Synthetic Cathinone Use Among Polysubstance Users: Indirect Indicator of Indiscriminate Drug Taking or Preferred Drug of Abuse?

AuthorWilliam W. Stoops,Kirsten E. Smith
Date01 April 2019
Published date01 April 2019
DOI10.1177/0022042619826079
Subject MatterArticles
https://doi.org/10.1177/0022042619826079
Journal of Drug Issues
2019, Vol. 49(2) 369 –386
© The Author(s) 2019
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DOI: 10.1177/0022042619826079
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Article
Synthetic Cathinone Use Among
Polysubstance Users: Indirect
Indicator of Indiscriminate Drug
Taking or Preferred Drug of Abuse?
Kirsten E. Smith1,2 and William W. Stoops1
Abstract
A survey pertaining to synthetic cathinone (SC) use was completed by 499 polysubstance
users enrolled in a residential recovery program in the Southeastern United States. Of the
final sample, 28% reported ever SC use. SC-users, compared with nonusers, were more often
younger (32.7 vs. 36.0, p = .001), White (93.4% vs. 80.8%, p = .001), and on probation/parole
since 2010 (80.9% vs. 70.9%, p = .032). SC-users evidenced extensive drug histories and were
less likely to be enrolled in an urban-based program, compared to a rural, Appalachian-based
program (73.8% vs. 86.6%, p = .001). Use of synthetic cannabinoids (adjusted odds ratio
[AOR] = 1.9, p = .044), kratom (AOR = 1.7, p = .045), and inhalants (AOR = 2.3, p = .001)
were significantly associated with SC use. Approximately 23% of SC-users preferred SCs to
amphetamines or cocaine; however, only 3.6% ranked SC as their most preferred drug. Past-
year SC use declined to 6.6%. Among polysubstance users in this sample, SC use may be a
potential indicator of versatile and indiscriminate drug-taking.
Keywords
synthetic cathinones, bath salts, polysubstance use, novel psychoactive substances
Introduction
A full decade has not yet passed since the emergence of synthetic cathinones (SCs) as drugs of
recreation and abuse in the United States (Sammler et al., 2010; Winstock et al., 2011). Yet, in
this short time, there has transpired first an increase and then peak in SC use, publication of doz-
ens of case reports documenting SC toxicology and SC-related fatalities, widespread media
attention, and passage of broad legislation prohibiting SC and other compounds considered part
of the growing novel psychoactive substances (NPS) taxonomy (Kasick, McKnight, & Klisovic,
2012; Miotto, Striebel, Cho, & Wang, 2013; Sacco & Finklea, 2016; Spiller, Ryan, Weston, &
Jansen, 2011; Stevens, Fortson, Measham, & Sumnall, 2015; Stogner & Miller, 2013; Swalve &
DeFoster, 2016; Wood et al., 2010).
SC are molecularly similar to cathinone, the main psychoactive constituent of the
botanical Catha edulis (common name “khat”) and to some amphetamines, demonstrating potent
1University of Kentucky, Lexington, USA
2University of Louisville, KY, USA
Corresponding Author:
Kirsten E. Smith, University of Louisville, Kent School of Social Work; Center on Drug and Alcohol Research,
University of Kentucky, Lexington, KY 40508, USA.
Email: kirstenelin.smith@louisville.edu
826079JODXXX10.1177/0022042619826079Journal of Drug IssuesSmith and Stoops
research-article2019
370 Journal of Drug Issues 49(2)
psychostimulant effects and serious risk for neurotoxicity (Angoa-Pérez, Anneken, & Kuhn,
2016; Baumann, Partilla, & Lehner, 2013; Carroll, Lewin, Mascarella, Seltzman, & Reddy, 2012;
Valente, De Pinho, de Lourdes Bastos, Carvalho, & Carvalho, 2014). Although preclinical mod-
els continue to investigate the pharmacodynamics and pharmacokinetics of first- and second-
generation analogs (e.g., 4-methylmethcathinone, methylone, methylenedioxypyrovalerone,
alpha-PVP) (Baumann, Baumann, Partilla, Lehner, Thorndike, et al., 2013; Bonano, Glennon, De
Felice, Banks, & Negus, 2014; Cameron, Kolanos, Verkariya, De Felice, & Glennon, 2013;
Naylor, Freeman, Blough, Woolverton, & Huskinson, 2015), clinical studies seeking to under-
stand the pharmacology of SC among humans remain limited due to practical and ethical con-
straints (Green & Nutt, 2014; Nutt, King, & Nichols, 2013).
