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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., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Nonmedical use of prescription drugs (NMUPD) is an urgent public health concern facing the United States. Young adults experiencing homelessness (YEH) are at increased risk of NMUPD; however, community estimates of NMUPD among YEH are sparse. This current study sought to understand patterns and correlates of NMUPD in a geographically heterogeneous sample of YEH recruited from seven cities across the United States., Methods: From June 2016 to July 2017, 1,426 YEH (aged 18-26) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information on substance use, mental health, trauma, and sexual-risk behaviors. Multivariable logistic regression was utilized to assess demographic, psychological, and behavioral correlates of self-reported past-month NMUPD and NMUPD types (i.e., prescription stimulant, sedative, and opioids)., Results: Approximately 20% of participants reported past-month NMUPD. Almost 9% reported misusing prescription opioids, 8.7% misused prescription sedatives, and 6% misused prescription stimulants. Multivariable logistic regressions revealed unmet mental health needs were associated with sedative and stimulant misuse but not opioid misuse. Having suicidal thoughts was associated with opioid misuse but not sedative or stimulant misuse. Although no geographical differences emerged for stimulant and sedative misuse, youth from Denver, Phoenix, and San Jose were more likely to engage in opioid misuse relative to youth in Los Angeles., Conclusions: These findings indicate that interventions designed to address NMUPD need to be multifaceted, designed to address other risk behaviors correlated with NMUPD, and target unmet mental health needs., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: South Africa has the highest number of people living with HIV (PLWH) and one of the largest antiretroviral therapy (ART) programs globally. High rates of substance use comorbidity exist, including speculation of recreational ART use (i.e., mixing ART with other illicit drugs). Recreational ART use may affect viral load among PLWH due to ART nonadherence and/or viral resistance; however, prior quantitative research has not examined rates of recreational ART use, nor associations with HIV treatment outcomes longitudinally., Methods: Data were drawn from a prospective, observational cohort study (n = 500) of ART-eligible adults recruited from two HIV voluntary counseling and testing centers in Cape Town, and Johannesburg, South Africa. Multiple logistic regression models assessed recreational ART use as a predictor of ART initiation over six months and viral load suppression over nine months, above and beyond other substance use (binge drinking and illicit drug use)., Results: Approximately 5% (n = 24) reported recreational ART use, which was less frequent in Cape Town compared to Johannesburg (AOR = 0.025; 95%CI: 0.003-0.19; p < 0.001). Recreational ART use was not significantly associated with ART initiation or viral suppression. Other substance use, but not recreational ART use, was significantly associated with lower odds of ART initiation (AOR = 0.54; 95%CI: 0.33-0.87; p = .01) and viral suppression (AOR = 0.47; 95%CI: 0.25-0.89; p = .02)., Conclusions: Recreational ART use was infrequent and not uniquely associated with ART initiation or viral suppression. Findings suggest that comorbid use of other substances is ultimately what may make recreational ART use problematic for ongoing engagement in care and viral suppression., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Due to a dramatic increase in the past 20 years, the non-medical use of prescription drugs (NMUPD) has become a global public health issue. College students have high prevalence of NMUPD in the United States. However, limited studies have been conducted among Chinese students. The purposes of this study were to examine the prevalence of NMUPD among college students in two urban centers (Beijing and Macau) in China and assess its relationships with cultural orientation (collectivism - primary focus on the group and individualism - primary focus on the individual)., Methods: In January-April 2017, 849 undergraduates (72.2% female) from Beijing and Macau, with an average age of 20 completed online surveys about their demographics, NMUPD, and cultural orientation., Results: Overall, 62.9% (lifetime) and 33.4% (past three-months) of students in Beijing reported NMUPD, while 35.9% (lifetime) and 21.8% (past three-months) of students in Macau reported NMUPD. The most commonly