Illicit Drug Research Articles

Manufacturing the Entheogenic Underground

Ethnographic research suggests that people across the United States are increasingly gathering to commune with their creators, to interact with their ancestors, to enter the spirit world, to gain supernatural insights, and to engage in what they otherwise describe as religious or spiritual experiences. In this regard, their actions are not particularly revolutionary or novel. What distinguishes these people is not their desire to have religious or spiritual experiences. Instead, it is the means they employ to occasion these experiences that set them apart, as their rituals and ceremonies involve the consumption of illegal drugs, specifically psychedelics and cannabis, substances they frequently term entheogens. The United States government has granted select groups an exemption from drug prohibition, thereby allowing them to legally consume what are otherwise illegal substances. The vast majority of these practitioners, however, operate without this exemption, thereby confining them to what scholars often term the underground, or the sociocultural, political, or economic spaces thought to operate outside the influence or purview of the state.4 This alleged “absence” of the government is the topic of this paper, which argues that the state is both the primary curator of the so-called underground and that the state’s influence pervades these “underground” communities. To demonstrate this, this essay will discuss the legal structures and case law impacting entheogenic churches in the United States, paying particular attention to the attorneys who advise these churches.

Suicidal thoughts and behaviors among gender-minority adolescents in the emergency department.

Gender-minority youth, whose gender identity differs from their sex assigned at birth, have elevated suicide risk compared to cisgender youth, yet few studies examine their suicide risk in the emergency department (ED). Our objectives were to determine the prevalence of and assess risk and protective factors associated with prior suicide attempt (SA) and recent suicide ideation (SI) among gender-minority adolescents in the ED. We conducted a secondary analysis of gender-minority adolescents in the Emergency Department Screening for Teens at Risk for Suicide (ED-STARS) multicenter, random-series prospective cohort study. Prior SA and recent SI were based on the Columbia Suicide Severity Rating Scale and Ask Suicide-Screening Questions, respectively. We conducted Firth's logistic regressions to assess risk and protective factors associated with prior SA and recent SI. Of 6641 adolescent participants in ED-STARS, 280 (4.2%) identified as gender minority. Of the gender minorities, 72% presented with a nonpsychiatric complaint, 37% admitted to a prior SA, and 25% reported recent SI. Prior SA was associated with the number of self-harm methods in the prior 12 months (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.3-1.9), sexual minority (aOR 5.0, 95% CI 2.5-10.6), and mother's history of prior SA (aOR 3.6, 95% CI 1.5-9.2). Recent SI was associated with hopelessness (aOR 4.2, 95% CI 1.5-13.9), lower positive affect (aOR 0.9, 95% CI 0.8-1.0), sexual minority (aOR 8.3, 95% CI 2.5-37.8), five or more self-harm events in the prior 12 months (aOR 4.9, 95% CI 2.1-11.6), and number of illicit drug classes (aOR 1.9, 95% CI 1.2-3.2). Among gender-minority ED adolescent patients, one in three experienced a SA prior to the ED visit. One in four endorsed SI within 2 weeks of the ED visit. The identified risk and protective factors among gender-minority adolescents may inform future ED-based efforts to detect and reduce suicide risk.

The Legal Definition of Religion in the Context of Modern Religious Exercise with Psychedelics: Protection, Double Standards, and Potential Expansion under RFRA

In the United States, the convergence of religious freedom and the prohibition of controlled substances is legally complex, increasing, and evolving. As interest in psychedelic religious practices expands, legal protection of religious exercise pursuant to the First Amendment and the Religious Freedom Restoration Act (RFRA) enables certain religious communities to use controlled substances in rituals through exemptions from the Controlled Substances Act (CSA). RFRA was enacted in response to a Supreme Court case that failed to safeguard sacramental drug use as a legitimate religious exercise and requires application of stricter analysis of federal government activities that infringe religious freedom. Key to this protection is defining what constitutes a legitimate religious belief when it involves illegal substances. By analyzing court precedents, this essay explores how the legal definition of religion has preferred Judeo-Christian concepts and determined, with a bias, that psychedelic religious practices are not recognizable enough as religious. It argues that the evolving nature of society and religious practice necessitates a reevaluation of legal standards to ensure that the legal right to religious exercise, as applied and intended, protects the minority and remains consistent with modern expressions of faith and ritual.

