The decriminalization of illicit drugs in British Columbia: a national evaluation protocol.

BACKGROUND: On January 31st, 2023, the province of British Columbia (BC), Canada, was granted a federal exemption allowing adults (aged 18 +) to possess up to 2.5 g of select illicit drugs. The exemption will be in place for three years (2023-2026), marking the first formal decriminalization of illicit drug policy reform in Canada. BC's decriminalization initiative is premised on several goals. This project seeks to evaluate each of these goals and their individual and combined contributions to determine the overall success of this policy. METHODS: The following protocol paper provides a detailed outline of a five-year (2022-2027) national evaluation of BC's decriminalization initiative, as well as the specific objectives, methodologies, and planned analyses for eight interrelated sub-studies that comprise the evaluation. These sub-studies fall under the following five topical areas of research: 1) people who use drugs (PWUD), 2) the police and the criminal justice system, 3) the general public, 4) the health services system, and 5) an economic analysis. Additional research activities may also be explored. RESULTS: The overall evaluation and specific sub-study designs were informed by intensive stakeholder engagement. The evaluation was developed in collaboration with an international expert committee who came together to undertake a nominal group technique to decide on the final evaluation design and corresponding logic model. The evaluation will also employ an advisory board and individual sub-study working groups comprised of experts and PWUD who will oversee the development and implementation of the overall evaluation as well as each sub-study. DISCUSSION: This evaluation will draw on implementation science research practices to evaluate and understand the full impacts of this novel drug policy experiment. Results will be widely disseminated through manuscripts, reports, presentations, and infographics, which will be adapted and tailored for specific audiences. The protocol identifies several anticipated challenges and limitations. This evaluation's evidence-based findings will be poised to offer pivotal insights that can shape and refine the discourse on drug policy and will serve as a critical resource for understanding the multifaceted impacts of decriminalization.

Changes in modes of cannabis consumption pre- and post-legalization and their correlates among adults in Ontario, Canada: 2017-2022.

Background: Despite an increase in the varieties of cannabis products available for consumption, limited evidence is available about the patterns of cannabis consumption methods before and after legalization.Objectives: To examine the changes in modes of cannabis use and their correlates among adults in Ontario, Canada both prior to and following cannabis legalization in 2018.Methods: Data were utilized from the 2017 to 2022 Centre for Addiction and Mental Health's (CAMH) Monitor study, a repeated cross-sectional survey of adults 18 years of age and older (n = 2,665; 56% male). The surveys employed a regionally stratified sampling design using computer-assisted telephone interviews and web surveys. Multinomial regression was performed to examine different modes of cannabis use.Results: The exclusive use of cannabis through ingestion methods increased from 4.0% in 2017 to 16.6% in 2022 (p < .001). However, the exclusive use of inhalation-based cannabis decreased from 49.4% in 2017 to 25.5% in 2022 (p < .001). Relative to inhalation-based modes, adults were about five times more likely to use ingestion-based modes in 2020 [RRR = 4.65 (2.94-7.35)] and 2022 [RRR = 4.75 (2.99-7.55)] than in 2019, after accounting for sociodemographic factors.Conclusions: Ingestion-based cannabis use among adults increased fourfold between 2017 and 2022, a period during which recreational cannabis use was legalized in Canada. The increase was especially evident after the legalization of cannabis edibles.

Identifying barriers and facilitators to COVID-19 vaccination uptake among People Who Use Drugs in Canada: a National Qualitative Study.

BACKGROUND: People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, and disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making. METHODS: Between March and October 2022, semi-structured interviews with PWUD across Canada were conducted. Fully vaccinated (2 or more doses) and partially or unvaccinated (1 dose or less) participants were recruited from a convenience sample to participate in telephone interviews to discuss facilitators, barriers, and concerns about receiving COVID-19 vaccines and subsequent boosters, and ways to address concerns. A total of 78 PWUD participated in the study, with 50 participants being fully vaccinated and 28 participants partially or unvaccinated. Using thematic analysis, interviews were coded based on the capability, opportunity, and motivation-behavior (COM-B) framework. RESULTS: Many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust toward government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD. CONCLUSION: PWLLE should be supported to design tailored information to reduce barriers and address mistrust. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.

