Opioid misuse can occur through two pathways of initiation: medical and nonmedical. This makes opioids unique relative to substances of misuse (e.g., nicotine, alcohol), where initial exposure starts with nonmedical experimentation. Differences in initiation may influence attributions toward individuals with Opioid Use Disorder (OUD). Those initiating use medically may be perceived as less personally responsible for their OUD diagnosis than those initiating nonmedically. Such differences may serve as a source of bias and, in turn, negatively impact treatment access and quality. In a series of studies, participants reported the extent to which fictional patients were personally responsible for their OUD diagnosis. These patients differed only in their initiation pathways. These procedures were applied using both between-subjects (Study 1) and within-subjects (Study 2) designs, across samples of medical students, undergraduate students, and community members. Study 2 further investigated whether initiation context influenced treatment prioritization. Results showed that patients described as having initiated medically were viewed as less personally responsible for the diagnosis than patients who initiated nonmedically. This pattern replicated across all designs and stakeholder groups. Additionally, Study 2a provided preliminary evidence that initiation context is influential in decisions regarding patient prioritization. For individuals with an OUD diagnosis, initiation context represents an understudied source of bias that may impact treatment quality and access.

Background: Unhealthy alcohol, marijuana, and cocaine use are major public health concerns among ethnoracial minority gay, bisexual, and other men who have sex with men (GBMSM), who experience compounded stressors related to sexual and ethnoracial minority identities. Guided by the Minority Stress Model, this study examined pathways linking everyday discrimination, perceived stress, and substance use among ethnoracial minority GBMSM. Objectives: To examine whether everyday discrimination is associated with unhealthy alcohol use, whether perceived stress mediates the association between discrimination and unhealthy alcohol use, whether unhealthy alcohol use mediates the relationship between perceived stress and marijuana/cocaine use, and whether nativity moderates these associations. Results: A secondary analysis was conducted using survey data from 683 ethnoracial minority GBMSM enrolled in the National Institutes of Health All of Us Research Program. Structural equation modeling was used to assess direct, indirect, and moderating pathways. Everyday discrimination was positively associated with unhealthy alcohol use (β = 0.25, 95% CI [0.03, 0.46]). Unhealthy alcohol use was associated with both marijuana use (β = 0.30, 95% CI [0.16, 0.43]) and cocaine use (β = 0.21, 95% CI [0.08, 0.34]). Evidence for perceived stress as a mediator of the discrimination–alcohol use association was inconclusive, and nativity did not demonstrate a conclusive moderating effect. Conclusions: Findings suggest that discrimination may influence substance use through mechanisms beyond self-reported stress and that unhealthy alcohol use may serve as a pathway to other substance involvement among ethnoracial minority GBMSM. Clinical screening for discrimination experiences and polysubstance use risk may help identify individuals at elevated risk. Future research is needed to clarify the mechanisms linking discrimination and substance use in this population.

Background While racial microaggressions (behaviors and statements made toward a person with or without the intention of expressing prejudice) are associated with increased substance use among several racial groups, the relationship between racial microaggressions and substance use in Asian American adults is less defined. It is also unknown if ethnic identity strength (the quality of an individual’s affiliation with their ethnic group) moderates any associations between racial microaggressions and substance use in Asian American adults. Methods We conducted a cross-sectional survey of English-speaking Asian American adults aged 18 years and older living in the United States (N = 523). Validated scales assessed distinct subsets of racial microaggressions and ethnic identity strength. We assessed former (ever use, but not in the past 30 days) and past 30-day tobacco, cannabis, and alcohol substance use. Adjusted logistic regression models examined associations between racial microaggression subscales and substance use outcomes, as well as potential moderation by ethnic identity strength. Results Participants’ mean age was 42.9 years. The most reported ethnicities were Indian (15.7%), Filipino (14.5%), Japanese (13.6%), and Chinese (13.0%). Greater exposure to racial microaggressions was associated with higher odds of past 30-day tobacco, cannabis, and alcohol use, while associations with former substance use were less consistent. Ethnic identity strength did not significantly moderate these associations. Conclusions Racial microaggressions are associated with multiple forms of substance use among Asian American adults. Clinical and public health interventions that address racial microaggressions may help improve substance-use-related health outcomes in this population.