Racial and ethnic discrimination and DSM-5 substance use disorders among U.S. adults.

Racial and ethnic discrimination is a risk factor for substance use among United States adults. However, whether discrimination is associated with substance use disorders (SUDs) overall and by race and ethnicity is less understood. We used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n=35,355) and defined past-year discrimination as a summary scale (range: 0-4). Past-year SUDs included alcohol use disorder (AUD), tobacco use disorder (TUD), cannabis use disorder (CUD), and illicit drug use disorder (IDUD) based on DSM-5 criteria, and number of SUDs included one, two, or three or more SUDs. We estimated associations between discrimination and each SUD outcome using logistic and multinomial logistic regression and examined effect modification by race and ethnicity. Discrimination was associated with each substance-specific SUD (OR range: 1.36-1.78) and with one, two, and three or more number of SUDs (OR range: 1.34-2.19). Models stratified by race and ethnicity revealed that discrimination was associated with AUD among all groups (OR range: 1.42-1.52), with TUD only among adults who were non-Hispanic White, non-Hispanic Black and another non-Hispanic race, with CUD only among non-Hispanic White and non-Hispanic Black adults, and with only IDUD among Hispanic, non-Hispanic White, and non-Hispanic Black adults. In addition, discrimination was associated with three or more number of SUDs among all groups. Discrimination was associated with all SUD outcomes, with variation in these relationships by race and ethnicity. Understanding this heterogeneity can inform efforts to prevent problematic substance use and promote health equity.

Factors associated with alcohol, smoking, and illicit drug use among university students in Yaoundé, Cameroon

BackgroundSubstance use, including alcohol, tobacco and illicit drugs, is a growing public health problem worldwide. There is a rapid increase in substance use among young adults in many sub-Saharan African countries. This study aimed to assess the factors associated with the use of different psychoactive substances among university students in Yaoundé.MethodsA cross-sectional and analytical study was conducted from September to October 2023 at Yaoundé I University in Cameroon. All eligible students aged 18 years and older who gave written informed consent were included. A convenience nonprobability sampling method was used to recruit consenting students. The collected data were reviewed and checked for completeness before being entered. The data were analyzed using Statistics 4.3.3.ResultsA total of 191 university students were enrolled in the study. Age (p-value = 0.002), level of study (p-value = 0.048), and smoking status (p-value = 0.005) of the participants were significant factors associated with alcohol use on univariate analysis. Multivariate logistic regression showed that students aged 20-25 years were significantly 2.9 times more likely to consume alcohol than those aged less than 20 years (p-value = 0.003). Students who smoke were 2.7 times more at risk to drink alcohol than those who do not smoke (p-value = 0.008). Living situation (p-value = 0.013) and drug use status (p-value < 0.0001) were significant factors associated with smoking on univariate analysis. On multivariate analysis, people who used drugs (cocaine, tramadol, cannabis, amphetamine) were 3.2 times more at risk to smoke than drug non-users (p-value < 0.0001). Drug use was significantly associated with district of residence of consumer on univariate analysis (p-value = 0.024). Living situation (p-value = 0.016), faculty/school (p-value = 0.04), and district of residence (p-value = 0.037) were significantly associated with polysubstance use. Students living in shared accommodation were 3.8 times more at risk to be polysubstance users than those living with their families (p-value = 0.023). Almost all smokers (95.1%) reported being aware of the psychosocial, mental and health consequences of substance use (p-value = 0.021).ConclusionsAge, living situation, district of residence and smoking status have been associated with substance use among college students. These sociodemographic factors can inform the development and implementation of tailored interventions to reduce the risk of subsequent substance dependence and other harmful consequences.

