Trends in drug use among nightclub and festival attendees in New York City, 2017-2022.

BACKGROUND: Drug use is prevalent among people who attend electronic dance music (EDM) parties at nightclubs or festivals. This population can serve as a sentinel population to monitor trends in use of party drugs and new psychoactive substances (NPS) that may diffuse through larger segments of the population. METHODS: We surveyed adults entering randomly selected EDM parties at nightclubs and dance festivals in New York City about their drug use in 2017 (n=954), 2018 (n=1,029), 2019 (n=606), 2021 (n=229), and 2022 (n=419). We estimated trends in past-year and past-month use of 22 drugs or drug classes based on self-report from 2017-2022 and examined whether there were shifts pre- vs. post-COVID (2017-2019 vs. 2021-2022). RESULTS: Between 2017 and 2022, there were increases in past-year and past-month use of shrooms (psilocybin), ketamine, poppers (amyl/butyl nitrites), synthetic cathinones ("bath salts"), and novel psychedelics (lysergamides and DOx series), increases in past-year cannabis use, and increases in past-month use of 2C series drugs. Between 2017 and 2022, there were decreases in past-year heroin use and decreases in past-month cocaine use, novel stimulant use, and nonmedical benzodiazepine use. The odds of use of shrooms, poppers, and 2C series drugs significantly increased after COVID, and the odds of use of cocaine, ecstasy, heroin, methamphetamine, novel stimulants, and prescription opioids (nonmedical use) decreased post-COVID. CONCLUSIONS: We estimate shifts in prevalence of various drugs among this sentinel population, which can inform ongoing surveillance efforts and public health response in this and the general populations.

Risky Party and Nightclub Attendance during the COVID-19 Nightlife Shutdown in New York City.

From March 2020 through May 2021, nightlife venues were shut down and large gatherings were deemed illegal in New York City (NYC) due to COVID-19. This study sought to determine the extent of risky party attendance during the COVID-19 shutdown among people who attend electronic dance music parties in NYC. During the first four months that venues were permitted to reopen (June through September 2021), time-space sampling was used to survey adults (n = 278) about their party attendance during the first year of the shutdown (March 2020-March 2021). We examined prevalence and correlates of attendance and mask-wearing at such parties. A total of 43.9% attended private parties with more than 10 people, 27.3% attended nightclubs, and 20.5% attended other parties such as raves. Among those who attended any, 32.3% never wore a mask and 19.3% reported attending parties in which no one wore a mask. Past-year ecstasy use was associated with increased risk for attending private (aPR = 1.51, 95% CI: 1.00-2.28) or other parties (aPR = 2.75, 95% CI: 1.48-5.13), and use of 2C series drugs was associated with increased risk for attending nightclubs (aPR = 2.67, 95% CI: 1.24-5.77) or other parties (aPR = 2.50, 95% CI: 1.06-5.87). Attending >10 parties was associated with increased risk for never wearing a mask (aPR = 2.74, 95% CI: 1.11-6.75) and for no other attendees wearing masks (aPR = 4.22, 95% CI: 1.26-14.07). Illegal dance parties continued in NYC during the COVID-19 shutdown. Prevention and harm reduction efforts to mitigate risk of COVID-19 transmission during such shutdowns are sorely needed.

Caution Is Necessary When Estimating Treatment Need for Opioid Use Disorder Using National Surveys

Heroin use in particular is thought to be severely underestimated by NSDUH largely because heroin use is a rare and particularly stigmatized behavior concentrated in hard-to-reach populations, whereas NSDUH aims to assess drug use trends in the general population.6 NSDUH also does not include certain populations in its sampling frame that may be more likely to experience OUD, including unstably housed individuals not living in shelters and incarcerated individuals.6,7 In addition, as noted by Saini et al., NSDUH does not ask questions about illicitly manufactured fentanyl use- intentional use or unintentional use via exposure as an adulterant or contaminant in substances such as cocaine and methamphetamine.8 The exclusion of fentanyl, its analogs, and other new synthetic opioids (e.g., U-47700) from NSDUH is particularly troubling given the shifting overdose epidemic, with rapidly increasing fentanyl-involved fatal overdoses and declining nonprescription opioid- and heroin-involved fatal overdoses.8,9 The absence of measures of fentanyl and novel opioids might affect prevalence estimates of opioid use and OUD in the general population. [...]prevalence estimates of past-year opioid (mis)use may be underestimated in NSDUH, potentially biasing population estimates of OUD and associated treatment needs. Physicians in outpatient nonspecialty settings were authorized to prescribe buprenorphine after receipt of training and a waiver issued by the Substance Abuse and Mental Health Services Administration with limits on the types of providers eligible to prescribe buprenorphine and the number of patients at a time to whom a provider could prescribe buprenorphine.10 Some of these strictures have been loosened to prevent coronavirus disease 2019 transmission (e.g., buprenorphine initiation via telehealth for new patients, 28-day medication supplies for established patients), but implementation of these policies across municipalities has been inconsistent.11 Understanding the prevalence of individual structural barriers to treatment access could have important implications for policy planning and expanded delivery of OUD treatment services. ACKNOWLEDGMENTS Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under award numbers R01DA044207, R01DA045872, and K01DA049900.

