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Research article

The effect of cannabis legislation on opioid and benzodiazepine use among aging Americans

  • Background 

    This study sought to evaluate whether medicinal cannabis (marijuana) laws (MMLs) influence opioid and benzodiazepine use through displacement from opioids and companion drugs toward cannabis for arguably better or comparable pain management among aging Americans (i.e., those aged 50 years and older) as opposed to concentrating on older people aged 65 years and above. This aging demographic is an understudied but vulnerable population to unknown or paradoxical policy effects amid the current medical and legal landscape. Should this displacement occur, the implementation of such legislation may ultimately aid in mitigating the adverse repercussions that ensue from an excessive dependence on these more traditional medications. However, it is also critical to assess whether these laws worsen outcomes among this population.

    Methods 

    To investigate these possibilities, 2022 data from the National Survey on Drug Use and Health (NSDUH) are used along with multiple logistic regression procedures to evaluate the use of opioids and benzodiazepines in MMLs for those aged 50 years and older compared to those younger.

    Results 

    Findings reveal that less opioid reliance is reported among the aging residing in MML states compared to non-MML states. However, no effect from the laws is observed for benzodiazepines or co-prescribed opioids and benzodiazepines among this population.

    Conclusions 

    MMLs may serve to attenuate the consequences of opioid reliance among the aging but not use of opiates in combination with benzodiazepines or the use of benzodiazepines alone.

    Citation: Jamie L. Flexon, Lisa Stolzenberg, Stewart J. D'Alessio. The effect of cannabis legislation on opioid and benzodiazepine use among aging Americans[J]. AIMS Medical Science, 2024, 11(4): 361-377. doi: 10.3934/medsci.2024025

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  • Background 

    This study sought to evaluate whether medicinal cannabis (marijuana) laws (MMLs) influence opioid and benzodiazepine use through displacement from opioids and companion drugs toward cannabis for arguably better or comparable pain management among aging Americans (i.e., those aged 50 years and older) as opposed to concentrating on older people aged 65 years and above. This aging demographic is an understudied but vulnerable population to unknown or paradoxical policy effects amid the current medical and legal landscape. Should this displacement occur, the implementation of such legislation may ultimately aid in mitigating the adverse repercussions that ensue from an excessive dependence on these more traditional medications. However, it is also critical to assess whether these laws worsen outcomes among this population.

    Methods 

    To investigate these possibilities, 2022 data from the National Survey on Drug Use and Health (NSDUH) are used along with multiple logistic regression procedures to evaluate the use of opioids and benzodiazepines in MMLs for those aged 50 years and older compared to those younger.

    Results 

    Findings reveal that less opioid reliance is reported among the aging residing in MML states compared to non-MML states. However, no effect from the laws is observed for benzodiazepines or co-prescribed opioids and benzodiazepines among this population.

    Conclusions 

    MMLs may serve to attenuate the consequences of opioid reliance among the aging but not use of opiates in combination with benzodiazepines or the use of benzodiazepines alone.



    Dedicated to the memory of Professor Ireneo Peral, with high feelings of admiration for his notable contributions in Mathematics and great affection

    In recent years, geometric analysis and partial differential equations on the Heisenberg group have attracted great attention. In this article, we investigate some concentration–compactness results related to the Hardy–Sobolev embedding on the classical and fractional Folland–Stein spaces in the Heisenberg group. Before stating the main results, let us recall some relevant contributions in the topic.

    The Heisenberg group Hn is the Lie group which has R2n+1 as a background manifold and whose group structure is given by the non–Abelian law

    ξξ=(z+z,t+t+2ni=1(yixixiyi))

    for all ξ, ξHn, with

    ξ=(z,t)=(x1,,xn,y1,,yn,t)  and  ξ=(z,t)=(x1,,xn,y1,,yn,t).

    We denote by r the Korányi norm, defined as

    r(ξ)=r(z,t)=(|z|4+t2)1/4,

    with ξ=(z,t), z=(x,y)Rn×Rn, tR, and |z| the Euclidean norm in R2n.

    A key result, whose importance is also due to its connection with the CR Yamabe problem, is the subelliptic Sobolev embedding theorem in Hn, which is due to Folland and Stein [14]. This result is valid in the more general context of Carnot groups, but we state it in the set up of the Heisenberg group. If 1<p<Q, where Q=2n+2 is the homogeneous dimension of the Heisenberg group Hn, we know by [14] that there exists a positive constant C=C(p,Q) such that

    Hn|φ|pdξCHn|DHφ|pHdξfor allφCc(Hn),p=pQQp, (1.1)

    and p is the critical exponent related to p. Moreover, the vector

    DHu=(X1u,,Xnu,Y1u,,Ynu)

    is the horizontal gradient of a regular function u, where {Xj,Yj}nj=1 is the basis of horizontal left invariant vector fields on Hn, that is

    Xj=xj+2yjt,Yj=yj2xjt,j=1,,n. (1.2)

    Unlike the Euclidean case, cf. [34] and [2], the value of the best constant in (1.1) is unknown. In the particular case p=2, the problem of the determination of the best constant in (1.1) is related to the CR Yamabe problem and it has been solved by the works of Jerison and Lee [21,22,23,24]. In the general case, existence of extremal functions of (1.1) was proved by Vassilev in [35] via the concentration–compactness method of Lions, see also [20]. This method does not allow an explicit determination of the best constant Cp of (1.1). However, we know from [35] that Cp is achieved in the Folland–Stein space S1,p(Hn), which is defined, for 1<p<Q, as the completion of Cc(Hn) with respect to the norm

    DHup=(Hn|DHu|pHdξ)1/p.

    Thus, we can write the best constant Cp of the Folland–Stein inequality (1.1) as

    Cp=infuS1,p(Hn)u0DHuppupp. (1.3)

    Note that the Euler–Lagrange equation of the nonnegative extremals of (1.1) leads to the critical equation

    ΔH,pu=|u|p2u in Hn,

    where the operator ΔH,p is the well known p Kohn–Spencer Laplacian, which is defined as

    ΔH,pφ=divH(|DHφ|p2HDHφ),

    for all φC2(Hn).

