Racial and Ethnic Differences in Heroin, Methamphetamine, and Cocaine Use, Treatment, and Mortality Trends in 3 National Data Sources-United States, 2010-2019.

BACKGROUND: As overdose deaths continue to rise, public health officials need comprehensive surveillance data to design effective prevention, harm reduction, and treatment strategies. Disparities across race and ethnicity groups, as well as trends in substance use, treatment, or overdose deaths, have been examined individually, but reports rarely compare findings across multiple substances or data sources. OBJECTIVE: To provide a broad assessment of the overdose crisis, we describe trends in substance use, treatment, and overdose mortality across racial and ethnic groups for multiple substances. RESEARCH DESIGN: We conducted a longitudinal, cross-sectional analysis comparing trends. SUBJECTS: We identified self-reported use from the National Survey on Drug Use and Health, substance use treatment admissions from the Treatment Episode Data Set-Admissions, and overdose deaths from the CDC's Multiple Cause of Death files. MEASURES: We measured rates of substance use, treatment, and deaths involving heroin, methamphetamine, and cocaine among United States adults from 2010 to 2019. RESULTS: Heroin, methamphetamine, and cocaine use increased, though not all changes were statistically significant. Treatment admissions indicating heroin and methamphetamine increased while admissions indicating cocaine decreased. Overdose deaths increased among all groups: methamphetamine (257%-1,115%), heroin (211%-577%), and cocaine (88%-259%). Changes in rates of use, treatment, and death for specific substances varied by racial and ethnic group. CONCLUSIONS: Substance use, treatment, and overdose mortality changed considerably, though not always equivalently. Identifying diverging trends in substance-related measures for specific substances and racial and ethnic groups can inform targeted investment in treatment to reduce disparities and respond to emerging changes in the overdose crisis.

Regional differences in fatal drug overdose deaths among Black and White individuals in the United States, 2012-2021.

BACKGROUND AND OBJECTIVES: The current study examines regional differences in Black/White fatal drug overdoses. METHODS: Black/White overdose mortality data (2012-2021; N = 537,085) were retrieved from CDC WONDER. We used death counts and corresponding Census Bureau population estimates by the decedent's age and race/ethnicity to calculate mortality rate ratios. RESULTS: From 2012 to 2021, there were 537,085 reported overdose deaths among White (85%) and Black (15%) individuals in the United States. In the South, Black individuals had lower fatal drug overdose deaths than their same-aged White counterparts. In the Northeast, Midwest, and West regions, Black individuals had around 10%-60% lower likelihood of overdoses among younger ages (15-24, 25-34, 35-44) but about 60%-300% higher likelihood of overdoses among older adults (55-64). Increases in overdose deaths during the pandemic (2020-2021) led to changes in Black/White overdose death patterns, whereas Black individuals of all ages in the Midwest and West regions had approximately 15%-425% higher likelihood of fatal overdoses than their same-aged White counterparts. Sex-stratified analysis suggests that Black females in the South had overdose death rates around 50% lower than same-aged White females, and overdose deaths were relatively equal for Black and White females in the Midwest-patterns not seen among males. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The findings indicate that the Black/White overdose mortality gap changed after the COVID-19 pandemic across all regions and age cohorts, with state and regional variations in magnitude. Behavioral interventions and policies to curb drug overdose deaths among populations most impacted should consider regional, sex, and age-related differences.

Understanding Regional Patterns of Overdose Deaths Related to Opioids and Psychostimulants.

