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  1. Article ; Online: Trends in Psychotropic Drug-Implicated Cardiovascular Mortality: Patterns in U.S. Mortality, 1999-2020.

    Kelly, Brian C / Vuolo, Mike

    American journal of preventive medicine

    2023  Volume 65, Issue 3, Page(s) 377–384

    Abstract: Introduction: Psychotropic drug-implicated (PDI) mortality-deaths in which psychotropic drugs were a contributing but not underlying cause of death-increased over two decades, with circulatory mortality as the primary cause leading to such deaths. ... ...

    Abstract Introduction: Psychotropic drug-implicated (PDI) mortality-deaths in which psychotropic drugs were a contributing but not underlying cause of death-increased over two decades, with circulatory mortality as the primary cause leading to such deaths. Trends in PDI circulatory mortality over a 22-year period and its patterning in U.S. deaths are described.
    Methods: Deaths extracted from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research Multiple Causes of Death database from 1999 to 2020 were analyzed to generate annual counts and rates for drug-implicated deaths due to diseases of the circulatory system, including by specific drug, sex, race/ethnicity, age, and state.
    Results: During a period when overall age-adjusted circulatory mortality rates declined, PDI circulatory mortality more than doubled, from 0.22 per 100,000 in 1999 to 0.57 per 100,000 by 2020, now representing 1 in 444 circulatory deaths. Although PDI deaths from ischemic heart diseases are proportionally aligned with overall circulatory deaths (50.0% vs 48.5%), PDI deaths from hypertensive diseases represent a larger proportion (19.8% vs 8.0%). Psychostimulants generated the greatest escalation for PDI circulatory deaths (0.029-0.332 per 100,000). The sex gap in PDI mortality rates widened (0.291 females, 0.861 males). PDI circulatory mortality is particularly notable for Black Americans and midlife Americans, with considerable geographic variability.
    Conclusions: Circulatory mortality with psychotropic drugs as a contributing cause escalated over 2 decades. Trends in PDI mortality are not evenly distributed across the population. Greater engagement with patients about their substance use is needed to intervene in cardiovascular deaths. Prevention and clinical intervention could contribute to reinvigorating previous trends of declining cardiovascular mortality.
    MeSH term(s) Female ; Humans ; Male ; Black or African American ; Cause of Death ; Hypertension/mortality ; Psychotropic Drugs/adverse effects ; United States/epidemiology ; Cardiovascular Diseases/mortality
    Chemical Substances Psychotropic Drugs
    Language English
    Publishing date 2023-03-07
    Publishing country Netherlands
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 632646-8
    ISSN 1873-2607 ; 0749-3797
    ISSN (online) 1873-2607
    ISSN 0749-3797
    DOI 10.1016/j.amepre.2023.02.016
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  2. Article ; Online: Correlates of Heroin Use, Pharmaceutical Fentanyl Misuse, and Dual Heroin-Fentanyl Use: Evidence from the U.S.

    Kelly, Brian C / Vuolo, Mike

    Drugs, habits and social policy

    2022  Volume 24, Issue 1, Page(s) 14–25

    Abstract: Purpose: The emergence of fentanyl has deepened concerns about the opioid crisis. The shift has created new distinctions in patterns of opioid use, which may be important for prevention and intervention. We examine socio-demographic correlates as well ... ...

