'Spice' Use Motivations, Experiences, and Repercussions among Veterans of the United States Armed Forces.

BACKGROUND AND OBJECTIVES: The potential for synthetic cannabinoids (SCs) to function as an alternative to marijuana without the same risk of a positive urinalyses led to claims of pervasive military SC use. Case studies confirm use among veterans, but no study has adequately explored SC use in the military using detailed interview data. METHODS: Interviews (1-2 h) were conducted with 318 justice-involved veterans. Recruitment was attempted with all participants in eight veterans treatment courts in three U.S. states (54.9% of 579 eligible veterans). Interviews were transcribed and thematic analyses completed. RESULTS: SC use was reported by 65 participants (21.3%). Major emergent themes indicated SCs were perceived as unpleasant, overly powerful, and a poor substitute for marijuana. Further, habitual use was rare as many chose not to reuse after initial negative experiences. Few indicated that the perception that SCs would not appear on routine military urinalyses enabled their use. Veterans were aware of the changing drug composition and feared "bad batches." CONCLUSIONS: SCs were explicitly disliked both independently and relative to marijuana. Nine discussed avoiding positive military drug screens as a consideration, but negative initial experiences generally prevented progression to habitual use. Veterans did not view SCs as a suitable marijuana replacement. Fears that SCs are being used as a marijuana alternative among veterans subject to frequent drug testing appear unfounded. These interviews suggest that routine military drug testing did not motivate individuals to use SCs habitually as a marijuana replacement; however, veterans' negative interpretation of SC effects contributed to this outcome.

Brief report: Synthetic cannabinoid use among military personnel.

BACKGROUND AND OBJECTIVES: Synthetic cannabinoids (SCs) may function as a marijuana alternative for soldiers subject to frequent drug screens, yet no study has interviewed past military users of SCs. METHODS: Veterans participating in eight US veterans treatment courts were interviewed (n = 318; response rate = 54.9%). Thematic analyses were completed. RESULTS: Sixty-five veterans (21.3%) reported SC use. Three major themes were identified: SCs were not a suitable marijuana replacement, the experience was unpleasant/problematic, and curiosity, sometimes paired with the perception of safely eluding drug screens, facilitated use. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: While members of the military experimented with SCs, habitual use of SCs within the Armed Forces does not appear widespread. The perception that SCs are excluded from all urinalyses may contribute to experimentation, but the unpleasant experience generally discourages recurrent use.

Does cannabis testing in the military drive synthetic cannabinoid use? Self-reported use motivations among justice-involved veterans.

BACKGROUND: Though synthetic cannabinoid receptor agonists (SCRAs) were controlled after being introduced as a 'legal high,' SCRAs likely remain appealing to individuals subject to routine drug screens as not all testing programs consistently include SCRAs. Military populations have been linked to SCRAs due to the unconfirmed supposition that testing protocols led many to substitute SCRAs for cannabis. This study aimed to explore SCRA use prevalence, correlates, and use motivations among veterans, with a particular focus on whether United States military personnel substituted SCRAs for cannabis to subvert testing protocols. METHODS: All veterans appearing in one of eight civilian criminal courts in three U.S. states were invited to answer questionnaire items related to military service, court functionality, and substance use. Of the 579 veterans eligible, 54.9% chose to participate, yielding a cross-sectional sample of 318 veterans charged with a criminal offense by civilian authorities. RESULTS: Sixty-five (21.3%) justice-involved veterans reported lifetime SCRA use. Use while within the military was reported by 15.0% of veterans enlisting after 2008. Only eight (12.3%) reported SCRAs were used as a substitute for cannabis. Boredom (36.9%), experimentation (27.7%), and social aspects of SCRA use (32.3%) were more commonly reported motives. Logistic regression models indicated that use of cannabis (aPR=2.06, p<.05), hallucinogens (aPR=2.50, p<.01), and SCRAs (aPR=2.49, p<.05) while in the military were risk factors for SCRA use after leaving the military, whereas older age at time of military exist was a protective factor (aPR=.87, p<.01) CONCLUSIONS: Drug testing programs within the military do not appear to have the unintended consequence of routing individuals to more risky drugs; however, SCRAs appear to have been an underappreciated problem within the military. Further, use extends beyond the military with many only initiating use after discharge, suggesting SCRA use may jeopardize the health of veterans post-service.

Sexual Orientation and Synthetic Cannabinoid Use: Examining the Role of Bullying Victimization.