    The study of critical equations is deeply connected to the concentration phenomena, which occur when considering sequences of approximated solutions. Indeed, given a weakly convergent sequence (uk)k in S1,p(Hn), we can infer that (uk)k is bounded in Lp(Hn), but we do not have compactness properties in general. On the other hand, we know that the sequences μk=|DHu|pHdξ and νk=|uk|pdξ weak converge to some measures μ and ν in the dual space M(Hn) of all real valued, finite, signed Radon measures on Hn. An essential step in the concentration–compactness method is the study of the exact behavior of the limit measures in the space M(Hn) and in the spirit of Lions. In particular, following [25,26], Ivanov and Vassilev in [20] proved the following result.

    Theorem A (Lemma 1.4.5, Ivanov and Vassilev [20]). Let (uk)k be a sequence in S1,p(Hn) such that uku in S1,p(Hn) and |uk|pdξν, |DHuk|pHdξμ in M(Hn), for some appropriate uS1,p(Hn), and finite nonnegative Radon measures μ, ν on Hn.

    Then, there exist an at most countable set J, a family of points {ξj}jJHn and two families of nonnegative numbers {μj}jJ and {νj}jJ such that

    ν=|u|pdξ+jJνjδξj,μ|DHu|pHdξ+jJμjδξjνp/pjμjCpforalljJ,

    where δξj are the Dirac functions at the points ξj of Hn.

    The aim of this paper is to extend Theorem A in two different ways. First, we want to prove a version of Theorem A suitable to deal with a combined Hardy and Sobolev embedding. Indeed, following [16], we set

    ψ(ξ)=|DHr(ξ)|H=|z|r(ξ) for ξ=(z,t)(0,0).

    Assume from now on that 1<p<Q and let φCc(Hn{O}). Then, the Hardy inequality in the Heisenberg group states as follows

    Hn|φ|pψpdξrp(pQp)pHn|DHφ|pHdξ. (1.4)

    Inequality (1.4) was obtained by Garofalo and Lanconelli in [16] when p=2 and then extended to all p>1 in [7,29]. When p=2, the optimality of the constant (2/(Q2))2 is shown in [18]. Let us also mention that a sharp inequality of type (1.4) has been derived in general Carnot–Carathéodory spaces by Danielli, Garofalo and Phuc in [8].

    Obviously, inequality (1.4) remains valid in S1,p(Hn). Moreover, inequalities (1.1) and (1.4) imply that for any σ(,Hp) the following best constant is well defined

    Iσ=infuS1,p(Hn)u0DHuppσupHpupp, (1.5)

    where

    Hp=infuS1,p(Hn)u0DHuppupHp,upHp=Hn|u|pψprpdξ. (1.6)

    Note that, when σ=0, we recover the Sobolev embedding, that is I0=Cp. However, the Hardy embedding S1,p(Hn)Lp(Hn,ψprpdξ) is continuous, but not compact, even locally in any neighborhood of O, where O=(0,0) denotes the origin of Hn. A challenging problem is then to provide sufficient conditions for the existence of a nontrivial solution to critical equations with Hardy terms in the whole space Hn, when a triple loss of compactness takes place. To overcome this difficulty, we prove in Theorem 1.1 and Theorem 1.2 some versions of the concentration–compactness principle for related to the embedding (1.5).

    Theorem 1.1. Let σ(,Hp) and let (uk)k be a sequence in S1,p(Hn) such that uku in S1,p(Hn), and|uk|pdξν, |DHuk|pHdξμ, |uk|pψpdξr(ξ)pω in M(Hn), for some appropriateuS1,p(Hn), and finite nonnegative Radon measures μ, ν, ω on Hn.

    Then, there exist an at most countable set J, a family of points {ξj}jJHn, two families of nonnegative numbers {μj}jJ and {νj}jJ and three nonnegative numbers ν0,μ0,ω0, such that

    ν=|u|pdξ+ν0δO+jJνjδξj, (1.7)
    μ|DHu|pHdξ+μ0δO+jJμjδξj, (1.8)
    ω=|u|pψpdξr(ξ)p+ω0δO, (1.9)
    νp/pjμjCpforalljJ,νp/p0μ0σω0Iσ, (1.10)

    whereCp=I0 and Iσ are defined in (1.3) and (1.5), while δO,δξj are the Dirac functions at the points O and ξj of Hn, respectively.

    Theorem 1.1 extends Theorem A and also Theorem 1.2 of [5] to the case of unbounded domains, see also [20,31,32]. The strategy is the same as the one in the seminal papers of Lions [25,26], but there are some complications due to the non Euclidean context.

    The whole Heisenberg group is endowed with noncompact families of dilations and translations, which could provide a loss of compactness due to the drifting towards infinity of the mass, or – in other words – the concentration at infinity. In order to deal with this type of phenomena, we prove a variant of the concentration–compactness principle of Lions, that is the concentration–compactness principle at infinity. This variant was introduced by Bianchi, Chabrowski and Szulkin in [3,6] and we prove an extension of their results suitable to deal with critical Hardy equations in the Heisenberg group.

    Denote by BR(ξ) the Korányi open ball of radius R centered at ξ. For simplicity BR is the ball of radius R centered at ξ=O.

    Theorem 1.2. Let (uk)k be a sequence in S1,p(Hn) as in Theorem 1.1 and define

    ν=limRlim supkBcR|uk|pdξ,μ=limRlim supkBcR|DHuk|pHdξ, (1.11)
    ω=limRlim supkBcR|uk|pψpdξr(ξ)p. (1.12)

    Then,

    lim supkHn|uk|pdξ=ν(Hn)+ν,lim supkHn|DHuk|pHdξ=μ(Hn)+μ, (1.13)
    lim supkHn|uk|pψpdξr(ξ)p=ω(Hn)+ω,νp/pμσωIσ, (1.14)

    where μ,ν,ω are the measures introduced in Theorem 1.1.