Determining the sex-specific distributions of average daily alcohol consumption using cluster analysis: is there a separate distribution for people with alcohol dependence?

BACKGROUND: It remains unclear whether alcohol use disorders (AUDs) can be characterized by specific levels of average daily alcohol consumption. The aim of the current study was to model the distributions of average daily alcohol consumption among those who consume alcohol and those with alcohol dependence, the most severe AUD, using various clustering techniques. METHODS: Data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used in the current analyses. Clustering algorithms were applied in order to group a set of data points that represent the average daily amount of alcohol consumed. Gaussian Mixture Models (GMMs) were then used to estimate the likelihood of a data point belonging to one of the mixture distributions. Individuals were assigned to the clusters which had the highest posterior probabilities from the GMMs, and their treatment utilization rate was examined for each of the clusters. RESULTS: Modeling alcohol consumption via clustering techniques was feasible. The clusters identified did not point to alcohol dependence as a separate cluster characterized by a higher level of alcohol consumption. Among both females and males with alcohol dependence, daily alcohol consumption was relatively low. CONCLUSIONS: Overall, we found little evidence for clusters of people with the same drinking distribution, which could be characterized as clinically relevant for people with alcohol use disorders as currently defined.

A qualitative examination of substance use service needs among people who use drugs (PWUD) with treatment and service experience in Ontario, Canada.

BACKGROUND: People who use drugs (PWUD) often have complex health and social support needs related to substance use, yet face numerous barriers to service access, resulting in unmet treatment needs and a corresponding gap in treatment. While initiatives to scale up substance use services for PWUD in Canada - and Ontario - have been undertaken, these have excluded PWUD' perspectives, and their needs have largely been defined by other actors. As end-users of services, PWUD' perspectives are vital to understanding what services are required, and whether existent services are adequate, appropriate and effective. Thus, the present study aimed to elicit in-depth knowledge from PWUD with lived experience of accessing services to better understand their unmet treatment and service needs, towards closing the service and treatment gap in Ontario. METHODS: This qualitative study included one-on-one interviews conducted with a cohort of n = 45 adult PWUD with substance use and treatment experience in Ontario, Canada. Participants were recruited from substance use services based on ConnexOntario's directory of all provincial addiction services, as well as by word-of-mouth. Questions focused on participants' experiences and perspectives on substance use services towards understanding their service needs. Data underwent an inductive thematic analysis based on key themes that emerged. RESULTS: Participants commonly engaged in polysubstance use, and identified a number of unmet substance use service needs including complex factors within the current service system that influenced access to available programs. Specifically, participants suggested the need to address stigmatization and system fragmentation, increase service provision and capacity, and scale up specific services and related supports such as harm reduction, counseling, treatment, and housing. CONCLUSIONS: This study identified PWUD' needs in relation to substance use service provision in Ontario, Canada, and highlighted important areas for policy change and program planning and implementation. Concrete recommendations include the development of a government-funded, low-barrier, comprehensive and integrated service delivery and referral models that include PWUD as collaborators and program facilitators to ensure that services are as accessible, effective, and cohesive as possible. Results from this study can be used to enhance provincial substance use treatment and service provision.

A supportive school environment may reduce the risk of non-medical prescription opioid use due to impaired mental health among students.

