Publications by authors named "Pia M Mauro"

42 Publications

Treatment outcome and readmission risk among women in women-only versus mixed-gender drug treatment programs in Chile.

J Subst Abuse Treat 2021 Sep 1:108616. Epub 2021 Sep 1.

Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Badajoz 130, Suite 1305, Las Condes, Santiago, Chile; Department of Population Health and Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, United States; School of Public Health, Universidad Mayor, José Toribio Medina 38, Santiago, Chile. Electronic address:

Introduction: Traditional treatment programs for substance use disorder (SUD) tend to be male-dominated environments, which can negatively affect women's access to treatment and related outcomes. Women's specific treatment needs have led some providers to develop women-only SUD treatment programs in several countries. In Chile, women-only programs were only fully implemented in 2010. We compared treatment outcomes and readmission risk for adult women admitted to state-funded women-only versus mixed-gender SUD treatment programs in Chile.

Methods: We used a registry-based retrospective cohort design of adult women in women-only (N = 8200) and mixed-gender (N = 13,178) SUD treatment programs from 2010 to 2019. The study obtained data from the National Drug and Alcohol Service from Chile. We used a multistate model to estimate the probabilities of experiencing treatment completion, discharge without completion (i.e., patient-initiated discharge and administrative discharge), or readmission, as well as the likelihood of being readmitted, conditioned on prior treatment outcome. We adjusted models for multiple baseline characteristics (e.g., substance use, socioeconomic).

Results: Overall, 24% of women completed treatment and 54% dropped out of treatment. The proportion of patient-initiated discharges within the first three month was larger in women-only than in mixed-gender programs (19% vs. 12%). In both programs, women who completed treatment were more likely to experience readmission at three months, and one and three years. In the long term, women in the women-only programs were more likely to complete treatment than women in mixed-gender programs (34% vs. 23%, respectively). The readmission probability was higher among women who previously completed treatment than those who had a discharge without completion (40% vs 21% among women in women-only programs; 38% vs. 19% among women in mixed-gender programs, respectively); no differences occurred in the risk of readmission between women-only and mixed-gender programs.

Conclusions: In terms of treatment outcomes and readmission risk, women-only programs had similar results to mixed-gender programs in Chile. The added value of these specialized programs should be addressed in further research.
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http://dx.doi.org/10.1016/j.jsat.2021.108616DOI Listing
September 2021

Treatment outcome and readmission risk among women in women-only versus mixed-gender drug treatment programs in Chile.

J Subst Abuse Treat 2021 Sep 1:108616. Epub 2021 Sep 1.

Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Badajoz 130, Suite 1305, Las Condes, Santiago, Chile; Department of Population Health and Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, United States; School of Public Health, Universidad Mayor, José Toribio Medina 38, Santiago, Chile. Electronic address:

Introduction: Traditional treatment programs for substance use disorder (SUD) tend to be male-dominated environments, which can negatively affect women's access to treatment and related outcomes. Women's specific treatment needs have led some providers to develop women-only SUD treatment programs in several countries. In Chile, women-only programs were only fully implemented in 2010. We compared treatment outcomes and readmission risk for adult women admitted to state-funded women-only versus mixed-gender SUD treatment programs in Chile.

Methods: We used a registry-based retrospective cohort design of adult women in women-only (N = 8200) and mixed-gender (N = 13,178) SUD treatment programs from 2010 to 2019. The study obtained data from the National Drug and Alcohol Service from Chile. We used a multistate model to estimate the probabilities of experiencing treatment completion, discharge without completion (i.e., patient-initiated discharge and administrative discharge), or readmission, as well as the likelihood of being readmitted, conditioned on prior treatment outcome. We adjusted models for multiple baseline characteristics (e.g., substance use, socioeconomic).

Results: Overall, 24% of women completed treatment and 54% dropped out of treatment. The proportion of patient-initiated discharges within the first three month was larger in women-only than in mixed-gender programs (19% vs. 12%). In both programs, women who completed treatment were more likely to experience readmission at three months, and one and three years. In the long term, women in the women-only programs were more likely to complete treatment than women in mixed-gender programs (34% vs. 23%, respectively). The readmission probability was higher among women who previously completed treatment than those who had a discharge without completion (40% vs 21% among women in women-only programs; 38% vs. 19% among women in mixed-gender programs, respectively); no differences occurred in the risk of readmission between women-only and mixed-gender programs.

Conclusions: In terms of treatment outcomes and readmission risk, women-only programs had similar results to mixed-gender programs in Chile. The added value of these specialized programs should be addressed in further research.
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http://dx.doi.org/10.1016/j.jsat.2021.108616DOI Listing
September 2021

Disparities in substance use disorder treatment use and perceived need by sexual identity and gender among adults in the United States.

Drug Alcohol Depend 2021 Sep 24;226:108828. Epub 2021 Jun 24.

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.

Background: Substance use disorder (SUD) treatment use is low in the United States. We assessed differences in treatment use and perceived need by sexual identity (i.e., lesbian, gay, bisexual, heterosexual) and gender among adults with a past-year SUD.

Methods: We pooled data from the 2015-2019 National Survey on Drug Use and Health for adults (18+) who met past-year DSM-IV SUD criteria and self-reported sexual identity (n = 21,926). Weighted multivariable logistic regressions estimated odds of past-year: 1) any SUD treatment; 2) specialty SUD treatment; 3) perceived SUD treatment need by sexual identity, stratified by gender and adjusted for socio-demographics.

Results: Any past-year SUD treatment use was low among adult men (heterosexual [10.4 %], gay [15.5 %], and bisexual [7.1 %]) and women (heterosexual [9.9 %], gay/lesbian [11.9 %], and bisexual [13.2 %]). Patterns were similar for specialty SUD treatment and perceived treatment need. Adjusted odds of any SUD treatment use were higher among gay men (aOR = 1.65 [95 % Confidence Interval 1.10-2.46]) and bisexual women (aOR = 1.31 [1.01-1.69]) than their heterosexual peers. Compared to their heterosexual counterparts, adjusted odds of perceived SUD treatment need were higher among bisexual women (aOR = 1.65 [1.22-2.25]), gay men (aOR = 1.76 [1.09-2.84]), and bisexual men (aOR = 2.39 [1.35-4.24]).

Conclusions: Most adults with SUD did not receive treatment. Gay men and bisexual women were more likely to receive treatment and reported higher perceived SUD treatment need than heterosexual peers. Facilitating treatment access and engagement is needed to reduce unmet needs among marginalized people who perceive SUD treatment need.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108828DOI Listing
September 2021

Gender differences in any alcohol screening and discussions with providers among older adults in the United States, 2015 to 2019.