    In the second part of the paper, we want to extend the previous results to the fractional case. Let 0<s<1 and 1<p<. We define the fractional Sobolev space HWs,p(Hn) as the completion of Cc(Hn) with respect to the norm

    HWs,p(Hn)=Lp(Hn)+[]H,s,p,

    where

    [φ]H,s,p=(Hn×Hn|φ(ξ)φ(η)|pr(η1ξ)Q+spdξdη)1/palong anyφCc(Hn). (1.15)

    The fractional Sobolev embedding in the Heinseberg group was obtained in [1] following the lines of [9] and states as follows. If sp<Q, then there exists a constant Cps depending on p,Q and s such that

    φppsCps[φ]pH,s,pfor allφCc(Hn),ps=pQQsp. (1.16)

    The proof of the above inequality is obtained directly, by extending the method of [9] to the Heisenberg context.

    For notational simplicity, the fractional (s,p) horizontal gradient of any function uHWs,p(Hn) is denoted by

    |DsHu|p(ξ)=Hn|u(ξ)u(η)|pr(η1ξ)Q+psdη=Hn|u(ξh)u(ξ)|pr(h)Q+psdh. (1.17)

    Note that the (s,p) horizontal gradient of a function uHWs,p(Hn) is well defined a.e. in Hn and |DsHu|pL1(Hn) thanks to Tonelli's theorem.

    From now on we fix 0<s<1, 1<p< with sp<Q. Then, the following result holds true.

    Theorem 1.3. Let (uk)k be a sequence in HWs,p(Hn) such that uku in HWs,p(Hn), and furthermore|uk|psdξν, |DsHuk|pdξμ, in M(Hn), for some appropriateuHW1,p(Hn), and finite nonnegative Radon measures μ, ν on Hn.

    Then, there exist an at most countable set J, a family of points {ξj}jJHn, two families of nonnegative numbers {μj}jJ and {νj}jJsuch that

    ν=|u|psdξ+jJνjδξj,μ|DsHu|pdξ+jJμjδξj, (1.18)
    νp/psjμjCpsforalljJ, (1.19)

    where the constant Cps is defined in (1.16).

    In the Euclidean setting, the first extension of the CC method in the fractional Sobolev spaces was obtained in [30] for p=2 and then in [28] for any p, with 1<p<N/s. We also refer to [4,10,12] for similar results in this context and to [33] for the vectorial fractional Sobolev spaces.

    In Theorem 1.3 we extend the previous results from the Euclidean setting to the Heisenberg environment and we also widen Theorem A from the local case to the fractional setup. To the best of our knowledge Theorem 1.3 is the first extension of the method in the fractional Sobolev space in Heisenberg group.

    Actually, the strategy is the same as the one in the seminal papers of Lions [25,26], but there are several complications due to both the nonlocal and the subelliptic context. In order to overcome these difficulties, we employ the crucial Lemmas 4.4 and 4.5, proved using the key Lemma 4.2 and Corollary 4.3. To enter into details, the latter results give precise decay estimates and scaling properties for the fractional (s,p) horizontal gradients of functions of class Cc(Hn), with respect to the intrinsic family of dilations δR.

    The paper is organized as follows. In Section 2, we recall some fundamental definitions and properties related to the Heisenberg group Hn. Section 3 is devoted to the proof of Theorems 1.1 and 1.2, while the final Section 4 deals with the proof of Theorem 1.3, based on some preliminary lemmas.

    In this section we present the basic properties of Hn as a Lie group. For a complete treatment, we refer to [13,16,17,20,35]. Let Hn be the Heisenberg group of topological dimension 2n+1, that is the Lie group which has R2n+1 as a background manifold and whose group structure is given by the non–Abelian law

    ξξ=(z+z,t+t+2ni=1(yixixiyi))

    for all ξ, ξHn, with

    ξ=(z,t)=(x1,,xn,y1,,yn,t)andξ=(z,t)=(x1,,xn,y1,,yn,t).

    The inverse is given by ξ1=ξ and so (ξξ)1=(ξ)1ξ1.

    The real Lie algebra of Hn is generated by the left–invariant vector fields on Hn

    Xj=xj+2yjt,Yj=yj2xjt,T=t,

    for j=1,,n. This basis satisfies the Heisenberg canonical commutation relations

    [Xj,Yk]=4δjkT,[Yj,Yk]=[Xj,Xk]=[Yj,T]=[Xj,T]=0.

    Moreover, all the commutators of length greater than two vanish, and so Hn is a nilpotent graded stratified group of step two. A left invariant vector field X, which is in the span of {Xj,Yj}nj=1, is called horizontal.

    For each real positive number R, the dilation δR:HnHn, naturally associated with the Heisenberg group structure, is defined by

    δR(ξ)=(Rz,R2t)for all ξ=(z,t)Hn.

    It is easy to verify that the Jacobian determinant of the dilatation δR is constant and equal to R2n+2, where the natural number Q=2n+2 is the homogeneous dimension of Hn.

    The anisotropic dilation structure on Hn introduces the Korányi norm, which is given by

    r(ξ)=r(z,t)=(|z|4+t2)1/4for all ξ=(z,t)Hn.

    Consequently, the Korányi norm is homogeneous of degree 1, with respect to the dilations δR, R>0, that is

    r(δR(ξ))=r(Rz,R2t)=(|Rz|4+R4t2)1/4=Rr(ξ)for all ξ=(z,t)Hn.

    Clearly, δR(ηξ)=δR(η)δR(ξ). The corresponding distance, the so called Korányi distance, is

    dK(ξ,ξ)=r(ξ1ξ)for all (ξ,ξ)Hn×Hn.

    Let BR(ξ0)={ξHn:dK(ξ,ξ0)<R} be the Korányi open ball of radius R centered at ξ0. For simplicity we put BR=BR(O), where O=(0,0) is the natural origin of Hn.

