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Changes in drug use in the general population during the COVID-19 pandemic and their long-term consequences are not well understood. We employed natural language processing and machine learning to analyse a large dataset of self-reported rates of and reasons for drug use during the pandemic, along with their associations with anxiety, depression and substance use problems post-pandemic. Our findings revealed a transient decrease in drug use at the pandemic's peak, primarily attributed to reduced social opportunities. Conversely, some participants reported increased drug use for self-medication, boredom, and lifestyle disruptions. While users of psychedelics and MDMA had anxiety and depression rates similar to non-users, users of opioid agonists and depressants—representing one in ten active drug users—reported greater mental health challenges post-pandemic. These results suggest that a subset of active drug users with distinct profiles faces elevated risks, particularly for anxiety and depression, and may benefit from targeted support. •After restrictions eased, recreational drug use returned to pre-pandemic levels.•A minority increased recreational drug use for self-medication amid the pandemic.•Pandemic recreational drug use correlated with greater anxiety and depression.•Post-pandemic opioid and benzodiazepine use is tied to mental health burdens.•Post-pandemic psychedelics and MDMA use show lowest anxious and depressive symptoms.

BackgroundRecent literature highlights the adverse effects of recreational marijuana on cerebrovascular pathologies and outcomes. However, its impact on arteriovenous malformation (AVM) outcomes is unknown.ObjectiveTo investigate the differences in AVM outcomes between marijuana users and non-users, focusing primarily on the likelihood of presenting with rupture and secondly, on the effects of other drugs on in-hospital mortality and complications.MethodsAdult patients diagnosed with cerebral AVMs from the National Inpatient Sample were included. Use of recreational drugs, including marijuana, alcohol, opioids, hallucinogens, stimulants, and tobacco, was documented. Univariate and multivariate logistic regression analyses identified associations between drug use and AVM outcomes.ResultsA total of 46 480 patients were analyzed, with 11 580 (24.9%) presenting with rupture. Smoking was the most prevalent substance used (18 010, 38.7%), followed by alcohol (3 065, 6.6%), and cannabis (745, 1.6%). Smoking tobacco (OR=0.801; P=0.0002) and cannabis use (OR=0.613; P=0.0523) showed trends towards a protective effect against presentation with AVM rupture. Tobacco use was associated with reduced likelihood of extended length of stay (OR=0.837; P=0.0013), any complications (OR=0.860; P=0.0082), and in-hospital mortality (OR=0.590; P=0.0003). Alcohol use was linked to increased extended length of stay (OR=1.363; P=0.0033) and complications (OR=1.442; P=0.0007).ConclusionsStimulant use increases the likelihood of presenting with ruptured AVMs and is associated with higher mortality. Tobacco and cannabis use appear to reduce the possibility of extended hospital stays and complications.

Background Most U.S. states have legalized cannabis for medical and/or recreational use. In a 6-month prospective observational study, we examined changes in adult cannabis use patterns and health perceptions following broadened legalization of cannabis use from medical to recreational purposes in California. Methods Respondents were part of Stanford University’s WELL for Life registry, an online adult cohort concentrated in Northern California. Surveys were administered online in the 10 days prior to state legalization of recreational use (1/1/18) and 1-month (2/1/18–2/15/18) and 6-months (7/1/2018–7/15/18) following the change in state policy. Online surveys assessed self-reported past 30-day cannabis use, exposure to others’ cannabis use, and health perceptions of cannabis use. Logistic regression models and generalized estimating equations (GEE) examined associations between participant characteristics and cannabis use pre- to 1-month and 6-months post-legalization. Results The sample ( N  = 429, 51% female, 55% non-Hispanic White, age mean = 56 ± 14.6) voted 58% in favor of state legalization of recreational cannabis use, with 26% opposed, and 16% abstained. Cannabis use in the past 30-days significantly increased from pre-legalization (17%) to 1-month post-legalization (21%; odds ratio (OR) = 1.28, p -value ( p ) = .01) and stayed elevated over pre-legalization levels at 6-months post-legalization (20%; OR = 1.28, p  = .01). Exposure to others’ cannabis use in the past 30 days did not change significantly over time: 41% pre-legalization, 44% 1-month post-legalization (OR = 1.18, p  = .11), and 42% 6-months post-legalization (OR = 1.08, p  = .61). Perceptions of health benefits of cannabis use increased from pre-legalization to 6-months post-legalization (OR = 1.19, p  = .02). Younger adults, those with fewer years of education, and those reporting histories of depression were more likely to report recent cannabis use pre- and post-legalization. Other mental illness was associated with cannabis use at post-legalization only. In a multivariate GEE adjusted for sociodemographic characteristics and diagnoses, favoring legalization and the interaction of time and positive health perceptions were associated with a greater likelihood of using cannabis. Conclusions Legalized recreational cannabis use was associated with greater self-reported past 30-day use post-legalization, and with more-positive health perceptions of cannabis use. Future research is needed to examine longer-term perceptions and behavioral patterns following legalization of recreational cannabis use, especially among those with mental illness.