Alcohol Clin Exp Res 2021 Jul 29. Epub 2021 Jul 29.

Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, California, USA.

Background: Unhealthy alcohol use is increasing among older adults, particularly women. We estimated gender differences in the prevalence of alcohol screening/discussions with healthcare providers among older adults who use alcohol.

Methods: Using the 2015 to 2019 National Survey on Drug Use and Health, we included 9663 adults age 65 and older in the United States who used alcohol and had a past-year healthcare encounter. We estimated the weighted prevalence of alcohol screening/discussions (no screening; screening only; discussions with providers) by gender. We used weighted multinomial logistic regression models to examine correlates of alcohol use screening/discussions.

Results: Among older adults who used alcohol and encountered the healthcare system in the past year, 24.68% of men and 27.04% of women reported no alcohol screening/discussions. Men were more likely than women to be asked about drinking frequency, amount, or problems related to drinking. Compared to no alcohol screening/discussions, women were 22% more likely (95% CI: 1.05, 1.42) to report alcohol screening only but were 18% less likely to discuss alcohol with providers (95% CI: 0.73, 0.91) than men. Women had 0.67 times (95% CI: 0.60, 0.74) the adjusted odds of reporting alcohol discussions with providers versus any alcohol screening only compared with men.

Conclusions: Over a quarter of older adults who used alcohol were not asked about their drinking, and older women were less likely than men to discuss alcohol use with providers. Given the increased risk for harms of alcohol use with aging, older adults should be screened and counseled regarding their alcohol use.
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http://dx.doi.org/10.1111/acer.14668DOI Listing
July 2021

Joint perceptions of the risk and availability of Cannabis in the United States, 2002-2018.

Drug Alcohol Depend 2021 Sep 15;226:108873. Epub 2021 Jul 15.

Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States.

Background: Prior work suggests that perceived risk and perceived availability of cannabis independently affect cannabis use. However, perceived risk likely modifies the effect of perceived availability, and vice versa. This study explored trends in joint perceived risk and availability of cannabis from 2002 to 2018 and the relationship between combined perceptions and cannabis use, frequent use, and cannabis use disorder (CUD).

Methods: National Surveys on Drug Use and Health data (n = 949,285, ages 12+) were used to create combined categories of perceived risk of weekly cannabis use and perceived cannabis availability. Descriptive analyses compared joint perceived risk/availability trends (pre/post-2015 due to survey redesign) overall and stratified by age, gender, past-year cannabis use, frequent use, and CUD. Regression analysis estimated associations between perceived risk/availability and cannabis outcomes.

Results: From 2002 to 2018, the prevalence of perceiving cannabis as low-risk doubled while perceiving cannabis as available remained unchanged. The proportion of individuals perceiving cannabis as Low-risk/Available increased by 86% from 2002 to 2014 (16.8%-31.2%) and 19% from 2015 to 2018 (30.1%-35.8%) while High-risk/Available and High-risk/Unavailable proportions declined. Differing patterns were observed by age and gender. Compared with individuals perceiving cannabis as High-risk/Unavailable, people in all other perception categories had greater risk of all cannabis outcomes. Results were consistent with additive interaction between perceived risk and availability in their effects on cannabis use.

Conclusions: Trends and associations with cannabis outcomes differ when considering perceived risk and availability independently versus jointly. Longitudinal studies and cannabis policy evaluations would advance understanding of links between cannabis perceptions and use.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108873DOI Listing
September 2021

Association between county jail incarceration and cause-specific county mortality in the USA, 1987-2017: a retrospective, longitudinal study.

Lancet Public Health 2021 04 23;6(4):e240-e248. Epub 2021 Feb 23.

Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.

Background: Mass incarceration has collateral consequences for community health, which are reflected in county-level health indicators, including county mortality rates. County jail incarceration rates are associated with all-cause mortality rates in the USA. We assessed the causes of death that drive the relationship between county-level jail incarceration and mortality.

Methods: In this retrospective, longitudinal study, we assessed the association between county-level jail incarceration rates and county-level cause-specific mortality using county jail incarceration data (1987-2017) for 1094 counties in the USA obtained from the Vera Institute of Justice and cause-specific mortality data for individuals younger than 75 years in the total county population (1988-2018) obtained from the US National Vital Statistics System. We fitted quasi-Poisson models for nine common causes of death (cerebrovascular disease, chronic lower respiratory disease, diabetes, heart disease, infectious disease, malignant neoplasm, substance use, suicide, and unintentional injury) with county fixed effects, controlling for all unmeasured stable county characteristics and measured time-varying confounders (county median age, county poverty rate, county percentage of Black residents, county crime rate, county unemployment rate, and state incarceration rate). We lagged county jail incarceration rates by 1 year to assess the short-term, by 5 years to assess the medium-term, and by 10 years to assess the long-term associations of jail incarceration with premature mortality.

Findings: A 1 per 1000 within-county increase in jail incarceration rate was associated with a 6·5% increase in mortality from infectious diseases (risk ratio 1·065, 95% CI 1·061-1·070), a 4·9% increase in mortality from chronic lower respiratory disease (1·049, 1·045-1·052), a 2·6% increase in mortality induced from substance use (1·026, 1·020-1·032), a 2·5% increase in suicide mortality (1·025, 1·020-1·029), and smaller increases in mortality from heart disease (1·021, 1·019-1·023), unintentional injury (1·015, 1·011-1·018), malignant neoplasm (1·014, 1·013-1·016), diabetes (1·013, 1·009-1·018), and cerebrovascular disease (1·010, 1·007-1·013) after 1 year. Associations between jail incarceration and cause-specific mortality rates weakened as time lags increased, but to a greater extent for causes of death with generally shorter latency periods (infectious disease and suicide) than for those with generally longer latency periods (heart disease, malignant neoplasm, and cerebrovascular disease).

Interpretation: Jail incarceration rates are potential drivers of many causes of death in US counties. Jail incarceration can be harmful not only to the health of individuals who are incarcerated, but also to public health more broadly. Our findings suggest important points of intervention, including disinvestment from carceral systems and investment in social and public health services, such as community-based treatment of substance-use disorders.

Funding: US National Institute on Drug Abuse (National Institutes of Health).
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http://dx.doi.org/10.1016/S2468-2667(20)30283-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054445PMC
April 2021

A Systematic Review of Drink Specials, Drink Special Laws, and Alcohol-Related Outcomes.

Curr Epidemiol Rep 2020 Dec 31;7(4):300-314. Epub 2020 Oct 31.

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.