    The Lebesgue measure on R2n+1 is invariant under the left translations of the Heisenberg group. Thus, since the Haar measures on Lie groups are unique up to constant multipliers, we denote by dξ the Haar measure on Hn that coincides with the (2n+1)–Lebesgue measure and by |U| the (2n+1)–dimensional Lebesgue measure of any measurable set UHn. Furthermore, the Haar measure on Hn is Q–homogeneous with respect to dilations δR. Consequently,

    |δR(U)|=RQ|U|,d(δRξ)=RQdξ.

    In particular, |BR(ξ0)|=|B1|RQ for all ξ0Hn.

    We define the horizontal gradient of a C1 function u:HnR by

    DHu=nj=1[(Xju)Xj+(Yju)Yj].

    Clearly, DHuspan{Xj,Yj}nj=1. In span{Xj,Yj}nj=1R2n we consider the natural inner product given by

    (X,Y)H=nj=1(xjyj+˜xj˜yj)

    for X={xjXj+˜xjYj}nj=1 and Y={yjXj+˜yjYj}nj=1. The inner product (,)H produces the Hilbertian norm

    |X|H=(X,X)H

    for the horizontal vector field X.

    For any horizontal vector field function X=X(ξ), X={xjXj+˜xjYj}nj=1, of class C1(Hn,R2n), we define the horizontal divergence of X by

    divHX=nj=1[Xj(xj)+Yj(˜xj)].

    Similarly, if uC2(Hn), then the Kohn–Spencer Laplacian in Hn, or equivalently the horizontal Laplacian, or the sub–Laplacian, of u is

    ΔHu=nj=1(X2j+Y2j)u=nj=1(2x2j+2y2j+4yj2xjt4xj2yjt)u+4|z|22ut2.

    According to the celebrated Theorem 1.1 due to Hörmander in [19], the operator ΔH is hypoelliptic. In particular, ΔHu=divHDHu for each uC2(Hn). A well known generalization of the Kohn–Spencer Laplacian is the horizontal p–Laplacian on the Heisenberg group, p(1,), defined by

    ΔH,pφ=divH(|DHφ|p2HDHφ) for all φCc(Hn).

    Let us now review some useful facts about the classical Sobolev spaces on the Heisenberg group Hn. We just consider the special case in which 1p<Q and Ω is an open set in Hn. Denote by HW1,p(Ω) the horizontal Sobolev space consisting of the functions uLp(Ω) such that DHu exists in the sense of distributions and |DHu|HLp(Ω), endowed with the natural norm

    uHW1,p(Ω)=(upLp(Ω)+DHupLp(Ω))1/p,DHuLp(Ω)=(Ω|DHu|pHdξ)1/p.

    By [14] we know that if 1p<Q, then the embedding

    HW1,p(Ω)Ls(Ω) for all s[p,p],p=pQQp,

    is continuous.

    Let us also briefly recall a version of the Rellich theorem in the Heisenberg group. This topic is largely treated in [13,16,17,20] for vector fields satisfying the Hörmander condition. The general Hörmander vector fields have been introduced in [19] and include, as a special case, the horizontal vector fields (1.2) on the Heisenberg group. For our purposes it is sufficient to recall that for any p, with 1p<Q, and for any Korányi ball BR(ξ0), the embedding

    HW1,p(BR(ξ0))↪↪Lq(BR(ξ0)) (2.1)

    is compact, provided that 1q<p. This result holds, more in general, for bounded Poincaré–Sobolev domains Ω of Hn and was first established in [27], even for general Hörmander vector fields. For a complete treatment on this topic we mention, e.g., [16,20,25].

    Let s(0,1) and 1<p<. We endow HWs,p(Hn), defined in the Introduction, with the norm

    HWs,p(Hn)=p+[]H,s,p.

    Our aim is to prove the compactness of the immersion HWs,p(Hn)Lp(BR(ξ0)) for all ξ0Hn and R>0. The proof relies on a Lie group version of the celebrated Frèchet–Kolmogorov Compactness Theorem, cf. Theorem A.4.1 of [11]. First, we need the following lemma.

    Lemma 2.1. Let 0<s<1, 1<p<.Then, there exists a constant C=C(s,p,n)>0 such that for any hHn, with 0<r(h)<1/2,

    τhuupCr(h)s[u]H,s,pforalluHWs,p(Hn),

    where τhu(ξ)=u(hξ) for ξHn.

    Proof. Fix uHWs,p(Hn), hHn, with 0<r(h)<1/2, and ξHn. Take any ηB(ξ,r(h)). Let us first observe that r(η1ξ)r(h), so that r(η1hξ)r(η1ξ)+r(h)2r(h) by the triangle inequality. Then,

    |τhu(ξ)u(ξ)|p2p1(|u(hξ)u(η)|p+|u(η)u(ξ)|p).

    Now, averaging in η over B(ξ,r(h)), we get

    |τhu(ξ)u(ξ)|pc(1r(h)QB(ξ,r(h))|u(hξ)u(η)|pdη+1r(h)QB(ξ,r(h))|u(η)u(ξ)|pdη),

    with c=c(s,p,n). Thus, integrating in ξ over Hn, we obtain

    τhuupcr(h)sp(HnB(ξ,r(h))|u(hξ)u(η)|pr(h)Q+spdηdξ+HnB(ξ,r(h))|u(η)u(ξ)|pr(h)Q+spdηdξ)2cr(h)sp(HnB(ξ,r(h))|u(hξ)u(η)|pr(η1hξ)Q+spdηdξ+HnB(ξ,r(h))|u(η)u(ξ)|pr(η1ξ)Q+spdηdξ)Cr(h)sp[u]H,s,p,

    with C=4c.

    Theorem 2.2. Let 0<s<1 and 1<p<. Then, for every sequence (uk)k bounded in HWs,p(Hn) there exists uHWs,p(Hn) and a subsequence (ukj)j(uk)k such thatfor all ξ0Hn and R>0

    ukjuinLp(BR(ξ0))asj.

