By Joseph E. Schumacher, Abdullah Ahsan, Amber H. Simpler, Adam P. Natoli & Bradley J. Cain

Conducting research within a carceral health care context offers a unique view into the nature of drug use among arrestees with potential to identify and prevent drug use consequences. The purpose of this study was to characterize the nature and extent of drug use among first-time jail arrestees to inform detection and treatment.

Methods

This study utilized a naturalistic research design to collect de-identified urine drug screens (UDS), jail characteristics, and arrestee demographic variables among arrestees indicating drug use from 25 jails across the United States in 2023 through a confidential data sharing agreement with NaphCare, Inc. using its proprietary electronic health record operating system. Descriptive statistics were used to detail the features of the dataset, Pearson’s chi-square tests of independence were performed to statistically analyze associations between UDS results and jail characteristics and arrestee demographics, and significant chi-square test results were further investigated by examining standardized residuals to clarify the nature and significance of within-group differences in proportions.

Results

Of the 43,553 UDS cases comprising the final sample (28.8% of total arrestees), 74.8% (32,561) were positive for one or more drugs, and 25.2% of UDS cases were negative for all drugs. Among those who tested positive, 69.0% were positive for cannabis, 54.8% for stimulants, 29.6% for opioids, and 12.4% for sedatives. Arrestees were positive for multiple drugs half the time, with combinations of cannabis, stimulants, and opioids most common. Significant associations between drug use and both jail characteristics and arrestee demographics were found.

Conclusions

Though drug use is not a recent phenomenon, the lethality potential of the drugs being used today is relatively new. Arrestees with positive urine drug screens are at heightened risk of adverse outcome due to sudden cessation of substance use. Findings highlight the need for objective clinical data to guide acute treatment of individuals at risk of withdrawing while detained. A

ddiction Science & Clinical Practice (2025), 15p.

By Jonathan P. Caulkins

Background and aims: Multiple countries are considering revising cannabis policies. This study aimed to measure long-term trends in cannabis use in the United States and compare them with alcohol use.

Design and setting: Secondary analysis of United States general population survey data.

Participants: The national surveys had a total of 1 641 041 participants across 27 surveys from 1979 to 2022.

Measurements

Rates of use reported to the US National Survey on Drug Use and Health and its predecessors are described, as are trends in days of use reported. Four milepost years are contrasted: 1979 (first available data and end of relatively liberal policies of the 1970s), 1992 (end of 12 years of conservative Reagan-Bush era policies), 2008 (last year before the Justice Department signaled explicit federal non-interference with state-level legalizations) and 2022 (most recent data available).

Findings

Reported cannabis use declined to a nadir in 1992, with partial recovery through 2008, and substantial increases since then, particularly for measures of more intensive use. Between 2008 and 2022, the per capita rate of reporting past-year use increased by 120%, and days of use reported per capita increased by 218% (in absolute terms from the annual equivalent of 2.3 to 8.1 billion days per year). From 1992 to 2022, there was a 15-fold increase in the per capita rate of reporting daily or near daily use. Whereas the 1992 survey recorded 10 times as many daily or near daily alcohol as cannabis users (8.9 vs. 0.9 M), the 2022 survey, for the first time, recorded more daily and near daily users of cannabis than alcohol (17.7 vs. 14.7 M). Far more people drink, but high-frequency drinking is less common. In 2022, the median drinker reported drinking on 4–5 days in the past month, versus 15–16 days in the past month for cannabis. In 2022, past-month cannabis consumers were almost four times as likely to report daily or near daily use (42.3% vs. 10.9%) and 7.4 times more likely to report daily use (28.2% vs. 3.8%).

Conclusions

Long-term trends in cannabis use in the United States parallel corresponding changes in cannabis policy, with declines during periods of greater restriction and growth during periods of policy liberalization. A growing share of cannabis consumers report daily or near daily use, and their numbers now exceed the number of daily and near daily drinkers.

Addiction, Volume119, Issue9, September 2024, Pages 1648-1652

By Patrick Lussier and Evan McCuish

Objectives

There is empirical evidence that sexual recidivism rates have been dropping for several decades, but it remains unclear whether this drop is an artifact of changing research methodologies over the years. The current study, therefore, examines whether the sexual recidivism drop is robust while accounting for various methodological factors.