Although rates of SC use in the United States appear lower than other NPS, SCs were the third
most commonly identified NPS type in 2017 after synthetic opioids and synthetic cannabinoid
receptor agonists (SCRAs; U.S. Drug Enforcement Agency, 2017). Globally, new cathinone ana-
logs continue to be identified, despite generic, “catch-all” legislation (Corkery, Guirguis, Papanti,
Orsolini, & Schifano, 2018; Hughes & Winstock, 2012). This abundance of different SC analogs
poses challenges for community-based researchers in that under this broad “SC umbrella” are
dozens of molecularly similar, but nevertheless distinct compounds (Murphy, Dulaney, Beuhler,
& Kacinko, 2013). Although some more knowledgeable or experienced users may be aware of
the specific cathinone analog they are consuming, and demonstrate preference for particular
product brands or analogs, many other may not have this knowledge or discrimination between
SC brands or analogs (Guirguis et al., 2017; Herrmann, Johnson, Johnson, & Vandrey, 2016).
SC use is often reported by younger individuals and males (P. S. Johnson & Johnson, 2014;
Miller & Stogner, 2014; Vardakou, Pistos, & Spiliopoulou, 2011; White, 2016), but it remains
unclear how best to characterize SC-users. For instance, SC and other NPS use has been reported
among people who evidence proclivity for drug experimentation and who participate in online
drug-using communities where the dissemination of experiential knowledge among peers is
common (e.g., “psychonauts,” “e-psychonauts”), although SC use has also been observed among
other substance-using subpopulations, such as men involved in Europe’s night club scene
(Ashrafioun et al., 2016; Corazza et al., 2014; Deluca et al., 2012; Measham, Wood, Dargan, &
Moore, 2011; Orsolini, Papanti, Francesconi, & Schifano, 2015). In addition, SC use has been
found among especially vulnerable populations, such as those who experience homelessness and
criminal justice involvement, with SC-users often appearing as more versatile polysubstance
users compared with polysubstance users not reporting SC use (Daveluy et al., 2017; Santa Maria
et al., 2018; Smith et al., 2017; Wagner et al., 2014). This drug use versatility is evidenced by a
greater number of different drug classes used at higher frequencies. Among younger populations
with less drug use history, SC use positively correlates with other drug use (Loi et al., 2015;
Miller & Stogner, 2014; Palamar, 2015; Sutherland et al., 2016), though not always (Palamar,
Salomone, Vincenti, & Cleland, 2016).
In attempting to characterize individuals who use SC in the United States, one question that
remains unanswered is if there are appreciable differences between polysubstance users who
report SC use and polysubstance users who do not. Although between-group comparisons of
drug users in cross-sectional studies have significant limitations for interpretability, in no small
part due to some degree of sample-wide homogeneity and some degree of (potentially signifi-
cant) within-group heterogeneity, this form of comparison is a useful point for exploration of SC
use among polysubstance users, particularly as other data are lacking (Shaw, Shah, Jolly, &
Wylie, 2008; Terracciano, Löckenhoff, Crum, Bienvenu, & Costa, 2008; Tetrault et al., 2008).
Because the long-term durability of SC popularity is uncertain, but appears to be waning, it is
of additional interest to determine whether polysubstance users prefer SCs compared with other
drugs, including traditional psychostimulants (e.g., amphetamines, cocaine). Users’ perception
of pleasure in association with drugs is a sometimes-overlooked component when attempting to

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