    Abstract Purpose: The emergence of fentanyl has deepened concerns about the opioid crisis. The shift has created new distinctions in patterns of opioid use, which may be important for prevention and intervention. We examine socio-demographic correlates as well as health and substance use characteristics of different groups of opioid users.
    Design: We utilized the 2015-2019 National Survey on Drug Use and Health to examine distinctions between groups (n=11,142) of individuals who misuse prescription opioids, use heroin but not fentanyl, misuse pharmaceutical fentanyl but not heroin, and use both heroin and fentanyl. Multinomial and logistic regression models were used to identify these distinctions.
    Findings: Few socio-demographic differences emerged between the prescription opioid group and pharmaceutical fentanyl misuse group. While those who misuse fentanyl have higher odds of using other drugs and experiencing certain mental health problems than those misusing prescription pills, both the heroin and fentanyl-heroin use groups reported considerably poorer health and substance use indicators relative to those who solely misuse fentanyl. It is also notable that both heroin use groups are more highly associated with cocaine and methamphetamine use than those misusing fentanyl alone.
    Originality: This study highlights distinctions between pharmaceutical fentanyl users, heroin users, and users of both substances.
    Implications: While we identify important distinctions between the opioid use groups studied, individuals using both heroin and pharmaceutical fentanyl report the poorest health and substance use characteristics. Important differences between the fentanyl-only group and the group who consume both drugs may have implications for prevention, intervention, and clinical work amidst shifting patterns of opioid use.
    Language English
    Publishing date 2022-09-22
    Publishing country England
    Document type Journal Article
    ISSN 2752-6747
    ISSN (online) 2752-6747
    DOI 10.1108/dhs-04-2022-0019
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  3. Article ; Online: Balancing consumption and constraint: Binge drinking, stimulant misuse, and relational capital among young adults.

    Pawson, Mark / Kelly, Brian C

    Social science & medicine (1982)

    2022  Volume 309, Page(s) 115244

    Abstract: Peer relations inform consumption practices that shape both alcohol use and prescription drug misuse. Integrating studies on pharmaceutical cognitive enhancement with research on consumptive based edgework, this paper examines the role of psychostimulant ...

    Abstract Peer relations inform consumption practices that shape both alcohol use and prescription drug misuse. Integrating studies on pharmaceutical cognitive enhancement with research on consumptive based edgework, this paper examines the role of psychostimulant medications in resolving contradictory aspects of contemporary peer building processes. Drawing on qualitative interviews (n = 162) from a U.S. based study on the context of young adult prescription drug misuse, we demonstrate how medical resources are incorporated into peer bonding rituals in order to enhance consumptive capacity, reduce social risks, and facilitate the accumulation of relational capital. These findings highlight the paradoxical and problematic health ramifications of consumptive based peer bonding practices as well as how psycho-stimulant medications may compound those issues in unintended ways.
    MeSH term(s) Alcohol Drinking/psychology ; Binge Drinking ; Central Nervous System Stimulants/therapeutic use ; Humans ; Peer Group ; Prescription Drug Misuse ; Young Adult
    Chemical Substances Central Nervous System Stimulants
    Language English
    Publishing date 2022-08-08
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 4766-1
    ISSN 1873-5347 ; 0037-7856 ; 0277-9536
    ISSN (online) 1873-5347
    ISSN 0037-7856 ; 0277-9536
    DOI 10.1016/j.socscimed.2022.115244
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  4. Article ; Online: Effects of County-Level Opioid Dispensing Rates on Individual-Level Patterns of Prescription Opioid and Heroin Consumption: Evidence From National U.S. Data.

    Vuolo, Mike / Kelly, Brian C

    The American journal of psychiatry

    2021  Volume 179, Issue 4, Page(s) 305–311

    Abstract: Objective: The authors examined directly whether county-level changes in opioid dispensing rates affect individual-level prescription opioid misuse, frequency of use, and dependence, as well as the same outcomes for heroin.: Methods: Using data from ... ...

