Free samples from Express HighsAuthor Caviness is the study project manager and free legal high samples 2015 the first draft of the manuscript. Author Tzilos helped with the initial manuscript conception, first draft, and all subsequent zamples. Author Anderson ran the statistical analyses. Author Stein is the principal investigator. He was involved in the initial manuscript conception and all manuscript revisions.
Free samples from Express Highs
Author Caviness is the study project manager and wrote the first draft of the manuscript. Author Tzilos helped with the initial manuscript conception, first draft, and all subsequent revisions. Author Anderson ran the statistical analyses. Author Stein is the principal investigator.
He was involved in the initial manuscript conception and all manuscript revisions. Synthetic cannabinoids SCs are a class of drugs of abuse with deleterious consequences.
Despite governmental regulations related to distribution and sale, SC variants are still available online. More research is needed to determine SC use prevalence and factors associated with SC use, especially among young adults. One thousand eighty individuals, years old, were surveyed, between January and July , during recruitment for a randomized controlled trial investigating health behaviors in young adults.
SC use was significantly associated with male gender, not being enrolled in school, and with use of cigarettes, binge alcohol drinking, daily and weekly marijuana use, and other drugs of abuse. There was a significant decrease in SC use after the federal ban in July, SC use was common in the past month and often overlaps with other drug use, particularly marijuana use, and should be asked about during clinical encounters with young adults. Currently available for purchase not only over the internet, but also at gas stations, convenience stores, and head shops, SCs, which are smoked similarly to marijuana, are undetectable on standard drug tests for marijuana and have been perceived as safe by consumers 2 - 5.
Although new drug test systems do include options for SC testing, the rapidity with which SC variations are becoming available makes it difficult for testing to keep pace. In early studies, prevalence rates of SC use have ranged from 7.
As SCs have risen in popularity, so have reports of deleterious effects from their use. Reported symptoms, often unanticipated and severe, include psychosis, kidney injury, tachycardia, agitation, and seizures 2 , 11 - In there were over eleven thousand reported emergency department visits related to SCs 13 and there continues to be localized reports of outbreaks of heavy emergency department visits across the United States tied directly to SC use 20 , 21 Further, according to one survey of reported SC users, 2.
Even when unanticipated negative symptoms do not require emergency care, they are unpleasant, and frequently experienced Synthetic cannabinoids are not listed as active ingredients on the package label 23 , and type and concentration of active compound is not consistent across different products, or even within batches of the same product 4.
Many SC products contain multiple SCs 24 , and other psychoactive ingredients 2. SCs may affect the central nervous system differentially than natural cannabis, and the full array of potentially toxic effects of the identified compounds remains unknown Additionally, as SCs break down in the bloodstream, they may remain potent, and potentially hazardous 24 , increasing the risk of deleterious effects.
In response to increasing use and abuse, and rising reports of negative effects across Europe and the United States, government agencies have taken legal steps to limit the sale and distribution of SCs 16 , 23 , Synthetic Drug Abuse Prevention Act of In the United States, bans in individual states are occurring piecemeal; for example, in Rhode Island, where the current study took place, a law banning the sale of SCs was not enacted until July, 27 , 28 , making it one of the last states to ban such products.
Due to its relative newness, growing numbers of reports of negative consequences, and rapidly shifting legal status, SC use is an emerging area of interest for substance abuse researchers. SCs were found to be the second most commonly used illicit substance, surpassed only by marijuana, among high school seniors in and 7 , 29 , something that did not change, even after the federal ban.
However, data from suggests high school seniors decreased their use of SCs significantly Research to date has found SC users are significantly more likely to be male 3 , 6 , 7 , 9 , 10 , 31 than female. Age is also related to use, with adolescents more likely to be SC users than young adults 6 , 9 , 32 , although this is not true across all studies 3 , Additionally, Stogner and Miller 9 found sexual orientation to be a significant predictor of SC use, where lesbian, gay, bisexual and transgender LGBT young adults were significantly more likely to be SC users than their straight counterparts.
This finding is unique in the literature and warrants further study. SC users report using other drugs and alcohol at very high rates. For example, alcohol, marijuana, and tobacco use are extremely high among SC users 3 , 9 , 10 , Beyond these substances, SC users, at least those recruited from a college campus and an internet survey, consumed other drugs of abuse at high levels as well 31 , especially compared with their non-SC using peers 9.
A clear picture of the socioeconomics of SC users has not emerged from the extant literature. Although the Monitoring the Future data show SC use is higher among those who are college-aged, those who are not full-time students use SCs more often than those who are 32 , perhaps indicating an association with economic opportunity as reflected by college enrollment.
The majority of studies have been conducted in exclusively college populations 6 , 8 , 9. The purpose of the current study is to better our understanding of SC use and its correlates in a community sample of young adults responding to an advertisement for a research study involving alcohol or marijuana use.
Supporting previous findings, we hypothesize that SC users will report using other substances at significantly higher rates than those who have not used SCs, and that SC use will be higher among those not currently enrolled in school.
Screening survey data from participants recruited for the larger RCT between January and July were used for the current study.
We included responses from all persons screened regardless of their eligibility for the larger RCT except those outside of the age range. Recruitment occurred in several formats; online through Craigslist and Facebook targeted at Southeastern New England, and through advertisements placed in local college newspapers, on public transportation, and on commercial radio.
