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AimsTo determine (1) whether prescription opioid poisoning (PO) hospital discharges spread across space over time, (2) the locations of 'hot-spots' of PO-related hospital discharges, (3) how features of the local environment contribute to the growth in PO-related hospital discharges and (4) where each environmental feature makes the strongest contribution.DesignHierarchical Bayesian Poisson space-time analysis to relate annual discharges from community hospitals to postal code characteristics over 10 years.SettingCalifornia, USA.ParticipantsResidents of 18 517 postal codes in California, 2001-11.MeasurementsAnnual postal code-level counts of hospital discharges due to PO poisoning were related to postal code pharmacy density, measures of medical need for POs (i.e. rates of cancer and arthritis-related hospital discharges), economic stressors (i.e. median household income, percentage of families in poverty and the unemployment rate) and concentration of manual labor industries.FindingsPO-related hospital discharges spread from rural and suburban/exurban 'hot-spots' to urban areas. They increased more in postal codes with greater pharmacy density [rate ratio (RR) = 1.03; 95% credible interval (CI) = 1.01, 1.05], more arthritis-related hospital discharges (RR = 1.08; 95% CI = 1.06, 1.11), lower income (RR = 0.85; 95% CI = 0.83, 0.87) and more manual labor industries (RR = 1.15; 95% CI = 1.10, 1.19 for construction; RR = 1.12; 95% CI = 1.04, 1.20 for manufacturing industries). Changes in pharmacy density primarily affected PO-related discharges in urban areas, while changes in income and manual labor industries especially affected PO-related discharges in suburban/exurban and rural areas.ConclusionsHospital discharge rates for prescription opioid (PO) poisoning spread from rural and suburban/exurban hot-spots to urban areas, suggesting spatial contagion. The distribution of age-related and work-place-related sources of medical need for POs in rural areas and, to a lesser extent, the availability of POs through pharmacies in urban areas, partly explain the growth of PO poisoning across California, USA.

Background and Aims: Benzodiazepines (BZDs) carry a risk for drug overdose and are prescribed alone or simultaneously with selective‐serotonin reuptake inhibitors (SSRIs) for the treatment of anxiety and depression in young adults. We aimed to measure risks of drug overdose following BZD treatment initiation, and simultaneous BZD and SSRI initiation, compared with SSRI treatment alone in young adults with depression or anxiety. Design, Setting, Participants: The cohort study used administrative databases covering privately (MarketScan, 1/1/2009–12/31/2018) and publicly (Medicaid, 1/1/2015–12/31/2016) insured young adults (18–29 years) in the United States. Those with depression or anxiety diagnoses newly initiating BZD or SSRI treatment (without BZD or SSRI prescriptions in prior year) were included. Simultaneous "BZD + SSRI" initiation was defined as starting BZD and SSRI treatment on the same day. The cohorts included 604 664 privately insured young adults (BZD = 22%, BZD + SSRI = 10%, SSRI = 68%) and 110 493 publicly insured young adults (BZD = 23%, BZD + SSRI = 5%, SSRI = 72%). Measurements: Incident medically treated drug overdose events were identified from emergency department and inpatient encounters (ICD poisoning codes) within 6 months of treatment initiation. Crude and propensity‐score adjusted cumulative incidence and hazard ratios (HR) were estimated. Sub‐analyses evaluated drug overdose intent. Findings Adjusted HRs of drug overdose for BZD vs. SSRI treatment was 1.36 (95% confidence interval [CI]:1.23–1.51) in privately and 1.59 (95%CI:1.37–1.83) in publicly insured young adults. The adjusted HRs of drug overdose for BZD + SSRI treatment vs. SSRI treatment were 1.99 (95%CI:1.77–2.25) in privately and 1.98 (95%CI:1.47–2.68) in publicly insured young adults. Conclusions: Among young adults in the United States, initiating benzodiazepine treatment for anxiety and depression, alone or simultaneously with selective‐serotonin reuptake inhibitors (SSRI), appears to have an increased risk of medically treated drug overdose compared with SSRI treatment alone. These associations were observed in publicly and privately insured individuals. [ABSTRACT FROM AUTHOR]