Method

The study is based on a systematic review and a quantitative meta-analysis of 468 empirical studies published between 1940 and 2019 that reported sexual recidivism rates. A total of 626 estimations (n = 388,994) of sexual recidivism were retrieved for the study period and of those, 238 were independent observations (n = 196,651). A series of sensitivity analyses were conducted using a meta-regression approach.

Results

A series of meta-regression analyses show that, even after accounting for various methodological factors (e.g., study settings, follow-up length, recidivism criteria), there has been a sexual recidivism rate drop of about 45–60% since the 1970s.

Conclusions

The study findings confirm the presence of a sexual recidivism drop while recognizing that sexual recidivism rates are sensitive to methodological details.

Journal of Criminal Justice

Volume 92, May–June 2024, 102188, p. 16

By Tse Yang Lim , Huiru Dong , Erin Stringfellow , Zeynep Hasgul , Ju Park , Lukas Glos , Reza Kazemi , Mohammad S Jalali 

Fentanyl and its analogs contribute substantially to drug overdose deaths in the United States. There is concern that people using drugs are being unknowingly exposed to fentanyl, increasing their risk of overdose death. This study examines temporal trends and spatial variations in the co-occurrence of fentanyl with other seized drugs.

Methods

We identified fentanyl co-occurrence (the proportion of samples of non-fentanyl substances that also contain fentanyl) among 9 substances or substance classes of interest: methamphetamine, cannabis, cocaine, heroin, club drugs, hallucinogens, and prescription opioids, stimulants, and benzodiazepines. We used serial cross-sectional data on drug reports across 50 states and the District of Columbia from the National Forensic Laboratory Information System, the largest available database on the U.S. illicit drug supply, from January 2013 to December 2023.

Findings

We analyzed data from 11,940,207 samples. Fentanyl co-occurrence with all examined substances increased monotonically over time (Mann-Kendall p < 0.0001). Nationally, fentanyl co-occurrence was highest among heroin samples (approx. 50%), but relatively low among methamphetamine (≤1%), cocaine (≤4%), and other drug samples. However, co-occurrence rates have grown to over 10% for cocaine and methamphetamine in several Northeast states in 2017–2023.

Interpretation: 

Fentanyl co-occurs most commonly with heroin, but its presence in stimulant supplies is increasing in some areas, where it may pose a disproportionately high risk of overdose.

Lancet Reg Health Amicas, 2024 Sep 27;39:100898. doi: 10.1016/j.lana.2024.100898

By Aili Malm, Nicholas Perez, Michael D. White

This publication represents the final research report of California State University, Long Beach’s (CSULB) evaluation of an intelligence-led problem-oriented policing (POP) project to better understand and address illicit fentanyl distribution networks in Long Beach, CA. The goals of this study were to: (1) employ problem-oriented policing to drive efforts to identify and disrupt fentanyl distribution networks in Long Beach, CA, and (2) use intelligence analysis to identify high-level distributors for investigation. To achieve these goals, researchers worked with a newly hired intelligence analyst and Long Beach Police Department (LBPD) Drug Investigation Section (DIS) detectives to improve their fentanyl distribution network investigations. The intervention included POP training, intelligence analyst support [cellular phone extractions, open-source intelligence (OSINT), social network analysis (SNA), etc.], and weekly interactions between the analyst and the research team. To assess the effectiveness of the project, we conducted both process and outcome evaluations. Primary data sources include: (1) interviews of detectives and the analyst; (2) DIS administrative data; (3) network data from three fentanyl distribution cases; and (4) fentanyl-related overdose data from the LBPD and the California Overdose Surveillance Dashboard. We identified findings across multiple analyses that, when taken together, represent a persuasive collection of circumstantial evidence regarding the positive effects of the project on two important outcomes: increased DIS activity and efficiency and effective fentanyl distribution network disruption. While fentanyl-related overdose rates did decrease substantially over the course of the project, there is no conclusive evidence that the project led to the reduction. The effects of COVID-19, the defund movement following George Floyd’s death, and the Los Angeles County District Attorney policy limiting the prosecution of drug offenses confounded our ability to draw a stronger connection between the project and enhanced DIS activity and efficiency, fentanyl distribution network disruption, and overdose rates.   

California State University, Long Beach; School of Criminology, Criminal Justice, and Emergency Management; 2024 77p. 