Purpose Of Review: The adverse health and safety consequences of heavy alcohol consumption are a leading problem around the world. While many risk factors have been extensively studied and presented in comprehensive summaries, not all questions regarding risk factors for problematic drinking behaviors have been answered and presented in systematic reviews. As of March 2020, no review has summarized studies assessing the role of promotional price practices at on-premises alcohol outlets, known as drink specials. Also missing was systematic information of policies that regulated these promotional practices. We aimed to synthesize the available research evidence of the effects that drink specials and drink special laws have on different alcohol-related outcomes.

Recent Findings: Twelve studies examined the effect of drink specials in seven countries between 1978 and 2018. Of these, 11 found a consistent positive association between drink specials and increased alcohol consumption, heavy drinking, and alcohol intoxication. Drink specials also increased reports of driving under the influence, fighting, and unprotected sex. Drink specials were also associated with expectations of higher consumption and modified attitudes and behaviors towards favorable views of drink specials. Effect sizes ranged from 1.80 to 4.43 increased odds for the examined alcohol-related outcomes. The only study examining the effects of a drink special law revealed mixed findings between prohibiting happy hours and three alcohol-related outcomes.

Summary: Drink specials were consistently associated with alcohol-related adverse outcomes, but almost nothing is known about the effects of laws restricting drink specials.
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http://dx.doi.org/10.1007/s40471-020-00247-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755127PMC
December 2020

Medical, Nonmedical, and Illegal Stimulant Use by Sexual Identity and Gender.

Am J Prev Med 2020 11 24;59(5):686-696. Epub 2020 Sep 24.

Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.

Introduction: Major knowledge gaps regarding medical and nonmedical prescription stimulant use and illegal stimulant use (i.e., cocaine/crack/methamphetamine) by sexual identity and gender have implications for individuals' health and well-being. This study improves stimulant use measurement by differentiating the type of stimulant use and focusing on lesbian, gay, and bisexual subpopulations.

Methods: Data were pooled for adults in the 2015-2017 National Survey on Drug Use and Health (n=126,463; analyzed in 2019). Gender-stratified logistic regression models examined associations between sexual identity and past-year illegal stimulant use. Gender-stratified multinomial logistic regression models estimated odds of (1) medical use only versus no past-year prescription stimulant use, (2) any nonmedical stimulant use versus no past-year use, and (3) any nonmedical stimulant use versus medical use only.

Results: Illegal stimulant use varied by sexual identity (men: gay, 9.2%; bisexual, 7.5%; heterosexual, 3.2%; women: gay/lesbian, 3.2%; bisexual, 7.8%; heterosexual, 1.5%), as did nonmedical prescription stimulant use. Relative to same-gender heterosexuals, gay (AOR=2.61, 95% CI=2.00, 3.40) and bisexual (AOR=1.70, 95% CI=1.24, 2.33) men had higher odds of past-year illegal stimulant use, as did gay/lesbian (AOR=1.63, 95% CI=1.16, 2.28) and bisexual (AOR=2.70, 95% CI=2.23, 3.26) women. Sexual minorities reported higher odds of nonmedical prescription stimulant use than heterosexuals. Any nonmedical prescription opioid use was reported by 26.4% of people who reported nonmedical stimulant use and 27.0% of people who reported illegal stimulant use.

Conclusions: Lesbian, gay, and bisexual individuals had a higher prevalence of stimulant use than their heterosexual counterparts. This has important implications for health disparities, especially given the high levels of polysubstance use. Taking a multilevel approach is crucial to reduce stimulant-related harms for lesbian, gay, and bisexual individuals.
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http://dx.doi.org/10.1016/j.amepre.2020.05.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577928PMC
November 2020

Medical cannabis laws and medical and non-medical prescription stimulant use among a nationally representative sample of US Adults: Examining the role of sexual identity and gender.

Int J Drug Policy 2020 10 24;84:102861. Epub 2020 Jul 24.

Department of Epidemiology, Columbia University Mailman School of Public Health. New York, NY, 10032, USA. Electronic address:

Background: Medical marijuana laws (MMLs) can impact marijuana and opioid use, but the relationship between MMLs and other drugs, such as prescription stimulants, remains unexamined. Because lesbian, gay and bisexual (LGB) individuals report higher levels of prescription stimulant use than heterosexuals, we explored the relationship between MMLs and past-year medical and non-medical stimulant use by sexual identity and gender.

Methods: We pooled 2015-2017 National Survey on Drug Use and Health data for adults (n = 126 463), and used survey-weighted multinomial logistic regression to estimate odds of past-year (a) medical prescription stimulant use, (b) non-medical prescription stimulant use and (c) non-medical versus medical stimulant use. We stratified by gender, adjusted for sociodemographic characteristics, and tested the interaction between MML state residence and sexual identity.

Results: Bisexual men had higher medical (6.4% versus 4.1%; aROR=1.93[1.29-2.88]) and non-medical stimulant use 6.6% versus 2.4%; aROR=2.23[1.44-3.44]) than heterosexual men. Bisexual women had higher non-medical stimulant use (6.8% versus 1.6%; aROR=1.54[1.23-2.93] than heterosexual women. Female (aROR=0.70[0.62-0.78]) and male (aROR=0.74[0.66-0.82]) heterosexuals in MML states had lower odds of medical stimulant use than in non-MML states. Bisexual men in MML states had lower odds of medical (aROR=0.36[0.21-0.61]) and non-medical stimulant use (aROR=0.48[0.29-0.81]) than bisexual men in non-MML states. Similar patterns emerged for bisexual women's non-medical use (aROR=0.57[0.40-0.81]).

Conclusion: Prescription stimulant use was higher in non-MML states for most LGB subgroups. MMLs may differentially impact stimulant use, primarily for bisexual men and women. States enacting MMLs should consider potential impacts on drugs other than marijuana, especially among LGB populations.
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http://dx.doi.org/10.1016/j.drugpo.2020.102861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738382PMC
October 2020

Anticipated use of a supervised drug consumption site among syringe services program clients in King County, Washington: Assessing the role of opioid overdose and injection behavior.

Drug Alcohol Depend 2020 Jun 12;213:108121. Epub 2020 Jun 12.

Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th St., New York, NY, 10032, United States.

Background: US jurisdictions are considering implementing supervised drug consumption sites (SCSs) to combat the overdose epidemic. No sanctioned SCS exists in the US, but King County, Washington has proposed Community Health Engagement Locations (CHELs), which would include supervised drug consumption. We assessed characteristics of people engaged in syringe services programs (SSPs) who anticipated SCS use.

Methods: We estimated prevalence of anticipated SCS use in a 2017 cross-sectional sample of King County SSP participants (N = 377). We used Poisson regression with robust standard errors to estimate likelihood of anticipated SCS use by overdose history (experienced, witnessed only, neither), public injection frequency (always, some/most times, never), drug use behaviors, and sociodemographic characteristics.

