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Journal ArticleDOI: 10.1111/ADD.15458

Heroin use cannot be measured adequately with a general population survey.

02 Mar 2021-Addiction (John Wiley & Sons, Ltd)-Vol. 116, Iss: 10, pp 2600-2609
Abstract: Background Globally, heroin and other opioids account for more than half of deaths and years-of-life-lost due to drug use and comprise one of the four major markets for illegal drugs. Having sound estimates of the number of problematic heroin users is fundamental to formulating sound health and criminal justice policies. Researchers and policymakers rely heavily upon general population surveys (GPS), such as the US National Survey on Drug Use and Health (NSDUH), to estimate heroin use, without confronting their limitations. GPS-based estimates are also ubiquitous for cocaine and methamphetamine, so insights pertaining to GPS for estimating heroin use are also relevant for those drug markets. Analysis Four sources of potential errors in NSDUH are assessed: selective non-response, small sample size, sampling frame omissions and under-reporting. An alternative estimate drawing on a variety of sources including a survey of adult male arrestees is presented and explained. Other approaches to prevalence estimation are discussed. Findings Under-reporting and selective non-response in NSDUH are likely to lead to substantial underestimation. Small sample size leads to imprecise estimates and erratic year-to-year fluctuations. The alternative estimate provides credible evidence that NSDUH underestimates the number of frequent heroin users by at least three-quarters and perhaps much more. Implications GPS, even those as strong as NSDUH, are doomed by their nature to estimate poorly a rare and stigmatized behavior concentrated in a hard-to-track population. Although many European nations avoid reliance upon these surveys, many others follow the US model. Better estimation requires models that draw upon a variety of data sources, including GPS, to provide credible estimates. Recent methodological developments in selected countries can provide guidance. Journals should require researchers to critically assess the soundness of GPS estimates for any stigmatized drug-related behaviors with low prevalence rates.

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Topics: Population (53%), Estimation (51%)
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13 results found


Journal ArticleDOI: 10.1001/JAMAPSYCHIATRY.2021.2588
22 Sep 2021-JAMA Psychiatry
Abstract: Importance Mortality associated with methamphetamine use has increased markedly in the US. Understanding patterns of methamphetamine use may help inform related prevention and treatment. Objective To assess the national trends in and correlates of past-year methamphetamine use, methamphetamine use disorder (MUD), injection, frequent use, and associated overdose mortality from 2015 to 2019. Design, Setting, and Participants This cross-sectional study analyzed methamphetamine use, MUD, injection, and frequent use data from participants in the 2015 to 2019 National Surveys on Drug Use and Health (NSDUH). Mortality data were obtained from the 2015 to 2019 National Vital Statistics System Multiple Cause of Death files. Exposures Methamphetamine use. Main Outcomes and Measures Methamphetamine use, MUD, injection, frequent use, and overdose deaths. Results Of 195 711 NSDUH respondents aged 18 to 64 years, 104 408 were women (weighted percentage, 50.9%), 35 686 were Hispanic individuals (weighted percentage, 18.0%), 25 389 were non-Hispanic Black (hereafter, Black) individuals (weighted percentage, 12.6%), and 114 248 were non-Hispanic White (hereafter, White) individuals (weighted percentage, 60.6%). From 2015 to 2019, overdose deaths involving psychostimulants other than cocaine (largely methamphetamine) increased 180% (from 5526 to 15 489; P for trend <.001); methamphetamine use increased 43% (from 1.4 million [95% CI, 1.2-1.6 million] to 2.0 million [95% CI, 1.7-2.3 million]; P for trend = .002); frequent methamphetamine use increased 66% (from 615 000 [95% CI, 512 000-717 000] to 1 021 000 [95% CI, 860 000-1 183 000]; P for trend = .002); methamphetamine and cocaine use increased 60% (from 402 000 [95% CI, 306 000-499 000] to 645 000 [95% CI, 477 000-813 000]; P for trend = .001); and MUD without injection increased 105% (from 397 000 [95% CI, 299 000-496 000] to 815 000 [95% CI, 598 000-1 033 000]; P for trend = .006). The prevalence of MUD or injection surpassed the prevalence of methamphetamine use without MUD or injection in each year from 2017 to 2019 (60% to 67% vs 37% to 40%; P for trend ≤.001). Adults with MUD or using injection were more likely to use methamphetamine frequently (52.68%-53.84% vs 32.59%; adjusted risk ratio, 1.62-1.65; 95% CI, 1.35-1.94). From 2015 to 2019, the adjusted prevalence of MUD without injection more than tripled among heterosexual women (from 0.24% to 0.74%; P < .001) and lesbian or bisexual women (from 0.21% to 0.71%; P < .001) and more than doubled among heterosexual men (from 0.29% to 0.79%; P < .001) and homosexual or bisexual men (from 0.29% to 0.80%; P = .007). It increased over 10-fold among Black individuals (from 0.06% to 0.64%; P < .001), nearly tripled among White individuals (from 0.28% to 0.78%; P < .001), and more than doubled among Hispanic individuals (from 0.39% to 0.82%; P < .001). Risk factors for methamphetamine use, MUD, injection, and frequent use included lower educational attainment, lower annual household income, lack of insurance, housing instability, criminal justice involvement, comorbidities (eg, HIV/AIDS, hepatitis B or C virus, depression), suicidal ideation, and polysubstance use. Conclusions and Relevance This cross-sectional study found consistent upward trends in overdose mortality, greater risk patterns of methamphetamine use, and populations at higher risk for MUD diversifying rapidly, particularly those with socioeconomic risk factors and comorbidities. Evidence-based prevention and treatment interventions are needed to address surges in methamphetamine use and MUD.