By Yulia Krylova  and· Louise Shelley

The last decade witnessed increasing involvement of criminal street gangs in domestic sex trafficking in the United States. This paper analyzes business models and practices of gang-controlled sex trafficking in Northern Virginia, based on the cases available from PACER, an electronic public access service of the United States federal court. This analysis shows that business models of gang-controlled sex trafficking have become more sophisticated, taking advantage of the globalized financial system, new technology, social media, and the increasing prevalence of illicit commerce in a digital world with greater connectivity. Gangs’ flexible structures combined with loyalty enforced among their members have shielded them from much law enforcement action. The analysis of different gangs involved in sex trafficking in Northern Virginia provides new insights into anti-trafficking policies and law enforcement responses tailored to their structures and modi operandi.

Crime, Law and Social Change, February 2023

By Melissa Farley & M. Alexis Kennedy

Background: Extreme violence and psychological abuse have been extensively documented and are pervasive in prostitution. Survivors of prostitution report high levels of posttraumatic stress disorder, dissociation, depression, and self-loathing. These are the same sequelae reported by torture survivors. Objective: Severe forms of violence have been categorized as torture by experts. The authors note that torture is commonly suffered during prostitution and should be appropriately named. Method: Using standardized measures and including a new measure of torture, we interviewed 45 women in the United States about their torture experiences in prostitution and their symptoms of PTSD, dissociation, childhood trauma, health status and somatic symptoms. The interviewees had exited prostitution and were in supportive programmes. Results: Formerly prostituted interviewees reported acts of physical, sexual, and psychological torture, including strangulation, rape, beatings, restriction of movement, denial of privacy, sleep, or food, and being forced to witness the torture of others. The 45 women had high levels of PTSD and dissociation. They endorsed needs for individual counselling, substance abuse treatment, and other medical care. Conclusions: A recognition of the physical, sexual, and psychological torture experienced in prostitution would strengthen psychological and medical interventions for survivors. Naming specific acts of prostitution as torture will reduce the survivor’s shame and selfblame. Holistic treatment includes medical and psychological interventions and peer support, as seen in torture rehabilitation programmes for survivors of state-sponsored torture. This research supports the perspective that private or non-state-sponsored torture against women and marginalized populations should be clinically and legally understood in the same way as state-sponsored torture.   

European Journal of Psychotraumatology, 15:1, 2404307, DOI: 10.1080/20008066.2024.2404307 To link to this article:

By  Almudena Arcelus, Carlos Chiapa, Pierre Cremieux, Maria Garibotti, Owen Hearey, Yeseul Hyun, Lu Jinks, Jee-Yeon Lehmann, Yao Lu, Kritika Narula, Lolo Palacios, Haimin Zhang 

Immigrants are an integral part of the U.S. economy. According to 2022 data from the U.S. Census Bureau, there are approximately 46 million immigrants in the United States, representing close to 14 percent of the total U.S. population. Immigrants participate in the civilian labor force at higher rates than native-born U.S. workers, and they are an important source for U.S. labor force growth that will help offset the large-scale retirement of baby boomers. A significant part of the growth in the foreign-born labor force in the United States over the past decade is associated with the arrival of immigrants who hold a bachelor’s degree or higher. Immigrants in the United States participate in a wide variety of occupations, ranging from high-skilled, high-wage jobs such as physicians and engineers to low-wage jobs such as agriculture work and food manufacturing. During the COVID-19 pandemic and associated lockdowns in the United States, immigrants played critical roles in key sectors of the economy, including healthcare, scientific research and development, agriculture, and food supply. Analysis by the Immigration Research Initiative, a nonpartisan think tank, estimates that in 2021, immigrants contributed $3.3 trillion to the U.S. gross domestic product (GDP), which represents 17 percent of total U.S. GDP. In addition to the civilian workforce, immigrants also serve in the U.S. military. As of 2022, nearly 731,000 veterans of the U.S. armed forces were born outside the United States, representing approximately 4.5 percent of the U.S. veteran population, with Mexican and Filipino immigrants comprising the largest groups of foreign-born veterans. 

Boston: The Analysis Group, 2024. 166p.

By Ariel G. Ruiz Soto

Immigrants in the United States commit crimes at lower rates than the U.S.-born population, notwithstanding the assertion by critics that immigration is linked to higher rates of criminal activity. This reality of reduced criminality, which holds across immigrant groups including unauthorized immigrants, has been demonstrated through research as well as findings for the one state in the United States—Texas—that tracks criminal arrests and convictions by immigration status. A growing volume of research demonstrates that not only do immigrants commit fewer crimes, but they also do not raise crime rates in the U.S. communities where they settle. In fact, some studies indicate that immigration can lower criminal activity, especially violent crime, in places with inclusive policies and social environments where immigrant populations are well established. 