Bullying is a common experience among youths with many adverse consequences. Research indicates that those who identify as lesbian, gay, and bisexual experience bullying at greater levels than heterosexuals. Studies also indicate that sexual minorities are more likely to use alcohol and other drugs, including synthetic cannabinoids (SCs). This paper examines whether the relationship between sexual minority status and SC use is mediated by differential exposure to bullying victimization. Data from the 2015 and 2017 Youth Risk Behavior Study were used. Participants include 30,389 adolescents. Supplemental analyses were conducted with state and district data as those collection efforts incorporated additional bullying measures. Ianobucci's zmediation was used to assess the relationships between sexual orientation, bullying victimization, and SC use. Results confirm the higher prevalence of bullying and SC use among LGBQ students. Multiple forms of bullying victimization (e.g., in-person, online, because of weight/appearance) mediate the relationship between sexual orientation and SC use. The greater prevalence of SC use within the LGBQ population is partially attributed to coping as a result bullying victimization.

Suicidal Ideation, Planning, and Attempts Among Synthetic Cannabinoid Users Across Different Demographic Subgroups.

Background: Case studies have linked synthetic cannabinoid (SC) use to suicide risk both during and following acute psychoactive effects. No study has explored whether a meaningful relationship exists between SC use and suicidal ideation, planning, and attempts within a generalizable sample. Aims: This work attempted to determine whether SC use is significantly associated with suicidal thoughts, planning, or attempts and whether the association between SC use and suicide may be stronger in certain demographic groups. Method: Cross-sectional self-report data from the Youth Risk Behavior Surveillance System were utilized. Logistic regression models were explored within a sample of 29,384 adolescents. Results: A clear connection emerged between SC use and suicidal thoughts and attempts. SC use and suicide risk were strongly related within the lesbian, gay, and bisexual and African Americans populations, even after controlling for depressive symptoms. Limitations: The study was cross-sectional and respondents may have underreported substance use or suicidal thoughts. Conclusion: Whether SC use has an impact on suicidal ideation directly, indirectly, or if it is simply a co-occurring phenomenon, it may serve as a flag of enhanced risk. Physicians must remain cognizant of the SC-suicide risk connection, particularly among African American and/or lesbian, gay, or bisexual patients.

Online Peers and Offline Highs: An Examination of Online Peer Groups, Social Media Homophily, and Substance Use.

Research indicates that youths are particularly susceptible to peer influence and that identifying with substance using peer groups predicts substance use. Today, youth spend more time interacting with distal peer groups via the Internet and have increased access to online drug cultures. Theoretically, this should have important implications for substance use. This study employs a nationally representative sample of U.S. youth (n = 1212), ages 15-25 years old, to examine whether online peer group identification and social media homophily predict substance use. Results indicate that online belonging and social media homophily are associated with some forms of substance use. While these factors were not significantly associated with regular marijuana or alcohol use among those who had initiated use, they predicted regular stimulant and opioid use among substance users. This suggests that online peer groups may promote progression into more problematic forms of substance use. Additional analyses of adolescent and young adult subgroups revealed important similarities and differences among the groups. The findings imply several directions for future research, and suggest that prevention policies and programs should continue to consider the role of online peers, and the Internet generally, in substance use initiation, escalation, and prevention.

Exploring the Relationships between Sexual Orientation and Gender Identity and Youth Synthetic Cannabinoid Use.

Purpose: Existing studies have identified sexual minorities as being at enhanced risk for reporting synthetic cannabinoid (SC) use. It is unclear whether this association is the result of those that identify as a minority due to sexual orientation being more likely to use SCs, due to those that identify as transgender using SCs more, or both. Deconstructing this relationship will allow for targeted clinical advice and public health campaigns. Methods: Data from the 2015 and 2017 Youth Risk Behavior Study are utilized. In total, 31,279 youth were asked about their gender identity, sexual orientation, and SC use history. Bivariate analyses and logistic regression models were completed to explore relevant associations. Results: Identifying as lesbian, gay, bisexual, or questioning was linked to SC use and continuing SC use. Similarly, identifying as transgender was linked to SC use and continuing use. Regression analyses showed no significant interactive effect; identifying as both LGBQ and transgender does not have a compounding effect on use likelihood. Conclusions: Both sexual orientation and gender identity contribute to the relationship between sexual minority status and SC use noted in extant literature. This relationship is hypothesized to be tied to increased exposure to discrimination, victimization, and social isolation. Thus, efforts to directly counsel LGBTQ patients about the dangers associated with SC use are warranted as well as social policy reforms to better protect and support members of the LGBTQ community.

Police Stress, Mental Health, and Resiliency during the COVID-19 Pandemic.