Results: The sample was primarily male (66.8 %), white (69.5 %), and averaged 37 years old. Almost two-thirds of participants witnessed or experienced an overdose in the past year (43.2 % witnessed only; 19.6 % experienced overdose). Four in five SSP participants (83.0 %) anticipated any SCS use. Anticipated SCS use was higher among participants who experienced an overdose (risk ratio [RR] = 1.14, 95 % CI = 1.04, 1.24) than those with no overdose experience. In multivariable analyses, anticipated SCS use was higher among people reporting injecting publicly (e.g., always vs. never: aRR = 1.26, 95 % CI = 1.11, 1.43), and lower among people primarily using methamphetamine (aRR = 0.80, 95 % CI = 0.67, 0.96) compared to people primarily using opioids.

Conclusions: In King County, SCS services would be used by people at high risk of overdose, including SSP participants reporting injecting in public. SCSs could be an important step to promote health and safety across communities.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108121DOI Listing
June 2020

Medication for opioid use disorder treatment and specialty outpatient substance use treatment outcomes: Differences in retention and completion among opioid-related discharges in 2016.

J Subst Abuse Treat 2020 07 11;114:108028. Epub 2020 May 11.

Department of Epidemiology, Columbia Mailman School of Public Health, United States of America.

Opioid medication treatment access is a public health priority aimed to improve opioid use treatment outcomes. However, Medicaid does not cover all forms of MOUD, particularly methadone, in many states. We examined associations between medication for opioid use disorder (MOUD) plans and substance use treatment discharge reason (e.g., completed treatment, dropped out of treatment) as well as treatment retention (i.e., length of stay), and estimated whether these relationships were modified by state Medicaid methadone coverage. Data from the 2016 Treatment Episode Data Set for Discharges (TEDS-D) included 152,196 opioid-related treatment episodes from 47 states using relative risk regression with state clustering. Discharges involving MOUD had higher treatment retention for >180 days (aRR: 1.60, 95% CI: 1.29, 1.99) and >365 days (aRR: 2.64, 95% CI: 2.00, 3.49) but lower treatment completion (aRR: 0.46, 95% CI: 0.38, 0.57). There was no evidence that state Medicaid methadone coverage modified any of these relationships. Focusing on treatment completion alone may obscure health benefits associated with longer MOUD treatment retention.
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http://dx.doi.org/10.1016/j.jsat.2020.108028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328306PMC
July 2020

Discussing Drug Use With Health Care Providers Is Associated With Perceived Need and Receipt of Drug Treatment Among Adults in the United States: We Need to Talk.

Med Care 2020 07;58(7):617-624

Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY.

Background: Drug treatment utilization is low despite a high public health burden of drug use disorders (DUDs). Engaging people at risk for DUDs across a broader range of health care settings may improve uptake of drug treatment.

Objectives: To estimate the prevalence of drug use screening/discussions between health care providers and individuals with past-year drug use, and to assess the associations between drug use screening/discussions and perceived need and use of drug treatment.

Methods: We analyzed representative cross-sectional data from the 2015 to 2017 National Surveys on Drug Use and Health. The sample included adults aged 18 years and above reporting past-year drug use and ≥1 health care visit. We measured correlates of drug use screening/discussions using multinomial logistic regression. Overall and among adults meeting DUD criteria, we used logistic regression to estimate associations between drug use screening/discussions and (1) past-year drug treatment and (2) perceived need for treatment.

Results: In the full sample (n=21,505), 34.50% reported no screening/discussions, 44.50% reported screening only, and 21.00% reported discussions with providers. Discussions were associated with significantly higher odds of receiving any drug treatment [adjusted odds ratio (aOR)=3.52 (2.66-4.65)], specialty drug treatment [aOR=4.13 (2.92-5.82)], and perceived treatment need [aOR=2.08 (1.21-3.59)]. Among people with DUD (n=3,834; 15.69%), discussions were associated with treatment use, but not with perceived need.

Conclusions: Discussing drug use with providers may impact people's perceptions of drug treatment need and use, indicating potential opportunities to engage people in addiction treatment. Addressing barriers to discussing drug use across care settings could increase treatment use, particularly among people with DUD.
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http://dx.doi.org/10.1097/MLR.0000000000001340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112806PMC
July 2020

Opioid Use Disorder Treatment Facilities With Programs for Special Populations.

Am J Prev Med 2020 09 21;59(3):e125-e133. Epub 2020 May 21.

Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, New York, New York.

Introduction: Special populations, including veterans, pregnant and postpartum women, and adolescents, benefit from opioid use disorder treatment tailored to their specific needs, but access to such services is poorly described. This study identifies the availability of opioid use disorder treatment facilities that use medications and have special programming and contextualizes facilities amid counties' opioid-related overdose mortality.

Methods: Data were compiled on 15,945 U.S. treatment facilities using medications for opioid use disorder listed in the Behavioral Health Services Treatment Locator in 2018. Facilities with programs tailored to special populations (veterans, pregnant and postpartum women, and adolescents) were identified and geocoded. Counties with such facilities were characterized. Cold spots (county clusters with poor treatment availability) were identified using Getis-Ord Gi* statistics. Data were extracted in October 2018 and analyzed from October 2018 to May 2019.

Results: Of all 3,142 U.S. counties, 1,889 (60.1%) had opioid use disorder treatment facilities. Facilities with tailored programs for veterans, pregnant and postpartum women, and adolescents were located in 701 (22.3%), 918 (29.2%), and 1,062 (33.8%) of the counties, respectively. Specific medications provided for opioid use disorder varied, with only a minority of facilities offering methadone (among facilities with tailored programs for veterans, 6.0%; pregnant and postpartum women, 13.2%; adolescents, 1.3%). Many counties reporting opioid-related overdose deaths lacked programs for special populations (veterans, 72.6%; pregnant and postpartum women, 54.8%; adolescents, 30.6%). Cold spots were located throughout the Midwest, U.S. Southeast, and portions of Texas.

Conclusions: Facilities using medications for opioid use disorder with tailored programs for veterans, pregnant and postpartum women, and adolescents are limited. There is a need for improved access to evidence-based programs that address the unique treatment needs of special populations.
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http://dx.doi.org/10.1016/j.amepre.2020.03.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484197PMC
September 2020

State criminal justice policy context and opioid agonist treatment delivery among opioid treatment admissions, 2015.

Drug Alcohol Depend 2020 01 2;206:107654. Epub 2019 Nov 2.

Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, United States.