Illicit drug use among adolescents and young adults with impairments in the US: A cross-sectional analysis of the National Survey on Drug Use And Health.

The purpose of this cross-sectional analysis is to compare the degree to which adolescents and adults with and without impairments in the US engage in illicit drug use. This cross-sectional study utilized data from the 2022 National Survey of Drug Use and Health. Impairment status (mobility, cognitive, hearing, vision, self-care, and communication impairments), illicit drug use (cocaine, crack, heroin, hallucinogens, LSD, ecstasy and molly, inhalants, and methamphetamine), and demographic variables were measured using self-report. Weighted prevalence estimates for illicit drug use across each category were provided. Group differences in drug prevalence between individuals with and without impairments were examined, then logistic regressions estimated crude and adjusted odds of drug use among impairment groups by age. Prevalence of use and age of first time use for illicit drugs were explored across impairment type. The sample comprised of 35,921 individuals, with an estimate of 12.9 % experiencing at least one impairment. Among emerging adults, hallucinogens were the highest reported used drug in the past year, with a significantly higher percentage of those with impairments (12.8 %, 95 % CI: 1.5, 9.6), compared to adults without impairments (7.1 %, 95 % CI: 6.3, 8.0), reporting recent use. Individuals with impairments (mean = 16.2 years) were significantly younger when they first tried an illicit drug compared to peers (mean = 18.1 years). Overall, individuals with impairments were more than twice as likely to engage in illicit drug use compared to counterparts. People with impairments were younger, on average, when they first tried any illicit drugs.

Electrochemical Aptamer-Based Biosensors for Cocaine Detection in Human Saliva: Exploring Matrix Interference.

Electrochemical aptamer-based biosensors (E-aptasensors) are emerging platforms for point-of-care (POC) detection of complex biofluids. Human saliva particularly offers a noninvasive matrix and unprecedented convenience for detecting illicit drugs, such as cocaine. However, the sensitivity of cocaine E-aptasensors is significantly compromised in saliva. Herein, we investigated the influence of salivary components on the sensing performance of a methylene blue (MB)-labeled classic cocaine aptamer by square-wave voltammetry (SWV), and in parallel, we report the development and optimization of a disposable E-aptasensor for cocaine detection fabricated by laser ablation. Cyclic voltammetry (CV), scanning electron microscopy (SEM), and atomic force microscopy (AFM) were used to study the cleanliness and surface topography of the disposable electrode surface. To enhance the sensing performance of the disposable platform, we developed a co-immobilization strategy by introducing both the target and 6-mercapto-1-hexanol (MCH) into the aptamer immobilization solution, achieving optimal sensing performance at the aptamer-to-MCH ratio of 1:100. In a buffer solution, we revealed that the aptasensor performs best at low ionic strength, the absence of multivalent ions, and neutral pH conditions, while salivary components such as viscosity and mucin have minimal impact. However, upon transition to human saliva, the presence of salivary proteins exerted a profound effect on the sensing performance. To reduce this impact, we discovered that a high NaCl concentration could significantly enhance the sensing response in saliva. This approach circumvents centrifugation and extensive dilution and facilitates cocaine detection in human saliva through a straightforward "mix-and-detect" method. This disposable aptasensor achieved a limit of detection (LOD) of 3.7 μM in 90% saliva, demonstrating immense promise for the application of electrochemical aptasensors in detecting cocaine, especially when administered via smoking.

The Psych Behind Psychedelics: Exploring Hallucinogen Use as a Marker for Untreated Mental Health Disorders.

Are individuals who use hallucinogens self-medicating their mental illness and are they more likely to abuse other illegal substances? Data from the National Survey on Drug Use and Health (NSDUH), collected by the Substance Abuse and Mental Health Services Administration (SAMHSA) database was queried for correlations with hallucinogen use. Using age group as a control variable, different variables were run through a crosstab in order to find significant data pointing to the implications of hallucinogen use. The data from the crosstab analysis showed three key findings about hallucinogen use: Those with mental illness or substance abuse issues were substantially more likely to use hallucinogens, the hallucinogen use greatly increased with the pandemic along with further mental health issues, and those who used hallucinogens were more significantly likely to abuse other illegal substances, primarily in a younger population. The positive correlation between mental health issues and hallucinogen use emphasizes the need for better mental health services, especially after the COVID-19 pandemic.The positive correlation between hallucinogen use and other drug use indicates the widespread drug abuse problem, especially within a younger population in which drugs pose a larger neurological threat.