The COVID-19 pandemic created social upheaval and altered norms for all members of society, but its effects on first responders have been particularly profound. Law enforcement officers have been expected to coordinate local shutdowns, encourage social distancing, and enforce stay-at-home mandates all while completing the responsibilities for which they are already understaffed and underfunded. The impact of the COVID-19 pandemic on officer stress, mental health, resiliency, and misconduct is explored drawing insight from reactions to the HIV epidemic over two decades earlier and the terrorist attacks of September 11, 2001. COVID-19 policing is hypothesized to serve as a significant stressor for officers and compound the general and organizational stress associated with the occupation. Avenues for providing officer support are discussed and recommendations for research into the phenomenon presented.

The "Other Side of The Fence": A Learning- And Control-Based Investigation Of The Relationship Between Deviance And Friendship Quality.

Utilizing frameworks of social control and differential association theories, this study addresses the extent to which deviance (a predictor) is related to friendship quality (the outcome). Using dyadic data, results demonstrate that the highest estimates of friendship quality come from actors who have non-deviant friends and who also refrain from theft and violence themselves. Shared deviance within the friendship, referred to as 'homophily,' harms friendship quality, although it does not mediate or moderate the deviance - friendship quality link. Overall, deviance relates to friendship quality in a way that supports a bonding tradition more than a learning tradition.

Butane hash oil and dabbing: insights into use, amateur production techniques, and potential harm mitigation.

The use of marijuana concentrates has escalated in recent years with butane extracts appearing particularly popular. The administration of butane hash oil, colloquially referred to as "dabbing," is distinct from traditional flower cannabis usage due to the THC content of samples and the presence of impurities such as unpurged butane. While this may confer heightened risk to the user, additional significant concerns are tied to fires and explosions. Using butane as a solvent in amateur "blasting" methods may result in a flammable vapor pooling in enclosed spaces and igniting when exposed to a spark. As research on butane extract users, amateur production techniques, health risks, and legality is in its infancy, we explored existing studies on the topic to create a review of substantiated knowledge related to THC extracted using butane. The resulting assessment centers on three areas: 1) dab users including both recreational users and medical marijuana patients; 2) butane extraction techniques including illicit amateur open methods and the safer closed-loop system employed in medicinal/recreational states; and 3) risks, both related to fires and legality. We follow the presentation of this material with a summary of the (mis)information reaching the public in print and online sources so that public educational campaigns can focus on dispelling the inaccuracies and false notions of safety that may be tied to amateur production.

Exploring synthetic heroin: Accounts of acetyl fentanyl use from a sample of dually diagnosed drug offenders.

INTRODUCTION AND AIMS: Acetyl fentanyl, a fentanyl analogue emerging onto the recreational drug scene, has been responsible for numerous recent fatal overdoses in the USA, Europe and Russia. Studies reporting acetyl fentanyl use are presently limited to case studies and mortality reports. This study explores the nature of acetyl fentanyl use through the collection of first-hand qualitative data from users to inform public health and drug control policy responses. DESIGN AND METHODS: A series of focus group interviews within a correctional setting-Delaware County (Ohio) Jail, USA. Participants were 102 individuals in one of two US Bureau of Justice Assistance Second Chance Act substance use treatment initiatives participating in at least one focus group session. Five of these individuals reported acetyl fentanyl use. Semi-structured qualitative focus group sessions queried subjects' drugs of choice and nature of drug use. Responses were explored through follow-up organic discourse. RESULTS: Acetyl fentanyl users were generally unaware that they had administered the substance until after use (initially believing that they were administering heroin). They described the effects of acetyl fentanyl as stronger and qualitatively different from heroin. These individuals showed no interest in using acetyl fentanyl again describing it as unpleasant and more risky, both because of potency and the threat of a 'bad batch'. DISCUSSION AND CONCLUSIONS: Acetyl fentanyl is reaching heroin users, some of which administer it unknowingly. Regulation of acetyl fentanyl is recommended in all countries as is increasing public awareness that the substance is distinct from and being sold as heroin. [Miller JM, Stogner JM, Miller BL, Blough S. Exploring synthetic heroin: Accounts of acetyl fentanyl use from a sample of dually diagnosed drug offenders. Drug Alcohol Rev 2018;37:121-127].

How Strong is the "Fake ID Effect?" An Examination Using Propensity Score Matching in Two Samples.