Washington, DC: Migration Policy Institute, 2024. 7p.

By: Lauren Stienstra, Diane P. Horn, Erica A. Lee, Bruce R. Lindsay, William L. Painter, Elizabeth M. Webster

On October 9, 2024, Hurricane Milton made landfall as a Category 4 hurricane in Florida’s Tampa Bay area bringing heavy rain, storm surge, and floods to many counties on the coast and in the interior of the state. Some areas in the state are still actively recovering from Hurricane Helene.

President Biden had previously issued an emergency declaration for this storm on October 7, under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act, P.L. 93-288, as amended; 42 U.S.C. §§5121 et seq.), authorizing Public Assistance (PA) for emergency protective measures put into action beginning October 5, 2024. On October 8, 2024, President Biden issued another emergency declaration authorizing federal assistance to Seminole Tribe of Florida.

As of October 11, President Biden declared a major disaster for Hurricane Milton in Florida, authorizing PA, Individual Assistance, and Hazard Mitigation Assistance. President Biden also increased the federal share of eligible response costs; the federal government will cover 100% of eligible costs of PA provided for emergency protective measures and debris removal for a period of 90 days.

The situation remains dynamic; additional declarations, or additional forms of assistance are expected given Milton’s impact.

Information about state and county disaster assistance is published in FEMA’s declaration database. FEMA’s Hurricane Milton web page provides information on how to apply for disaster assistance. FEMA has also created another site to dispel rumors and misinformation related to aid to survivors, evacuation, and relief funding.

CRS Insight, IN12438; Oct. 13, 2024

By Ariel G. Ruiz Soto

Immigrants in the United States commit crimes at lower rates than the U.S.-born population, notwithstanding the assertion by critics that immigration is linked to higher rates of criminal activity. This reality of reduced criminality, which holds across immigrant groups including unauthorized immigrants, has been demonstrated through research as well as findings for the one state in the United States—Texas—that tracks criminal arrests and convictions by immigration status. A growing volume of research demonstrates that not only do immigrants commit fewer crimes, but they also do not raise crime rates in the U.S. communities where they settle. In fact, some studies indicate that immigration can lower criminal activity, especially violent crime, in places with inclusive policies and social environments where immigrant populations are well established. A Look at the Overall Immigrant Population National studies have examined incarceration rates and prosecutions of immigrants in the country, overwhelmingly finding that immigrants of all legal statuses commit crimes at lower rates than those who were born in the United States. Immigrants Are Prosecuted and Imprisoned at Lower Rates than the U.S. Born Immigrants in the United States have had lower incarceration rates than the native-born population since at least 1870 (when such data were first recorded). In 2020, immigrants were 60 percent less likely to be incarcerated than the U.S. born, according to a study by the National Bureau of Economic Research. And though a 2021 Justice Department study points out prosecutions of immigrants increased between 1990 and 2018, nearly 90 percent were for violations of immigration-related laws. Notably, U.S. born citizens were ten times more likely than immigrants to be incarcerated for committing weapons- related offenses, five times more likely for violent offenses, more than twice as likely for property crimes, and nearly twice as likely for drug offenses.  At the state level, multiple studies have found there is no clear relationship between violent crime and immigration. And research at the city level suggests that increases in immigration can be associated with declining homicide rates, with the largest effect on municipalities with long histories of immigration, as well as reductions in property crimes and robbery. This makes immigrants  less likely to be either offenders or victims of crime at the local level compared to the U.S.-born population

Washington, DC: Immigration Policy Institute, 2024. 5p.   

By Mahmoud A ElSohly , Chandrani G Majumdar , Suman Chandra , Mohammed M Radwan 

The prevalence of cannabis as the most commonly used illicit substance in the United States and around the globe is well-documented. Studies have highlighted a noticeable uptrend in the potency of cannabis in the United states. This report examines the concentration of cannabinoids in illicit cannabis samples seized by the United States Drug Enforcement Administration (DEA) over the last 10 years (2013–2022).

Methods

Samples received during the course of study (2013–2022) were categorized based on the geographical region where collected, as Western Region, Midwest Region, Northeast Region, South East Region, Southern Region as well as Alaska and Hawaii. These samples were processed for analysis using a validated gas chromatography with flame ionization detector method.