Have you recently used marijuana or alcohol? You may be eligible to participate in a research study about the health behaviors of young adults. Interested persons called the study phone number or sent an email to the study address to receive a return call to be screened. Screening was anonymous with verbal informed consent. Descriptive statistics summarize the characteristics of the cohort.
Among the full cohort of 1, persons aged years, just over half One hundred individuals 9. In this cohort of persons years old, use of SCs was not associated with age.
Use of SCs was also not significantly associated with the 4-category indicator of ethnicity Table 1. Use of SCs was not associated with sexual orientation. By comparison, rates of daily and weekly marijuana use among those reporting no use of SCs were Only 1 SC user reported no use of marijuana.
The current study took place in one of the last states to ban SC use, just prior to legal limits being set on the sale and distribution of SCs due to increasing reports reporting its deleterious effects. Although SC use was federally outlawed at the time of this study, SCs were widely available in convenience stores, smoke shops, and other retailers until the prohibition through state law was enacted.
Our survey extends recent work by describing SC use in a large diverse sample of year olds recruited from the community, who responded to an advertisement for recent alcohol or marijuana use. Importantly, this study sampled both college students and non-college students, and included persons using alcohol and drugs at various levels. Given that substance use across almost all classes of drugs is lower among college students than their non-college peers 29 , we were able to compare SC use through the years of young adulthood in both college and non-college enrolled individuals.
Interestingly, SC use was more frequently endorsed in this sample prior to the broad federal ban enacted in July, This is surprising, given how widely available SCs continued to be in the state at gas stations, convenience stores, and head shops, as was true in other regions 33 , and over the internet, even after the federal ban, and the high rate of other illicit substance use in this population.
We would not have hypothesized that federal legality of SCs would have been a motivating factor for discontinued use among this group of users. It is possible that media coverage of adverse effects leading up to, and accompanying the federal ban also played a role in the decreased frequency of use. It is also possible that individuals no longer saw advantages over marijuana once SC was also criminalized.
Our findings support the and Monitoring the Future results 29 , 32 that found those not in college were twice as likely to report using SCs, 8. Our data do not allow us to distinguish between those not in school due to college graduation and those who never enrolled, however, our pattern of results are similar to those found by Johnson et al. The greater use of SCs among those not in college and in the workforce could be explained by this group being more motivated to avoid positive drug tests on employer toxicology screens, or wanting what they perceive as a legal alternative to natural marijuana, easily purchased over the internet.
It is possible our sample, who also used marijuana heavily, switched to SC leading up to a known drug test in order to avoid a positive screen, or that in this sample, that was not their leading motivation for SC use.
These authors speculated that their findings were due in part to more affluent college students having more disposable income available to spend on SCs, which at the time of their study, were much more expensive than natural marijuana.
We did not measure family income in the current study, but this would be an interesting line of inquiry to explore further, especially given findings in contrast with the Monitoring the Future data and the current results regarding college attendance. SC use was more common in males than in females. Male gender seems to be a stable predictor of SC use as it has consistently been found across studies 3 , 6 , 7 , 9 , 10 , However, contrary to one previous report, we did not find sexual orientation to be significantly related to SC use 9.
The majority of our sample who identified as LGBT, self-identified as bisexual. This may be different than the population sampled in the previous report and account for the divergent findings.
Given the dearth of information related to sexual orientation and SC use, more investigation is warranted. This is consistent with previous findings, whereby SC users had consistently riskier drug use profiles than their non-SC using counterparts 3 , 9 , 31 , and smoked cigarettes at high rates 3 , 10 , Of note, only one individual reported using SC but not natural marijuana in this study.
This association between marijuana and SC is consistent with the literature. Winstock and Barratt 10 found a strong preference for natural marijuana among SC users despite the perceived benefits of SCs over marijuana, including SC use not being detectable on many standard drug tests and its relative safety.
Our results are consistent with these findings. This study has important strengths. Data were collected from a large sample of year old young adults through a variety of community advertising methods. The sample was diverse across gender, race and ethnicity, sexual orientation, and levels of substance and alcohol use, and unlike previous work in this area, more than fifty percent of our participants were not currently attending any form of higher education, increasing the generalizability of these results to the larger population of young adults.
There are also study limitations worth noting. First, SC use was measured using a single-item question and we do not have any information on the frequency of use, age of first use, or preference for SCs as compared to other drugs. Second, this sample was recruited for a study specifically seeking young adults who used alcohol or marijuana and therefore our sample reported higher levels of use of these substances than has been found in large national surveys 32 , Third, our findings may not generalize to other age groups or other regions.
Indeed, our data were collected during a period, and in a state, where SCs were not yet banned. Finally, when seeking information about stimulant use, we asked if participants had used either prescription and non-prescription stimulants, therefore this finding should be interpreted with caution as a number of these respondents may have been using a medication as prescribed e.
SCs are understudied, rapidly evolving, synthetic drugs which warrant careful consideration from lawmakers, medical professionals, researchers, and SC users themselves. Health service practitioners can engage young adults about their SC use and in doing so may find an opportunity to discuss legal, educational, health, and alcohol and drug concerns, including marijuana use, which is now legal in several states. As the current study found, SC users tend to engage in high risk drug use, in addition to their SC use.
Querying young adults who use marijuana, especially young men who are not attending college, about SC use may be a non-threatening way to begin a conversation about a number of high risk behaviors.
Additionally, it is important to continue to study the impact of SCs on individuals, in concert with other drug use, and on our medical and legal systems, as this will inform ways to improve regulatory and intervention efforts. Trial registered at clinicaltrials. The NIAAA and NIDA had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.