    Proof. Let M=supkNukHWs,p(Hn). Clearly, if (uk)k is bounded in HWs,p(Hn), then is also bounded in Lp(Hn). Moreover, by Lemma 2.1, we know that

    τhukukpCr(h)s[uk]H,s,pCMr(h)s.

    Consequently,

    limhOsupkNτhukukp=0.

    Therefore, a Lie group version of the Fréchet–Kolmogorov theorem, cf. Theorem A.4.1 of [11], yields the existence of a function uLp(Hn) and a subsequence of (uk)k, still denoted (uk)k, such that uku a.e. in Hn and uku in Lp(BR(ξ0)) for all ξ0Hn and R>0.

    It remains to prove that uHWs,p(Hn). This follows straightly from an application of Fatou's Lemma. Indeed,

    0limk|uk(η)uk(ξ)|pr(η1ξ)Q+sp=|u(η)u(ξ)|pr(η1ξ)Q+sp for a.e. (ξ,η)Hn×Hn.

    Consequently, Fatou's Lemma, together with the lower semicontinuity of []H,s,p, gives

    [u]H,s,plimk[uk]H,s,psupkN[uk]H,s,p<.

    This concludes the proof.

    This section is devoted to the proof of Theorems 1.1 and 1.2.

    Proof of Theorem 1.1. Let (uk)k be a sequence in S1,p(Hn) as in the statement of the theorem. Obviously, (1.7), (1.8) and the first part of (1.10) follow from Theorem A, see [20]. Thus, there is no reason to repeat the proof here. Let us then focus on the proof of (1.9). We proceed diving the argument into two cases.

    Case 1. u=0. Fix φCc(Hn). Then, since clearly φukS1,p(Hn) for all k, we get by (1.6)

    HpφukpHpHn|φ|p|DHuk|pHdξ+DHφukpp. (3.1)

    Now, by the subelliptic Rellich Theorem, see (2.1), we know that uk0 in Lp(BR) for all R>0. Therefore,

    limkDHφukp=0. (3.2)

    Consequently, by the weak convergence and (3.2), letting k, we obtain

    (Hn|φ|pdω)1/pH1/pp(Hn|φ|pdμ)1/pfor all φCc(Hn).

    Thus, by Lemma 1.4.6 of [20], we conclude that there exist an at most countable set J, a family of points {ξj}jJHn and a family of nonnegative numbers {ωj}jJ{0}, such that

    ω=ω0δO+jJωjδξj. (3.3)

    Clearly, the set J determined in (3.3) is not necessary the same of the one obtained in the representation of ν. However, since the coefficients νj,μj,ωj are allowed to be 0, we can replace these two sets with their union (which is still at most countable). For this reason we keep the same notation J for the index set.

    In order to conclude the proof of (1.9) on Case 1, it remains to show that ω is concentrated at O, namely that ωj=0 for any jJ. But this is obvious. Indeed, fix φCc(Hn), with Osuppφ, so that ξ|φ(ξ)|pψpr(ξ)p is in L(suppφ). Then, since obviously uk0 in Lp(suppφ), we get

    Hn|φ|p|uk|pψpdξr(ξ)p=suppφ|φ|p|uk|pψpdξr(ξ)pCsuppφ|uk|pdξ0

    as k. This, combined with the weak convergence, gives Hn|φ|pdω=0, that is ω is a measure concentrated in O. Hence ω=ω0δO, and so (1.9) in proved in Case 1.

    Case 2. u0. Set ˜uk=uku. Clearly, ˜uk0 in S1,p(Hn) and (3.1) still holds for φ˜uk for any φCc(Hn). Moreover, thanks to Case 1, there exists a finite nonnegative Radon measure ˜ω on Hn, such that, up to a subsequence still labelled (˜uk)k, we have as k

    |˜uk|pψpdξr(ξ)p˜ωin M(Hn), (3.4)

    where

    ˜ω=ω0δO, (3.5)

    and ω0 is an appropriate nonnegative number as shown in Case 1. Now, by (2.1), up to a subsequence,

    ukua.e. in Hn,|uk|gRa.e. in Hn

    for some gRLp(BR) and all R>0. Thus, for all φCc(Hn) an application of Brézis–Lieb lemma yields

    limk(φukpHpφ~ukpHp)=φupHp.

    A combination of the above formulas gives for all φCc(Hn)

    |uk|pψpdξr(ξ)p|u|pψpdξr(ξ)p=|uku|pψpdξr(ξ)po(1), (3.6)

    where o(1)0 in M(Hn). Then, computing the limit in (3.6), by the weak convergence and (3.4), we get ˜ω=ω|uku|pψpdξr(ξ)p. Consequently, taking into account (3.5), we obtain (1.9).

    It remains to prove that νp/p0(μ0σω0)/Iσ. Fix φCc(Hn) such that 0φ1, φ(O)=1 and supp φ=¯B1. Take ε>0 and put φε(ξ)=φ(δ1/ε(ξ)), ξHn. Then,

    Iσ(Hn|φε|p|uk|pdξ)p/pHn|φε|p|DHuk|pHdξ+DHφεukppσHn|φε|p|uk|pψpdξr(ξ)p=Hn|φε|p|DHuk|pHdξ+o(1)σHn|φε|p|uk|pψpdξr(ξ)p, (3.7)

    arguing as before. Now, we know that

    limε0+limkHn|φε|p|uk|pdξ=ν0, (3.8)

    and

    limε0+limkHn|φε|p|DHuk|pHdξ=μ0. (3.9)

    Finally, from (1.9) and the fact that ωω0δO we get

    limε0+limkHn|φε|p|uk|pψpdξr(ξ)p=limε0+Bε|φε|pdωω0. (3.10)

    Hence, passing to the limit as k and ε0+ in (3.7), by (3.8)–(3.10) we obtain that

    Iσνp/p0μ0σω0.

    This concludes the proof.