Results

The data showed that the cannabinoids profile of all high Δ9-THC cannabis samples, regardless of the state or region from which the samples are seized or the state from which the sample is produced under a state medical marijuana program, is basically the same with the major cannabinoid being Δ9-THC (>10% for most samples) and all other cannabinoids with less than 0.5%, with the exception of CBG (<1%) and CBN (<1%).

Conclusion

Overall, it appears the cannabinoids profile is controlled by the genetics of the plant and is not affected much by the geographical location in which the plants are cultivated.

Front Public Health. 2024 Oct 3;12:1442522.

By Delvon T. Mattingly  , Maggie K. Richardson ,  Joy L. Hart

Introduction: Cannabis use is increasing due to several factors including the adoption of laws legalizing its use across the United States (US). We examined changes in current cannabis use among US youth and adults and by key socio-demographic groups. Methods: Using data from the 2013–2022 National Survey on Drug Use and Health (n=543,195), we estimated the prevalence of (2013–2019, 2020, 2021–2022) and trends in (2013–2019, 2021–2022) current (i.e., past 30- day) cannabis use among US youth (aged 12–17) and adults (aged 18+) overall and by age, gender, race and ethnicity, educational attainment, and total annual family income. We also examined sociodemographic factors associated with use from 2013 to 2019, in 2020, and from 2021 to 2022. Results: Cannabis use increased from 7.59 % to 11.48 % in 2013–2019, was 11.54 % in 2020, and increased again from 13.13 % to 15.11 % in 2021–2022. Among youth, cannabis use remained constant from 2013 to 2019 and 2021–2022. In 2022, use was highest among aged 18–34, male, non-Hispanic multiracial, and generally lower SES adults. From 2021–2022, cannabis use increased among several groups such as adults who were aged 35–49 (14.25–17.23 %), female (11.21–13.00 %), and Hispanic (10.42–13.50 %). Adults who were aged 18–25, male, non-Hispanic multiracial, some college educated, and of lower annual family income had consistently higher odds of current cannabis use from 2013 to 2019, in 2020, and from 2021 to 2022. Conclusions: Cannabis use is increasing overall and among certain sociodemographic groups. Our findings inform prevention and harm reduction efforts aimed at mitigating the prevalence of cannabis use in the US. 

Drug and Alcohol Dependence Reports 12 (2024) 10025 

By Patricia C. Lewis , Nadine J. Kaslow, Yuk Fai Cheong, Dabney P. Evans and Kathryn M. Yount

Femicide Refers to the intentional gender-related killing of women and girls (1). Despite the high prevalence of female murder victimization in the United States (U.S.) (2, 3), the U.S. lags behind other nations in defining and documenting gender-related female homicides (4). While efforts are underway within the criminal justice and public health sectors to better track violent deaths, deficient surveillance systems limit efforts to estimate the annual incidence of femicide in the U.S. Here, we position femicide as a preventable death that should be treated as a social and public health problem and a distinct form of homicide in the legal code. This approach is especially salient, given the documented increase of non-lethal intimate partner violence (IPV) in major cities (5) and nationally (6) during the COVID-19pandemic, demonstrating the collateral impacts of public-health crises on violence against women (VAW). 

Front. Public Health, 27 February 2024 Sec. Injury Prevention and Control Volume 12 - 2024 |

