castaldelli-Maia JM, Nicastri S, Cerdá M, Kim JH, Oliveira LG, Andrade AG, Martins, SS. In-transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern. Drug Alcohol Rev 2017;00:000-000].

Effect of Adolescent Cigarette Smoking on Adulthood Substance Use and Abuse: The Mediating Role of Educational Attainment

BACKGROUND

Even though the association between cigarette smoking and later substance use has been shown, there is still no compelling evidence that demonstrates the long-term effects in a high drug using community in African Americans. Few studies have examined the mediating mechanisms of the effect of adolescent cigarette smoking on the drug progression pathway.

OBJECTIVES

We examined the long-term influence of adolescent smoking on later illegal drug use in a cohort of urban African Americans, and the mediating role of educational attainment in the drug progression pathway.

METHODS

The study used a longitudinal dataset from the Woodlawn Project that followed 1,242 African Americans from 1966-1967 (at age 6-7) through 2002-2003 (at age 42-43). We used the propensity score matching method to find a regular and a nonregular adolescent smoking group that had similar childhood characteristics; we used the matched sample to assess the association between adolescent smoking and drug progression, and the mediating role of educational attainment.

RESULTS

Adolescent regular smokers showed significantly higher odds of using marijuana, cocaine, and heroin, having alcohol abuse problems and any drug dependence, and abuse problems in adulthood. We found that educational attainment mediated most of the drug progression pathway, including cigarette smoking, marijuana, cocaine and heroin use, and drug dependence or abuse problems in adulthood, but not alcohol abuse.

CONCLUSIONS

More focus needs to be put on high school dropout and development of interventions in community settings for African Americans to alter the pathway for drug progression for adolescents who use cigarettes regularly.

The role of drug use sequencing pattern in further problematic use of alcohol, tobacco, cannabis, and other drugs

BACKGROUND

There has been considerable debate regarding what typically occurs after experimentation with drugs throughout the life of young people who used various drugs.

AIMS

To evaluate the clinical importance of the most common sequence for the first use of a drug by two models (the "gateway model" and the "alternative model", which is the most popular sequence for Brazilian university students according to a previous study) regarding the problematic use of alcohol, tobacco, cannabis and other illegal drugs, assessed by ASSIST.

METHOD

People who had already experimented with three or more drugs across different stages of the two models were selected from a representative sample of university students from 27 Brazilian capitals (n = 12 711).

FINDINGS

There were no differences regarding the problematic use of the most consumed drugs in Brazil (alcohol, tobacco and cannabis) between the models. Multiple drug seekers and violators had more problematic use of illegal drugs other than cannabis than individuals in the model sequence. However, in the case of violators, this was only evident in the alternative model.

CONCLUSIONS

Multiple drug seekers and violators deserve special attention due to their increased risk of problematic use of other illegal drugs.