    In Theorem 1.1 we examine the behavior of weakly convergent sequences in the Folland–Stein space in situations in which the lack of compactness occurs. However, this method does not exclude a possible loss of compactness due to the drifting towards infinity of the mass, or – in other words – the concentration at infinity. Let us then turn to the proof of the concentration–compactness principle at infinity, which extend the method introduced in the Euclidean setting in [3,6].

    Proof of Theorem 1.2. Fix a sequence (uk)k in S1,p(Hn), as in the statement of the Theorem 1.1.

    Let ΨC(Hn) be such that 0Ψ1, Ψ=0 in B1 and Ψ=1 in Bc2. Take R>0 and put ΨR(ξ)=Ψ(δ1/R(ξ)), ξHn. Write

    Hn|DHuk|pHdξ=Hn|DHuk|pH|ΨR|pdξ+Hn|DHuk|pH(1|ΨR|p)dξ. (3.11)

    We first observe that

    Bc2R|DHuk|pHdξHn|DHuk|pH|ΨR|pdξBcR|DHuk|pHdξ

    and so by (1.11)

    μ=limRlim supkHn|DHuk|pH|ΨR|pdξ. (3.12)

    On the other hand, since μ is finite, 1|ΨR|p has compact support and ΨR0 a.e. in Hn, we have by the definition of μ and the dominated convergence theorem that

    limRlim supkHn|DHuk|pH(1|ΨR|p)dξ=limRHn(1|ΨR|p)dμ=μ(Hn). (3.13)

    Using (3.12) and (3.13) in (3.11) we obtain the second part of (1.13). Arguing similarly for ν and ω, we see that

    ν=limRlim supkHn|ΨR|p|uk|pdξ,ω=limRlim supkHn|ΨR|p|uk|pψpdξr(ξ)p, (3.14)

    and

    limRlim supkHn(1|ΨR|p)|uk|pdξ=ν(Hn),limRlim supkHn(1|ΨR|p)|uk|pψpdξr(ξ)p=ω(Hn).

    Thus, (1.13)–(1.14) are proved in the same way.

    In order to show the last part of (1.14), let us consider again the regular function ΨR. Then, since 0ΨR1, by (1.5) applied to ΨRukS1,p(Hn), we get for all k

    Iσ(Hn|ΨR|p|uk|pdξ)p/pHn|ΨR|p|DHuk|pHdξ+DHΨRukppσHn|ΨR|p|uk|pψpdξr(ξ)p. (3.15)

    Finally, from the fact that limRlim supkDHΨRukpp=0, using (3.12) and (3.14) in (3.15) we obtain the desired conclusion.

    This section is devoted to the proof of Theorem 1.3. Before getting there, we need some preliminary results.

    Lemma 4.1. Let φCc(Hn), ε>0 and ξ0Hn. Define Hnξφε(ξ)=φ(δ1/ε(ξ10ξ)). Then,

    |DsHφε(ξ)|p=1εsp|DsHφ(δ1/ε(ξ10ξ))|p.

    Proof. Fix φCc(Hn), ε>0 and ξ0Hn. The proof is a simple consequence of the change of variables formula. Indeed, if we put η=δ1/ε(h), dη=εQdh, then

    |DsHφε(ξ)|p=Hn|φε(ξh)φε(ξ)|pr(h)Q+psdh=Hn|φ(δ1/ε(ξ10ξh))φ(δ1/ε(ξ10ξ))|pr(h)Q+psdh=Hn|φ(δ1/ε(ξ10ξ)δ1/ε(h))φ(δ1/ε(ξ10ξ))|pr(h)Q+psdh=1εspHn|φ(δ1/ε(ξ10ξη)φ(δ1/ε(ξ10ξ))|pr(η)Q+psdη,

    as required thanks to (1.17).

    Note that, in general, the nonlocal (s,p) horizontal gradient of a compactly supported function does not need to have compact support. For this, we use the following lemma, which gives valuable decay estimates of the fractional (s,p) horizontal gradient of a Cc(Hn) function as r(ξ). The next lemma is an extension of Lemma 2.2 of [4] to the Heisenberg setting.

    Lemma 4.2. Let φCc(Hn) be such that 0φ1, suppφBR for some R>0.Then, there exists a constant C=C(s,p,n) such that for any ξHn

    |DsHφ(ξ)|pCmin{1,RQr(ξ)(Q+sp)}.

    In particular, |DsHφ|pL(Hn).

    Proof. Let us first prove the global L bound. Consider for any ξHn

    |Dsφ(ξ)|p=Hn|φ(ξh)φ(ξ)|pr(h)Q+psdh=(B1+Bc1)|φ(ξh)φ(ξ)|pr(h)Q+psdh

    and compute separately the last two integrals. By the mean value theorem and [14]

    B1|φ(ξh)φ(ξ)|pr(h)Q+psdhC1B11r(h)Q+sppdhC2,

    since Q+spp<Q. On the other hand,

    Bc1|φ(ξh)φ(ξ)|pr(h)Q+psdh2pφpBc11r(h)Q+spdhC3,

    being obviously Q+sp>Q. Now, consider ξHn with r(ξ)2R. Clearly, φ(ξ)=0 and so

    |Dsφ(ξ)|p=Hn|φ(ξh)|pr(h)Q+psdh=r(ξh)<R|φ(ξh)|pr(h)Q+psdh.

    Now, if r(ξh)<R and r(ξ)>2R, then r(ξ)r(h)r(ξh) so that r(h)r(ξ)Rr(ξ)/2. Therefore,

    |Dsφ(ξ)|p2Q+spr(ξ)Q+spφpr(ξh)<RdhCRQr(ξ)(Q+sp).

    This concludes the proof of the lemma.

    Combining Lemma 4.1 and Lemma 4.2, we obtain the following.

    Corollary 4.3. Let φCc(Hn) be such that 0φ1 and suppφB1. Let ξ0Hn and define Hnξφε(ξ)=φ(δ1/ε(ξ10ξ)). Then, there exists a constant C=C(s,p,n) such that for any ξHn

    |DsHφε(ξ)|pCmin{εsp,εQr(ξ)(Q+sp)}.