Evaluating Delta-8-THC–Induced Psychosis: A Systematic Review

Objectives This study reviews literature on the psychiatric effects of delta-8-THC, particularly psychosis and severe mental health outcomes, to highlight the need for further research and regulation. Background Marijuana, the most widely used illicit drug in the United States, sees increasing use due to legalization. Although moderate use is generally safe, adverse effects can occur, especially in those with preexisting conditions. Delta-9-THC is known for its psychoactive effects and potential to induce psychosis. Delta-8-THC, another cannabinoid, is gaining popularity and has been linked to severe adverse events but remains under-researched. Methods A comprehensive search of PubMed and Web of Science followed PRISMA guidelines to identify studies and case reports on delta-8-THC and psychosis. Articles on delta-9-THC or other cannabinoids were excluded. Relevant studies were screened, and duplicates removed. The included studies were evaluated using the Critical Appraisal Skills Programme Checklist for Case Reports. Results The search identified 201 studies, with 12 meeting the inclusion criteria for full-text analysis. Six case reports, involving 9 patients, were reviewed. Most patients were male and in their 20s, with varied psychiatric histories, including no prior psychiatric history, schizophrenia, posttraumatic stress disorder, and generalized anxiety disorder. Reported symptoms included psychosis, mood lability, and cannabinoid hyperemesis syndrome. Treatments varied, with different clinical outcomes. Conclusions Delta-8-THC poses significant psychiatric risks despite being less intoxicating than delta-9-THC. The lack of Food and Drug Administration regulation and the availability of delta-8-THC products heighten these risks. More rigorous studies are needed to understand delta-8-THC's impact on mental health and inform regulatory actions.

Seasonal variability and risk evaluation of emerging organic contaminants in European river: linking in silico and in vitro approaches to prioritize hazardous EOCs.

Emerging organic contaminants (EOCs) are a growing concern for aquatic ecosystems, underscoring the need for advanced risk assessment methodologies. This study employed an integrated approach to evaluate the risks associated with 563 EOCs across 13 monitoring sites along the Sava River in Croatia. Sampling was conducted during the winter and spring months, spanning February to May. The detected substances, totaling 551 compounds, included pharmaceuticals, illicit drugs, pesticides, industrial chemicals, hormones, artificial sweetener, and sunscreen chemical. We hypothesized that combining high-resolution chemical monitoring with bio-effect assessment tools could enhance the prioritization of high-risk EOCs and their mixtures. Persistent, bioaccumulative, and toxic (PBT) profiling and risk quotient (RQ) evaluations identified pesticides and industrial chemicals as key contributors to biological impacts, peaking in April due to agricultural activities. In vitro prioritization using exposure-activity ratios (EARs) derived from the ToxCast database revealed exacerbated biological effects during colder months (February and March), driven by elevated levels of pharmaceuticals, particularly synthetic glucocorticoids used for treatments of respiratory infections. By integrating PBT, RQ, and EAR assessments, eight EOCs, including methylprednisolone (a synthetic glucocorticoid), bisphenol A (an industrial chemical), nicotine (a stimulant), and five pesticides (temephos, disulfoton, pyridaben, bifenthrin, and chlorpyrifos-methyl), were prioritized for monitoring and regulatory attention. This multi-method framework advances next-generation risk assessment, offering critical insights for managing EOC pollution and safeguarding aquatic ecosystems and public health.

In Support of the Decriminalization of Personal Drug and Paraphernalia Use and Possession: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education, Research, Substance Use and Addiction).