BACKGROUND: As overdose rates increase for multiple substances, policymakers need to identify geographic patterns of substance-specific deaths. In this study, we describe county-level opioid and psychostimulant overdose patterns and how they correlate with county-level social vulnerability measures. METHODS: A cross-sectional observational study, we used nationwide 2016-2018 restricted access Centers for Disease Prevention and Control county-level mortality files for 1,024 counties. We estimated quartiles of opioid and psychostimulant overdose mortality and provided estimates of their association with county-level Social Vulnerability Index (SVI) percentile. RESULTS: There was high opioid and psychostimulant overdose mortality in the Middle Atlantic, South Atlantic, East North Central, and Mountain regions. The Central US had the lowest opioid and psychostimulant overdose mortality rates. Counties with higher SVI scores (i.e. higher social vulnerability) were significantly more likely to experience high opioid and high psychostimulant overdose (high-high) mortality. A 10-percentile increase in SVI score was associated with a 3.1 percentage point increase in the likelihood of being a high-high county (p < 0.001) in unadjusted models and a 1.5 percentage point increase (p < 0.05) in models adjusting for region. CONCLUSION: Our results illustrated the heterogenous geographic distribution of the growing concurrent opioid and psychostimulant overdose crisis. The substantial regional variation we identified highlights the need for local data to guide policymaking and treatment planning. The association of opioid-psychostimulant overdose mortality with social vulnerability demonstrates the critical need in impacted counties for tailored treatment that addresses the complex medical and social needs of people who use both opioids and psychostimulants.

Medical marijuana laws (MMLs) and dispensary provisions not associated with higher odds of adolescent marijuana or heavy marijuana use: A 46 State Analysis, 1991-2015.

Background: States are rapidly moving to reverse marijuana prohibition, most frequently through legalization of medical marijuana laws (MMLs), and there is concern that marijuana legalization may affect adolescent marijuana use. Methods: This natural-experimental study used state Youth Risk Behavior Survey (YRBS) data collected from participants in grades 9-12 from 1991 to 2015 in 46 states (N = 1,091,723). Taking advantage of heterogeneity across states in MML status and MML dispensary design, difference-in-difference estimates compared states with enacted MMLs/dispensaries to non-MML/dispensaries states. Multivariable logistic regression modeling was used to adjust for state and year effects, and student demographics. The main outcome assessed was past 30-day adolescent marijuana use ["any" and "heavy" (≥20)]. Results: In the overall sample, the adjusted odds of adolescents reporting any past 30-day marijuana use was lower in states that enacted MMLs at any time during the study period (OR 0.94, 95% CI 0.89 to 0.99; p < .05), and in states with operational dispensaries in 2015 (OR 0.93, 95% CI 0.88 to 0.99; p < .05). Among grade cohorts, only 9th graders showed a significant effect, with lower odds of use with MML enactment. We found no effects on heavy marijuana use. Conclusions: This study found no evidence between 1991 and 2015 of increases in adolescents reporting past 30-day marijuana use or heavy marijuana use associated with state MML enactment or operational MML dispensaries. In a constantly evolving marijuana policy landscape, continued monitoring of adolescent marijuana use is important for assessing policy effects.

Risky Sexual Behaviors, Substance Use, and Perceptions of Risky Behaviors Among Criminal Justice Involved Women Who Trade Sex.

This study examined risky sexual behaviors, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV)-defined alcohol and substance use disorders, and perceptions of risky behaviors among community released, justice-involved women, who are currently trading sex (CTS), formerly traded sex (FTS), or have never traded sex. Data were derived from 266 sexually active women recruited from a Municipal Drug Court System in St. Louis, Missouri. In an adjusted multinomial regression model, being dependent on alcohol and cocaine was the most robust correlate of sex-trading status (adjusted odds ratio [AOR]: CTS = 4.21, FTS = 4.66). Perceptions of sexual risk and HIV were significantly associated with CTS (AOR = 3.39), however, not FTS. Other significant correlates of sex trading status included age, lifetime injection drug use, lower education, child sexual abuse, and unstable housing. Gender-specific interventions tailored toward currently and formerly sex-trading women are needed.

Heterogeneity of state medical marijuana laws and adolescent recent use of alcohol and marijuana: Analysis of 45 states, 1991-2011.

