JMIR Publications

ABSTRACT

Background:

A resurgence of stimulant-involved overdose, both with and without opioids, indicate the latest overdose wave will likely involve polysubstance and stimulant-involved overdose, in addition to opioid-involved overdose. Recent assessments of transitions leading to non-pharmaceutical stimulant use and prescription stimulant misuse have shown complex patterns that are likely not universally applicable to all individuals who non-medically use stimulants. These past studies have isolated individual populations (e.g., college students) or individual behaviors (e.g., initiation of any misuse) when examining transitions. A comprehensive analysis of transitions between behaviors and the associations with downstream problematic drug use have not been conducted.

Objective:

The objective of this study was to determine whether adults from the general population who use stimulants follow a single behavioral pattern of initiation or whether initiation occurs through a heterogenous combination of behaviors. We also quantify the association between these typologies with present-day problematic drug use.

Methods:

A cross-sectional survey was conducted among adults who have reported use of any stimulant in their lifetime. Participants were recruited from a nationally representative online survey on drug use to answer questions about past stimulant use in a follow-up survey. Individuals were asked about what stimulants they used, reasons for use, routes of administration, and sources of the drug. For each drug-related behavior, they were asked what age they initiated the behavior. A latent transition analysis was used to characterize heterogeneity in initiation statuses and estimate likelihood of transitions across time.

Results:

Three initiation statuses were identified with frequent transitions between them, and statuses were differentiated primarily by whether individuals initiated few behaviors or many behaviors in 6-year age windows between ages 6-30. Statuses were differentiated by whether individuals initiated few behaviors or many behaviors in the age windows. Choice of drug initiated was not a strong differentiator. Those who were only in an Illicit Experimentation status (Prevalence: 20%) had the lowest odds of having severe, present-day problematic drug use. Odds were higher for a Conservative Initiation only status (Prevalence: 36%), higher still for those moving from Illicit Experimentation to Conservative Initiation (Prevalence: 19%), and highest for a Non-discriminatory Experimentation status (Prevalence: 22%). Only 3% could not be classified.

Conclusions:

Initiation of new drugs and behaviors occurred across many time windows, indicating multiple intervention opportunities are presented. Screening should be continued throughout adulthood so unhealthy drug use can be addressed before developing into full substance use disorders.