non-medically used class of medicine (lifetime) was analgesics (62.9% Beijing; 35.5% Macau), followed by sedatives (4.0% Beijing; 0.9% Macau), anxiolytics (2.7% Beijing; 0.6% Macau), and stimulants (1.0% Beijing; 0.2% Macau). Multivariate analyses suggested a positive association of individualism with lifetime NMUPD (OR = 1.78, 95% CI = 1.15, 2.75, p < .01 in Beijing; OR = 1.53, 95% CI = 1.16, 2.02, p < .01 in Macau)., Conclusion: NMUPD in Chinese college students appears to be common. More discussion is needed in China about regulation of prescription drugs. Future culturally-tailored NMUPD-risk reduction intervention programs may be beneficial to Chinese college students., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Benzodiazepine use dramatically increases the risk of unintentional overdose among people who use opioids non-medically. However, little is known about the patterns of co-occurring benzodiazepine and opioid use among young adults in the United States., Methods: The Rhode Island Young Adult Prescription Drug Study (RAPiDS) was a cross-sectional study from January 2015-February 2016. RAPiDS recruited 200 young adults aged 18-29 who reported past 30-day non-medical prescription opioid (NMPO) use. Using Wilcoxon rank sum test and Fisher's exact test, we examined correlates associated with regular prescribed and non-medical use (defined as at least monthly) of benzodiazepines among NMPO users in Rhode Island., Results: Among participants, 171 (85.5%) reported lifetime benzodiazepine use and 125 (62.5%) reported regular benzodiazepine use. Nearly all (n=121, 96.8%) reported non-medical use and 43 (34.4%) reported prescribed use. Compared to the 75 participants who did not regularly use benzodiazepines, participants who reported regular use were more likely to be white (66.3% vs. 58.0%, p=0.03), have ever been incarcerated (52.8% vs. 37.3%, p=0.04), and have ever been diagnosed with a psychiatric disorder (bipolar: 29.6% vs. 16.0%, p=0.04; anxiety: 56.8 vs. 36.0%, p=0.01). Although the association was marginally significant, accidental overdose was higher among those who were prescribed the benzodiazepine they used most frequently compared to those who were not (41.9% vs. 24.4%, p=0.06)., Conclusion: Benzodiazepine use and misuse are highly prevalent among young adult NMPO users. Harm reduction and prevention programs for this population are urgently needed., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Among those with opioid use disorder, heroin use is associated with poorer prognosis relative to use of prescription opioids alone. However, relatively little is known about distinguishing features between those who use heroin relative to those who use prescription opioids. In the present study we evaluated differences in delay discounting in those with opioid use disorder based on primary opioid of use. Delay discounting is associated with a range of negative outcomes and is an important therapeutic target in this population., Methods: Treatment-seeking adults with opioid dependence completed self-report measures including past-month opioid use and the Monetary Choice Questionnaire (Kirby and Marakovic, 1996; Kirby et al., 1999), a measure of delay discounting. Participants were divided into two groups based on whether they used any heroin in the past 30days or only prescription opioids, and delay discounting scores were compared between the groups. Group differences in sociodemographic or clinical variables were included in the analysis as covariates., Results: Results from a forward stepwise linear regression indicated that heroin use was associated with significantly higher delay discounting (B=-0.99, SE B =0.34, t=-2.88, p=0.005), even when considering covariates., Conclusions: Adults with opioid dependence who exclusively used prescription opioids had lower delay discounting relative to those who used heroin. This finding contributes further to the literature suggesting that heroin use is associated with greater clinical severity among those with opioid use disorder., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Prescription opioid (PO) injection among people who use illicit drugs (PWUD) is an ongoing concern, yet little is known about drug use trajectories associated with initiating PO injection, including potential associations with heroin use. This study aimed to identify predictors of PO injection initiation among PWUD, and examine trends in heroin use before and after initiating PO injection., Methods: Data were merged from three cohorts of PWUD recruited between September 2005 and November 2015. Predictors of PO injection initiation were identified using extended