More than 25% of all arrests made nationwide are related to drug offenses, affecting almost 1.2 million people and their social networks. Furthermore, roughly 20% of people in jails and prisons across the United States are incarcerated for a drug offense and millions more are under community supervision for these charges. This criminalization of drug use has negatively affected the health and well-being of people who use drugs (PWUD) and their communities. Decriminalization-a process of removing criminal sanctions for a previously criminalized behavior-of drug use is central to harm reduction as it mitigates these negative consequences of drug use and supports the health of PWUD. As such, AMERSA supports the decriminalization of drug and paraphernalia possession for personal use for all currently illicit drugs and all associated equipment. AMERSA continues to strongly advocate for the funding of harm reduction strategies and addiction services to improve the health and well-being of PWUD since decriminalization without complementary funding for harm reduction services, addiction treatment services, and social safety nets will be incomplete.

Comparison of strength and adulteration between illicit drugs obtained from cryptomarkets versus off-line.

Drugs sold on cryptomarkets are thought to have lower levels of adulteration and higher strength compared with those sourced off-line. The present study aimed to determine whether cryptomarket and off-line-sourced 3,4-methylenedioxy-N-methamphetamine (MDMA), cocaine, amphetamine, methamphetamine and lysergic acid diethylamide (LSD) differed in adulteration and strength. A between-groups design was used to compare cryptomarket versus off-line-sourced drugs. Regression analyses controlling for year and service were conducted. Drug-checking services were conducted in Spain (Energy Control) and the Netherlands (Drugs Information and Monitoring System). The cases comprised drug samples that underwent drug checking between 2016 and 2021 and were expected to contain MDMA (tablets; n = 36 065; powder: n = 6179), cocaine (n = 11 419), amphetamine (n = 6823), methamphetamine (n = 293) and LSD (n = 1817). Drugs were measured for (1) matching the advertised substance (i.e. containing any amount of the expected substance); (2) strength; (3) presence of adulteration; and (4) number of adulterants. The expected drug was more likely to be identified when sourced from cryptomarkets versus off-line for MDMA tablets [adjusted odds ratio (AOR) = 2.10, 95% confidence interval (CI) = 1.28-3.43], MDMA powder (AOR = 2.64, CI = 1.55-4.51), cocaine (AOR = 3.65, CI = 1.98-6.71) and LSD (AOR = 1.75, CI = 1.13-2.72). Cryptomarket-sourced MDMA powder (β = 0.03, P = 0.012), cocaine (β = 0.08, P < 0.001) and methamphetamine (β = 0.15, P = 0.028) were statistically significantly higher in strength than substances from off-line sources. Conversely, MDMA tablets (β = -0.01, P = 0.043) and amphetamine (β = -0.07, P < 0.001) from cryptomarkets were statistically significantly lower in strength than from off-line sources. MDMA powder (AOR = 0.53, CI = 0.33-0.86) and cocaine (AOR = 0.66, CI = 0.55-0.79) were statistically significantly less likely to be adulterated if sourced from cryptomarkets. However, amphetamine (AOR = 1.54, CI = 1.25-1.90) and LSD (AOR = 1.31, CI = 1.00-1.71) were found to be more likely to be adulterated when purchased from cryptomarkets. Cocaine from cryptomarkets exhibited fewer adulterants (incidence rate ratio = 0.71, CI = 0.60-0.85). The relationship between on-line drug market-places and substance quality varies depending on both the specific substance and the dynamics of the cryptomarket.

Evaluation of rewarding effects of nitazene analogs: results from conditioned place preference tests and in vivo microdialysis experiments in mice.