    Using the previous estimates, we are able to prove the next result, which is an extension of Lemma 2.4 of [4] to the Heisenberg context.

    Lemma 4.4. Let φCc(Hn).Then, the following embedding is compact

    HWs,p(Hn)↪↪Lp(Hn,|DsHφ|pdξ).

    Proof. Let (uk)k be a bounded sequence in HWs,p(Hn), say supkukHWs,p(Hn)M, with M>0. From the reflexivity of HWs,p(Hn) and Theorem 2.2, there exist uHWs,p(Hn) and a subsequence, still denoted by (uk)k, such that

    uku in HWs,p(Hn),ukuLp(BR)for any R>0. (4.1)

    Fix R>0 so large that suppφBR. Certainly,

    Hn|uk(ξ)u(ξ)|p|DsHφ(ξ)|pdξ=(B2R+Bc2R)|uk(ξ)u(ξ)|p|DsHφ(ξ)|pdξ.

    Now, from Lemma 4.2 and (4.1)

    B2R|uk(ξ)u(ξ)|p|DsHφ(ξ)|pdξDsHφpB2R|uk(ξ)u(ξ)|pdξ=o(1) (4.2)

    as k. On the other hand, using (1.16) and the Hölder inequality with q=ps/p=Q/(Qsp) and q=Q/sp, we get by Lemma 4.2

    Bc2R|uk(ξ)u(ξ)|p|DsHφ(ξ)|pdξukupps(Bc2R|Hn|φ(ξh)φ(ξ)|pr(h)Q+psdh|Q/sdξ)sp/Q2p21φp2(ukpps+upps)(Bc2Rdξr(ξ)Q(1+Q/sp))sp/QC(Bc2Rdξr(ξ)Q(1+Q/sp))sp/Q (4.3)

    where C=2p2φp2Mp. Now, for any τ>0 we can choose R>0 ever larger, if necessary, so that

    (Bc2Rdξr(ξ)Q(1+Q/sp))sp/Q<τC.

    Finally, by (4.2) and (4.3), we obtain

    lim supkHn|uk(ξ)u(ξ)|p|DsHφ(ξ)|pdξτ

    for all τ>0. Sending τ0+ we get the desired conclusion.

    The proof of the next lemma is based on the precise decay rate of |DsHφε|p, cf. Corollary 4.3. The main difficulty here, as we already pointed out in the Introduction, is based essentially on the fact that the nonlocal (s,p) horizontal gradient |DsHφε|p does not need to have compact support. The proof uses the same strategy of Lemma 4.4, which is effective thanks to the decay estimates given in Lemma 4.1 and Corollary 4.3.

    Lemma 4.5. Let (uk)k be a bounded sequence in HWs,p(Hn) and let φCc(Hn) besuch that 0φ1, φ(O)=1 andsupp φB1. Take ε>0, fix ξ0Hn and putHnξφε(ξ)=φ(δ1/ε(ξ10ξ)). Then

    limε0+lim supkHn|DsHφε|p|uk|pdξ=0.

    Proof. Let (uk)k be a bounded sequence in HWs,p(Hn), say supkukHWs,p(Hn)=M. From the reflexivity of HWs,p(Hn) and Theorem 2.2, there exist uHWs,p(Hn) and a subsequence, still denoted by (uk)k, such that

    uku in HWs,p(Hn),uku in Lp(BR(ξ0)), (4.4)

    for any R>0 and ξ0Hn. Clearly,

    Hn|DsHφε|p|uk|pdξ=(Bε(ξ0)+Bcε(ξ0))|DsHφε|p|uk|pdξ.

    Let us first estimate the integral over Bε(ξ0). By Corollary 4.3 there exists C=C(s,p,n)>0 such that

    lim supkBε(ξ0)|DsHφε|p|uk|pdξClim supkεspBε(ξ0)|uk|p=CεspBε(ξ0)|u|pdξε0+0 (4.5)

    thanks to (4.4) and the Lebesgue theorem, being sp<Q.

    Now we turn to the integral over Bcε(ξ0). Using the Hölder inequality with q=ps/p=Q/(Qsp) and q=Q/sp, and again Corollary 4.3, we get

    Bcε(ξ0)|DsHφε|p|uk|pdξukpps(Bcε(ξ0)|DsHφε(ξ)|Q/sdξ)sp/QCMpεQ(Bcεdξr(ξ)Q(1+Q/sp))sp/QCMp|B1|sp/QεQ(εQ(1Q/sp))sp/Q=CMp|B1|sp/Qεsp.

    Therefore, it follows that

    lim supkBcε|DsHφε|p|uk|pdξCMp|B1|sp/Qεsp. (4.6)

    Finally, using (4.5) and (4.6), we conclude

    limε0+lim supkHn|DsHφε,j|p|uk|pdξlimε0+(CεspBε(ξ0)|u|pdξ+CMp|B1|sp/Qεsp)=0,

    as required.

    Lemma 4.5 extends to the Heisenberg case a remark given in the proof of Theorem 1.1 of [4], stated in the Euclidean framework.

    Proof of Theorem 1.3. Let (uk)k be a sequence in HWs,p(Hn), as in the statement of the theorem, and let us divide the proof into two cases.

    Case 1. u=0. Fix φCc(Hn). Then, an application of Lemma 4.4 immediately yields

    Hn×Hn|uk(ξ)|p|φ(ξ)φ(η)|pr(η1ξ)Q+spdξdη=o(1),

    as k. Consequently, since φukHWs,p(Hn) for all k, we get

    Cps(Hn|φ|ps|uk|psdξ)p/ps[φuk]pH,s,p=(Hn×Hn|(φuk)(ξ)(φuk)(η)|pr(η1ξ)Q+spdξdη)2p1(Hn×Hn|φ(η)|p|uk(ξ)uk(η)|pr(η1ξ)Q+spdξdη+Hn×Hn|uk(ξ)|p|φ(ξ)φ(η)|pr(η1ξ)Q+spdξdη)2p1Hn|φ|p|DsHuk|pdξ+o(1) (4.7)

    as k. Therefore, passing to the limit in (4.7), by the weak convergence we have the following reverse Hölder inequality

    (Hn|φ|psdν)1/psC(Hn|φ|pdμ)1/qfor all φCc(Hn).