Cox regression models. Trends in heroin use pre- and post-initiation were examined with McNemar's test and compared to matched controls with linear growth curve models., Results: Among 1580 participants, 247 initiated PO injection yielding an incidence density of 3.9 (95% Confidence Interval [CI]: 3.4-4.4) per 100 person-years. In a multivariable analysis, independent predictors of PO injection initiation included heroin injection (Adjusted Hazard Ratio [AHR]=4.39, 95% CI: 3.24-5.95) and non-injection PO use (AHR=1.99, 95% CI: 1.25-3.17). In a sub-analysis, compared to matched controls, PO injection corresponded with elevated heroin use post-initiation (p≤0.05)., Discussion: In this study, heroin use and non-injection PO use strongly predicted PO injection initiation. Those who initiated PO injecting had elevated heroin use patterns post-initiation compared to controls. These findings suggest that transitioning to PO injection does not appear to be a substitute for heroin use among PWUD. These findings highlight the importance of addressing PO injection in harm reduction and treatment settings., Competing Interests: No conflict declared, (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Increases in illicit pharmaceutical opioid (PO) use have been associated with risk for transition to heroin use. We identify predictors of transition to heroin use among young, illicit PO users with no history of opioid dependence or heroin use at baseline., Methods: Respondent-driven sampling recruited 383 participants; 362 returned for at least one biannual structured interview over 36 months. Cox regression was used to test for associations between lagged predictors and hazard of transition to heroin use. Potential predictors were based on those suggested in the literature. We also computed population attributable risk (PAR) and the rate of heroin transition., Results: Over 36 months, 27 (7.5%) participants initiated heroin use; all were white, and the rate of heroin initiation was 2.8% per year (95% CI=1.9%-4.1%). Mean length of PO at first reported heroin use was 6.2 years (SD=1.9). Lifetime PO dependence (AHR=2.39, 95% CI=1.07-5.48; PAR=32%, 95% CI=-2% to 64%), early age of PO initiation (AHR=3.08, 95%; CI=1.26-7.47; PAR=30%, 95% CI=2%-59%), using illicit POs to get high but not to self-medicate a health problem (AHR=4.83, 95% CI=2.11-11.0; PAR=38%, 95% CI=12%-65%), and ever using PO non-orally most often (AHR=6.57, 95% CI=2.81-17.2; PAR=63%, 95% CI=31%-86%) were significant predictors., Conclusion: This is one of the first prospective studies to test observations from previous cross-sectional and retrospective research on the relationship between illicit PO use and heroin initiation among young, initially non-opioid dependent PO users. The results provide insights into targets for the design of urgently needed prevention interventions., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Non-medical prescription drug use (NMPDU) is a growing public health problem among adolescents. This is the first study to examine the correlates of early NMPDU initiation during middle school, and how early initiation is associated with four domains of functioning in high school (mental health, social, academic, and delinquency)., Methods: Students initially in 6th-8th grades from 16 middle schools completed in-school surveys between 2008 and 2011 (Waves 1-5), and a web-based survey in 2013-2014 (Wave 6). We used discrete time survival analysis to assess predictors of initiation from Waves 1 to 5 based on students who provided NMPDU information at any of these waves (n=12,904), and regression analysis to examine high school outcomes associated with initiation based on a sample that was followed into high school, Wave 6 (n=2539)., Results: Low resistance self-efficacy, family substance use, low parental respect, and offers of other substances from peers were consistently associated with NMPDU initiation throughout middle school. Further, perceiving that more of one's peers engaged in other substance use was associated with initiation at Wave 1 only. By high school, those students who initiated NMPDU during middle school reported lower social functioning, and more suspensions and fighting, compared to students who did not initiate NMPDU during middle school., Conclusion: NMPDU initiation during middle school is associated with poorer social functioning and greater delinquency in high school. It is important for middle school prevention programs to address NMPDU. Such programs should focus on both family and peer influences, as well as strengthening resistance self-efficacy., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)