OBJECTIVE: To assess associations between enactment of state medical marijuana laws (MMLs), MML restrictiveness, and past-30-day youth alcohol use overall, and in relation to marijuana use. METHOD: This quasi-experimental difference-in-difference designed study used state-level Youth Risk Behavior Survey data of 9th-12th grade students in 45 states from 1991-2011 (N D 715,014). We conducted bivariate (unadjusted) and multivariable (adjusted for state, year, individual characteristics) logistic regression analyses to examine the effect of MML enactment (yes/no) and less restrictive vs. more restrictive MMLs on five varying measures of past 30-day alcohol use (i.e., any use or binge) and alcohol and marijuana use behaviors. RESULTS: In the final adjusted analyses, MML enactment was associated with lower odds of adolescent past 30-day (1) alcohol use (OR D 0.92, [0.87, 0.97], p < .01) and (2) use of both alcohol and marijuana (OR D 0.93, [0.87, 0.99], p < .05). States with less restrictive MMLs had lower odds of past 30-day (1) alcohol use (OR D 0.94, [0.92, 0.97], p < .001), (2) binge drinking (OR D 0.96, [0.93, 0.97], p < .05), (3) alcohol use without any marijuana use (OR D 0.96, [0.93, 0.99], p < .01), and (4) use of both alcohol and marijuana (OR D 0.96, [0.92, 0.99], p < .05). CONCLUSIONS: This study found that enactment of any MML, and of less restrictive MMLs, was associated with lower odds of past 30-day adolescent alcohol use among adolescents. With continued change in state marijuana laws, it is important to monitor the effect of their enactment and implementation, as well as their specific provisions (e.g. dispensaries, home cultivation), which may differentially affect adolescent behaviors.

The Association Between Religiosity and Substance Use Patterns Among Women Involved in the Criminal Justice System.

A growing body of research is exploring the association between religiosity and drug use. Thus, this analysis examines the association between religiosity and substance use patterns among females in the criminal justice system. Data derived from 318 women recruited from a Municipal Drug Court System in St. Louis, Missouri, were used to determine the association between religiosity and substance use patterns. Results indicate that religiosity decreased the odds of cocaine use, observed for both crack/cocaine (CC) use alone (adjusted odds ratio [AOR] = 0.41) and crack/cocaine + marijuana (CC + MJ) (AOR = 0.32). Interestingly, this association was not found for MJ use alone. Other variables that were significantly associated with CC + MJ use included being non-Black (CC + MJ: AOR = 0.46; MJ: AOR = 0.28), 4+ arrests (CC + MJ: AOR = 4.66; CC: AOR = 2.64), and <30 years of age (CC + MJ: AOR = 0.37; CC: AOR = 0.16; MJ: AOR = 2.84). Future drug prevention and interventions should consider the potential protective effects of religiosity on substance use.

Substance Use Treatment Utilization Among Individuals With Substance Use Disorders in the United States During the COVID-19 Pandemic: Findings on the Role of Polysubstance Use, Criminal Justice Involvement, and Mental Illness From the National Survey on Drug Use and Health.

This study used the National Survey on Drug Use and Health to assess a nationally representative sample (N = 4596) weighted to represent 35.2 million adults with DSM-5 criteria-determined substance use disorders (SUDs). This study explored substance use treatment utilization in 2020, emphasizing populations with high vulnerability (e.g., criminal justice involvement (CJI) through parole or probation, polysubstance use, severe mental illness, and HIV/STI). Substance use treatment was broadly defined (any inpatient, outpatient/doctor's office, self-help/other for alcohol/drugs). Our results indicated that among adults with SUDs in 2020, 7 million (20%) had multiple SUDs, 1.75 million (5%) had CJI, 5.3 million (15%) had a severe mental illness, and 1.8 million (5%) had a diagnosis of HIV/STI in the last year. Only 7% of individuals with SUD sought any substance use treatment in the past year. CJI (aOR: 13.39, 95% CI: [7.82, 22.94]), serious mental illness (aOR: 3.27, 95% CI: [1.93, 5.55]), and having both 2 (aOR: 2.10, 95% CI: [1.29, 3.42]) or 3 or more SUDs (aOR: 3.46, 95% CI: [1.82, 6.58]) were all associated with a greater likelihood of receiving treatment. Marriage (aOR: 0.43, 95% CI: [0.25, 0.74]) and having an income twice the poverty threshold (aOR: 0.53, 95% CI: [0.29, 0.94]) were associated with reduced odds of receiving any substance use treatment. Compared to those 18 to 25, older individuals had increased odds (2-4 times) of receiving treatment. Interventions are crucially needed to increase access to treatment among those with SUDs.