Summary Objectives The COVID-19 pandemic has had unprecedented and deteriorating effects on the mental health of adolescents and young adults. Various studies have described changes regarding substance abuse, but findings are conflicting. Study design We conducted a cross-sectional online survey on nicotine, alcohol, and illicit drug use. Methods From March to May 2023, 502 participants aged 14–24 from a community-based sample completed the questionnaire. Results We found a general trend of declining or stable substance use during the first 2 years of the pandemic; however, in the third year (i.e., 2022), substance use returned to pre-pandemic levels or exceeded it. Compared with young adults (age 19–24), adolescents’ (age 14–18) use increased more clearly. Participants who scored above the cut-off on screening measures for problematic substance use showed a more pronounced increase in the use of cigarettes and illicit drugs but not of alcohol. Higher alcohol consumption during lockdowns was associated with increased likelihood of current problematic alcohol (odds ratio [OR]: 3.03) and cannabis use (OR: 2.60). Furthermore, individuals who reported increased usage of one psychotropic substance during lockdowns were more likely to have increased their use of other substances as well (OR: 2.66–4.87). Conclusions Although not optimally generalizable due to the retrospective online format and convenience sampling, our results support the notion that special attention ought to be paid to certain subgroups such as younger people and those who already exhibit problematic substance use during the pandemic. Following up on post-pandemic trends in substance use is crucial for developing prevention measures and targeted interventions.

Drug consumption estimates are of relevance because of public health effects as well as associated criminal activities. Wastewater analysis of drug residues enables the estimation of drug consumption and drug markets. Short-term and long-term trends of cocaine, MDMA (ecstasy), amphetamine (speed) and methamphetamine (crystal meth), were studied for the city of Amsterdam. MDMA (+41%) and cocaine (+26%) showed significantly higher weekend vs. week consumption, while no differences were observed for the other drugs. The consumption of MDMA, cocaine, amphetamine and methamphetamine significantly increased between 2011 and 2019. Weekly trends emerging from wastewater analyses were supported by qualitative and quantitative data from a recreational drug use monitoring scheme. However, information collected in panel interviews within nightlife networks and surveys among visitors of pubs, clubs and festivals only partially reflected the long term increase in consumption as registered from wastewater analysis. Furthermore, methamphetamine use was not well presented in survey data, panel studies and test service samples, but could be monitored trough wastewater analysis. This illustrates that wastewater analysis can function as an early warning if use and user groups are small or difficult to reach trough other forms of research. All in all, this study illustrates that wastewater-based epidemiology is complementary to research among user groups, and vice versa. These different types of information enable to connect observed trends in total drug consumption to behaviour of users and the social context in which the use takes place as well as validate qualitative signals about (increased) consumption of psychoactive substances. Such a multi angular approach to map the illicit drug situation on local or regional scale can provide valuable information for public health. [Display omitted] •Wastewater analyses Amsterdam 2011–2019.•Increased consumption of MDMA, cocaine, amphetamine and methamphetamine.•Higher weekend vs. week consumption of MDMA and cocaine.•Findings wastewater analysis partially supported by recreational drug use monitor.

We assess the current and describe possible future public health impacts of the legalisation of cannabis production, sale, and use in the Americas. First, we describe global patterns of cannabis use and their most probable adverse health effects. Second, we summarise evidence regarding the effectiveness of cannabinoids for medicinal use and describe approaches that have been used to regulate the use of medicinal cannabis and how these approaches might have affected medicinal and recreational use and harms (eg, road crashes). Third, we describe how jurisdictions that have legalised recreational use have regulated production and sale of cannabis. Fourth, we evaluate the effects of cannabis legalisation on cannabis use and harms and on the use of alcohol, tobacco, and other drugs. Fifth, we use alcohol and tobacco policy examples to identify possible long-term public health effects of cannabis legalisation. Finally, we outline policy approaches that could minimise harms to public health arising from the legalisation of a commercial cannabis industry.