Canada is in the midst of an ongoing, escalating opioid crisis, with significant impacts on adolescents and young adults. Accordingly, mental health impairment was examined as a risk factor for non-medical prescription opioid use (NMPOU) among high school students. In addition, the moderating effects of the school environment, in terms of the availability of mental health services and substance use policies, were characterized. Self-reported, cross-sectional data were obtained from the COMPASS study, including 61,239 students (grades 9-12) in 121 secondary schools across Canada. Current and lifetime NMPOU were ascertained. Categorical indicators of mental health impairment and school environment were derived. The main analytical strategy encompassed hierarchal multilevel logistic regression, including the addition of interaction terms to characterize the moderation effects. Current and lifetime NMPOU were reported by 5.8% and 7.2% of the students, respectively. After adjusting for confounders, students in the highest quintile of mental health impairment had odds ratios (OR) of 2.60 (95% confidence interval [CI] 2.29-2.95) and 2.96 (95% CI 2.64-3.33) for current and lifetime NMPOU, respectively when compared to students in the lowest quintile of mental health impairment. A significant interaction between mental health impairment and school environment indicated relatively lower risks of NMPOU in students from schools that provide more mental health services and have stricter substance use policies. Mental health impairment increased the risk of NMPOU, but the associations were moderated by the school environment. These findings underscore the importance of mental health services and substance use regulations in schools.

Alcohol consumption as a risk factor for tuberculosis: meta-analyses and burden of disease.

Meta-analyses of alcohol use, alcohol dosage and alcohol-related problems as risk factors for tuberculosis incidence were undertaken. The global alcohol-attributable tuberculosis burden of disease was also re-estimated.Systematic searches were conducted, reference lists were reviewed and expert consultations were held to identify studies. Cohort and case-control studies were included if there were no temporal violations of exposure and outcome. Risk relations (RRs) were pooled by using categorical and dose-response meta-analyses. The alcohol-attributable tuberculosis burden of disease was estimated by using alcohol-attributable fractions.36 of 1108 studies were included. RRs for alcohol use and alcohol-related problems were 1.35 (95% CI 1.09-1.68; I2: 83%) and 3.33 (95% CI 2.14-5.19; 87%), respectively. Concerning alcohol dosage, tuberculosis risk rose as ethanol intake increased, with evidence of a threshold effect. Alcohol consumption caused 22.02 incident cases (95% CI 19.70-40.77) and 2.35 deaths (95% CI 2.05-4.79) per 100 000 people from tuberculosis in 2014. Alcohol-attributable tuberculosis incidence increased between 2000 and 2014 in most high tuberculosis burden countries, whereas mortality decreased.Alcohol consumption was associated with an increased risk of tuberculosis in all meta-analyses. It was consequently a major contributor to the tuberculosis burden of disease.

Quantifying the global contribution of alcohol consumption to cardiomyopathy.

BACKGROUND: The global impact of alcohol consumption on deaths due to cardiomyopathy (CM) has not been quantified to date, even though CM contains a subcategory for alcoholic CM with an effect of heavy drinking over time as the postulated underlying causal mechanism. In this feasibility study, a model to estimate the alcohol-attributable fraction (AAF) of CM deaths based on alcohol exposure measures is proposed. METHODS: A two-step model was developed based on aggregate-level data from 95 countries, including the most populous (data from 2013 or last available year). First, the crude mortality rate of alcoholic CM per 1,000,000 adults was predicted using a negative binomial regression based on prevalence of alcohol use disorders (AUD) and adult alcohol per capita consumption (APC) (n = 52 countries). Second, the proportion of alcoholic CM among all CM deaths (i.e., AAF) was predicted using a fractional response probit regression with alcoholic CM crude mortality rate (from Step 1), AUD prevalence, APC per drinker, and Global Burden of Disease region as predictions. Additional models repeated these steps by sex and for the wider Global Burden of Disease study definition of CM. RESULTS: There were strong correlations (>0.9) between the crude mortality rate of alcoholic CM and the AAFs, supporting the modeling strategy. In the first step, the population-weighted mean crude mortality rate was estimated at 8.4 alcoholic CM deaths per 1,000,000 (95% CI: 7.4-9.3). In the second step, the global AAFs were estimated at 6.9% (95% CI: 5.4-8.4%). Sex-specific figures suggested a lower AAF among females (2.9%, 95% CI: 2.3-3.4%) as compared to males (8.9%, 95% CI: 7.0-10.7%). Larger deviations between observed and predicted AAFs were found in Eastern Europe and Central Asia. CONCLUSIONS: The model proposed promises to fill the gap to include AAFs for CM into comparative risk assessments in the future. These predictions likely will be underestimates because of the stigma involved in all fully alcohol-attributable conditions and subsequent problems in coding of alcoholic CM deaths.