Background Young people’s expectations regarding the consequences of vaping are critical determinants of their vaping behavior; therefore, valid and reliable instruments are essential for accurately assessing these expectations. The aim of this study was to adapt the “Short Form Vaping Consequences Questionnaire” to Turkish culture and to evaluate its psychometric properties. Methods This methodological study included 840 university students. Data were collected face-to-face via Google Forms and analyzed using SPSS 22.0 and AMOS 25. The internal structure of the scale was examined. To evaluate the cultural and psychometric adaptation of the scale, validity was assessed through content and construct analyses (exploratory and confirmatory factor analyses), while reliability was evaluated using item-total correlations, Cronbach’s alpha, and test-retest. Results For the Turkish version, item-level content validity index values ranged from 0.83 to 1.00, scale-level content validity index was 1.00, and average scale-level content validity index was 0.95. Confirmatory factor analysis confirmed the original four-factor structure, with standardized loadings between 0.786 and 0.967. Cronbach’s alpha values ranged from 0.921 to 0.982. Test-retest results showed no significant differences (p > 0.05), and intraclass correlation coefficients values ranged from 0.801 to 0.979 (p < 0.001). Conclusions The findings of this study provide evidence of validity and reliability for the Turkish version of the Short Form Vaping Consequences Questionnaire in assessing vaping outcome expectancies among both users and non-users in university students.

Background Poisoning is a common method for suicide or suicide attempts. In this context, drug use, including cocaine, is described as a risk factor. Therefore, the use of cocaine in suicide attempts by self-poisoning should be investigated. Methods Data from poisoning cases registered by a Brazilian Poison Center between 2005 and 2024 were collected. Only suicide attempt cases involving cocaine as a toxic agent were selected. Demographic and toxicological variables were analyzed. Temporal analysis was carried out to verify changes along the analyzed period. Results A total of 1,089 cases of cocaine-related suicide attempts were registered. Approximately 64.1% were males, and young adults (20–39 years old) were the most prevalent age group (73.7%). An ARIMA model indicated that the number of observed cases from 2020 onwards was higher than expected, considering data up to 2019. An increase of 1,833% in cocaine-related suicide attempts over a 20-year period was assessed. Conclusions This study identified a marked rise in cocaine-related suicide attempts in recent years, with a clear shift during the COVID-19 pandemic. The predominant profile is men aged 20–39 years.

Background Prenatal cannabis use may be underreported due to social stigma and fear of legal repercussions. The study assesses the validity of self-reported prenatal cannabis use versus urine toxicology measures and determines correlates of non-disclosure. Methods Data are from a statewide population-based pregnancy cohort (MARCH- Michigan Archive for Research on Child Health). Participants were recruited at first prenatal visit from 22 clinics in 2017-2023. We calculated sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) of self-reported cannabis use using urine toxicology as the criterion standard. Results 606 participants who self-reported cannabis use data within 30 days of urine collection were considered for analysis. Self-reports identified a prevalence of 14.2% for prenatal cannabis use, whereas urinalysis prevalence was 19.1%. Sensitivity, specificity, PPV, and NPV of self-report were 57.8%, 96.1%, 77.9% and 90.6%, respectively. No significant differences were observed between participants who disclosed and those who did not, except for race and ethnicity. The sensitivity of self-reports among Non-Hispanic Blacks was 45.5% compared to 73.0% for their non-Hispanic White counterparts. Conclusions Self-reports can underestimate prenatal cannabis use especially among disadvantaged populations. The use of biospecimens to assess cannabis exposure is warranted for reducing misclassification and improving validity in research studies.

Background For individuals who smoke cigarette daily, there is published guidance on standardizing smoke exposure in the laboratory; however, we lack such a procedure for individuals who smoke cigarettes intermittently (ITS). Objective The purpose of this study was to pilot a standardized cigarette self-administration procedure for ITS (i.e., 4 to 27 days per month) and evaluate associated changes in withdrawal, craving, and motivation for smoking cessation. Methods Twenty-seven adult ITS completed two counterbalanced appointments: one involving typical self-administration (ad lib smoking) and another involving standardized self-administration (prescribed timing and number of puffs). Results The standardized puffing procedure appeared feasible; however, could not be verified using objective puff topography data. There were no significant differences between conditions on craving or withdrawal reduction, cigarette evaluation, or beliefs or motivations pertaining to smoking cessation. Conclusions The evaluated controlled self-administration procedure is a tool to standardize smoking exposure among ITS, without substantially altering craving, withdrawal, or smoking cessation-related variables. The procedure could be used in future research to better understand ITS smoking response and associated predictors with a fixed amount of smoke exposure.