Background: Criminal justice referral to treatment is associated with reduced odds of receiving opioid agonist treatment (OAT), the gold-standard treatment for opioid use disorder. States vary substantially in the extent of criminal justice system involvement in opioid treatment; however, the effects on treatment provision are not clear. We examined whether state-level criminal justice involvement in the substance use treatment system modified the association between criminal justice referral to treatment and OAT provision among opioid treatment admissions.

Methods: We conducted a random effects logistic regression to investigate how the effects of criminal justice referral to treatment on OAT provision differed in states with high vs. low state-level criminal justice involvement in opioid treatment, adjusting for individual and state-level covariates, among 22 states in the 2015 Treatment Episode Dataset-Admissions.

Results: Criminal justice referral to treatment was associated with an 85% reduction in the odds of receiving OAT, compared to other sources of treatment referral (OR = 0.15; 95% CI: 0.15, 0.16). Among opioid treatment admissions resulting from criminal justice referral in 2015, receiving treatment in high criminal justice involvement states was associated with a 63% reduction in the odds of OAT provision, compared to opioid treatment received in low criminal justice involvement states (interaction OR = 0.37, 95% CI: 0.11, 0.89).

Conclusion: The effects of criminal justice referral to treatment on OAT provision varied by criminal justice involvement in opioid treatment at the state level. Targeted interventions should increase access to OAT in states that rely on the criminal justice system for opioid treatment referrals.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.107654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377924PMC
January 2020

Cannabis use disorder among people using cannabis daily/almost daily in the United States, 2002-2016.

Drug Alcohol Depend 2019 12 16;205:107621. Epub 2019 Oct 16.

Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA. Electronic address:

Background: Cannabis use disorder (CUD) prevalence among people reporting past-year cannabis use declined from 2002-2016. We examined whether similar reductions in CUD were observed among people reporting daily/almost daily cannabis use. We expected that CUD prevalence among people reporting daily/almost daily use would not decrease.

Methods: We used 2002-2016 National Survey on Drug Use and Health (NSDUH) data, including 22,651 individuals using cannabis 300+ days in the past year. CUD was defined using DSM-IV criteria for cannabis abuse and/or dependence. Age categories included: 12-17, 18-25, and 26 + . Annual prevalence of CUD, cannabis dependence, cannabis abuse, and each individual abuse/dependence items accounted for the complex survey design. Differences in trends over time were examined by age group.

Results: From 2002-2016, the prevalence of CUD among people reporting daily/almost daily cannabis use decreased by 26.8% in adolescents, by 29.7% in ages 18-25, and by 37.5% in ages 26 + . Prevalence of DSM-IV cannabis dependence decreased significantly among adolescents (-43.9%) and young adults (-26.8%) but remained stable in adults 26 + . Reductions in most dependence items were observed in young adults, with less consistent patterns in adolescents and adults 26 + . Prevalence of DSM-IV cannabis abuse decreased overall and for each abuse item across all age groups.

Conclusions: Contrary to expectations, CUD prevalence decreased significantly across all ages reporting daily/almost daily cannabis use between 2002-2016. Cannabis dependence prevalence decreased for adolescents and young adults and was stable only among adults ages 26+ reporting daily/almost daily cannabis use. Potential drivers of this decrease should be further explored.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.107621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359630PMC
December 2019

Sex differences in nonmedical prescription tranquilizer and stimulant use trends among secondary school students in Argentina, Chile, and Uruguay.

Drug Alcohol Depend 2019 12 4;205:107607. Epub 2019 Oct 4.

Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA.

Background: Little is known about recent nonmedical prescription tranquilizer and stimulant use trends in Latin America. We tested whether recent trends among students in three South American countries differed by sex over time.

Methods: Three countries independently collected National School Students Survey on Drugs. Students in 8th, 10th, and 12th grades were sampled in Argentina (2007-2014, N = 328,202), Chile (2007-2015, N = 136,379), and Uruguay (2007-2016, N = 32,371). Weighted linear regression models predicted the prevalences and trends over time of past-year nonmedical tranquilizer and stimulant use by country, and tested whether trends differed by sex, adjusting for school type and grade.

Results: In Argentina from 2007 to 2014, past-year nonmedical prescription tranquilizer (girls: 2.8 to 2.6%, boys: 2.5 to 2.3%) and stimulant (girls: 1.7 to 1.3%, boys: 1.9 to 1.5%) use trends did not differ by sex. In Chile from 2007 to 2015, nonmedical prescription tranquilizer use trends significantly differed comparing girls (3.9 to 10%) with boys (3.2 to 6.9%); stimulant use trends did not differ comparing girls (1.6 to 2.0%) with boys (2.0 to 1.3%). In Uruguay from 2007 to 2014 and 2014-2016, past-year nonmedical prescription tranquilizer (girls: 5.1 to 6.6%; boys: 2.8 to 4.2%) and stimulant (girls: 1.8 to 0.7%; boys: 1.8 to 0.7%) use trends did not differ by sex.

Conclusions: Trends of nonmedical prescription tranquilizer use recently increased in Chile and Uruguay, widening by sex over time in Chile only. The drivers of increasing tranquilizer use among girls in Chile and Uruguay merit further investigation.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.107607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6943976PMC
December 2019

Measuring polysubstance use over the life course: implications for multilevel interventions.

Lancet Psychiatry 2019 10 11;6(10):797-798. Epub 2019 Sep 11.

Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA.

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http://dx.doi.org/10.1016/S2215-0366(19)30328-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213041PMC
October 2019

Past-year use of prescription opioids and/or benzodiazepines among adults in the United States: Estimating medical and nonmedical use in 2015-2016.

Drug Alcohol Depend 2019 11 30;204:107458. Epub 2019 Aug 30.

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA. Electronic address:

Background: The growing use of prescription opioids and benzodiazepines has become a major health threat in the United States, so it is important to document their use among adults to inform health policies or interventions.

Methods: This study included 81,186 adults ages 18 and older from 2015 and 2016 National Survey on Drug Use and Health. Participants' self-reported medical and nonmedical use of prescription opioids and/or benzodiazepines in the past year was assessed along with their demographic characteristics.

Results: In 2015-2016, 41.13% of adults reported using prescription opioids and/or benzodiazepines in the past year; 8.24% reported both, 28.59% reported prescription opioids only, and 4.30% reported benzodiazepines only. The majority of adults used the drugs for medical purposes, including 71.35% of participants who reported both drugs in the past year, 90.36% of those who reported prescription opioids only, and 86.24% of those who reported benzodiazepines only. Younger adults ages 18-34 were more likely to use prescription opioids and/or benzodiazepines for nonmedical purposes compared to adults ages 35 and over.

