Quantifying Exposure to Illicit Drugs & Psychosocial Stress in Real Time

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Assessment of episodes of drug use and psychosocial stress is complicated by the fact that each is often transient and difficult to recall accurately. Assessment of their causal connections with one another, and of their genetic and environmental determinants, is complicated by the complexity of the causal connections and by the elusive nature of what constitutes the environment. Our group pioneered the use of ecological momentary assessment (EMA) for real-time field assessment of drug-related behaviors. Our method prior to the Covid pandemic required frequent on-site visits from participants and therefore had to be paused in 2020-2021. We used that time to change our methodology so that we could implement EMA remotely and nationwide. In a continuation of this project during the current reporting period, we used EMA to study a nationwide sample of people who use the drug kratom. To complement the EMA data, we ran an on-site substudy in which some participants took their kratom under our observation for pre-post behavioral and physiological assessment and a test in a driving simulator, providing information that was directly relevant to the project goal of assessing drug effects as they would manifest in daily life. The kratom project has been exceedingly successful, both in terms of its rapid implementation and its scientific productivity. The nationwide EMA study enrolled participants at a pace that was unprecedented for us, and the behavioral data have been deeply informative, in part because we had participants ship samples of their purchased kratom project for laboratory analysis so we could examine relationships between specific alkaloid content and effects reported in real time. We are analyzing and writing up the results and submitting them for publication. We have also published several related systematic reviews, a methods paper, and a paper summarizing narrative interviews with participants; the interviews informed and clarified our interpretations of both the field (EMA) data and the human-laboratory data. The methods we developed and implemented for the kratom project will be our model for real-time assessment going forward.