Predictors of changes in marijuana consumption in Germany during the covid-19 pandemic.

During the Covid-19 pandemic Germany experienced its first increase in the proportion of heavy cannabis users since 1995. With the expected nationwide decriminalization of cannabis before 2025, we investigate the potential causes for that increase. Data were from the 2021 European Web Survey on Drugs (EWSD) including 762 12-month marijuana users from Germany (72.9% male, mean age = 29.5 years). Both heavy and regular cannabis consumers reported an increase in marijuana consumption during the pandemic, with infrequent users reporting a decrease. Using multinomial logistic regression, we found younger individuals (OR = 0.95 [95% CI = 0.92, 0.98]) and those not pursuing or completing higher education (OR = 1.86 [1.23, 2.81]) had increased use. Additionally, using cannabis to self-medicate (OR = 2.79 [1.56, 4.99]) and purchasing marijuana (OR = 2.26 [1.35, 3.77]) was associated with increased use. We found, relative to infrequent users, both regular (OR = 4.00 [2.39, 6.72]) and notably heavy users (OR = 31.17 [12.10, 80.32]) were more likely to use cannabis to self-medicate. Both regular (OR = 4.09 [2.47, 6.77]) and especially heavy users (OR = 13.53 [6.74, 27.16]) were also more likely to purchase marijuana. Heavy users were also more likely to be past 30-day tobacco users (OR = 5.92 [2.81, 12.45]). We identified the self-reported motivation of using cannabis to self-medicate as well as act of purchasing marijuana as having the strongest relation to being a heavy user and increasing marijuana use during the Covid-19 pandemic.

Changes in the Use of Tobacco, Alternative Tobacco Products, and Tobacco Alternatives in Germany.

BACKGROUND: Due to the increasing use of alternative tobacco products (waterpipes, heat-not-burn) and tobacco alternatives (e-cigarettes), we studied recent changes in the prevalence of conventional tobacco use and alternative products. METHODS: Data come from ten waves of the Epidemiological Survey of Substance Abuse (ESA) from 1995 to 2021, with representative samples collected via paperpencil questionnaires, telephone interviews, or online. We compared the prevalence of conventional tobacco use and alternative products by gender and age (18-24, 25-39, 40-59 years). RESULTS: In all age groups, the use of conventional tobacco products decreased. The prevalence of the exclusive use of one of the three alternative products differed statistically significantly between age groups and in 2021 was higher for ages 18-24 (females: 11.1%, males: 12.4%) compared to ages 25-39 (females: 2.9%; males: 4.9%) and ages 40-59 (females: 1.4%; males: 2.0%). The use of alternative products was mainly due to the exclusive use of waterpipes among individuals aged 18 to 24 and 25 to 39 and the exclusive use of e-cigarettes among individuals aged 40 to 59. CONCLUSION: The higher prevalence of alternative product use among young adults implies a turning point that needs to be considered in prevention. Because of the addictive potential of these products, young adults can be expected to maintain their use into middle and older adulthood. There is a need to monitor the use of alternative products, identify the risks associated with them, and develop effective prevention and cessation interventions for adults.

Subtypes in Patients Taking Prescribed Opioid Analgesics and Their Characteristics: A Latent Class Analysis.

Background: Owing to their pharmacological properties the use of opioid analgesics carries a risk of abuse and dependence, which are associated with a wide range of personal, social, and medical problems. Data-based approaches for identifying distinct patient subtypes at risk for prescription opioid use disorder in Germany are lacking. Objective: This study aimed to identify distinct subgroups of patients using prescribed opioid analgesics at risk for prescription opioid use disorder. Methods: Latent class analysis was applied to pooled data from the 2015 and 2021 Epidemiological Survey of Substance Abuse. Participants were aged 18-64 years and self-reported the use of prescribed opioid analgesics in the last year (n = 503). Seven class-defining variables based on behavioral, mental, and physical health characteristics commonly associated with problematic opioid use were used to identify participant subtypes. Statistical tests were performed to examine differences between the participant subtypes on sociodemographic variables and prescription opioid use disorder. Results: Three classes were extracted, which were labeled as poor mental health group (43.0%, n = 203), polysubstance group (10.4%, n = 50), and relatively healthy group (46.6%, n = 250). Individuals within the poor mental health group (23.2%, n = 43) and the polysubstance group (31.1%, n = 13) showed a higher prevalence of prescription opioid use disorder compared to those of the relatively healthy group. Conclusion: The results add further evidence to the knowledge that patients using prescribed opioid analgesics are not a homogeneous group of individuals whose needs lie in pain management alone. Rather, it becomes clear that these patients differ in their individual risk of a prescription opioid use disorder, and therefore identification of specific risks plays an important role in early prevention.

The Use of Psychoactive Substances in Germany.