Conclusions: In the United States, the proportion of adults who used prescription opioids and/or benzodiazepines in the past year was high; most of them reported using these drugs for medical purposes. Special attention is needed to prevent potentially unnecessary medical co-prescribing of these drugs, particularly among younger adults, who were more likely report nonmedical use of both drugs than older adults.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.04.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954591PMC
November 2019

State-level marijuana policies and marijuana use and marijuana use disorder among a nationally representative sample of adults in the United States, 2015-2017: Sexual identity and gender matter.

Drug Alcohol Depend 2019 11 26;204:107506. Epub 2019 Aug 26.

Department of Epidemiology, Columbia University Mailman School of Public Health. 722 West 168th Street, New York, NY, 10032 USA. Electronic address:

Background: Research demonstrates an association between state-level medical marijuana laws (MMLs) and increased marijuana use (MU) and MU disorder (MUD) among adults, but has yet to explore this association among lesbian, gay and bisexual (LGB) individuals, including gender differences.

Methods: We pooled the 2015-2017 National Survey on Drug Use and Health data for adults (n = 126,463) and used gender-stratified adjusted multivariable logistic regression to model the odds of past-year MU, past-year medical MU, daily/near-daily MU, and MUD; we also tested the interaction between MML state residence and sexual identity.

Results: Bisexual women had higher past-year MU (40% versus 10.3%; aOR = 2.9[2.4-3.4]), daily/near-daily MU (9.8% versus 1.5%; aOR = 4.6[3.3-6.2]), and medical MU ((5.5% versus 1.2%) aOR = 5.5[3.8-8.1]) than heterosexual women. Gay/lesbian women also had higher past-year MU (26.1% versus 10.3%; aOR = 2.8[2.2-3.7]), daily/near-daily MU (5.6% versus 1.5%; aOR = 2.9[1.8-4.6]), and medical MU (4.7% versus 1.2%; aOR = 3.0(1.4-6.6]) than heterosexual women. Bisexual women in MML states had higher past-year MU ((44.4% vs. 34.1%); aOR = 1.8[1.5-2.1]) and medical use (7.1% vs. 3.3% (aOR = 2.5[1.5-3.9]) than bisexual women in non-MML states. The odds of any past-year medical MU for bisexual versus heterosexual women was different in MML versus non-MML states (Exponentiated β = 0.53, p = 0.01). Gay men in MML states had higher past year MU (31.2% versus 25.7%; aOR = 1.6[1.1-2.5] and medical MU (6.4% vs 1.7%; aOR = 5.0[4.2-6.1]) than gay men in non-MML states.

Conclusions: Results suggest that MMLs may differentially impact MU for sexual minority individuals-particularly bisexual women. Findings demonstrate the need for states enacting MMLs to consider potential differential impacts on LGB populations.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.06.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878202PMC
November 2019

Association of US Medical Marijuana Laws With Nonmedical Prescription Opioid Use and Prescription Opioid Use Disorder.

JAMA Netw Open 2019 07 3;2(7):e197216. Epub 2019 Jul 3.

Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York.

Importance: Between 1997 and 2017, the United States saw increases in nonmedical prescription opioid use and its consequences, as well as changes in marijuana policies. Ecological-level research hypothesized that medical marijuana legalization may reduce prescription opioid use by allowing medical marijuana as an alternative.

Objectives: To investigate the association of state-level medical marijuana law enactment with individual-level nonmedical prescription opioid use and prescription opioid use disorder among prescription opioid users and to determine whether these outcomes varied by age and racial/ethnic groups.

Design, Setting, And Participants: This cross-sectional study used restricted data on 627 000 individuals aged 12 years and older from the 2004 to 2014 National Survey on Drug Use and Health, a population-based survey representative of the civilian population of the United States. Analyses were completed from March 2018 to May 2018.

Exposures: Time-varying indicator of state-level medical marijuana law enactment (0 = never law enactment, 1 = before law enactment, and 2 = after law enactment).

Main Outcomes And Measures: Past-year nonmedical prescription opioid use and prescription opioid use disorder among prescription opioid users. Odds ratios of nonmedical prescription opioid use and prescription opioid use disorder comparing the period before and after law enactment were presented overall, by age and racial/ethnic group, and adjusted for individual- and state-level confounders.

Results: The study sample included 627 000 participants (51.51% female; 9.88% aged 12-17 years, 13.30% aged 18-25 years, 14.30% aged 26-34 years, 25.02% aged 35-49 years, and 37.50% aged ≥50 years; the racial/ethnic distribution was 66.97% non-Hispanic white, 11.83% non-Hispanic black, 14.47% Hispanic, and 6.73% other). Screening and interview response rates were 82% to 91% and 71% to 77%, respectively. Overall, there were small changes in nonmedical prescription opioid use prevalence after medical marijuana law enactment (4.32% to 4.86%; adjusted odds ratio, 1.13; 95% CI, 1.06-1.20). Prescription opioid use disorder prevalence among prescription opioid users decreased slightly after law enactment, but the change was not statistically significant (15.41% to 14.76%; adjusted odds ratio, 0.95; 95% CI, 0.81-1.11). Outcomes were similar when stratified by age and race/ethnicity.

Conclusions And Relevance: This study found little evidence of an association between medical marijuana law enactment and nonmedical prescription opioid use or prescription opioid use disorder among prescription opioid users. Further research should disentangle the potential mechanisms through which medical marijuana laws may reduce opioid-related harm.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.7216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647549PMC
July 2019

Associations between state-level policy liberalism, cannabis use, and cannabis use disorder from 2004 to 2012: Looking beyond medical cannabis law status.

Int J Drug Policy 2019 03 23;65:97-103. Epub 2019 Jan 23.

Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY, 10032, USA. Electronic address:

Background: Medical cannabis laws (MCL) have received increased attention as potential drivers of cannabis use (CU), but little work has explored how the broader policy climate, independent of MCL, may impact CU outcomes. We explored the association between state-level policy liberalism and past-year cannabis use (CU) and cannabis use disorder (CUD).

Methods: We obtained state-level prevalence of past-year CU and CUD among past year cannabis users for ages 12-17, 18-25, and 26+ from the 2004-2006 and 2010-2012 National Surveys on Drug Use and Health. States were categorized as liberal, moderate, or conservative based on state-level policy liberalism rankings in 2005 and 2011. Linear models with random state effects examined the association between policy liberalism and past-year CU and CUD, adjusting for state-level social and economic covariates and medical cannabis laws.

Results: In adjusted models, liberal states had higher average past-year CU than conservative states for ages 12-17 (+1.58 percentage points; p = 0.03) and 18-25 (+2.96 percentage points; p = 0.01) but not for 26+ (p = 0.19). CUD prevalence among past year users was significantly lower in liberal compared to conservative states for ages 12-17 (-2.87 percentage points; p = 0.045) and marginally lower for ages 26+ (-2.45 percentage points; p = 0.05).