Crude estimates of cannabis-attributable mortality and morbidity in Canada-implications for public health focused intervention priorities.

BACKGROUND: Cannabis is the most commonly used drug in Canada; while its use is currently controlled by criminal prohibition, debates about potential control reforms are intensifying. There is substantive evidence about cannabis-related risks to health in various key outcome domains; however, little is known about the actual extent of these harms specifically in Canada. METHODS: Based on epidemiological data (e.g. prevalence of relevant cannabis use rates and relevant risk behaviors; risk ratios; and annual numbers of morbidity/mortality cases in relevant domains), and applying the methodology of comparative risk assessment, we estimated attributable fractions for cannabis-related morbidity and mortality, specifically for: (i) motor-vehicle accidents (MVAs); (ii) use disorders; (iii) mental health (psychosis) and (iv) lung cancer. RESULTS: MVAs and lung cancer are the only domains where cannabis-attributable mortality is estimated to occur. While cannabis use results in morbidity in all domains, MVAs and use disorders by far outweigh the other domains in the number of cases; the popularly debated mental health consequences (e.g., psychosis) translate into relatively small case numbers. CONCLUSIONS: The present crude estimates should guide and help prioritize public health-oriented interventions for the cannabis-related health burden in the population in Canada; formal burden of disease calculations should be conducted.

Trends in drug overdose deaths among adults 65 years of age and older in Canada (2000-2022).

Background: Although young adults and middle-aged adults have borne the brunt of the drug overdose crisis in Canada, older adults are also at an increased risk of harms. We examined trends in drug overdose deaths and opioid overdose deaths among adults 65 years of age and older. Methods: Age-standardized rates of drug overdose deaths in Canada (2000-2022) and of opioid overdose deaths in Ontario (2003-2021) were computed. Drug overdose deaths were based on vital statistics registries, while opioid overdose deaths were based on toxicologic testing. Trends were characterized using joinpoint regression. Results: Drug overdose deaths among adults 65 years of age and older in Canada rose from 4.3 to 9.9 deaths per million in the entire population between 2000 and 2022 (Average Annual Percentage Change [AAPC; 95 % CI]: 3.1 % [2.6 %-3.6 %]). Increases were observed in males (AAPC [95 % CI]: 4.0 % [3.1 %-4.9 %]), females (2.1 % [1.0 %-3.2 %]) and unintentional deaths (6.0 % [1.0 %-11.3 %]) after stratification by sex and manner of death. Opioid overdose deaths among adults 65 years of age and older in Ontario increased from 1.5 to 5.2 deaths per million in the entire population between 2003 and 2021 (AAPC [95 % CI]: 7.5 % [4.5 %-10.5 %]). Conclusions: Drug overdose deaths more than doubled in Canada and opioid overdose deaths more than tripled in Ontario among adults 65 years of age and older during the past two decades. These findings indicate a need for education of patients, prioritization of harm reduction interventions, screening, intervention and treatment and adherence to prescribing guidelines.

Changes in medical cannabis use in Ontario, Canada (2014 to 2019): Trajectory of trends, medical authorization patterns and association with recreational cannabis legalization.