Background and aims: Given the shifting landscape of hallucinogen use, particularly with increased therapeutic use, understanding current changes in use is a necessary part of examining the potential risk hallucinogens pose to vulnerable populations, such as young adults. This study aimed to measure hallucinogen use among young adults aged 19–30 years from 2018 to 2021. Design, setting and participants: This was a longitudinal cohort study among young adults aged 19–30 years from the US general population, interviewed between 2018 and 2021. Participants comprised 11 304 unique respondents, with an average number of follow‐ups of 1.46 (standard deviation = 0.50). Of the observed data points, 51.9% were among females. Measurements: We examined past 12‐month self‐reported use of lysergic acid diethylamide (LSD), as well as hallucinogens besides LSD (e.g. psilocybin), monitoring any use as well as frequency, overall and by sex. Findings From 2018 to 2021, past 12‐month use of LSD among young adults in the US remained relatively unchanged, from 3.7% [95% confidence interval (CI) = 3.1–4.3] in 2018 to 4.2% in 2021 (95% CI = 3.4–5.0). Non‐LSD hallucinogen [e.g. 'shrooms', psilocybin or PCP (phenylcyclohexyl piperidine)] use, however, increased in prevalence from 3.4% (95% CI = 2.8–4.1) to 6.6% from 2018 to 2021 (95% CI = 5.5–7.6). Across years, the odds of non‐LSD use were higher for males [odds ratio (OR) = 1.86, 95% CI = 1.52–2.26] and lower for black than white participants (OR = 0.29, 95% CI = 0.19–0.47) and those without a college‐educated parent (OR = 0.80, 95% CI = 0.64–0.99). Demographic disparities were similar for LSD use. Conclusion: Prevalence of past‐year use non‐lysergic acid diethylamide (LSD) hallucinogen was twice as high in 2021 as in 2018 among US young adults. Correlates of non‐LSD hallucinogen use included being male, white and from higher socio‐economic status backgrounds. [ABSTRACT FROM AUTHOR]

Background and Aims: Alcohol use is increasing among women in mid‐life concurrently with societal changes in timing of parenthood and changing cultural norms, which may influence alcohol use. The aim of this study was to determine if age of first parenting was associated with excessive drinking [i.e. past 2‐week binge drinking and past 5‐year alcohol use disorder (AUD) symptoms] among women during mid‐life in the United States and to determine if there were pronounced cohort effects influencing these relationships. Design: This was a retrospective cohort, longitudinal study. Setting, Participants and Measurements: Data were drawn from the Monitoring the Future survey, an annual ongoing survey of high school students' substance use behaviors in the United States. Participants were women who completed the age 35 survey between 1993 and 2019, corresponding to high school senior years 1976–2002 (n = 9988). Past 2‐week binge drinking and past 5‐year AUD symptoms were self‐reported. Age of first parenting was self‐reported. Findings Binge drinking and AUD symptoms were higher among women in recent than in older cohorts. Women from the 2018–19 cohort had increased odds of binge drinking [odds ratio (OR) = 1.73, 95% confidence interval (CI) = 1.41–2.12] and AUD symptoms (OR = 1.51, CI = 1.27–1.80) relative to women from the 1993–97 cohort. Throughout cohorts, there was an inverse association between transition to parenthood and excessive drinking outcomes (e.g. range for ORs for binge drinking among those without children compared with those who had had children between the ages of 18 and 24: 1.22–1.55). Simultaneously, there was a population shift towards delaying parenting in recent cohorts (i.e. 54% of women in the 1993–97 cohort had children before age 30 compared with 39% in the two recent cohorts), increasing the size of the group at highest risk for excessive drinking. Conclusions: In the United States, subgroups of women at highest risk of excessive drinking appear to be expanding, probably supported in part by a trend towards delayed parenting. [ABSTRACT FROM AUTHOR]

Background and Aims: Age‐related changes in physiological, metabolic and medication profiles make alcohol consumption likely to be more harmful among older than younger adults. This study aimed to estimate cross‐national variation in the quantity and patterns of drinking throughout older age, and to investigate country‐level variables explaining cross‐national variation in consumption for individuals aged 50 years and older. Design Cross‐sectional observational study using previously harmonized survey data. Setting Twenty‐two countries surveyed in 2010 or the closest available year. Participants: A total of 106 180 adults aged 50 years and over. Measurements Cross‐national variation in age trends were estimated for two outcomes: weekly number of standard drink units (SDUs) and patterns of alcohol consumption (never, ever, occasional, moderate and heavy drinking). Human Development Index and average prices of vodka were used as country‐level variables moderating age‐related declines in drinking. Findings Alcohol consumption was negatively associated with age (risk ratio = 0.98; 95% confidence interval = 0.97, 0.99; P‐value < 0.001), but there was substantial cross‐country variation in the age‐related differences in alcohol consumption [likelihood ratio (LR) test P‐value < 0.001], even after adjusting for the composition of populations. Countries' development level and alcohol prices explained 31% of cross‐country variability in SDUs (LR test P‐value < 0.001) but did not explain cross‐country variability in the prevalence of heavy drinkers. Conclusions: Use and harmful use of alcohol among older adults appears to vary widely across age and countries. This variation can be partly explained both by the country‐specific composition of populations and country‐level contextual factors such as development level and alcohol prices. [ABSTRACT FROM AUTHOR]