Conclusion: Liberal states had higher past-year CU, but lower CUD prevalence among users, compared to conservative states. Researchers and policy makers should consider how the broader policy environment, independent of MCL, may contribute to CU outcomes.
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http://dx.doi.org/10.1016/j.drugpo.2018.10.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432643PMC
March 2019

Changes over time in marijuana use, deviant behavior and preference for risky behavior among US adolescents from 2002 to 2014: testing the moderating effect of gender and age.

Addiction 2019 04 18;114(4):674-686. Epub 2018 Dec 18.

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

Background And Aims: Among adolescents, risk preference and deviant behaviors are associated with marijuana use, which exhibit substantial historical trends. We examined (1) trends, (2) effect modification by sex and age, (3) associations of marijuana use with deviant behaviors and risk preferences and (4) differences by sex, age and year.

Design: Adjusted logistic and relative risk regression models, using data from the 2002-14 National Survey on Drug Use and Health, annual cross-sectional surveys of US households.

Setting: United States.

Participants: A nationally representative sample of adolescents aged 12-17 years (n = 230 452).

Measurements: We estimated associations between past-year marijuana use [self-reported using computer-assisted personal interviewing/audio computer-assisted self-interviewing (CAPI/ACASI)], deviant behavior (i.e. selling drugs; stealing; attacking someone) and risk preference (i.e. getting a kick; testing oneself).

Findings: Marijuana use, deviant behaviors and risk preferences declined among adolescents from 2002 to 2014. There were no significant sex or age differences in the decline of marijuana use over time. There were sex [sold drugs: β = 0.90, 95% confidence interval (CI) = 0.75, 1.04] and age (attacked someone: β = 0.32, 95% CI = 0.22, 0.42) differences in the prevalence of deviant behaviors, and trends over time differed by sex and age for attacking someone.

Conclusions: While marijuana use, deviant behavior and risk preferences among US adolescents declined from 2002 to 2014, associations have remained stable, with marijuana use positively associated with deviant behaviors and risk preferences.
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http://dx.doi.org/10.1111/add.14506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619500PMC
April 2019

Factors promoting and impeding HIV testing among adolescents in juvenile drug court.

AIDS Care 2019 02 15;31(2):177-180. Epub 2018 Nov 15.

c Oregon Social Learning Center.

A randomized pilot study compared Risk Reduction Therapy for Adolescents (RRTA) to treatment as usual (TAU); the present study examined whether intervention condition influenced HIV testing, barriers to HIV testing, and HIV communication among adolescents involved in juvenile drug courts overall and by sexual experience. Of 105 participants, 13.3% had HIV pre-treatment testing, whereas 27.2% (of 92 participants) indicated follow-up HIV testing. Sexually active youth in RRTA (but not in TAU) reported a significant increase in HIV testing over time. RRTA demonstrated the greatest increase in HIV testing (8% pre-treatment to 44% follow-up), but not significantly more than TAU. Prevalence of barriers to HIV testing were observed at consistent rates among adolescents who did not get tested for HIV within either treatment condition. Adolescents in both conditions reported increased communication about HIV at follow-up. HIV testing was positively associated with perceived need for testing and testing resource accessibility. Stigma remained a barrier to testing at follow-up for RRTA (22%) and TAU (21%) participants. The RRTA intervention increased HIV testing and both interventions increased adolescents' communication about HIV; however, barriers persisted, warranting treatment modification.
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http://dx.doi.org/10.1080/09540121.2018.1546818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296754PMC
February 2019

Correct knowledge of medical cannabis legal status in one's own state: Differences between adolescents and adults in the United States, 2004-2013.

Addict Behav 2019 01 30;88:23-28. Epub 2018 Jul 30.

Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States.

Background: Studies have found age-specific effects of medical cannabis laws (MCLs), particularly affecting adult cannabis use but not adolescent use. We examined whether age differences in MCL knowledge are in accordance with age differences in MCL effects on cannabis use.

Methods: Data from the 2004-2013 repeated cross-sectional National Surveys on Drug Use and Health included people ages 12 and older in the United States. State-aggregated MCL knowledge was the proportion of people that correctly identified living in a state that did not allow medical cannabis prior to MCL enactment, or that allowed medical cannabis after MCL enactment. We regressed state-aggregated MCL knowledge on time-varying MCL enactment (i.e., no MCL by 2015, before MCL, after MCL), testing associations by age strata (12-17, 18-25, 26+), open dispensary status, and adjusting for time and state-level demographics.

Results: Model-based MCL knowledge was significantly lower among adolescents than adults; after enactment, 36.8% of ages 12-17, 48.8% of ages 18-25, and 45.4% of ages 26+ were aware of their state's MCL status. Correct MCL status knowledge decreased across all age groups after MCL enactment (i.e., low knowledge of MCL changes at the time they occurred). Open cannabis dispensaries significantly increased correct MCL knowledge, with a 7.7-point increase for adolescents and a 17.5-point increase for adults 26 + .

Conclusions: Lower MCL knowledge among adolescents than adults was in accordance with MCL effects on cannabis use previously observed among adults only. Studies should assess whether MCL knowledge is a consequence or predictor of individual-level cannabis use across age groups.
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http://dx.doi.org/10.1016/j.addbeh.2018.07.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538076PMC
January 2019

Age Differences in Daily and Nondaily Cannabis Use in the United States, 2002-2014.

J Stud Alcohol Drugs 2018 05;79(3):423-431

Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.

Objective: Adult cannabis use has increased in the United States since 2002, particularly after 2007, contrasting with stable/declining trends among youth. We investigated whether specific age groups disproportionately contributed to changes in daily and nondaily cannabis use trends.

Method: Participants ages 12 and older (N = 722,653) from the 2002-2014 National Survey on Drug Use and Health reported past-year cannabis use frequency (i.e., daily = ≥300 days/year; nondaily = 1-299 days/year; none). Multinomial logistic regression was used to model change in past-year daily and nondaily cannabis use prevalence by age group (i.e., 12-17, 18-25, 26-34, 35-49, 50-64, ≥65), before and after 2007. Multinomial logistic regressions estimated change in relative odds of cannabis use frequency over time by age, adjusting for other sociodemographics.

Results: Daily cannabis use prevalence decreased in ages 12-17 before 2007 and increased significantly across adult age categories only after 2007. Increases did not differ significantly across adult ages 18-64 and ranged between 1 and 2 percentage points. Nondaily cannabis use decreased among respondents ages 12-25 and 35-49 before 2007 and increased across adult age categories after 2007, particularly among adults 26-34 (i.e., 4.5 percentage points). Adjusted odds of daily versus nondaily cannabis use increased after 2007 for ages 12-64.