BACKGROUND: Underage college students who obtain and use false identification (fake ID) are at risk for negative outcomes. However, it is currently unclear how uniquely the fake ID itself serves as a vehicle to subsequent harm (i.e., the "fake ID effect") over and above general and trait-related risk factors (e.g., deviant peers, low self-control). METHODS: To investigate whether the "fake ID effect" would hold after accounting for phenotypic risk, we utilized propensity score matching (PSM) in a cross-sectional sample of 1,454 students, and a longitudinal replication sample of 3,720 undergraduates. Individuals with a fake ID were matched with individuals without a fake ID, in terms of a number of trait-based and social risk factors. These matched groups were then compared on 5 problematic outcomes (i.e., frequent binge drinking, alcohol-related problems, arrests, marijuana use, and hard drug use). RESULTS: Findings showed that "fake ID effects" were substantially-although not fully-diminished following PSM. The "fake ID effect" remained strongest for alcohol-related arrests. This may relate to issues of enforcement and students' willingness to engage in deviant behavior with a fake ID, or it may be a function of combined processes. CONCLUSIONS: Overall, the findings suggest that interventions should not only be aimed at reducing the fake ID-related alcohol access specifically, but should also be aimed more generally toward at-risk youths' access to alcohol. Future research might examine whether fake IDs have their strongest potency as moderators of the effects of risky traits-such as impulsiveness-on drinking outcomes.

Deception and Drug Acquisition: Correlates of "Success" Among Drug-Seeking Patients.

PURPOSE: Most research examining patient-based drug diversion neglects to assess physician deception directly. We attempt to determine if motives for deception are linked to success, and, similarly, if any health, demographic, or substance use history characteristics of the patients are predictive of being able to successfully deceive a physician. METHODS: Stratified random sampling was utilized to obtain a sample of 2349 young adults. Respondents completed a survey detailing their substance use histories and whether they had ever deceived a physician for medication. Ninety-three of these respondents reported attempting to deceive a physician for a medication and compose the analytic sample for the study. RESULTS: Of the 93 young adults who reported having attempted to deceive a physician for pharmaceuticals (4.0% of the general sample), 64 (68.8%) were successful. This included 24 only seeking medications for their own use, 9 only for financial purposes, and 31 with both motives. Respondents who reported recreationally using pharmaceuticals in the past were more likely to report successful attempts at obtaining a prescription compared with respondents without a history of abuse. With respect to demographic characteristics of the respondents, only race/ethnicity distinguished between successful attempts and failure. CONCLUSIONS: Although a rare occurrence in the overall sample, significant correlates of successful deception did emerge. Respondents motivated to obtain a prescription in order to sell it to others were overwhelmingly likely to succeed in their pursuit to deceive as compared with respondents who sought prescriptions for their own abuse. Successful deceivers were also more likely to have been legitimately prescribed medication in the past. Successful respondents were more likely to be Caucasian than any other race/ethnicity.

Genetic Modification of the Relationship between Parental Rejection and Adolescent Alcohol Use.

AIMS: Parenting practices are associated with adolescents' alcohol consumption, however not all youth respond similarly to challenging family situations and harsh environments. This study examines the relationship between perceived parental rejection and adolescent alcohol use, and specifically evaluates whether youth who possess greater genetic sensitivity to their environment are more susceptible to negative parental relationships. METHODS: Analyzing data from the National Longitudinal Study of Adolescent Health, we estimated a series of regression models predicting alcohol use during adolescence. A multiplicative interaction term between parental rejection and a genetic index was constructed to evaluate this potential gene-environment interaction. RESULTS: Results from logistic regression analyses show a statistically significant gene-environment interaction predicting alcohol use. The relationship between parental rejection and alcohol use was moderated by the genetic index, indicating that adolescents possessing more 'risk alleles' for five candidate genes were affected more by stressful parental relationships. CONCLUSIONS: Feelings of parental rejection appear to influence the alcohol use decisions of youth, but they do not do so equally for all. Higher scores on the constructed genetic sensitivity measure are related to increased susceptibility to negative parental relationships.

Exploring Butane Hash Oil Use: A Research Note.

The practice of "dabbing" has seen an apparent upswing in popularity in recent months within American drug subcultures. "Dabbing" refers to the use of butane-extracted marijuana products that offer users much higher tetrahydrocannabinol content than flower cannabis through a single dosage process. Though considerably more potent than most marijuana strains in their traditional form, these butane hash oil products and the practice of dabbing are underexplored in the empirical literature, especially in prohibition states. A mixed-methods evaluation of a federally funded treatment program for drug-involved offenders identified a small sample (n = 6) of butane hash oil users and generated focus group interview data on the nature of butane hash oil, the practice of dabbing, and its effects. Findings inform discussion of additional research needed on butane hash oil and its implications for the ongoing marijuana legalization debate, including the diversity of users, routes of administration, and differences between retail/medical and prohibition states.