Objectives: We characterized trends in medical cannabis use; examined characteristics associated with medical cannabis use without medical authorization; and examined the association between recreational cannabis legalization and medical cannabis use in Ontario, Canada. Methods: Data were from a repeated, population-based, cross-sectional survey of adults (N = 19,543; 2014-2019). Cannabis use was categorized as either medical cannabis use, recreational cannabis use or no cannabis use. The analytical strategy included jointpoint regression, logistic regression and multinomial logistic regression. Results: Medical cannabis use increased from 4 % to 11 % (Annual Percentage Change [APC]: 25 %, 95 % Confidence Interval [CI]: 17 %-33 %) and recreational cannabis use increased from 9 % to 15 % (APC: 9 %, 95 % CI: 3 %-15 %) between 2014 and 2019. Being 18 to 29 years old compared with being 65+ years old was associated with an increased likelihood of medical cannabis use without medical authorization (Odds Ratio [OR]: 4.05, 95 % CI: 2.12-7.72), while being of fair or poor self-perceived health compared with excellent, very good or good self-perceived health (OR: 0.61, 95 % CI: 0.40-0.95) was associated with a decreased likelihood of medical cannabis use without medical authorization. Recreational cannabis legalization was associated with an increased likelihood of medical cannabis use compared with no cannabis use (OR: 1.48, 95 % CI: 1.19-1.85) and of recreational cannabis use compared with no cannabis use (OR: 1.35, 95 % CI: 1.11-1.65). Conclusions: Although medical cannabis use increased, it was largely used without medical authorization. Guidance and education that encourages medical usage under clinical supervision is recommended, and mitigation of known barriers to medical cannabis authorization.

Surveillance of alcohol use through population surveys in the Americas from 2010 to 2019.

AIMS: The aims of this study were to identify alcohol-related population surveys administered in the Americas, determine which alcohol-related measures are examined and identify coverage gaps regarding alcohol-related measures. METHODS: As part of the Global Information System on Alcohol and Health study, a systematic search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to identify regionally or nationally representative survey reports of the general population from 1 January 2010 to 6 August 2019. Alcohol-related measures extracted from surveys were categorized into 10 domains: alcohol consumption status; alcohol consumption; unrecorded alcohol consumption; drinking patterns; symptoms of dependence and/or harmful use; drinking during pregnancy; treatment coverage; second-hand harms; economic; and other. RESULTS: The systematic search identified 7417 survey reports, 94 of which were new and included in this study, with an additional 11 studies included from a previous systematic study of alcohol surveys. In total, 94 unique surveys and 161 unique survey waves were located, representing 105 unique survey questionnaires covering 30 countries. No population surveys were found for five member states; namely, Antigua and Barbuda, Dominica, Haiti, Saint Vincent and the Grenadines and Saint Kitts and Nevis. All countries with population-based alcohol surveys had had a population survey probing alcohol use in the past year/month. Questions regarding heavy episodic drinking, alcohol use disorders, treatment-seeking for alcohol use, drinking during pregnancy, harms to others and the amounts spent on alcohol were asked in 26, 25, 10, 6, 22 and 11 countries, respectively. CONCLUSIONS: The heterogeneity in alcohol-related population surveys in the Americas from 2010 to 2019 limits their comparability throughout countries and over time. Future surveys should implement a standardized set of core questions to provide consistency in the monitoring of alcohol consumption and alcohol-related harms.

The association between physical availability of cannabis retail outlets and frequent cannabis use and related health harms: a systematic review.