By Yanwen Wang, Jacquelyn Gilbreath , Lynne Mock

While drug crime-related criminal legal system and victim costs reached $113 billion across the United States in 2007, just $14.6 billion was spent on treating substance use disorder (National Institute on Drug Abuse, 2014). Due, in part, to drug crimes, many U.S. citizens are under correctional supervision, with 1 in 66 adults being on probation or parole in 2020 (Bureau of Justice Statistics, 2021). In Illinois, 67,587 individuals were on probation in 2020 (Administrative Offices of the Illinois Courts, 2021) and 26,426 were on parole (Illinois Department of Corrections, 2020). The supervision population rate of substance use is estimated to be two to three times higher than that of the general population, with nearly half of the people under community supervision having a substance use disorder (PEW Charitable Trusts, 2018). The Illinois Criminal Justice Information Authority’s Adult Redeploy Illinois (ARI) program was established by the Crime Reduction Act of 2009 to provide financial incentives to local jurisdictions for programs that divert justice-involved individuals from state prisons by providing community-based supervision and individualized services. While researchers have evaluated ARI, models used in some jurisdictions (DeLong & Reichert, 2016; Kroner, et al., 2021; Mock et al., 2017; Reichert et al., 2016), research on ARI client outcomes related to the impact of drug testing is limited. The research goals for this study included: • Quantitatively examining all local ARI program drug test data, including tested drugs, drug test frequencies, and drug test results. • Systematically examining how ARI drug testing contributes to the possibility of revocation including other factors such as age, sex, and race. • Proposing recommendations for better program practice to reduce the rate of revocation. This study sought to answer the following research questions: 1. How is drug testing being practiced and observed in ARI in terms of its frequency, pass rates, and tested drugs? 2. Does drug testing have a significant impact on ARI participant outcomes when controlling for demographic variables? The study included 53,159 records of 1,055 individuals collected from October 3, 2011, to June 20, 2019. The median number of drug tests per individual was 19, and the median of the average days between drug tests was 10 days. The most frequently tested drugs also had the highest positive results: heroin (32%), marijuana/THC (30%), cocaine/crack (14%), alcohol (10%), and other opiates (8%). Logistic regression analyses were used to determine what demographic, drug testing, and criminal justice variables predicted program outcomes of completion or revocation. Among the demographic variables, only age predicted program outcomes. Neither sex nor race emerged as significant program outcome predictors. Drug test positivity rates predicted revocation, as well as drug test frequency (number of times an individual was tested) and average number of days between the drug tests. i Overall, the average drug positivity rate was 29% and most tests were passed with no drug found. Most successful clients who were older women at medium to medium-high recidivism risk and whom tested monthly with lower test positivity rates. Those most likely to experience program revocation were younger men who tested several times per month with higher test positivity rates during their program tenure. Graphing the programs by test positivity, number of tests, and frequency of tests suggests that individuals enrolled in some programs had higher test positivity rates (>50%) and were subject to less frequent drug tests than other programs. This study focuses on drug test outcomes, however, it also would be worth exploring data on drug testing rewards, sanctions, and requirements for program completion and their impacts on program outcomes.   

Chicago:  Illinois Criminal Justice Information Authority., 2022. 33p 

By Pamela B. Teaster, Erica Wood,  Sally B. Hurme,  Carlisle Shealy

In the United States, 10.6% of adults ages 18-64 and 35.2% of people age 65 and older live with a disability (Kraus et al., 2018). Four and a half percent of adults ages 18-64 and 8.9% of people age 65 and older have a cognitive disability (Kraus et al., 2018). Certain cognitive disabilities make adults vulnerable to abuse and require the help of a surrogate decision-maker, such as a guardian or an agent under a power of attorney (Gunther, 2011). A wide spectrum of adults may need the assistance of a guardian, including individuals with serious mental illness, intellectual disability, and traumatic brain injury. The number of adults with serious mental illness increased from 8.3 million in 2008 to 13.1 million in 2019; the greatest increase occurred in young adults ages 18-25 (Lipari, 2020). More than 7 million people in the United States have an intellectual disability, with many requiring assistance (Population Specific Fact Sheet–Intellectual Disability | National Disability Navigator Resource Collaborative, n.d.). The Centers for Disease Control and Prevention estimates that each year there are more than 2.87 million visits to emergency departments, hospitalizations, and deaths due to traumatic brain injury; some of these result in long-term disability (TBI Data | Concussion | Traumatic Brain Injury | CDC Injury Center, 2021). The U.S. Department of Veterans Affairs reports that more than 400,000 U.S. service members experienced a traumatic brain injury between 2000 and 2019 (VA Research on Traumatic Brain Injury (TBI), n.d.). Individuals with serious mental illness, intellectual disability, and traumatic brain injury may require short- or long-term guardianship depending on the progression and treatment of their disability. Advancements in medical care not only expand the lifespan of older individuals but also enhance the life expectancies of younger individuals with brain injuries, serious mental illness, or intellectual disabilities, who may outlive their family caregivers (Patja et al., 2000). Terminology for guardianship differs by state. In many but not all states, court-appointed surrogates who make decisions concerning an individual’s finances are referred to as “conservators,” and those who make decisions concerning an individual’s health or personal matters are called “guardians.” For this report, we use the term guardian to refer to both, unless specifically indicated. Guardians are bound by statutory requirements and case law — as well as ethical principles — to act in the best interests of a vulnerable adult. Guardians are fiduciaries, which means that they must act according to the highest standards of care, accountability, trust, honesty, confidentiality, and avoidance of conflict of interest (Managing Someone Else’s Money: Help for Court Appointed Guardian of Property and Conservators, 2019). Powers given to guardians are often immense — for example, the authority to sell a person’s home and personal property, make contracts on their behalf, and consent to all medical treatments. In addition, guardians may be authorized to charge fees for their services that are payable from an adult’s estate — a situation that, left unmonitored, opens the potential for abuse. Moreover, adults with cognitive impairments may be unable to recognize when guardians are not serving as they should. Although guardians should provide protection, there is also the risk that a guardian may take advantage of an adult whom they were named to protect. Despite this situation, we currently lack reliable data both on how many guardianships or guardians exist and on the outcomes of these  arrangements. A number of high-profile media exposés (e.g., Aviv, 2017; Day, Stark, & Coscarelli, 2021; Garland, 2017) have highlighted how, in some egregious cases, guardian actions have harmed adults who are at risk. 