Background and aim Extended-release injectable naltrexone (XR-Naltrexone) is an effective treatment for opioid use disorder (OUD); however, initiation can be challenging as it requires an opioid-free period. This exploratory analysis examines patient characteristics associated with successful initiation of XR-Naltrexone in the National Drug Abuse Treatment Clinical Trials Network (CTN-0051) Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment (X:BOT) trial. Methods Patient demographics and clinical variables associated with successful XR-Naltrexone initiation were examined among 283 participants with OUD randomized to XR-Naltrexone in the X:BOT trial. Variables included severity of opioid use, characteristics of opioid and other substance use, treatment history, psychiatric history, baseline depression, and pain. Logistic regression models were used to estimate the effect of variables on the odds of induction success. Results 204 (72%) of 283 participants randomized to receive XR-Naltrexone completed successful induction. Housing status and pain were significantly associated with XR-Naltrexone induction status. Reported homelessness was significantly associated with higher odds of successful XR-Naltrexone induction (OR: 2.31; 95% CI: 1.12, 4.76). Individuals that reported moderate or extreme pain on the EuroQoL had half the odds of successful induction compared to those without pain (OR: 0.49; 95% CI: 0.27, 0.89). Conclusions Among patients with OUD initiating treatment on inpatient units, homelessness was associated with greater likelihood of successfully initiating XR-Naltrexone, while chronic pain was associated with lower likelihood of XR-Naltrexone initiation. Future research on XR-Naltrexone initiation should consider tailoring treatment based on housing status and other social determinants, and evaluation and management of pain.

Background Cannabis marketing exposure has been shown to influence use among youth by increasing positive cannabis perceptions and interest. However, little is known about what specific cannabis advertising features influence youth’s perceptions, a key precursor to youth use. Methods Respondents consisted of 409 youth (age 16–20 years) surveyed in 2022 who reported susceptibility to using cannabis and were living in California, which legalized adult-use cannabis sales in 2018. Using an online experiment, respondents were randomly assigned to view cannabis advertisements with and without features previously shown to be appealing to adolescents, followed by questions related to cannabis perceptions. Exploratory factor analysis identified three underlying types of cannabis perceptions following ad exposure: cannabis as fun, healthy, or dangerous. Multivariable ordered logistic regressions tested associations of specific advertisement content features with these perceptions. Results Results revealed features that created perceptions of cannabis as fun, including depictions of positive sensations, psychoactive appeal, food or flavor references, the use of illustrated imagery, and animals or creatures. Features associated with perceptions of cannabis as healthy included positive sensations, adventure, showing the product, and price information. Ads depicting heavy consumption, faces, socializing, and using cannabis to avoid negative moods resulted in youth perceptions of cannabis as dangerous, and those with food or flavor references were perceived as less dangerous. Conclusion Results provide new insight into the psychological pathways by which marketing may operate. This can inform marketing standards and regulations to limit the effects of cannabis marketing on youth.

Background: Self-stigma refers to the internalization of negative societal beliefs and has been associated with reduced self-efficacy, self-esteem and treatment avoidance among substance users. However, little research has explored antecedents of self-stigma such as substance use motives. This may be particularly salient for psilocybin which is used both as a therapeutic agent and a recreational substance and these different motivations for use may shape how users’ behaviors are interpreted and internalized. Methods : The current study assessed associations between motives for psilocybin use and self-stigma across cognitive, affective and behavioral dimensions. Participants with prior experience of psilocybin (N = 239) completed an online questionnaire assessing their motives for using psilocybin and levels of self-stigma. A principal component analysis identified three components of psilocybin use motives, Social Recreation (ω t = 0.78), Experiential Enhancement (ω t = 0.80) and Therapeutic Growth (ω t = 0.73). Results: Hierarchical regression analyses demonstrated that greater Therapeutic Growth motives were associated with reduced self-stigma while greater Social Recreation motives were associated with increased self-stigma for all dimensions. No significant associations were found for Experiential Enhancement. Therapeutic Growth motives were also associated with increased frequency of psilocybin use. Conclusions: Although the variance explained was modest, these findings suggest that motives for psilocybin use may influence the extent to which users internalize stigma. This finding has implications for other substances and is important given the growing clinical interest in psilocybin.