In illicit drug markets, the most recently expanding new synthetic opioid subclass is benzimidazoles, also known as nitazenes, which were originally developed as analgesics in the 1950s. The emergence of this classical, potent drug family has attracted extensive research interest in the field of forensic toxicology; however, information on their psychological and physical dependence is very limited. Herein, we evaluated the rewarding effects of four nitazene analogs using a battery of in vivo experiments, with a positive control drug (isotonitazene). The four test materials, metonitazene, etodesnitazene, metodesnitazene, and flunitazene, were administered to male C57BL/6J mice by i.p. administration at 0.5, 2, 20, and 20 mg/kg, respectively. In comprehensive behavioral observation tests, representative opioid-related physiological and behavioral states, including analgesia, stereotypic circling behavior, hyperlocomotion, and Straub tail response, were observed. A set of conditioned place preference tests revealed that all the four analogs induced palatability in mice. Furthermore, measurements of dopamine levels in the nucleus accumbens shell by in vivo microdialysis resulted in significant elevations in all test material-treated groups, suggesting that the nitazenes elicit the rewarding effect through a neural circuit originating from the μ-opioid receptor activation at the ventral tegmental area. Our findings add important data regarding the psychological dependence of nitazenes and highlight the abuse potential of these four materials and other prevailing nitazene analogs.

Complexities in Assessing Health Risks of Anabolic Steroid Abuse

The misuse of anabolic androgenic steroids (AAS) has been linked to a broad spectrum of adverse effects, ranging from mild symptoms like acne and gynecomastia to severe health risks, including cardiovascular complications. However, establishing causality for these outcomes is hindered by significant methodological limitations in many studies, which often rely on case reports, uncontrolled cohorts, or retrospective analyses. Additionally, numerous confounding factors complicate the interpretation of results, such as the use of counterfeit or adulterated drugs, excessive dosing, prolonged use, polypharmacy, and the absence of medical oversight. This letter raises critical considerations for analyzing the health effects of AAS misuse, emphasizing the need to account for pre-existing health conditions, drug quality, dosing regimens, and concurrent substance use. Factors such as the duration of supraphysiological dosing, lifetime exposure, and whether users were monitored by healthcare professionals are crucial in evaluating risks. The chaotic and uncontrolled context of AAS abuse, often marked by high doses and the simultaneous use of legal and illegal substances, presents significant challenges to identifying specific causal relationships. While the dangers of prolonged, unsupervised AAS misuse are well-documented, attributing precise causality to AAS in adverse health events remains complex. This discussion underscores the importance of robust methodologies and critical evaluation in future research to better understand the health risks associated with AAS and to mitigate potential harm.

Factors associated with not smoking among Aboriginal and Torres Strait Islander adolescents and young people: Analysis of data from the 2014 to 15 National Aboriginal and Torres Strait Islander Social Survey.

Smoking rates have been steadily declining among Aboriginal and Torres Strait Islander people. Examining the factors associated with not smoking in young people is crucial for understanding the motivations and influences that lead individuals to adopt healthy behaviours. Secondary analysis was undertaken of data collected as part of the National Aboriginal and Torres Strait Islander Social Survey (NATSISS) 2014-15 (n = 1456). Factors associated with not smoking were explored with three multivariate regressions: (1) socio-demographic characteristics; (2) health, social and emotional factors; and (3) cultural identity characteristics. Overall, 66% of Aboriginal and Torres Strait Islander young people aged 15-24 years did not smoke. Factors associated with not smoking included being younger, female, and engaged in study or employment. Those who lived with no smoking in the house, had lower illicit drug and alcohol use, and participated in Aboriginal or Torres Strait Islander sports carnivals were also more likely to be non-smokers. Study findings reinforce the influence of social determinants on smoking behaviour. Efforts to reduce smoking among Aboriginal and Torres Strait Islander young people should focus on removing barriers to education and employment, promoting positive peer and family influences within households, taking a multi-drug approach to cessation, and considering cultural identity and its role in promoting healthy lifestyles. SO WHAT?: Understanding the protective factors associated with not smoking in young Aboriginal and Torres Strait Islander people will help with developing effective policies and initiatives to improve health outcomes.