    Abstract Objective: The authors examined directly whether county-level changes in opioid dispensing rates affect individual-level prescription opioid misuse, frequency of use, and dependence, as well as the same outcomes for heroin.
    Methods: Using data from the restricted-access National Survey on Drug Use and Health, the Centers for Disease Control and Prevention's retail opioid prescription database, the Prescription Drug Abuse Policy System, and the U.S. Census, the authors applied fixed-effects models to determine whether county-level dispensing rates affected prescription opioid outcomes as intended and whether changes in rates adversely affected heroin use outcomes. Bayes factors were used to confirm evidence for null findings.
    Results: The sample included 748,800 respondents age 12 and older from 2006 to 2016. The odds of prescription opioid misuse, increased frequency of misuse, and dependence were 7.2%, 3.5%, and 10.4% higher, respectively, per standard deviation increase in the county-level opioid dispensing rate per 100 persons. There was no evidence for any association between opioid dispensing rates and the three heroin outcomes. The odds ratio was nonsignificant according to frequentist techniques in fixed-effects models, and Bayesian techniques confirmed very strong support for the null hypothesis.
    Conclusions: County-level opioid dispensing rates are directly associated with individual-level prescription opioid misuse, frequency of misuse, and dependence. Changes in dispensing were not associated with population shifts in heroin use. Reductions in opioid dispensing rates have contributed to stemming prior increases in prescription opioid misuse while not adversely affecting heroin use. Physicians and other health care providers can take action to minimize opioid dispensing for tangible benefits regarding prescription opioid misuse without adverse effects on heroin use.
    MeSH term(s) Analgesics, Opioid/therapeutic use ; Bayes Theorem ; Child ; Heroin/therapeutic use ; Humans ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Prescription Drug Misuse/prevention & control ; Prescriptions ; United States/epidemiology
    Chemical Substances Analgesics, Opioid ; Heroin (70D95007SX)
    Language English
    Publishing date 2021-12-08
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 280045-7
    ISSN 1535-7228 ; 0002-953X
    ISSN (online) 1535-7228
    ISSN 0002-953X
    DOI 10.1176/appi.ajp.2021.21060602
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  5. Article ; Online: Do naloxone access laws affect perceived risk of heroin use? Evidence from national US data.

    Kelly, Brian C / Vuolo, Mike

    Addiction (Abingdon, England)

    2021  Volume 117, Issue 3, Page(s) 666–676

    Abstract: Background and aims: Whether expanded access to naloxone reduces perceptions of risk about opioid use has been subject to debate. Our aim was to assess how implementation of naloxone access laws shapes perceived risk of heroin use.: Design: Using ... ...

    Abstract Background and aims: Whether expanded access to naloxone reduces perceptions of risk about opioid use has been subject to debate. Our aim was to assess how implementation of naloxone access laws shapes perceived risk of heroin use.
    Design: Using data from the restricted-access National Survey on Drug Use and Health, Prescription Drug Abuse Policy System and the US Census, we applied two-way fixed-effects models to determine whether naloxone access laws decreased perceived risk of any heroin use or regular heroin use. We used Bayes factors (BFs) to confirm evidence for null findings.
    Setting: United States.
    Participants: A total of 884 800 respondents aged 12 and older from 2004 to 2016.
    Measurements: A binary indicator of whether a state implemented naloxone access laws was regressed on respondent-perceived risk of (1) any heroin use and (2) regular heroin use. Ratings of perceived risk were assessed on a scale of 1 (none) to 4 (great risk).
    Findings: In all instances, the BFs support evidence for the null hypothesis. Across models with three distinct specifications of naloxone access laws, we found no evidence of decreased risk perceptions, as confirmed by BFs ranging from 0.009 to 0.057. Across models of specific vulnerable subgroups, such as people who use opioids (BFs = 0.039-0.225) or young people (BFs = 0.009-0.158), we found no evidence of decreased risk perceptions. Across diverse subpopulations by gender (BFs = 0.011-0.083), socio-economic status (BFs = 0.015-0.168) or race/ethnicity (BFs = 0.016-0.094), we found no evidence of decreased risk perceptions.
    Conclusions: There appears to be no empirical evidence that implementation of naloxone access laws has adversely affected perceptions of risk of heroin in the broader US population or within vulnerable subgroups or diverse subpopulations.
    MeSH term(s) Adolescent ; Analgesics, Opioid/therapeutic use ; Bayes Theorem ; Drug Overdose/drug therapy ; Drug Overdose/epidemiology ; Heroin/therapeutic use ; Humans ; Naloxone/therapeutic use ; Narcotic Antagonists/therapeutic use ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; United States/epidemiology
    Chemical Substances Analgesics, Opioid ; Narcotic Antagonists ; Naloxone (36B82AMQ7N) ; Heroin (70D95007SX)
    Language English
    Publishing date 2021-10-06
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1141051-6
    ISSN 1360-0443 ; 0965-2140
    ISSN (online) 1360-0443
    ISSN 0965-2140
    DOI 10.1111/add.15682
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  6. Article ; Online: Developing explanatory models for life course shifts in the burden of substance use to inform future policy and practice.