Objectives. To examine the association between Colorado’s legalization of recreational cannabis use and opioid-related deaths. Methods. We used an interrupted time-series design (2000–2015) to compare changes in level and slope of monthly opioid-related deaths before and after Colorado stores began selling recreational cannabis. We also describe the percent change in opioid-related deaths by comparing the unadjusted model-smoothed number of deaths at the end of follow-up with the number of deaths just prior to legalization. Results. Colorado’s legalization of recreational cannabis sales and use resulted in a 0.7 deaths per month (b = −0.68; 95% confidence interval = −1.34, −0.03) reduction in opioid-related deaths. This reduction represents a reversal of the upward trend in opioid-related deaths in Colorado. Conclusions. Legalization of cannabis in Colorado was associated with short-term reductions in opioid-related deaths. As additional data become available, research should replicate these analyses in other states with legal recreational cannabis.

Background Marijuana is the most commonly used illicit drug in the United States. More and more states legalized medical and recreational marijuana use. Adolescents and emerging adults are at high risk for marijuana use. This ecological study aims to examine historical trends in marijuana use among youth along with marijuana legalization. Method Data ( n  = 749,152) were from the 31-wave National Survey on Drug Use and Health (NSDUH), 1979–2016. Current marijuana use, if use marijuana in the past 30 days, was used as outcome variable. Age was measured as the chronological age self-reported by the participants, period was the year when the survey was conducted, and cohort was estimated as period subtracted age. Rate of current marijuana use was decomposed into independent age, period and cohort effects using the hierarchical age-period-cohort (HAPC) model. Results After controlling for age, cohort and other covariates, the estimated period effect indicated declines in marijuana use in 1979–1992 and 2001–2006, and increases in 1992–2001 and 2006–2016. The period effect was positively and significantly associated with the proportion of people covered by Medical Marijuana Laws (MML) (correlation coefficients: 0.89 for total sample, 0.81 for males and 0.93 for females, all three p values < 0.01), but was not significantly associated with the Recreational Marijuana Laws (RML). The estimated cohort effect showed a historical decline in marijuana use in those who were born in 1954–1972, a sudden increase in 1972–1984, followed by a decline in 1984–2003. Conclusion The model derived trends in marijuana use were coincident with the laws and regulations on marijuana and other drugs in the United States since the 1950s. With more states legalizing marijuana use in the United States, emphasizing responsible use would be essential to protect youth from using marijuana.

Given the paucity of data on recreational drug use and the recent media attention on the abuse of drugs such as codeine cough syrups and tramadol, in Nigeria, our study examined the prevalence and frequency of recreational drug use among young adults from two Nigerian universities. We drew from the Socio-ecological Model to examine the influence of factors at the individual and family level on recreational drug use among adolescents and young adults. This cross-sectional study was conducted between February and March 2018 among a final sample of 784 male and female university students selected using stratified random sampling. Binary logistic regression was used to identify significant predictors of ever use and current use of drugs. Our analyses showed that 24.5% of students had ever used drugs for recreational purposes, and 17.5% are current users. The median drug use frequency over the past month was six days among current users (n = 137). In the multivariable analyses, living in the same household as one's mother (AOR 0.28 95% CI 0.16-0.49), adequate family support (AOR 0.48 95% CI 0.26-0.89) and frequent attendance of religious fellowships (AOR 0.13 95% CI 0.07-0.25) were significantly associated with a lower likelihood of recreational drug use. However, male sex (AOR 1.52 95% CI 1.05-2.21) was associated with higher odds of recreational drug use. The family should be considered as an important unit to sensitize young people on the harmful effects of drug use. It is also vital that religious leaders speak against drug use in their various fellowships. There is a need to address recreational drug use on Nigerian campuses by educating students about its adverse impacts.

Research is scant regarding differential effects of specific types of recreational drugs use on antiretroviral therapy adherence among women, particularly to single-tablet regimens (STR). This is increasingly important in the context of marijuana legalization. We examined the effects of self-reported substance use on suboptimal (<95%) adherence in the Women’s Interagency HIV Study, 2003–2014. Among 1799 HIV-infected women, the most prevalent substance used was marijuana. In multivariable Poisson GEE regression, substance use overall was significantly associated with suboptimal adherence (adjusted prevalence ratio, aPR = 1.20, 95% CI 1.10–1.32), adjusting for STR use, socio-demographic, behavioral, and clinical factors. Among STR users, compared to no drug use, substance use overall remained detrimental to ART adherence (aPR = 1.61, 95% CI 1.24–2.09); specifically, both marijuana (aPR = 1.48, 95% CI: 1.11–1.97) and other drug use (aPR = 1.87, 95% CI 1.29–2.70) predicted suboptimal adherence. These findings highlight the need to intervene with drug-using women taking antiretroviral therapy to maintain effective adherence.