Washington DC: National Institute of Justice , 2022. 64p.

By Amanda T. Dinwiddie, MPH1; Stephanie Gupta, MPH1; Christine L. Mattson, PhD1; Julie O’Donnell, PhD1; Puja Seth, PhD1 

What is already known about this topic?: During 2022, nearly 108,000 persons died of drug overdose in the United States. Persons with substance use disorders and non–substance-related mental health disorders, which frequently co-occur, are at increased risk for overdose.

What is added by this report?: In 2022, 22% of persons who died of drug overdose had a non–substance-related mental health disorder. The most common disorders were depressive (13%) and anxiety (9%). Approximately one quarter of decedents with a non–substance-related mental health disorder had at least one recent potential opportunity for intervention (e.g., current treatment for substance use disorders or recent emergency department visit).

What are the implications for public health practice?: Implementing evidence-based screening for substance use and mental health disorders during potential intervention opportunities and expanding efforts to integrate care for these disorders could improve mental health and reduce overdoses.

Drug overdose deaths remain a public health crisis in the United States; nearly 107,000 and nearly 108,000 deaths occurred in 2021 and 2022, respectively. Persons with mental health conditions are at increased risk for overdose. In addition, substance use disorders and non–substance-related mental health disorders (MHDs) frequently co-occur. Using data from CDC’s State Unintentional Drug Overdose Reporting System, this report describes characteristics of persons in 43 states and the District of Columbia who died of unintentional or undetermined intent drug overdose and had any MHD. In 2022, 21.9% of persons who died of drug overdose had a reported MHD. Using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, the most frequently reported MHDs were depressive (12.9%), anxiety (9.4%), and bipolar (5.9%) disorders. Overall, approximately 80% of overdose deaths involved opioids, primarily illegally manufactured fentanyls. Higher proportions of deaths among decedents with an MHD involved antidepressants (9.7%) and benzodiazepines (15.3%) compared with those without an MHD (3.3% and 8.5%, respectively). Nearly one quarter of decedents with an MHD had at least one recent potential opportunity for intervention (e.g., approximately one in 10 decedents were undergoing substance use disorder treatment, and one in 10 visited an emergency department or urgent care facility within 1 month of death). Expanding efforts to identify and address co-occurring mental health and substance use disorders (e.g., integrated screening and treatment) and strengthen treatment retention and harm reduction services could save lives.

Morbidity and Mortality Weekly Report Weekly / August 29, 2024 / 73(34);747–753

By Byongook Moon, John McCluskey,  Guan Saw

This report summarizes a research project on violence against teachers in the 50 largest school districts in the U.S. The report discusses the project’s main goals and objectives; research design and methodology, including data collection and sample; and research findings. It also examines school policies, and notes some conclusions and implications for practice. The results section explores the prevalence of seven distinct types of victimization that occurred during Waves I and II of the research project, along with negative impacts on victimized teachers, such as emotional distress and distrust of students. The report also examines how school administrators respond to incidents of teacher victimization and the satisfaction or dissatisfaction of victimized teachers regarding the school responses. The Appendix documents include four manuscripts that have either been accepted or are under review for publication in academic journals, providing detailed examinations of the primary goals and key findings of the research.

Final report to the U.S. National Institute of Justice, 2024. 29p.

