Drug use trajectories among U.S. adults during the first year of the COVID-19 pandemic.

This study characterized the prevalence, sociodemographic characteristics, and behavioral health of U.S. adult subpopulations with distinct drug use trajectories during the first year of the COVID-19 pandemic. Adult respondents (n = 8306) in a nationally-representative longitudinal study completed 13 monthly web surveys (March 2020-March 2021). Frequency of past-week drug use, cannabis use, and alcohol use (range:0-7), as well as anxiety and depressive symptoms, were assessed at each survey. Growth mixture models were used to parse out distinct subpopulations with homogenous drug use trajectories based on mean drug use days over time. Four drug use trajectories were identified: Stable Abstinence (85.7% [95%CI = 85.0-86.5] of the sample) with <1 mean past-week drug use days; Escalating Infrequent Use (7.1% [95%CI = 6.6-7.7]) with 0.2 March mean past-week drug use days and increases from April to October; Use Cessation (4.3% [95%CI = 3.8-4.7]) with 1.1 March mean past-week drug use days that initially increased, then sharply decreased to near zero; and Stable Frequent Use (2.9% [95%CI = 2.5-3.3]) with between 2.4 and 3.5 past-week drug use days across the study period. Compared to the stable abstinence group, the other subgroups were more likely to be Hispanic or Black, younger in age, unemployed, below the federal poverty line, and less likely to have a college degree or be married. They also reported higher levels of alcohol and cannabis use, as well as higher anxiety and depressive symptoms. These results provide opportunities to optimize the targeted delivery of preventive interventions for substance use during the COVID-19 pandemic and future public health emergencies.