An increasing number of regions have or are considering legalising the sale of cannabis for adult use. Experience from tobacco and alcohol regulation has found that greater access to physical retail stores is positively associated with increased substance use and harm. Whether this association exists for cannabis is unclear. We completed a systematic review examining the association between cannabis retail store access and adverse health outcomes. We identified articles up until July 20, 2023 by searching four databases. We included studies examining the association between measures of cannabis store access and adverse outcomes: frequent or problematic cannabis use, healthcare encounters due to cannabis use (e.g., cannabis-induced psychosis), and healthcare encounters potentially related to cannabis (e.g., self-harm episodes). Results were compared by study design type, retail access measure, and by subgroups including: children, adolescents, young adults, adults, and pregnant individuals. This review was registered with PROSPERO (CRD42021281788). The search generated 5750 citations of which we included 32 studies containing 44 unique primary analyses (unique retail measure and outcome pairs). Studies come from 4 countries (United States, Canada, Netherlands and Uruguay). Among the included analyses, there were consistent positive associations between greater cannabis retail access and 1) increased healthcare service use or poison control calls directly due to cannabis (10/12 analyses; 83%) (2) increased cannabis use and cannabis-related hospitalization during pregnancy (4/4; 100%) and 3) frequent cannabis use in adults and young adults (7/11; 64%). There was no consistent positive association between greater cannabis retail and increased frequent cannabis use in adolescents (1/4; 25%), healthcare service use potentially related to cannabis (2/6; 33%) or increased adverse neonatal birth outcomes (2/7; 26.8%). There is a positive association between greater cannabis store access and increases in cannabis harm. In countries with legal cannabis, retail restrictions may reduce use and harm. Funding: Canadian Centre on Substance Use and Addiction (CCSA).

Effects of cannabis legalisation on patterns of cannabis consumption among adolescents in Ontario, Canada (2001-2019).

INTRODUCTION: Cannabis legalisation was enacted on 17 October 2018 in Canada. Accordingly, the effects of cannabis legalisation on patterns of cannabis consumption were examined among adolescents, including on cannabis initiation, any cannabis use, daily cannabis use and cannabis dependence. METHODS: Data from a biennial population-based, cross-sectional survey of students in Ontario were pooled in a pre-post design (2001-2019; N = 89,238). Participants provided self-reports of cannabis initiation, any cannabis use, daily cannabis use and cannabis dependence. Long-term trends in these patterns of cannabis consumption over two decades of observation were characterised to provide a broader context of usage. The effects of cannabis legalisation on patterns of cannabis consumption were quantified using logistic regression analyses. RESULTS: Long-term trends over the two decades of observation indicated that cannabis initiation decreased and then increased (p = 0.0220), any cannabis use decreased and daily cannabis use decreased (p < 0.0001 and p = 0.0001, respectively) and cannabis dependence remained unchanged (p = 0.1187). However, in comparisons between the pre-cannabis legalisation period (2001-2017) and the post-cannabis legalisation period (2019), cannabis legalisation was not associated with cannabis initiation (odds ratio; 95% confidence interval 1.00; 0.79-1.27), but it was associated with an increased likelihood of any cannabis use (1.31; 1.12-1.53), daily cannabis use (1.40; 1.09-1.80) and cannabis dependence (1.98; 1.29-3.04). DISCUSSION AND CONCLUSIONS: Cannabis legalisation was not associated with cannabis initiation, but it was associated with an increased likelihood of any cannabis use, daily cannabis use and cannabis dependence.

Cannabis legalization and driving under the influence of cannabis and driving under the influence of alcohol among adult and adolescent drivers in Ontario, Canada (2001-2019).

BACKGROUND: The impacts of cannabis legalization on driving under the influence of cannabis and driving under the influence of alcohol among adults and adolescents were examined in Ontario, Canada. METHODS: Data were sourced from adult (N=38,479) and adolescent (N=23,216) populations-based surveys (2001-2019). The associations between cannabis legalization and driving within an hour of using cannabis and driving within an hour of drinking two or more drinks of alcohol were quantified using logistic regression, with testing of multiplicative interactions between cannabis legalization and age and sex. All analyses were conducted separately for adults and adolescents and restricted to participants with a valid driver's license. RESULTS: Cannabis legalization was not associated with driving within an hour of using cannabis among adults (OR, 95% CI: 1.21, 0.69-2.11). However, a multiplicative interaction indicated that there was an increased likelihood of driving within an hour of using cannabis among adults ≥55 years of age (4.23, 1.85-9.71) pre-post cannabis legalization. Cannabis legalization was not associated with driving within an hour of using cannabis among adolescents (0.92, 0.72-1.16), or with driving within an hour of consuming two or more drinks of alcohol among adults (0.78, 0.51-1.20) or adolescents (0.87, 0.42-1.82). CONCLUSIONS: An increased likelihood of driving under the influence of cannabis among adults ≥55 years of age was detected in the year following cannabis legalization, suggesting the need for greater public awareness and education and police monitoring and enforcement concerning driving under the influence of cannabis, particularly among older adults.