BACKGROUND: Monitoring the use of psychoactive substances and substance-related problems in the population allows for the assessment of prevalence and associated health and social consequences. METHODS: The data are derived from the Epidemiological Survey of Substance Abuse (ESA) 2021 (n = 9046, 18-64 years). We estimated prevalence rates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications, as well as the prevalence rates of their problematic use (indicating dependence) using screening instruments, and extrapolated the results to the resident population (N = 51 139 451). RESULTS: Alcohol was the most frequently used substance, with a 30-day prevalence of 70.5% (36.1 million people), followed by non-opioid analgesic drugs (47.4%; 24.2 million) and conventional tobacco products (22.7%; 11.6 million). E-cigarettes were used by 4.3% (2.2 million) and heat-not-burn products by 1.3% (665 000). Among illegal drugs (12-month prevalence), cannabis was the most frequently used (8.8%; 4.5 million), followed by cocaine/crack (1.6%; 818 000) and amphetamine (1.4%; 716 000). Rates of problematic use among the study participants were 17.6% for alcohol (9.0 million), 7.8% for tobacco (4.0 million), 5.7% for psychoactive medications (2.9 million), and 2.5% for cannabis (1.3 million). CONCLUSION: The consumption of psychoactive substances continues to be widespread in Germany. In view of the imminent legal changes, the high prevalence of cannabis use and its problematic use need to be taken into consideration.

Abuse of Non-opioid Analgesics in Germany: Prevalence and Associations Among Self-Medicated Users.

Background: Abuse of non-opioid analgesics (NOA) is associated with serious health consequences. However, due to inconsistent definitions of NOA abuse, prevalence estimates for the German population are unclear. Objectives: This study aimed to estimate the 12-month prevalence of NOA abuse among self-medicated users of these drugs in the general German population and to identify risk factors. Methods: Data are from the 2015 Epidemiological Survey of Substance Abuse, a nationally representative sample with 9,204 individuals aged 18-64 years. Classification of NOA abuse was based on self-reported information according to the definition of the ICD-10-GM diagnosis F55.2 abuse of non-dependence producing substances. Multiple logistic regression was performed to examine associations between NOA abuse and sociodemographic, behavioral, and health-related variables. Results: The weighted 12-month prevalence of NOA abuse was 14.6% (95%-CI [13.2- 16.0]) among self-medicated users of these drugs. Extrapolation of the proportion of individuals abusing NOA to the German population aged 18 to 64 is 3,243,396 individuals or 6.4% (95%-CI [5.7- 7.1]). Inexplicable physical pain, being underweight, depression, hazardous alcohol use, daily smoking, illegal drug use, and frequent use of NOA (one or more times per week and daily use) were associated with an increased probability of NOA abuse. The use of cannabis was associated with a lower probability of NOA abuse. Conclusion: Abuse of NOA is highly prevalent in the German population. Against the background of increasing self-medication of NOA, healthcare providers need to be aware of potential risk factors of abuse to better identify and prevent this problem.

Trends In Substance Use And Related Disorders: Analysis of the Epidemiological Survey of Substance Abuse 1995 to 2018.

BACKGROUND: Changes in the use of psychoactive substances and medications and in the occurrence of substance-related disorders enable assessment of the magni- tude of the anticipated negative consequences for the population. METHODS: Trends were analyzed in the consumption of tobacco, alcohol, cannabis and other illegal drugs, analgesics, and hypnotics/sedatives, as well as trends in substance-related disorders, as coded according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The data were derived from nine waves of the German Epidemiological Survey of Substance Abuse (Epidemiologischer Sucht- survey, ESA) from 1995 to 2018. The data were collected in written form or by means of a combination of paper and internet-based questionnaires or telephone interviews. RESULTS: The estimated prevalence rates of tobacco and alcohol consumption and the use of hypnotics/sedatives decreased over time. On the other hand, increasing prevalence rates were observed for the consumption of cannabis and other illegal drugs and the use of analgesics. The trends in substance-related disorders showed no statistically significant changes compared to the reference values for the year 2018, except for higher prevalence rates of nicotine dependence, alcohol abuse and dependence, analgesic dependence, and hypnotic/sedative dependence in the year 2012 only. CONCLUSION: Trends in tobacco and alcohol consumption imply a future decline in the burden to society from the morbidity, mortality, and economic costs related to these substances. An opposite development in cannabis use cannot be excluded. No increase over time was seen in the prevalence of analgesic dependence, but the observed increase in the use of analgesics demands critical attention.

The Use of Alcohol, Tobacco, Illegal Drugs and Medicines: An Estimate of Consumption and Substance-Related Disorders in Germany.

BACKGROUND: Prevalence estimates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications and of substance-related disorders enable an assessment of the effects of substance use on health and society. METHODS: The data used for this study were derived from the 2018 Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey, ESA). The sample of the German adult population comprised 9267 persons aged 18 to 64 (response rate, 42%). Population estimates were obtained by extrapolation to a total resident population of 51 544 494 people. RESULTS: In the 30 days prior to the survey, 71.6% of the respondents (correspond- ing to 36.9 million persons in the population) had consumed alcohol, and 28.0% (14.4 million) had consumed tobacco. 4.0% reported having used e-cigarettes, and 0.8% reported having used heat-not-burn products. Among illegal drugs, cannabis was the most commonly used, with a 12-month prevalence of 7.1% (3.7 million), followed by amphetamines (1.2%; 619 000). The prevalence of the use of anal- gesics without a prescription (31.4%) was markedly higher than that of the use of prescribed analgesics (17.5%, 26.0 million); however, analgesics were taken daily less commonly than other types of medication. 13.5% of the sample (7.0 million) had at least one dependence diagnosis (12-month prevalence). CONCLUSION: Substance use and the consumption of psychoactive medications are widespread in the German population. Substance-related disorders are a major burden to society, with legal substances causing greater burden than illegal substances.