    Kelly, Brian C / Vuolo, Mike

    The International journal on drug policy

    2021  Volume 94, Page(s) 103182

    Abstract: Past approaches to policy and practice for substance use have focused heavily on young people, but recent trends indicate this approach may not be where the future lies. The crises with escalating overdose mortality in several countries, particularly ... ...

    Abstract Past approaches to policy and practice for substance use have focused heavily on young people, but recent trends indicate this approach may not be where the future lies. The crises with escalating overdose mortality in several countries, particularly overdoses related to opioids, have drawn attention to life course shifts in the burdens of substance use. Overdose mortality rates for individuals in midlife have considerably outpaced those of adolescents and individuals in early adulthood. These diverging life course trends are occurring not only in the United States, but in other countries with growing overdose problems as well. The future of effective policy and practice depend upon evidence and analyses that adapt to emerging data on shifting life course trends in drug related mortality. Within this manuscript, we consider a range of theoretical possibilities on the divergence of midlife drug mortality trends from those of young people for the purpose of outlining an agenda for future research and practice. Specifically, we consider the following theoretical approaches to move research forward in this area: Changes in Medical Context hypothesis; Emergent Comorbidities hypothesis; Cohort hypothesis; Generational Forgetting hypothesis; Legal Regulation hypothesis; Strength of Life Course Bonds hypothesis; Deepening Inequality hypothesis; Measurement Reliability hypothesis. These theoretical frameworks attend specifically to the overdose crisis but extend to other aspects of substance use. Beyond setting an agenda for research by providing empirically verifiable hypotheses, this manuscript also identifies future directions in policy and practice that are attentive to life course trends.
    MeSH term(s) Adolescent ; Adult ; Analgesics, Opioid/therapeutic use ; Drug Overdose/drug therapy ; Drug Overdose/epidemiology ; Humans ; Policy ; Reproducibility of Results ; Substance-Related Disorders/drug therapy ; Substance-Related Disorders/epidemiology ; United States/epidemiology
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2021-03-06
    Publishing country Netherlands
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2010000-0
    ISSN 1873-4758 ; 0955-3959
    ISSN (online) 1873-4758
    ISSN 0955-3959
    DOI 10.1016/j.drugpo.2021.103182
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  7. Article ; Online: Comprehensive vaping bans are associated with lower odds of initiation into electronic nicotine delivery systems use among young people.

    Vuolo, Mike / Orsini, Maria M / Staff, Jeremy / Maggs, Jennifer L / Kelly, Brian C

    Addiction (Abingdon, England)

    2024  Volume 119, Issue 6, Page(s) 1037–1047

    Abstract: Background and aims: E-cigarette and other electronic nicotine delivery systems (ENDS) use has grown considerably over the past decade, with notable increases among young people. US state policy contexts for ENDS and tobacco may shape initiation into ... ...