Exploring the association between lifetime prevalence of mental illness and transition from substance use to substance use disorders: results from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC).

BACKGROUND AND OBJECTIVES: The association between substance use disorders (SUDs) and mental illness (MI) has been well established. Previous studies reporting this association in various clinical populations have not taken into account former substance use. This may be important as increased prevalence of substance use among individuals with MI may partially explain the strong association between SUDs and MI. METHODS: In this study we included only individuals with previous substance use and explored the association between lifetime diagnosis of MI and transition from substance use to SUDs. Analyses were conducted across six different categories of substances (alcohol, nicotine, cannabis, cocaine, hallucinogens, inhalants) based on a large representative US sample, the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC, n = 43,093). RESULTS: Lifetime diagnoses of any MI, and particularly personality disorders and psychotic disorders, were found to be associated with higher prevalence of transition from substance use to SUDs across most categories of substances. This association was particularly strong for nicotine (adjusted OR = 2.95 (2.72-3.20)). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This cross-sectional study expands on previous research by highlighting the association between lifetime diagnosis of any MI and increased rates of transition from substance use to SUDs across a range of substances. Longitudinal studies exploring temporal effects of this association are further needed.

Gender differences in prevalence of substance use disorders among individuals with lifetime exposure to substances: results from a large representative sample.

BACKGROUND AND OBJECTIVES: Research regarding substance use and substance use disorders (SUDs) shows significant gender differences in prevalence of substance use and dependence. Though lifetime exposure to substances is higher among males, previous reports have not regarded gender differences in prevalence of SUDs among individuals formerly exposed to substances. In addition, though substance abuse is particularly important when exploring gender differences, previous reports have largely focused on rates of transition to substance dependence alone. In this study, we explored gender differences in prevalence of SUDs among individuals with lifetime exposure to substances using a single diagnostic category (abuse or dependence). METHODS: We analyzed 11 different categories of substances: heroin, cocaine, cannabis, nicotine, alcohol, hallucinogens, inhalants, sedatives, tranquilizers, opioids, and amphetamines. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1, n = 43,093). The impact of gender on prevalence of SUDs among individuals with lifetime exposure to substances was assessed with odds ratios (ORs) using logistic regressions and adjusted for socio-demographic factors. RESULTS: Our results show that among individuals with lifetime exposure to substances, males had a significantly higher prevalence of alcohol (OR = 2.95), sedatives (OR = 2.00), cannabis (OR = 1.93), tranquilizers (OR = 1.64), opioids (OR = 1.54), hallucinogens (OR = 1.31), and cocaine (OR = 1.26) use disorders compared with females. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Using a single broad diagnostic category highlights gender differences in the prevalence of SUDs among individuals with former exposure to substances. Specifically, the significant gender differences found for alcohol, sedatives, and cannabis use disorders may be important for tailoring preventive measures targeted at reducing rates of SUDs among males using these substances.

Changes in health harms due to cannabis following legalisation of non-medical cannabis in Canada in context of cannabis commercialisation: A scoping review.

ISSUE: On 17 October 2018, Canada legalised non-medical cannabis. Critically, the cannabis market in Canada has changed considerably since legalisation. In this scoping review, we identified available evidence on changes in cannabis-related health harms following legalisation and contextualised findings based on legal market indicators. APPROACH: Electronic searches were conducted to identify studies that compared changes in cannabis-related health harms pre- and post-legalisation. We contextualised each study by the mean per capita legal cannabis stores and sales during the study period and compared study means to per capita stores and sales on October 2021-3 years following legalisation. IMPLICATIONS AND CONCLUSIONS: Some measures of cannabis harms have increased since legalisation but studies to date have captured periods of relatively low market maturity. Longer-term monitoring of health harms as the market continues to expand is indicated.