International cooperation in the fight against drug trafficking in a changed geopolitical situation

Drug addiction of the world's population has remained a key threat to the security of any modern society and state over the past century. The problem of illicit drug trafficking is aggravated during periods of unstable international situation. This is evidenced by growing figures of the number of people involved in drug crimes and the number of crimes themselves. Due to the increase in crimes in the field of drug trafficking and due to their transnational nature, further development of cooperation between states is necessary. The purpose of the study is to analyze the international legal regulation of drug trafficking control, previously identified areas and implemented forms of cooperation, the study of Russia's criminal policy on this issue, the measures taken and approved means to combat drug trafficking, as well as development of new ways and directions of interaction with international partners–epicenters of drug trafficking to prevent drug traffickers from using the unstable situation in the world to expand its influence. Materials and methods. The main international acts developed and ratified by most countries of the world, Russian strategic documents, as well as official reports and statements from authorized bodies and organizations for the period from XX to XXI centuries are analyzed. In the process of studying the required information, a sociological method was used – the analysis of documents. In addition, the methodological basis of the study was made up of both general scientific and particular methods, but the advantage was given to the comparative legal method. Research results. Statistical data on the increase in the number of crimes in the field of drug trafficking are presented; a range of interrelated crimes is outlined; the experience of creating international unions to combat drug traffickers is analyzed. The problem of interrupting the investigation of large associations of drug traffickers and/or creating new groups on the basis of previously existing and formally liquidated ones, which are even more actively spreading information about access to drugs and flooding the market with their deadly goods, as a result of ruptured diplomatic relations between countries and terminated cooperation in the middle of the way, has been identified. Based on the study of positive experience in cooperation with the former members of the Soviet Union in this area, new areas of cooperation for the Russian Federation are proposed. Conclusions. Joint actions in the field of combating crime are important for international relations. They will ensure law and order both inside our country and in the world, as well as national and international security. Unification of the countries that were previously part of the USSR in order to counter drug crime will allow controlling the level of drug trafficking and even reducing it during the period of complicated relations with European representatives.

An unusual case of acute respiratory distress syndrome in a young man

Acute Respiratory Distress Syndrome (ARDS) is a complex and progressive lung injury that results in respiratory failure, often caused by pulmonary or systemic disorders. We present a 32-year-old male who developed ARDS following intranasal inhalation of cocaine. Diagnosis was established thorough clinical evaluation, identification of characteristic ultrasonographic patterns, and careful exclusion of other potential causes. The patient was managed with conservative medical therapy, including non-invasive ventilation, bronchodilators, antibiotic therapy, and comprehensive supportive care. Despite initial concerns about the severity of his condition, the patient's outcome was favourable, reflecting the diverse presentations and potential reversibility of ARDS. This case highlights two main aspects: i) the critical role of emergency physicians in recognizing and managing ARDS, even when the underlying cause is not immediately apparent; and ii) the importance of considering illicit drug use as a potential trigger during the initial assessment of respiratory complications.

Relational anonymity in reducing the harms of illicit drug use: accounts of users of dark web- and street-based services in Finland

BackgroundProtecting individual anonymity is a common practice in harm reduction (HR), as it can mitigate the fears that may prevent people from accessing services. Protecting anonymity usually means applying for services with a pseudonym. However, anonymity protection practices have diversified in current HR environments, for example, on the streets or in the Tor network, which relies on technology to guarantee exceptionally strong anonymity. Despite its importance, the individual’s need for anonymity when seeking help to reduce drug-related harm has been underexplored.MethodsThe research contexts included four street- and dark web-based HR services in Finland. The data consisted of service user interviews and naturally occurring conversations in the Tor network. We focused on service users’ accounts of their need for anonymity and applied the concept of relational anonymity, acknowledging that wider contextual relations intertwine with situational needs for anonymity. We asked: What kinds of needs for anonymity do service users express when discussing seeking help to reduce drug-related harm? How do service users account for their need for anonymity when seeking such help? To which kinds of contextual relations are these accounts attached?ResultsWe identified connections between the accounts of the need for anonymity and various contextual relations: (1) excusing the need for anonymity by referring to societal relations: blaming Finnish society for stigmatising attitudes and exclusionary practices; (2) excusing the need for anonymity by referring to service system relations: blaming the service system for the risk of negative consequences from recording the use of illicit drugs; (3) justifying and excusing the need for anonymity by referring to personal relations: appealing to personal situation, feelings and experiences.ConclusionsThe need for anonymity reflects problematic societal relations, in which the stigma towards drug use is strong. The service users’ accounts were motivated by rational actions to avoid possible sanctions and the perceived abuse of power in Finnish society and services, which the service users deemed to have various negative consequences in their lives. Societies should promote cultural atmospheres and information sharing practices where anonymity is not needed, but services that protect anonymity are crucial in the current societal conditions.

