Are trait impulsivity and exposure to cannabis or alcohol associated with the age of trajectory of cocaine use? A gender-specific dimensional analysis in humans with cocaine dependence diagnosis.

Abstract

Cocaine use disorders (CUD) cause major morbidity and optimized prevention efforts are critical. It is unclear if trait impulsivity and exposure to cannabis or alcohol are associated with age trajectory of cocaine use (e.g., age of onset of heaviest use, or time of escalation), or with vulnerability to develop a CUD. This is an observational study with volunteers (≥18 years old), from a metropolitan area. The sample (n = 1,010) included: n = 360 normal volunteers, n = 438 with cocaine dependence (CD) diagnoses, and n = 212 with other addictive diseases. Trait impulsivity was examined with BIS-11 scores. Maximal self-exposure to cannabis, alcohol, and cocaine were characterized dimensionally with Kreek-McHugh-Schluger-Kellogg (KMSK) scales. Time of escalation was defined as the interval between age of first use and age of onset of heaviest use. Onset of maximal use of cannabis (median age = 17) and alcohol (median age = 21) preceded that of cocaine (median age = 27), in volunteers with CD. Multivariate Cox regressions in volunteers with CD show that increasing self-exposure to cannabis was a predictor of earlier onset of heaviest use of cocaine. Also, more rapid time of escalation of alcohol was a predictor of more rapid time of escalation of cocaine. A multiple logistic regression shows that increasing self-exposure to cannabis or alcohol was a positive predictor of odds of CD diagnosis. Trait impulsivity and gender were not significant predictors in these multivariate analyses. This study shows that aspects of adolescent exposure to nonmedical cannabis and alcohol are predictors of early onset of CUD, and may be potentially targeted for prevention efforts.

Overdose mortality rates for opioids or stimulants are higher in males than females, controlling for rates of drug misuse: State-level data

“…However, potential post-menopausal effects of progesterone cannot be fully excluded [12,83,84]. It should also be noted that the age trajectory of these SUD typically commences earlier in the lifespan [19,20,60], and that the lower mortality occurring in post-menopausal women could be a “carryover” of sexually dimorphic bio-behavioral factors that occur prior to menopause.…”

Bidirectional influence of heroin and cocaine escalation in persons with dual opioid and cocaine dependence diagnoses.

“…As a follow-up, we also examined whether times of heroin or cocaine escalation differed in these persons with dual OD + CD diagnoses, compared to persons who have either OD or CD, respectively. This was based on a comparison with other groups of volunteers, which were similarly recruited and ascertained in this laboratory and presented in other publications (Butelman et al, 2020; Butelman, Maremmani, et al, 2018). In unadjusted survival analyses, we did not detect a significant difference in times of heroin escalation between OD + CD and OD groups (log-rank test; not shown).…”

“…This instrument also collects two age-related "milestones": age at first use of a drug and age at onset of heaviest use (in whole years). Time of escalation is calculated as the age at onset of heaviest use minus the age at first use (Butelman et al, 2019(Butelman et al, , 2020. Therefore, the most rapid time of escalation that can be recorded with this instrument is 0 years (i.e., first use and onset of heaviest use occur within the same year).…”

“…Several studies have reported telescoping, or faster escalation, for mu-opioid agonists or cocaine, in female rodents (Lynch, Roth, & Carroll, 2002; Lynch & Taylor, 2004; Towers, Tunstall, McCracken, Vendruscolo, & Koob, 2019) or female humans (Hernandez-Avila, Rounsaville, & Kranzler, 2004; Kosten et al, 1996; McCance-Katz, Carroll, & Rounsaville, 1999). However, some studies in humans did not detect that female participants escalate use of a mu-opioid agonist or cocaine more rapidly than do male or that these gender differences are subtle (Butelman et al, 2019; Butelman et al, 2020; Lewis, Hoffman, & Nixon, 2014; Stoltman, Woodcock, Lister, Greenwald, & Lundahl, 2015). Aside from escalation per se, the prevalence of severe opioid and cocaine use disorders, and overdose deaths, tends to be greater in male than female users (Kariisa, Scholl, Wilson, Seth, & Hoots, 2019; Merikangas & Almasy, 2020; Saloner et al, 2020; Scholl, Seth, Kariisa, Wilson, & Baldwin, 2018).…”

Age of Onset and Its Related Factors in Cocaine or Methamphetamine Use in Adults from the United States: Results from NHANES 2005–2018

“…While some evidence has suggested an association with previous substance use, personality disorders, and social factors with early age of onset of general substance use [15][16][17][18], few studies have examined factors associated with the age of onset of psychostimulant use specifically. To this end, large publicly available datasets such as the National Health and Nutrition Examination Survey (NHANES) are vital in finding potential factors associated with early onset psychostimulant use.…”