Pregnancy- and parenting-related barriers to receiving medication for opioid use disorder: A multi-paneled qualitative study of women in treatment, women who terminated treatment, and the professionals who serve them.

BACKGROUND: Women face unique barriers when seeking treatment for substance use disorders, often related to pregnancy and parenting. OBJECTIVES: This study adds to the extant literature by elucidating the pregnancy- and parenting-related barriers women face when initiating or continuing medication for opioid use disorder, specifically. DESIGN: This study is based on qualitative semi-structured interviews. METHODS: Three subgroups participated in semi-structured interviews regarding their experiences (N = 42): women with current or past opioid use disorders who have used or were presently using medication for opioid use disorder, professionals working in substance use disorder treatment programs, and criminal justice professionals. RESULTS: Three parenting-related subthemes were identified: (1) insufficient access to childcare to navigate appointments and meetings, (2) fear of losing custody of, or access to, one's children, and (3) prioritizing one's children's needs before one's own. Three subthemes were identified with regard to pregnancy as a barrier: (1) hesitancy among physicians to prescribe medication for opioid use disorder for pregnant patients, (2) limited access to resources in rural areas, and (3) difficulty navigating a complex, decentralized health system. CONCLUSION: Systemic changes are needed to reduce pregnant and parenting women's barriers to seeking medication for opioid use disorder. These include improved childcare support at both in-patient and outpatient treatment programs, which would assuage women's barriers related to childcare, as well as their fears of losing access to their children if they spend time away from their children for treatment. An additional systemic improvement that may reduce barriers for these women is access to comprehensive, integrated care for their prenatal care, postpartum care, pediatric appointments, and appropriate substance use disorder treatment.

Pregnancy and parenting-related barriers to receiving medication for opioid use disorder: Interview themes from multiple perspectivesWomen face unique barriers when seeking treatment for substance use disorders, often related to pregnancy and parenting. This study used one-on-one interviews to learn more about the pregnancy- and parenting-related barriers women face when initiating or continuing medication for opioid use disorder, specifically. Three different groups were interviewed: women with current or past opioid use disorders who have used or were presently using medication for opioid use disorder, professionals working in substance use disorder treatment programs, and criminal justice professionals (N = 42). Three parenting-related themes emerged from the interviews: (1) insufficient access to childcare to navigate appointments and meetings, (2) fear of losing custody of, or access to, one's children, and (3) prioritizing one's children's needs before one's own. Three pregnancy-related themes emerged from the interviews: (1) hesitancy among physicians to prescribe medication for opioid use disorder for pregnant patients, (2) limited access to resources in rural areas, and (3) difficulty navigating a complex health system. Systemic changes are needed to reduce pregnant and parenting women's barriers to seeking medication for opioid use disorder. These include improved childcare support at treatment programs, which would assuage women's barriers related to childcare, as well as their fears of losing access to their children if they spend time away from their children for treatment. An additional systemic improvement that may reduce barriers for these women is access to comprehensive, integrated care for their prenatal care, postpartum care, pediatric appointments, and appropriate substance use disorder treatment.