Conclusions: Increases in daily and nondaily cannabis use prevalence after 2007 were specific to adult age groups in the context of increasingly permissive cannabis legislation, attitudes, and lower risk perception. Although any cannabis use may be decreasing among teens, relative odds of more frequent use among users increased in ages 12-64 since 2007. Studies should assess not only any cannabis use, but also frequency of use, to target prevention efforts of adverse effects of cannabis that are especially likely among frequent users.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005250PMC
http://dx.doi.org/10.15288/jsad.2018.79.423DOI Listing
May 2018

Association of Mental Health Symptoms and Peer Behaviors with Risk for Substance Use and Condomless Sex among Youth in Juvenile Drug Court.

J Child Adolesc Subst Abuse 2018 20;27(3):133-145. Epub 2018 Feb 20.

Associate Professor, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 415 N Washington St., Baltimore, MD 21231.

Juvenile drug courts are a growing response to adolescent substance use, but a better understanding of modifiable risk factors is needed to improve program outcomes. Youth's mental health symptoms and peers' activities may impede the effectiveness of these "therapeutic" courts. In a unique longitudinal sample of 105 adolescents involved in juvenile drug court, we find elevated internalizing symptoms and deviant behavior of peers were each associated with increased risk of alcohol and marijuana use. Similar effects were seen on risk for condomless sex. Mental health and peer behaviors should be intervention targets for evidence-based juvenile drug court programming.
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http://dx.doi.org/10.1080/1067828x.2018.1430642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8048375PMC
February 2018

Predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime cannabis use disorder in the United States.

Drug Alcohol Depend 2017 12 18;181:223-228. Epub 2017 Oct 18.

Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, New York, 10032, USA; Department of Psychiatry, College of Physicians and Surgeons, 630 W. 168th Street, New York, New York, 10032, USA.

Objective: To present information on predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime DSM-5 cannabis use disorder (CUD).

Method: Face-to-face survey of a representative sample of the adult US general population (n=36,309).

Results: Treatment rates for CUD were low in this general population survey (13.7%). Severity of CUD and comorbidity of other lifetime drug use disorders were significant predictors of lifetime treatment utilization for CUD. Preference for self-reliance, minimizing problems, fear of stigma, and financial and structural issues were among the most frequently endorsed reasons for respondents not seeking treatment when they perceived the need for treatment among individuals with lifetime CUD, regardless of whether they eventually utilized treatment at some time in their lives.

Conclusions: Given the rising prevalence of CUD in the US over the past decade and currently low treatment rates for CUD, increased provision for services for CUD appears critically needed, especially those that screen for and treat, when present, other drug use disorders. Programs to reduce stigma and financial barriers are needed, as well as programs to increase awareness among the general public, health care professionals about the nature and seriousness of CUD, and the availability and effectiveness of treatment for this disorder.
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http://dx.doi.org/10.1016/j.drugalcdep.2017.09.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310167PMC
December 2017

Impact of Medical Marijuana Laws on State-Level Marijuana Use by Age and Gender, 2004-2013.

Prev Sci 2019 02;20(2):205-214

Department of Epidemiology, Columbia University, New York, NY, USA.

In states that have passed medical marijuana laws (MMLs), marijuana use (MU) increased after MML enactment among people ages 26 and older, but not among ages 12-25. We examined whether the age-specific impact of MMLs on MU varied by gender. Data were obtained from the 2004-2013 restricted-use National Survey on Drug Use and Health, aggregated at the state level. The exposure was a time-varying indicator of state-level MML (0 = No Law, 1 = Before Law, 2 = After Law). Outcomes included past-month MU prevalence, daily MU prevalence among past-year users (i.e., 300+ days/year), and past-year marijuana use disorder (MUD) prevalence. Linear models tested the state-level MML effect on outcomes by age (12-17, 18-25, 26+) and gender. Models included a state-level random intercept and controlled for time- and state-level covariates. Past-month MU did not increase after enactment of MML in men or women ages 12-25. Among people 26+, past-month MU increased for men from 7.0% before to 8.7% after enactment (+ 1.7%, p < 0.001) and for women from 3.1% before to 4.3% after enactment (+ 1.1%, p = 0.013). Among users 26+, daily MU also increased after enactment in both genders (men 16.3 to 19.1%, + 2.8%, p = 0.014; women 9.2 to 12.7%, + 3.4%, p = 0.003). There were no statistically significant increases in past-year MUD prevalence for any age or gender group after MML enactment. Given the statistically significant increase in daily use among past-year users aged 26+ following enactment, education campaigns should focus on informing the public of the risks associated with regular marijuana use.
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http://dx.doi.org/10.1007/s11121-017-0848-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934322PMC
February 2019

Shifting characteristics of ecstasy users ages 12-34 in the United States, 2007-2014.

Drug Alcohol Depend 2017 12 6;181:20-24. Epub 2017 Oct 6.

Columbia University, Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.

Background: Ecstasy/MDMA has been one of the most prevalent party drugs for decades, and powder ecstasy recently increased in popularity. We examined trends in use to determine who to best target for prevention and harm reduction.

Methods: Secondary analysis of the 2007-2014 National Survey on Drug Use and Health, a repeated cross-sectional, nationally representative probability sample, was conducted. Linear trends in past-year ecstasy use and trends in demographic and other past-year substance use characteristics among ecstasy users were examined among participants ages 12-34 (N=332,560).

Results: Past-year prevalence of ecstasy use was stable across years at 2% (P=0.693). Over time, the proportion of ecstasy users with a college degree increased from 11.5% in 2007/08 to 24.5% in 2013/14 (P<0.001). The proportion of users who were age 12-17 decreased, as did proportions of users who are non-Hispanic black, and reported income <$20,000/year (Ps<0.001). Prevalence of past-year use of marijuana, LSD, ketamine, and DMT/AMT/Foxy increased among ecstasy users (Ps<0.05); DMT/AMT/Foxy use increased more than four-fold from 2.1% in 2007/08 to 8.7% in 2013/14. Perception of great risk associated with LSD use decreased among users and ease of obtaining LSD increased (Ps<0.05). Past-year use of 5 or more other substances also increased over time (P<0.05).

Conclusions: Ecstasy use in the US appears to be increasing among those with college degrees and use of other substances among ecstasy users is growing-particularly use of otherwise rare substances such as tryptamines. Results inform prevention and harm reduction strategies in this increasingly shifting group of ecstasy users.
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http://dx.doi.org/10.1016/j.drugalcdep.2017.09.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683908PMC
December 2017
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