Predictions instead of panics: the framework and utility of systematic forecasting of novel psychoactive drug trends.

BACKGROUND: Countless novel psychoactive substances have been sensationally described in the last 15 years by the media and academia. Though some become significant issues, most fail to become a substantial threat. The diversity and breadth of these potential problem substances has led policymakers, law enforcement officers, and healthcare providers alike to feel overwhelmed and underprepared for dealing with novel drugs. OBJECTIVE: Inadequacies in training and preparation may be remedied by a response that is more selective and more proactive. The current manuscript seeks to clarify how to most efficiently forecast the "success" of each newly introduced novel psychoactive substance in order to allow for more efficient decision making and proactive resource allocation. METHODS: A review of literature, published case reports, and legal studies was used to determine which factors were most closely linked to use of a novel drug spreading. Following the development of a forecasting framework, examples of its use are provided. RESULTS: The resulting five-step forecast method relies on assessments of the availability of a potential user base, the costs--legal and otherwise--of the drug relative to existent analogues, the subjective experience, the substance's dependence potential and that of any existent analogue, and ease of acquisition. These five factors should serve to forecast the prevalence of novel drug use, but reaction should be conditioned by the potential for harm. CONCLUSIONS: The five-step forecast method predicts that use of acetyl fentanyl, kratom, Leonotis leonurus, and e-cigarettes will grow, but that use of dragonfly and similar substances will not. While this forecasting approach should not be used as a replacement for monitoring, the use of the five-step method will allow policymakers, law enforcement and practitioners to quickly begin targeted evaluative, intervention, and treatment initiatives only for those drugs with predicted harm.

DAT1 and Alcohol Use: Differential Responses to Life Stress during Adolescence.

Stressful life events can impact both substance use initiation and the quantity of substances consumed by adolescents; however, the effect of stress on substance use may be contingent on other factors including social support, peers, and genotype. DAT1, a polymorphic dopamine transporter gene, is one such factor that may be responsible for differential susceptibility to cumulative life pressures. Data from the National Longitudinal Study of Adolescent Health was utilized to determine whether adolescents with the 10-repeat allele are more likely to respond to life stresses by engaging in alcohol use than those without the allele. Respondents' self-reports of key stressors were used to create a composite life stress scale. The interaction of this measure with the number of 10-repeat DAT1 alleles was evaluated in series of logistic regression models. A significant interaction emerged between stressful life experiences and DAT1 for alcohol use among females, but this pattern was not seen in males. Females with the 10-repeat allele appear to be more sensitive to life stress as compared to those without the allele. It appears that variation in the DAT1 gene may help explain why some women are more likely to consume alcohol when confronted with stress. It however does not appear to condition the reaction of men, in terms of alcohol use, to stress.

Deception for drugs: self-reported "doctor shopping" among young adults.

BACKGROUND: Pharmaceutical abuse is a burgeoning problem, and various forms of drug diversion are becoming more common. At present, little is known about those who attempt to deceive physicians to receive medications, and even less is known about those who successfully avoid detection and abuse-related repercussions. The goal of this study is to assess the prevalence of attempted physician deception in a general population, explore common motives, and evaluate risk factors associated with the behavior. METHODS: A stratified random sampling technique was used to obtain a locally representative sample of 2349 young adults. The sample was 48.4% male, 68.9% white, 24.4% black, and 2.8% Hispanic. Selected individuals were surveyed using a self-report instrument (80.4% response rate). RESULTS: Of the respondents, 93 (4.0%) self-reported having attempted to deceive a physician to obtain a pharmaceutical. Most of these indicated that they were at least partially motivated by their own abuse. Approximately half reported that selling a portion of the prescription was a motivating factor. Alcohol use, marijuana use, and pharmaceutical misuse each were risk factors associated with attempted deception. Although no traits were definitively linked to the behavior, attempted deception was more commonly reported by men, Hispanics, self-identified lesbian/gay/bisexual/transgender individuals, and those at the lowest and highest extremes of the income spectrum. Logistic regression models of rare events indicated that past substance use along with sexual orientation and family income were related to attempted deception when controlling for other factors. CONCLUSION: Results suggest that attempted physician deception may be more common than previously believed. Practicing physicians should attempt to use risk factor information presented within this study, albeit very cautiously. This study identifies general characteristics of young people who might divert medications but notes that only a small minority of any patient group will do so. Awareness should not equal bias in the treatment of these patients; instead, it should reinforce the need for careful clinical interviewing and the utilization of prescription drug monitoring programs and local law enforcement databases.