Women and Treatment for Opioid Use Disorder: Contributors to Treatment Success From the Perspectives of Women in Recovery, Women With Past Attempts in Drug Treatment, and Health and Criminal Justice Professionals.

Introduction: The disproportionate incidence of opioid use disorder (OUD) and the alarming increases in opioid-related overdose deaths among women highlight a clear need for the expansion of effective harm reduction and treatment practices. Research supports medications for opioid use disorders (MOUD) as an effective intervention; however, with low rates of utilization of such, there is a need to identify factors that facilitate MOUD treatment uptake and retention for women. Thus, the current study examines contributors to treatment success through the triangulation of perspectives from affected women as well as health and criminal justice professionals. Methods: Interviews (N = 42) were conducted from May to July 2022 with women in recovery who previously used or currently use MOUD (N = 10), women who currently use opioids who terminated a MOUD program previously (N = 10), SUD treatment professionals (N = 12), and criminal justice professionals who work with women who use opioids (N = 10). Interviews for all participants centered around their backgrounds, perceived barriers and facilitators to MOUD treatment, and issues specific to women in treatment for substance use disorder. We used a thematic qualitative data analysis process to analyze transcripts. Results: Participants highlighted contributors to treatment success from 3 domains: (1) internal processes (including promoting self-efficacy and setting realistic goals), (2) access to resources (including material resources, such as food and shelter, educational resources and social support), and (3) treatment structure (such as treatment type and protocol). Conclusion: Internal processes, access to resources, and treatment structure contribute to MOUD treatment success for women with OUD. Structured support where experiences are shared, and realistic goals are set, may promote feelings of acceptance and empowerment, thereby bolstering chances of treatment success. Additionally, the court system can promote evidence-based and trauma-informed substance use treatment and provide accessible educational resources related to substance use to extend these benefits to more women.

The impact of family systems and social networks on substance use initiation and recovery among women with substance use disorders.

OBJECTIVE: While social networks influence individuals with substance use disorders (SUDs), the mechanisms for such influence are under-explored among women who use drugs. This study triangulates the perspectives of criminal justice professionals, SUD treatment professionals, and women with past and current experiences with substance use to explore these dynamics. METHOD: We conducted semistructured interviews (N = 42) in 2022 with women with current or past opioid use disorder (n = 20), SUD treatment professionals (n = 12), and criminal justice professionals (n = 10) who work with women with opioid use disorder. Interviews centered around participants' backgrounds, perceived barriers and facilitators to medications for opioid use disorder (MOUD) treatment, and gender-specific issues in MOUD treatment. All interviews were audio-recorded, transcribed, and deidentified. We used a four-step qualitative data analysis process to code transcripts. RESULTS: Across these participants' accounts, we identified mechanisms by which women's social networks influenced their opioid use trajectories: intergenerational substance use, family support and strain, intimate partner influence, and peer support and pressure. Overall, the emergent themes in the present study reflect the embedded nature of support within social systems. Women who had access to and engaged with various forms of social support tended to be those who use/used MOUD and self-identified as in recovery. CONCLUSIONS: Combining MOUD treatment with psychosocial interventions allows women to heal from trauma, learn effective coping skills, and receive valuable resources to support recovery. Interventions focusing on family resilience and peer recovery support can disrupt the cycle of addiction and promote MOUD treatment success. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The role of polysubstance use on criminal justice involvement in the United States.

PURPOSE OF REVIEW: Polysubstance use, broadly defined as using more than one type of substance, disproportionately impacts those involved in the criminal justice system (CJS). This review synthesizes recent findings on polysubstance use among those involved in the CJS and highlights areas of particular concern and interventions. RECENT FINDINGS: We use 18 recent articles to identify the prevalence and types of criminal justice involvement and correlates of polysubstance use and criminal justice involvement. We highlight latent patterns of polysubstance use among various criminal justice populations (adults, pregnant women, and youth) and differential associations with adverse substance use and criminal justice outcomes. Lastly, we discuss substance use treatment in the justice system, the role of polysubstance use in treatment access and outcomes, and substance use-related services for previously incarcerated individuals reentering society. SUMMARY: Current research provides further evidence of the syndemic nature of polysubstance use, criminal justice involvement, and adverse outcomes, which are complicated by significant barriers to accessing evidence-based treatment in justice settings. Yet, current research is limited due to methodological inconsistency and limited focus on the social determinants of health, racial/ethnic disparities, and interventions to increase treatment and reentry services.