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2 Citations


Open accessJournal ArticleDOI: 10.1111/ADD.15480
Rebecca McKetin1Institutions (1)
22 Mar 2021-Addiction

1 Citations



Open accessPosted ContentDOI: 10.1101/2020.09.25.20201848
28 Sep 2020-medRxiv
Abstract: Background. We extend the model introduced by Anderson et al. [M.D. Anderson, D.I. Rees, J.J. Sabia, American Journal of Public Health 104, 2369-2376] to evaluate the public mental health implications of new developments in marijuana policy, such as recreational marijuana access and additional years of data on suicide mortality. Methods. We obtained state-level suicide data from the National Vital Statistics System9s Mortality Detail Files for 1999-2018. We used panel regression analysis to examine the association between suicides per 100 000 population and both medical and recreational marijuana access. Three specifications of the equation were employed as a robustness test. Results. After adjusting for economic conditions, alcohol taxes and consumption, time effects, state fixed effects, and state-specific linear time trends, the legalization of recreational marijuana was associated with a 2.9% (95% confidence interval [CI] = -5.6, -.03) reduction in the suicide rate for the most rigorous specification, but didn9t pass the robustness check at the P < .05 level for the other two specifications. However, recreational marijuana legalization was associated with a 5.4% reduction (95% CI = -9.4%, -1.4%) in suicide rates for males in the 40 to 49 age group, passing the robustness check for all specifications. Conclusion. Suicide rates among men in the 40 to 49 age group fell after recreational marijuana legalization compared with those in states that did not legalize, which is consistent with the results found by Anderson et al. for medical marijuana when that same population was younger. There was no consistent relationship between medical marijuana legalization and suicide rates for any population. Additionally, mental health indicators at the state level were unaffected by either recreational or medical marijuana legalization. We confirm the findings of Anderson et al. (2014), observing no consistent relationship between marijuana legalization and observable mental health outcomes. However, suicide rates increase at lower rates on average relative to other states following recreational marijuana legalization.

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Topics: Legalization (53%), Population (53%)

1 Citations


Journal ArticleDOI: 10.1111/ADD.15596
Martijn van Hasselt1Institutions (1)
22 Jun 2021-Addiction
Topics: Substance abuse (55%)

1 Citations


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32 results found


Open accessJournal ArticleDOI: 10.1056/NEJMRA1508490
Abstract: A large fraction of heroin users now report that they formerly used prescription opioids nonmedically, a finding that has led to restrictions on opioid prescribing. Nevertheless, only a small fraction of prescription-opioid users move on to heroin use.

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Topics: Prescription Drug Misuse (55%), Heroin (53%), Oxycodone (51%)