Sex- and Substance-Specific Associations of Circadian-Related Genes with Addiction in the UK Biobank Cohort Implicate Neuroplasticity Pathways.

The circadian clockwork is implicated in the etiology of addiction, with circadian rhythm disruptions bidirectionally linked to substance abuse, but the molecular mechanisms that underlie this connection are not well known. Here, we use machine learning to reveal sex- and substance-specific associations with addiction in variants from 51 circadian-related genes (156,702 SNPs) in 98,800 participants from a UK Biobank cohort. We further analyze SNP associations in a subset of the cohort for substance-specific addictions (alcohol, illicit drugs (narcotics), and prescription drugs (opioids)). We find robust (OR > 10) and novel sex-specific and substance-specific associations with variants in synaptic transcription factors (ZBTB20, CHRNB3) and hormone receptors (RORA), particularly in individuals addicted to narcotics and opioids. Circadian-related gene variants associated with male and female addiction were non-overlapping; variants in males primarily involve dopaminergic pathways, while variants in females factor in metabolic and inflammation pathways, with a novel gene association of female addiction with DELEC1, a gene of unknown function. Our findings underscore the complexity of genetic pathways associated with addiction, involving core clock genes and circadian-regulated pathways, and reveal novel circadian-related gene associations that will aid the development of targeted, sex-specific therapeutic interventions for substance abuse.

Characteristics and outcomes of in-hospital patients with Covid-19 and history of tuberculosis: a matched case-control from the Brazilian Covid-19 Registry

BackgroundThe Covid-19 pandemic caused a negative impact on other infectious diseases control, prevention, and treatment. Consequently, low and middle-income countries suffer from other endemic diseases, such as tuberculosis. This study was designed to compare Covid-19 manifestations and outcomes between patients with previously treated tuberculosis and controls without this condition.MethodsWe performed a matched case-control study drawn from the Brazilian Covid-19 Registry data, including in-hospital patients aged 18 and over with laboratory-confirmed Covid-19 from March 1, 2020, to March 31, 2022. Cases were patients with a past history of tuberculosis. Controls were Covid-19 patients without a tuberculosis history. Patients were matched by hospital, sex, presence of HIV, and number of comorbidities, with a 1:4 ratio.ResultsOf 13,636 patients with laboratory-confirmed diagnoses of Covid-19 enrolled in this study, 80 had a history of tuberculosis. Statistical differences in history of chronic pulmonary obstructive disease (15% vs. 3.2%), psychiatric disease (10% vs. 3.5%,), chronic kidney disease (11.2% vs. 2.8%), and solid-organ transplantation; (5% vs. 0.9%, p < 0.05 for all) were higher in patients with a past history of tuberculosis. Prior use of inhalatory medications (5% vs. 0.6%,), oral corticoids (8.8% vs. 1.9%), immunosuppressants (8.8% vs. 1.9%,) and the use of illicit drugs were more common in the case group (6.2% vs. 0.3% p < 0.05for all). There were no significant differences in in-hospital mortality, mechanical ventilation, need for dialysis, and ICU admission.ConclusionsPatients with a history of tuberculosis infection presented a higher frequency of use of illicit drugs, chronic pulmonary obstructive disease, psychiatric disease, chronic kidney disease, solid-organ transplantation, prior use of inhalatory medications, oral corticoids, and immunosuppressants. The outcomes were similar between cases and controls.