    Abstract Background and aims: E-cigarette and other electronic nicotine delivery systems (ENDS) use has grown considerably over the past decade, with notable increases among young people. US state policy contexts for ENDS and tobacco may shape initiation into ENDS use among adolescents as they age into early adulthood. We aimed to determine whether state-level comprehensive vaping ban policies reduce the odds of youth initiation into ENDS use, net of additional state-level ENDS and tobacco policies, as well as the youth's cigarette smoking status.
    Design: Longitudinal data from the Population Assessment of Tobacco and Health study were merged with a state-year database on tobacco and ENDS policies. Multivariable discrete-time event history models of ENDS initiation were estimated.
    Setting: United States.
    Participants: Twenty thousand twelve youth assessed over six waves from 2013 to 2019 (n = 53 974 observations).
    Measurement: We examined comprehensive indoor vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) as a key factor in initiation into ENDS use (i.e. first instance of vaping) from age 13 to 22.
    Findings: Among young people, residing in a state with a comprehensive vaping ban was associated with 18% lower odds of ENDS initiation (odds ratio = 0.82; 95% confidence interval =[0.71, 0.94]), even after controlling for other state ENDS and tobacco policies, the youth's cigarette smoking and socio-demographic background and state-level covariates.
    Conclusions: In the United States, state-level vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) are associated with reduced odds of youth initiation into electronic nicotine delivery systems use.
    MeSH term(s) Humans ; Vaping/epidemiology ; Adolescent ; Electronic Nicotine Delivery Systems/statistics & numerical data ; Male ; Female ; United States/epidemiology ; Longitudinal Studies ; Young Adult ; Restaurants/legislation & jurisprudence ; Cigarette Smoking/epidemiology
    Language English
    Publishing date 2024-02-27
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1141051-6
    ISSN 1360-0443 ; 0965-2140
    ISSN (online) 1360-0443
    ISSN 0965-2140
    DOI 10.1111/add.16450
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  8. Article ; Online: E-cigarette use among early adolescent tobacco cigarette smokers: testing the disruption and entrenchment hypotheses in two longitudinal cohorts.

    Kelly, Brian C / Vuolo, Mike / Maggs, Jennifer / Staff, Jeremy

    Tobacco control

    2023  

    Abstract: Objective: Using longitudinal data from two large-scale cohorts in the UK and USA, we examine whether e-cigarette use steers adolescent early smokers away from tobacco cigarettes (disruption hypothesis) or deepens early patterns of tobacco smoking ( ... ...

    Abstract Objective: Using longitudinal data from two large-scale cohorts in the UK and USA, we examine whether e-cigarette use steers adolescent early smokers away from tobacco cigarettes (disruption hypothesis) or deepens early patterns of tobacco smoking (entrenchment hypothesis) in comparison with early smokers who do not use e-cigarettes.
    Methods: Youth who smoked tobacco cigarettes by early adolescence (before age 15) were selected from the ongoing UK Millennium Cohort Study (n=1090) and the US Population Assessment of Tobacco and Health (n=803) study. In regression models, the focal predictor was lifetime use of an e-cigarette by early adolescence and the primary outcome was current tobacco use by late adolescence (before age 18). Logistic and multinomial models controlled for early adolescent risk factors and sociodemographic background, and were weighted for attrition and adjusted for complex survey designs.
    Results: Among youth who were early cigarette smokers, 57% of UK and 58% of US youth also used e-cigarettes. The odds of later adolescent smoking among early smoking youth were significantly higher among e-cigarette users relative to those who had not used e-cigarettes (adjusted OR (AOR
    Conclusions: Despite national differences in e-cigarette regulation and marketing, there is evidence e-cigarette use among early adolescent smokers in the UK and USA leads to higher odds of any smoking and more frequent tobacco cigarette use later in adolescence.
    Language English
    Publishing date 2023-04-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 1146554-2
    ISSN 1468-3318 ; 0964-4563
    ISSN (online) 1468-3318
    ISSN 0964-4563
    DOI 10.1136/tc-2022-057717
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  9. Article ; Online: Adolescent Cannabis Use During a Period of Rapid Policy Change: Evidence From the PATH Study.

    Orsini, Maria M / Vuolo, Mike / Kelly, Brian C

    The Journal of adolescent health : official publication of the Society for Adolescent Medicine

    2022  Volume 72, Issue 3, Page(s) 412–418

    Abstract: Purpose: To determine whether shifts in various state-level cannabis policies are associated with individual-level changes in adolescent cannabis use following implementation.: Methods: We use the restricted-access youth cohort of the PATH Study, a ... ...