798 Citations


Open accessJournal ArticleDOI: 10.1016/S2215-0366(18)30337-7
Abstract: Summary Background Alcohol and drug use can have negative consequences on the health, economy, productivity, and social aspects of communities. We aimed to use data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 to calculate global and regional estimates of the prevalence of alcohol, amphetamine, cannabis, cocaine, and opioid dependence, and to estimate global disease burden attributable to alcohol and drug use between 1990 and 2016, and for 195 countries and territories within 21 regions, and within seven super-regions. We also aimed to examine the association between disease burden and Socio-demographic Index (SDI) quintiles. Methods We searched PubMed, EMBASE, and PsycINFO databases for original epidemiological studies on alcohol and drug use published between Jan 1, 1980, and Sept 7, 2016, with out language restrictions, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to estimate population-level prevalence of substance use disorders. We combined these estimates with disability weights to calculate years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 1990–2016. We also used a comparative assessment approach to estimate burden attributable to alcohol and drug use as risk factors for other health outcomes. Findings Globally, alcohol use disorders were the most prevalent of all substance use disorders, with 100·4 million estimated cases in 2016 (age-standardised prevalence 1320·8 cases per 100 000 people, 95% uncertainty interval [95% UI] 1181·2–1468·0). The most common drug use disorders were cannabis dependence (22·1 million cases; age-standardised prevalence 289·7 cases per 100 000 people, 95% UI 248·9–339·1) and opioid dependence (26·8 million cases; age-standardised prevalence 353·0 cases per 100 000 people, 309·9–405·9). Globally, in 2016, 99·2 million DALYs (95% UI 88·3–111·2) and 4·2% of all DALYs (3·7–4·6) were attributable to alcohol use, and 31·8 million DALYs (27·4–36·6) and 1·3% of all DALYs (1·2–1·5) were attributable to drug use as a risk factor. The burden of disease attributable to alcohol and drug use varied substantially across geographical locations, and much of this burden was due to the effect of substance use on other health outcomes. Contrasting patterns were observed for the association between total alcohol and drug-attributable burden and SDI: alcohol-attributable burden was highest in countries with a low SDI and middle-high middle SDI, whereas the burden due to drugs increased with higher S DI level. Interpretation Alcohol and drug use are important contributors to global disease burden. Effective interventions should be scaled up to prevent and reduce substance use disease burden. Funding Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.

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Topics: Disease burden (67%), Years of potential life lost (53%), Quality-adjusted life year (52%) ... show more

397 Citations


Journal ArticleDOI: 10.1177/002204269502500107
Abstract: Surveys of drug use are continually criticized on the premise that respondents underreport the extent of their drug use. Validation studies conducted prior to the mid-1980s involving known samples of drug users or urinalysis techniques showed that drug use was fairly accurately reported in self-report surveys. However, more recent validation studies conducted with criminal justice clients using improved urinalysis techniques suggest less concordance between urinalysis and self-report. This paper reviews these studies and their implications for the validity of self-report in epidemiological drug surveys. Some general conclusions can be drawn from various validation studies. Valid self-reporting of drug use is a function of: 1) the recency of the event, 2) the social desirability of the drug, and 3) nuances of data collection methodology. The paper discusses methods used to improve the validity and quality of self-report data on drug use.

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235 Citations


Open accessJournal ArticleDOI: 10.1016/J.JPEDS.2015.04.071
Abstract: Objectives To examine the relationship between nonmedical use of prescription opioids and heroin initiation from childhood to young adulthood, and to test whether certain ages, racial/ethnic, and income groups were at higher risk for this transition. Study design Among a nationally representative sample of US adolescents assessed in the 2004-2011 National Surveys on Drug Use and Health cross-sectional surveys (n = 223 534 respondents aged 12-21 years), discrete-time hazard models were used to estimate the age-specific hazards of heroin initiation associated with prior history of nonmedical use of prescription opioids. Interactions were estimated between prior history of nonmedical use of prescription opioids and age of nonmedical use of prescription opioid initiation, race/ethnicity, and income. Results A prior history of nonmedical use of prescription opioids was strongly associated with heroin initiation (hazard ratio 13.12, 95% CI 10.73, 16.04). Those initiating nonmedical use of prescription opioids at ages 10-12 years had the highest risk of transitioning to heroin use; the association did not vary by race/ethnicity or income group. Conclusions Prior use of nonmedical use of prescription opioids is a strong predictor of heroin use onset in adolescence and young adulthood, regardless of the user's race/ethnicity or income group. Primary prevention of nonmedical use of prescription opioids in late childhood may prevent the onset of more severe types of drug use such as heroin at later ages. Moreover, because the peak period of heroin initiation occurs at ages 17-18 years, secondary efforts to prevent heroin use may be most effective if they focus on young adolescents who already initiated nonmedical use of prescription opioids.

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Topics: Medical prescription (53%), Substance abuse (52%), Heroin (51%)

167 Citations


Open accessJournal ArticleDOI: 10.1016/S0140-6736(19)32229-9
Louisa Degenhardt1, Jason Grebely2, Jack Stone3, Matthew Hickman3  +7 moreInstitutions (7)
26 Oct 2019-The Lancet
Abstract: Summary We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40·5 million people were dependent on opioids (95% uncertainty interval 34·3–47·9 million) and 109 500 people (105 800–113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes—eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7·7% of deaths in Kentucky, 10·7% in Kiev, and 25·9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.

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148 Citations


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