Serious Psychological Distress, Substance Use Disorders, and Social Issues Among Men and Women in the United States During the COVID-19 Pandemic.

PURPOSE: This study assesses the association between SUD, economic hardship, gender, and related risk and protective factors on serious psychological distress (SPD) during the COVID-19 pandemic. DESIGN: Quantitative cross-sectional design. SETTING: National Survey on Drug Use and Health (NSDUH). SAMPLE: Data were from the NSDUH (2020) N = 25,746, representing 238,677,123 US adults, who identified as 18 or older and either male or female. MEASURES: SPD measured as scoring a 13 or more on the Kessler (K6) distress scale. SUDs were determined using DSM5 criteria. Sociodemographic and socioeconomic variables included in analyses. ANALYSIS: Logistic regressions evaluated the association between gender, protective, and risk factors on SPD. RESULTS: After controlling for sociodemographic and related factors of SPD, having a SUD was the strongest correlate of SPD. Other significant correlates of SPD included female gender and an income level at or below the federal poverty threshold. Gender stratified regressions illustrated that religiosity, self-identifying as Black, and high levels of education were protective against SPD for women but not men. Poverty level was more associated with SPD for women than men. CONCLUSION: In the United States, individuals with SUDs were nearly four times more likely to report SPD than those without SUDs, controlling for economic hardship and markers of social support during 2020. Effective social interventions to reduce SPD among individuals with SUDs are needed.

The Role of Substance Use Disorders on Suicidal Ideation, Planning, and Attempts: A Nationally Representative Study of Adolescents and Adults in the United States, 2020.

Few nationally representative studies examine suicidality and substance use during 2020; as such, we explored the role of substance use disorders (SUDs) on suicidality among adults and adolescents in 2020. Data were derived from N = 26,084 adult participants, representing 240 million U.S. adults weighted, and N = 5,723 adolescent participants, representing 25 million U.S. adolescents (12-17 years.). Separate logistic regressions for adults and adolescents were used to assess the association of DSM-5 SUDs, related factors, and suicidal thoughts and behaviors (ideation, planning, and attempts). In 2020, adults with SUDs were nearly 4 times more likely to seriously consider suicide (aOR = 3.94, 95% CI: 3.19, 4.86), 3 times more likely to make a suicide plan (aOR = 3.09, 95% CI: 2.25, 4.25), and nearly 4 times more likely to attempt suicide (aOR = 3.77, 95% CI: 2.29, 6.19) than adults without SUDs. Adolescents with SUDs were 4 times more likely to consider suicide (aOR = 3.69, 95% CI: 2.47, 5.51), 5 times as likely to make a suicide plan (aOR = 5.14, 95% CI: 3.25, 8.13) and to attempt suicide (aOR = 5.27, 95% CI: 2.91, 9.53) than adolescents without SUDs. Adult females and individuals experiencing poverty were twice as likely to attempt suicide than adult males and individuals not living in poverty. Adolescent females were 3-5 times more likely to seriously consider, plan, and attempt suicide than adolescent males. Interventions to curb suicidality among individuals with SUDs are crucial.

Impacts of intergenerational substance use and trauma among black women involved in the criminal justice system: A longitudinal analysis.