The impact of methamphetamine use on medications for opioid use disorder (MOUD) treatment retention: a scoping review.

BACKGROUND: An emerging public health threat of methamphetamine/opioid co-use is occurring in North America, including increases in overdoses related to concomitant methamphetamine/opioid use. This presents a potential risk to established treatments for opioid use disorder (i.e., medications for opioid use disorder [MOUD]). To date, few studies have examined the impact of methamphetamine use on MOUD-related outcomes, and no studies have synthesized data on MOUD retention. METHODS: A scoping review was undertaken to examine the impact of methamphetamine use on MOUD retention. All original published research articles were searched in Embase, MEDLINE, PsychINFO, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Cochrane Protocols, and Google scholar databases. Data were extracted into a standardized data extraction chart. Findings were presented narratively. RESULTS: All eight included studies demonstrated an increased likelihood of treatment discontinuation or dropout among patients enrolled in MOUD who used methamphetamine. The frequency of methamphetamine use was also associated with MOUD dropout, in that those who used methamphetamine more often were more likely to discontinue MOUD. The definitions and measurements of MOUD retention varied considerably, as did the magnitude of effect size. CONCLUSIONS: Results indicate that methamphetamine use has an undesirable impact on MOUD retention and results in an increased risk of treatment discontinuation or dropout. Strategies to identify concurrent methamphetamine use among individuals engaging in MOUD and educate them on the increased risk for dropout should be undertaken. Further research is needed to understand how MOUD retention among patients with concomitant opioid and methamphetamine use can be improved.

Modeling the impact of COVID-19 pandemic-driven increases in alcohol consumption on health outcomes and hospitalization costs in the United States.

BACKGROUND AND AIMS: Alcohol consumption increased in the early phases of the COVID-19 pandemic in the United States. Alcohol use disorder (AUD) and risky drinking are linked to harmful health effects. This paper aimed to project future health and cost impacts of shifts in alcohol consumption during the COVID-19 pandemic. DESIGN: An individual-level simulation model of the long-term drinking patterns for people with life-time AUD was used to simulate 10 000 individuals and project model outcomes to the estimated 25.9 million current drinkers with life-time AUD in the United States. The model considered three scenarios: (1) no change (counterfactual for comparison); (2) increased drinking levels persist for 1 year ('increase-1') and (3) increased drinking levels persist for 5 years ('increase-5'). SETTING: United States. PARTICIPANTS: Current drinkers with life-time AUD. MEASUREMENTS: Life expectancy [life-years (LYs)], quality-adjusted life-years (QALYs), alcohol-related hospitalizations and associated hospitalization costs and alcohol-related deaths, during a 5-year period. FINDINGS: Short-term increases in alcohol consumption (increase-1 scenario) resulted in a loss of 79 000 [95% uncertainty interval (UI]) 26 000-201 000] LYs, a loss of 332 000 (104 000-604 000) QALYs and 295 000 (82 000-501 000) more alcohol-related hospitalizations, costing an additional $5.4 billion ($1.5-9.3 billion) over 5 years. Hospitalizations for cirrhosis of the liver accounted for approximately $3.0 billion ($0.9-4.8 billion) in hospitalization costs, more than half the increase across all alcohol-related conditions. Health and cost impacts were more pronounced for older age groups (51+), women and non-Hispanic black individuals. Increasing the duration of pandemic-driven increases in alcohol consumption in the increase-5 scenario resulted in larger impacts. CONCLUSIONS: Simulations show that if the increase in alcohol consumption observed in the United States in the first year of the pandemic continues, alcohol-related mortality, morbidity and associated costs will increase substantially over the next 5 years.