    Abstract Purpose: To determine whether shifts in various state-level cannabis policies are associated with individual-level changes in adolescent cannabis use following implementation.
    Methods: We use the restricted-access youth cohort of the PATH Study, a recent, longitudinal, and nationally representative dataset, to assess whether changes in cannabis policy affect youth cannabis use. Data include respondents aged 12 to 17 years across up to six repeated observations (N = 26,673). Hybrid (between-person and within-person) panel models are used to examine adolescent past-month cannabis use.
    Results: Within-person effects showed that the odds of past-month cannabis use are lower (odds ratio [OR] = 0.632; p < .05) in years when a respondent's state allowed only cannabidiol (CBD) compared to years when the state had legalized medical cannabis. The odds of past-month cannabis use are lower during years when a respondent's state had decriminalized (OR = 0.617; p < .01) or criminalized (OR = 0.648; p < .05) adult recreational cannabis possession compared to years when it was legalized. These effects were robust to numerous controls, including time and state fixed effects. By contrast, significant between-person effects became nonsignificant with state fixed effects included, implying that state-level average use distinguishes average differences between states rather than policy.
    Discussion: Liberalized cannabis policy is significantly associated with recent adolescent cannabis use. The most consequential policy shift associated with adolescent use is from either criminalization or decriminalization of cannabis possession to legalization, such that states making these changes should consider additional prevention efforts.
    MeSH term(s) Adult ; Humans ; Adolescent ; United States ; Cannabis ; Medical Marijuana/therapeutic use ; Public Policy ; Research ; Cannabidiol ; Legislation, Drug
    Chemical Substances Medical Marijuana ; Cannabidiol (19GBJ60SN5)
    Language English
    Publishing date 2022-12-05
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1063374-1
    ISSN 1879-1972 ; 1054-139X
    ISSN (online) 1879-1972
    ISSN 1054-139X
    DOI 10.1016/j.jadohealth.2022.10.010
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  10. Article ; Online: Surveillance, Self-Governance, and Mortality: The Impact of Prescription Drug Monitoring Programs on U.S. Overdose Mortality, 2000-2016.

    Vuolo, Mike / Frizzell, Laura C / Kelly, Brian C

    Journal of health and social behavior

    2022  Volume 63, Issue 3, Page(s) 337–356

    Abstract: Policy mechanisms shaping population health take numerous forms, from behavioral prohibitions to mandates for action to surveillance. Rising drug overdoses undermined the state's ability to promote population-level health. Using the case of prescription ... ...

    Abstract Policy mechanisms shaping population health take numerous forms, from behavioral prohibitions to mandates for action to surveillance. Rising drug overdoses undermined the state's ability to promote population-level health. Using the case of prescription drug monitoring programs (PDMPs), we contend that PDMP implementation highlights state biopower operating via mechanisms of surveillance, whereby prescribers, pharmacists, and patients perceive agency despite choices being constrained. We consider whether such surveillance mechanisms are sufficient or if prescriber/dispenser access or requirements for use are necessary for population health impact. We test whether PDMPs reduced overdose mortality while considering that surveillance may require time to reach effectiveness. PDMPs reduced opioid overdose mortality 2 years postimplementation and sustained effects, with similar effects for prescription opioids, benzodiazepines, and psychostimulants. Access or mandates for action do not reduce mortality beyond surveillance. Overall, PDMP effects on overdose mortality are likely due to self-regulation under surveillance rather than mandated action.
    MeSH term(s) Analgesics, Opioid/therapeutic use ; Benzodiazepines/therapeutic use ; Drug Overdose ; Humans ; Prescription Drug Monitoring Programs ; United States/epidemiology
    Chemical Substances Analgesics, Opioid ; Benzodiazepines (12794-10-4)
    Language English
    Publishing date 2022-01-09
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 218206-3
    ISSN 2150-6000 ; 0022-1465
    ISSN (online) 2150-6000
    ISSN 0022-1465
    DOI 10.1177/00221465211067209
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