INTRODUCTION: Intergenerational substance use and trauma disproportionately impact racialized women. Yet, how these factors impact outcomes in women involved in the criminal justice system is understudied. METHODS: Using data from 443 participants in the Black Women in a Study of Epidemics, we assessed the impact of intergenerational substance use and trauma on participant drug use and open Child Protective Services (CPS) cases over 18 months. In repeated-measures logistic regression, intergenerational substance and trauma were independent variables, while participants' drug use at each follow-up and any open CPS case (s) served as separate dependent variables. Models were adjusted for criminal justice involvement, age, marital status, education, childhood guardian, number of children, and prior year homelessness. RESULTS: On average, participants were aged 35 years, 64 % had never married, and 44 % were raised by both parents. Two-thirds of women (67 %) reported intergenerational substance use (≥1 parent and/or grandparent with alcohol/drug problems), while only 13 % reported intergenerational trauma. Each increase in the number of parents/grandparents with drug/alcohol problems was associated with 30 % increased odds of participants' drug use (aOR 1.30, 95 % CI: 1.07,1.57) and 40 % increased odds of having an open CPS case (aOR 1.40, 95 % CI: 1.11, 1.78). The association of intergenerational trauma and CPS cases was attenuated with sociodemographic/contextualizing factors. CONCLUSIONS: Intergenerational substance use and trauma are associated with negative outcomes. Our findings highlight the need for substance use treatment to address the pervasive generational effects of substance use and trauma faced by racialized women in the criminal justice system.

Non-engagement in substance use treatment among women with an unmet need for treatment: A latent class analysis on multidimensional barriers.

BACKGROUND: Women with substance use disorders experience multifaceted barriers in accessing substance use treatment. Little is known about how these barriers may aggregate. Using a person-centered approach, this study evaluates patterns of treatment barriers and the factors associated with experiencing distinct sets of barriers among women. METHODS: Data were from the NSDUH (2015-2019). 461 adult women with an unmet need for substance use treatment in the last year reported on 14 treatment barriers. Latent class analysis examined classes of barriers; multinomial logistic regression assessed predictors of class membership. RESULTS: Three classes were identified: just not ready to abstain (71.2%), logistical barriers and stigmatization (18.2%), and barriers across all dimensions (10.6%). Higher education (aOR:1.94, p = 0.03) and psychological distress (aOR:2.19, p = 0.02) predicted higher odds-and identifying as African American predicted lower odds (aOR:0.17, p = 0.02)-of belonging to the "Logistics and Stigma Barriers" class relative to the "Just Not Ready" class. Similarly, higher education (aOR: 2.57, p = 0.02) and having children (aOR:2.28, p = 0.03) predicted higher odds-and marriage predicted lower odds (aOR:0.22, p = 0.02)-of belonging to the "High and Diverse Barriers" class relative to the "Just Not Ready" class. Having children predicted higher odds (aOR: 2.93, p = .02), and marriage predicted lower odds (aOR:0.19, p = 0.02) of belonging to the "High and Diverse Barriers" class relative to the "Logistics and Stigma" class. CONCLUSION: A lack of readiness to abstain, socioeconomic circumstances, and family obligations are main barriers to SUD treatment among women. Interventions incorporating motivational interviewing, family systems, and social networks are needed.

Medical Cannabis Laws and Adolescent Alcohol Use Initiation.