On the efficacy of online drug surveys during the time of COVID-19

Most human subjects research involving contact with participants has been halted in the US due to the COVID-19 crisis. We have been testing an online method to recruit and survey participants as a temporary replacement for our street-intercept survey method. Online surveys already generate less generalizable findings than other surveys, but offering compensation for online survey completion further reduces generalizability because this increases mischievous submissions. In this letter we discuss methods to help detect invalid responses, such as utilizing a screener to test for eligibility and using flags to detect mischievous responses and repeat submissions. We recommend that researchers approach online recruitment and surveying with caution.

Virtual raves and happy hours during COVID-19: New drug use contexts for electronic dance music partygoers.

BACKGROUND: The popularity of virtual raves and happy hours has increased during the COVID-19 pandemic. While nightlife settings are often associated with drug use, it is unknown whether virtual events are associated with use. METHODS: Electronic dance music (EDM) partygoers who live in New York and reported recent drug use were recruited online and screened for eligibility throughout April and May 2020. Eligible adults (n = 128) were asked about virtual rave and happy hour attendance during the COVID-19 crisis. We examined prevalence and correlates of drug use during such events. RESULTS: 55.5% of participants attended virtual raves and 69.5% attended virtual happy hours. 40.9% used illegal drugs during virtual raves and the most frequently used drugs were cannabis (29.6%), ecstasy/MDMA/Molly (8.5%), LSD (7.0%), and cocaine (4.2%). 33.7% used illegal drugs during virtual happy hours and the most frequently used drugs were cannabis (29.2%), cocaine (3.4%), and ketamine (3.4%). Older participants were more likely to use illegal drugs during virtual raves, and those reporting past-year use of more drugs were more likely to use drugs during virtual raves and/or happy hours (ps<0.05). CONCLUSIONS: EDM partygoers are at risk for using drugs during virtual events. Results can inform prevention and harm reduction efforts.

Shifts in drug seizures in the United States during the COVID-19 pandemic.

BACKGROUND: Little is known regarding how the COVID-19 pandemic has affected patterns of drug use in the United States. Because drug seizures can serve as a proxy for drug availability, we examined shifts in drug seizures in the US during the pandemic. METHODS: We examined trends in seizures of marijuana, cocaine, methamphetamine, heroin, and fentanyl within five High Intensity Drug Trafficking Areas-Washington/Baltimore, Chicago, Ohio, New Mexico, and North Florida. Trends were examined for number and total weight of seizures from March 2019 through September 2020 using Joinpoint regression. RESULTS: Significant decreases in seizures involving marijuana (ß = -0.03, P = 0.005) and methamphetamine (ß = -0.02, P = 0.026) were detected through April 2020, and then seizures of marijuana (ß = 0.10, P = 0.028) and methamphetamine (ß = 0.11, P = 0.010) significantly increased through September 2020. The number of seizures involving marijuana and methamphetamine peaked in August 2020, exceeding the highest pre-COVID-19 number of seizures. Fentanyl seizures increased overall (ß = 0.05, P < .001), but did not significantly drop during the start of COVID-19, and significant changes were not detected for cocaine or heroin. We also detected a significant increase in weight of marijuana seized from April through September 2020 (ß = 0.40, P = .001). The weight of marijuana seized in August 2020 exceeded the highest pre-COVID-19 weight. CONCLUSION: The COVID-19 pandemic was associated with an immediate decrease in marijuana and methamphetamine seizures, and then increases throughout 2020 with some months exceeding the number (and weights) of seizures from the previous year. More research is warranted to determine the extent to which these seizures reflect changes in drug use.

Shifts in Drug Use Behavior Among Electronic Dance Music Partygoers in New York During COVID-19 Social Distancing.

Background: Little is known about how COVID-19-related social distancing has affected illegal drug use. We surveyed electronic dance music (EDM) partygoers-a population known for high levels of drug use-to determine whether their drug use patterns had changed during state-mandated social distancing in New York. Methods: Individuals were recruited online and screened for eligibility throughout April and May 2020. We surveyed 128 eligible adults and queried, retrospectively, whether their drug use behavior had changed during COVID-19-related social distancing. Results: Most participants reporting past-three-month use reported decreased frequency of use during COVID-19-related social distancing. Specifically, 78.6% reduced frequency of use of cocaine, 71.1% reduced frequency of use of ecstasy/MDMA/Molly, and 68.0% reduced frequency of use of LSD. Although some participants reported increased frequency of use of cocaine (7.1%), ecstasy (7.9%), or LSD (12.0%), 35.0% reported increased frequency of cannabis use. Most (66.7%) of those reporting cocaine use reduced the amount used. The majority of those reporting use of cannabis, ecstasy, cocaine, and/or LSD reported that drug cost (80.0-84.0%) and drug quality (84.2-92.0%) did not change during social distancing. Having a college degree was associated with higher odds for decreasing frequency of cannabis use. Older participants (ages ≥23) were at lower odds for decreasing frequency of cocaine use, as were those earning >$500 per week, and participants who attended EDM events biweekly or more often were at higher odds for decreasing frequency of LSD use. Conclusions: Participants in this sample tended to reduce party drug use during COVID-19-related social distancing.

On the efficacy of online drug surveys during the time of COVID-19.

Most human subjects research involving contact with participants has been halted in the US due to the COVID-19 crisis. We have been testing an online method to recruit and survey participants as a temporary replacement for our street-intercept survey method. Online surveys already generate less generalizable findings than other surveys, but offering compensation for online survey completion further reduces generalizability because this increases mischievous submissions. In this letter we discuss methods to help detect invalid responses, such as utilizing a screener to test for eligibility and using flags to detect mischievous responses and repeat submissions. We recommend that researchers approach online recruitment and surveying with caution.