21st Century Drugs: Examining the Predictors of Synthetic Cannabinoid Use Among a Sample of Adolescents in Kentucky

Introduction:

Synthetic cannabinoid (SC) use related reports to poison centers from 2013 to 2015 increased from 2,668 to 7,779, and over the past year a threefold increase in reported deaths related to SC-use have occurred in the United States. SCs are an extensive, heterogeneous group of human-made chemicals, which are composed to mimic the effects of δ-9-tetrahydrocannabinol (THC) – the primary psychoactive chemical in marijuana. SCs include a host of chemicals that provide high-efficacy full agonists of the CB1 and/or CB2 cannabinoid receptors. Unlike traditional illicit drugs, SCs are available at convenience stores, gas stations, “smoke shops,” and online. SCs are particularly appealing to adolescents due to their perceived legality/harmlessness, their affordable cost, and their concealment in urine drug screens – especially for adolescents involved in the criminal justice system. Yet, to date there is little knowledge regarding the psychosocial predictors of SC-use among adolescents. This cross-sectional study aims to develop a SC-user descriptive profile and to assess predictors of SC-use among a sample of adolescents in Kentucky.

Methods:

Data and samples: Extant data was analyzed from three statewide samples of adolescents receiving treatment for substance abuse (N = 1,831) in 2014-2016. Data was collected by clinicians at intake, using a structured online survey tool (including inpatient, outpatient, and intensive outpatient).

Measures: Bivariate tests of association with past 12-month SC-use included gender, race, age, and referral status. Multivariate predictors of past 12-month SC-use consisted of variables from three behavioral health domains: 1) Substance use; 2) Interpersonal Victimization; and 3) Mental Health. Substance use and interpersonal victimization variables were based on client self-report over the past 12-months. Mental health measures were taken from three Pediatric Symptom Checklist-17 (PCS) subscales: 1) Attention Problems; 2) Internalizing Problems; and 3) Externalizing Problems. These subscales were operationalized by using cutoff points to indicate significant impairments.

Analyses: Descriptive analyses included raw percentages and cross-tabs chi-square bivariate tests. A binary logistic regression test was used to ascertain significant predictors of SC-use across the three psychosocial domains.

Results:

Overall 19.6% of clients reported SC-use. Caucasian males who were older the 16-years-of-age or older and that were court referred to treatment reported the greatest SC-use, although not significant at the bivariate-level. The binary logistic regression analysis, χ²(7, 1,824)=303.308, p<.000 resulted in significant predictors of SC-use across all three behavioral domains. Marijuana use (OR = 4.35; CI = 2.23 – 8.45), cocaine use (OR = 2.83; CI = 1.90 – 4.25), and opioid use (OR = 2.54; CI = 1.83 – 3.51) were statistically significant predictors in the substance use domain. Emotional neglect (OR = 1.94; CI = 1.22 – 3.09) was the only statistically significant predictor of SC-use in the interpersonal victimization domain, and clients meeting criteria for externalizing problems (OR = 1.52; CI = 1.12 – 2.10) was the statistically significant mental health predictor of SC-use.

Conclusions:

SC-use predictors included behavioral conduct issues, marijuana use and other drug use, and neglect/maltreatment histories. These predictors should be considered during clinical encounters with adolescents and in development of substance abuse prevention programs.