Background: The effects of medical cannabis laws (MCLs) on adolescent alcohol use remains unclear. Previous literature investigates alcohol consumption rather than alcohol initiation among adolescents, and does not examine the effect by sociodemographic characteristics and state-level dispensary status. We used population representative, state-level data to examine the relationship between MCLs and adolescent alcohol initiation. Methods: Data for this study were derived from the Youth Risk Behavior Survey (YRBS), a nationally representative, cross-sectional school-based survey administered by the Centers for Disease Control (CDC) in odd-numbered years from 1991 to 2015. We used a difference-in-difference model to assess pre and post effects of state MCL enactment on adolescent alcohol use initiation. Logistic regression analyses assessed associations between MCLs and varying ages of initiation. We further stratified our results by race/ethnicity, gender, and dispensary status. Results: Results from adjusted logistic regression models showed higher odds of initiating alcohol among adolescents in states without MCLs when compared to adolescents in states with MCLs (OR 1.37, [95% CI = 1.29, 1.44]). This effect was consistent across age, race/ethnicity, and gender groups. Reductions in self-report of alcohol initiation were also consistently found in multiple age strata (9-10, 11-12, and 13-14), though this finding did not reach conventional levels of statistical detection in all race/ethnicities. Conclusions: Our findings support a substitutive effect, suggesting that adolescents in states with MCLs, as opposed to states without MCLs, may substitute cannabis for alcohol. Considering the evolving landscape of medical cannabis laws and the proliferation of state-level legalization laws, further research into the effects of such policies, such as adult-use cannabis laws, is warranted to further elucidate their effects on adolescent substance use.

State Medical Marijuana Laws and Initiation of Cigarettes among Adolescents in the U.S., 1991-2015.

Objective: Although cigarette use has declined among adolescents, marijuana use has increased in subgroups of this population. The association between medical marijuana laws (MMLs) and cigarette initiation among adolescents, however, needs further examination. We investigated the association between MMLs and age of cigarette initiation and stratified findings by gender, race/ethnicity, and state dispensary status. Method: Data were from N=939,725 adolescents in 9th-12th grade living in 46 states who participated in the Youth Risk Behavior Surveillance System between 1991-2015. Participants were asked the age they first smoked a cigarette and other sociodemographic characteristics. States were categorized as MML states if they had legalized marijuana for medicinal purposes by 2015. We used a difference-in-difference methodology and logistic regressions to assess the relationship between MMLs and cigarette initiation. Results: Our results indicate lower odds of initiating cigarettes, in every age group (8 years old or younger, 9-10, 11-12, 13-14, 15-16, 17 years old or older) in states with MMLs when compared to non-MML states. After stratification, we find lower odds of cigarette initiation in certain age groups by gender, race/ethnicity, and state dispensary status. We report no difference in state MML implementation and age of cigarette initiation among Hispanic adolescents in every age group, and Black adolescents 8 years or younger and 17 years or older. Conclusions: Cigarette initiation has decreased among adolescents in MML states compared with those in non-MML states. Further research should evaluate how MMLs and recreational marijuana policies are associated with e-cigarette initiation and use.

Heroin and nonmedical prescription opioid use among high school students in urban school districts.

BACKGROUND: Research on adolescent heroin use has focused on national surveillance, access, prevalence of use, and overdose deaths, however, to our knowledge, no study has examined local-level differences in the prevalence of adolescent heroin use in the context of nonmedical prescription opioid (NMPO) use. This study characterizes heroin and NMPO use among US high school students in select urban areas by sex and race/ethnicity. METHODS: Data are from 21 urban school districts that participate in CDC's Local Youth Risk Behavior Surveillance System. We describe 2017 prevalence estimates (and 95 % confidence intervals) of lifetime heroin and NMPO use among youth stratified by sex and race/ethnicity (i.e., White, Black, Hispanic/Latino). RESULTS: The highest estimates of heroin use were in Baltimore, MD (7.6 %), Shelby County, TN (6.3 %), and Duval County, FL (6.1 %), whereas NMPO use was highest in Duval County, FL (18.1 %), Cleveland, OH (18.0 %), and Shelby County, TN (16.8 %). Heroin use was higher among boys than girls, especially among Hispanic/Latino boys in Duval County (12.3 %) and Black boys in Baltimore (10.9 %). NMPO use was highest among Hispanic/Latino girls (21.3 %) and White girls (19.9 %) in Duval County. DISCUSSION: While some cities and subpopulations with high levels of adolescent heroin use also had elevated levels of NMPO use, others did not, illustrating the complexities of this opioid epidemic.