Background and Aims: Changes in cannabis legalization and availability in Australia necessitate monitoring use and attitudes. We estimated age–period–cohort effects of past‐year cannabis use and attitudes toward criminalization and legalization. Design Analysis of six waves of the Australian National Drug Strategy Household Survey (NDSHS) every 3 years (2001–2016). Setting and participants: The study was nationally representative of Australian households using multistage random sampling, totaling 145 168 respondents 18–79 years old. Data were collected using telephone, face‐to‐face, and drop‐and‐collect. Sample sizes per analysis varied based on data availability (~107 000–127 000 per model). Measurements Six waves of data for past‐year cannabis use (by sex and education), attitudes toward criminalization and legalization. Findings Past‐year cannabis use decreased in young adults ages 18–35 from 2001–2016 (25.1%–18.6%) and increased in middle adults ages 36–55 (8.6%–10.1%) and older adults ages 56–79 (0.6%–3.0%). We observed a positive period effect and negative cohort effect for recent cohorts for past‐year use (e.g. 1955 cohort had 1.41 (95% CI: [1.11, 1.70]) increased log odds vs. 1998 cohort had −2.86 (95% CI: [−3.17, −2.55]) increased log odds) compared with the mean across years. Results were consistent by sex and varied by education. We observed a negative period effect for criminalization favorability (0.14 (95% CI: [0.003, 0.28]) increased log odds in 2001 vs. ‐0.31 (95% CI: [−0.45, −0.17]) increased log odds in 2016) and positive cohort effect for recent cohorts. Last, we observed a positive period effect for legalization support (−0.03 (95% CI: [−0.20, 0.14]) increased log odds in 2001 vs. 0.38 (95% CI: [0.22, 0.55]) increased log odds in 2016) and negative cohort effect for recent cohorts. Conclusion: Cannabis use appears to be increasing in Australia among adults over 35, while decreasing among adolescents and young adults. Legalization support also appears to have been increasing since 2007, signaling discordance between use and attitudes among adolescents and young adults, and potentially predicting increases in use over time. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aims: To use simulation to estimate the impact of alcohol taxation on drinking, non‐fatal violent victimization and homicide in New York City (NYC). We simulate the heterogeneous effects of alcohol price elasticities by income, level of consumption and beverage preferences, and examine whether taxation can reduce income inequalities in alcohol‐related violence. Design Agent‐based modeling simulation. Setting: NYC, USA. Participants: Adult population aged 18–64 years in the year 2000 in the 59 community districts of NYC. The population of 256 500 agents approximates a 5% sample of the NYC population. Measurements Agents were parameterized through a series of rules that governed alcohol consumption and engagement in violence. Six taxation interventions were implemented based on extensive reviews and meta‐analyses, increasing universal alcohol tax by 1, 5 and 10%, and beer tax by 1, 5 and 10%. Findings Under no tax increase, approximately 12.2% [95% credible interval (prediction interval, PI) = 12.1–12.3%] were heavy drinkers. Taxation decreased the proportion of heavy drinkers; a 10% tax decreased heavy drinking to 9.6% (95% PI = 9.4–9.8). Beer taxes had the strongest effect on population consumption. Taxation influenced those in the lowest income groups more than the highest income groups. Alcohol‐related homicide decreased from 3.22 per 100 000 (95% PI = 2.50–3.73) to 2.40 per 100 000 under a 10% universal tax (95% PI = 1.92–2.94). This translates into an anticipated benefit of ~1200 lives/year. Conclusion: Reductions in alcohol consumption in a large urban environment such as New York City can be sustained with modest increases in universal taxation. Alcohol tax increases also have a modest effect on alcohol‐related violent victimization. Taxation policies reduce income inequalities in alcohol‐related violence. [ABSTRACT FROM AUTHOR]

Adults and adolescents in the United States are experiencing unprecedented increases in depression and suicide, yet while marijuana and other drug use are increasing among adults,they are decreasing among adolescents. The causes and,therefore the remedies, of this public health burden may be fundamentally different between the two generations. [ABSTRACT FROM AUTHOR]