    Thus, by Lemma 1.4.6 of [20], we conclude that there exist an at most countable set J, a family of points {ξj}jJHn and a family of nonnegative numbers {νj}jJ such that

    ν=jJνjδξj (4.8)

    Case 2. u0. Set ˜uk=uku. Clearly, ˜uk0 in HWs,p(Hn) and (4.7) still holds for φ˜uk for any φCc(Hn). Moreover, k|˜uk|psdξ and k|DsH˜uk|pdξ are still bounded sequences of measures and so by Proposition 1.202 of [15], we can conclude that there exist two bounded nonnegative Radon measure ˜ν and ˜μ on Hn, such that, up to a subsequence, we have

    |DsH˜uk|pdξ˜μ,|˜uk|psdξ˜ν in M(Hn). (4.9)

    Thus, from Case 1 there exist an at most countable set J, a family of points {ξj}jJHn and a family of nonnegative numbers {νj}jJ such that ˜ν=jJνjδξj. Consequently, the claimed representation (1.7) of ν follows exactly as in Theorem 1.1.

    Let us now prove the first part of (1.10). Fix a test function φCc(Hn), such that 0φ1, φ(O)=1 and supp φB1. Take ε>0 and put φε,j(ξ)=φ(δ1/ε(ξ1jξ)), ξHn, for any fixed jJ, where {ξj}j is introduced in (1.7). Fix jJ and τ>0. Then, there exists Cτ>0 such that, by (1.16) applied to φε,juk, we have

    Cps(Hn|φε,j|ps|uk|psdξ)p/psHn×Hn|(φε,juk)(ξ)(φε,juk)(η)|pr(η1ξ)Q+spdξdη(1+τ)Hn|φε,j|p|DsHuk|pdξ+CτHn|DsHφε,j|p|uk|pdξ. (4.10)

    We aim to pass to the limit in (4.10) as k and ε0+. To do this, let us observe first that from the weak convergence and (1.7) we get

    limε0+limkHn|φε,j|ps|uk|psdξ=limε0+Bε(ξj)|φε,j|psdν=limε0+{Bε(ξj)|φε,j|ps|u|psdξ+νjδξj(φε,j)}=νj, (4.11)

    since

    Bε(ξj)|φε,j|ps|u|psdξBε(ξj)|u|psdξ=o(1)

    as ε0+, being 0φ1. On the other hand, the weak convergence gives

    limkHn|φε,j|p|DsHuk|pdη=Hn|φε,j|pdμ, (4.12)

    while Lemma 4.5 yields

    limε0+lim supkHn|DsHφε,j|p|uk|pdη=0. (4.13)

    Then, combining (4.11)–(4.13) and letting ε0+ in (4.10), we find that

    Cpsνp/psj(1+τ)μj for any jJ,

    where μj=limε0+μ(Bε(ξj)). Since τ>0 is arbitrary, sending τ0+, we finally obtain

    Cpsνp/psjμj,jJ.

    Obviously,

    μjJμjδξj.

    Denote by Bε(ξ0) the Euclidean ball of R2n+1 of center ξ0Hn and radius ε. By Lebesgue's differentiation theorem for measures (see for example [15]), in order to prove that μ|DsHu|pdξ it suffices to show that

    lim infε0+μ(Bε(ξ0)|Bε(ξ0)||DsHu|p(ξ0)for a.e.ξ0Hn, (4.14)

    where |Bε(ξ0)| is the Lebesgue measure of the Euclidean ball Bε(ξ0).

    Clearly, since |DsHu|pdξL1loc(Hn), we know that for a.e. ξ0Hn

    limε0+1|Bε(ξ0)|Bε(ξ0)|DsHu|p(ξ)dξ=|DHu|pH(ξ0). (4.15)

    Fix ε>0 and ξ0Hn such that (4.15) holds. Now, the functional Φ:HWs,p(Hn)R, defined as

    Φu=Bε(ξ0)Hn|u(ξ)u(η)|pr(η1ξ)Q+spdηdξ=Bε(ξ0)|DsHu|pdξ,

    is convex and strongly continuous on HWs,p(Hn). Thus, since uku in HWs,p(Hn), we have

    lim infkBε(ξ0)|DsHuk|pdξBε(ξ0)|DsHu|pdξ.

    Therefore, an application of Proposition 1.203 – Part (ii) of [15] gives

    μ(Bε(ξ0)|Bε(ξ0)|lim supkμk(Bε(ξ0))|Bε(ξ0)|=lim supk1|Bε(ξ0)|Bε(ξ0)|DsHuk|pdξlim infk1|Bε(ξ0)|Bε(ξ0)|DsHuk|pdξ1|Bε(ξ0)|Bε(ξ0)|DsHu|pdξ.

    Now, passing to the liminf as ε0+ and using (4.15), we obtain (4.14).

    Finally, since |DsHu|pdξ is orthogonal to jJμjδξj, we get the desired conclusion. This concludes the proof.

    The authors are members of the Gruppo Nazionale per l'Analisi Matematica, la Probabilità e le loro Applicazioni (GNAMPA) of the Istituto Nazionale di Alta Matematica (INdAM). P. Pucci was partly supported by the INdAM – GNAMPA Project Equazioni alle derivate parziali: problemi e modelli (Prot_U-UFMBAZ-2020-000761) and also by the Fondo Ricerca di Base di Ateneo – Esercizio 2017–2019 of the University of Perugia, named PDEs and Nonlinear Analysis.

    All authors declare no conflicts of interest in this paper.



    Conflict of interest



    All authors declare no conflict of interest in this paper.

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