By Delvon T. Mattingly a b, Maggie K. Richardson c, Joy L. Hart 

Cannabis use is increasing due to several factors including the adoption of laws legalizing its use across the United States (US). We examined changes in current cannabis use among US youth and adults and by key sociodemographic groups. Methods: Using data from the 2013-2022 National Survey on Drug Use and Health (n=543,195), we estimated the prevalence of (2013-2019, 2020, 2021-2022) and trends in (2013 2019, 2021-2022) current (i.e., past 30-day) cannabis use among US youth (aged 12-17) and adults (aged 18+) overall and by age, gender, race and ethnicity, educational attainment, and total annual family income. We also examined sociodemographic factors associated with use from 2013-2019, in 2020, and from 2021-2022. Results: Cannabis use increased from 7.59% to 11.48% in 2013-2019, was 11.54% in 2020, and increased again from 13.13% to 15.11% in 2021-2022. Among youth, cannabis use remained constant from 2013-2019 and 2021-2022. In 2022, use was highest among aged adults 18-34, male, non-Hispanic multiracial, and generally lower SES adults. From 2021-2022, cannabis use increased among several groups such as adults who were aged 35-49 (14.25% to 17.23%), female (11.21% to 13.00%), and Hispanic (10.42% to 13.50%). Adults who were aged 18-25, male, non-Hispanic multiracial, some college educated, and of lower annual family income had consistently higher odds of current cannabis use from 2013-2019, in 2020, and from 2021-2022. Conclusions: Cannabis use is increasing overall and among certain sociodemographic groups. Our findings inform prevention and harm reduction efforts aimed at mitigating the burden of cannabis use in the US. 

Drug and Alcohol Dependence Reports

By Beau Kilmer, Michelle Priest, Rajeev Ramchand, Rhianna C. Rogers, Ben Senator, Keytin Palmer

Psychedelic substances, such as psilocybin mushrooms and LSD, have long been touted as holding promise for treating various mental health conditions, and the past decade has seen another round of enthusiasm for this hope. Although the clinical research and associated media reports on these substances continue to grow, what receives less attention is the changing policy landscape for some psychedelics in the United States. Despite the federal prohibition on supply and possession — outside approved clinical research, the Food and Drug Administration’s Expanded Access program, and some religious exemptions — some state and local governments are loosening their approaches to some psychedelics. In fact, some states are implementing or considering approaches that legalize some forms of supply to adults for any reason. It seems likely that more jurisdictions will consider and implement alternative policies to prohibit the nonclinical supply of some psychedelics, possibly including retail sales. The primary goal of this mixed-methods report is to present new data and analysis to help inform policymakers participating in these discussions in the United States, but much of this report should also be useful to decision-makers in other countries. These insights should also be useful to anyone interested in learning more about these substances and the public policy issues surrounding them.

Key Findings

• Unlike people who use cannabis and many other drugs, infrequent users of psychedelics account for most of the total days of use.

• The total number of use days for psychedelics — a proxy for the size of the market — is two orders of magnitude smaller than it is for cannabis.

• Within the class of drugs generally classified as psychedelics, psilocybin has the highest past-year and past-month prevalence rates among U.S. adults. Of those ages 18 and older, 3.1 percent — or approximately 8 million people — used psilocybin in 2023.

• Among those reporting the use of psilocybin in the past year, nearly half reported microdosing the last time they used it.

• Scientific literature is limited in its understanding of the consequences of using psychedelics and preventing and mitigating adverse events.

• Most of the policy changes at the state and local levels focus on supporting research and deprioritizing the enforcement of certain laws about psychedelics, but a few states have legalized some forms of supply and others are considering it.

• There are many supply policy options between prohibition and legalizing production and sales by for-profit companies.

• The role of price as a regulatory tool may matter less for psychedelics compared with many other drugs.

  Recommendations

• Those participating in psychedelics policy debates and analyses should be specific about the changes being considered, implemented, or evaluated.

• Meaningful policy discussions should include Indigenous Peoples who are community-authorized to speak on these matters.

• Policymakers need to be thoughtful about the role of supervision and facilitators when considering changes to psychedelics policies.

• It is critical to improve the data infrastructure on psychedelics to better support policy analyses.

• Now is the time for U.S. federal policymakers to decide whether they want psilocybin and other psychedelic substances to follow in the footsteps of the for-profit cannabis model.

Psychedelic substances, such as psilocybin and LSD, have long been touted as holding promise for treating some mental health conditions. An increasing number of U.S. state and local governments are implementing or considering alternative policies to prohibit some of these substances for nonclinical purposes (i.e., adults can use them for any reason). The authors of this report present new data and analysis to inform these discussions.

Santa Monica, CA: RAND, 2024. 161p.