Psychoactive Substance Misuse Research Articles

Peculiarities of Modern Expert and Forensic Studies of "Criminal Drugs", Abuse of Which Leads to Addiction

The objective of this research was to delve into the unique aspects of the distribution and handling of psychoactive substances, often referred to as "criminal drugs," in the context of forensic and forensic pharmaceutical examinations. This study involved an in-depth analysis of the experiences of United Nations experts in relation to the rising trend of adolescent addiction, particularly focusing on the misuse of psychoactive substances that fall under various classification and legal categories, such as narcotics, psychotropics, and precursors. Special attention was given to the investigation of altered psychoactive substances that are found in combination drugs containing codeine or ephedrine. Additionally, the research examined the intricacies involved in conducting expert criminological, forensic, and pharmaceutical studies on these modified psychoactive substances that are often the subject of forensic investigations. This included exploring the methods and techniques used in these studies, the challenges faced by experts in identifying and analyzing these substances, and the implications of their findings for legal and regulatory frameworks. By understanding these peculiarities, the research aimed to contribute to more effective strategies for managing and controlling the misuse of psychoactive substances, as well as to enhance the accuracy and reliability of forensic investigations in this area. This comprehensive approach to studying psychoactive "criminal drugs" is essential for developing a deeper understanding of their impact on society and the legal system.

Organization of Pharmaceutical Business and Forensic Pharmacy: Multidisciplinary Gender Study of Risks in Cases of Violations of Circulation of Psychoactive Substances

The contemporary pharmaceutical industry plays an integral role in ensuring healthcare quality by developing, producing, and distributing medications to mitigate various ailments. However, this industry's intersection with forensic pharmacy, particularly in the context of psychoactive substances abuse, presents a myriad of challenges, risks, and considerations. This study explored these challenges from a multidisciplinary gendered lens, attempting to unearth the different ways genders experience risks associated with psychoactive substance abuse. Findings reveal that the pharmaceutical business structure, predominantly male-driven in leadership roles, has inadvertently shaped drug development and marketing strategies. This often neglects gender-specific responses and considerations for psychoactive substances, leading to gender disparities in drug-related harm and misuse. Women, for instance, metabolize certain substances differently, making them more susceptible to side effects and potential misuse. Additionally, forensic pharmacy, which investigates drug-related incidents and ensures regulatory compliance, frequently overlooks gender-specific patterns of substance misuse. There is a need for improved gender-inclusive data analytics, ensuring that drug-related forensic investigations consider male and female biological and sociocultural differences. The study suggests that a gender-responsive approach in both pharmaceutical business operations and forensic pharmacy investigations can mitigate the risks and enhance preventive measures. This could lead to better drug safety profiles, more accurate forensic results, and a reduction in the prevalence of psychoactive substance misuse. Emphasizing the need for a multidisciplinary and inclusive approach, this research underscores the importance of acknowledging gender as a pivotal factor in understanding and addressing the challenges in the intersection of pharmaceutical business organization and forensic pharmacy related to psychoactive substances abuse.

Knowledge and Perceived Effects of Psychoactive Substances among Undergraduate Students of Achievers University, Owo, Ondo State, Nigeria

Abstract Background: The use of drugs and other psychoactive substances by students poses a significant risk to public health that affects multiple aspects of individuals’ lives, including health, social interactions, and the economy. As a result, this research seeks to evaluate the level of understanding and the perceived consequences of psychoactive substances among undergraduate students at Achievers University in Owo, Ondo state. Materials and Methods: This descriptive cross-sectional research was conducted between September 2022 and November 2022. A total of 351 students from different departments were selected using a multistage sampling technique. The researchers utilized a self-structured questionnaire that was validated to gather data that aligns with the objectives of the study. The acquired data were then codified and analyzed through descriptive and Chi-square tests set with a significance level of 0.05 using SPSS version 25. Results: Out of 351 individuals surveyed, a majority of 88.3% were aware of the existence of illegal drugs. Among them, 22.2% were found to be currently abusing such substances, whereas 20.5% acquired them from friends. Respondents reported abusing various substances, including alcohol (20.5%), tramadol (13.4%), coffee (11.4%), cigarettes (18.2%), stimulants (2.0%), marijuana (2.0%), and tobacco (16.8%). The use of psychoactive substances was found to have negative impacts on individuals, such as low self-esteem (47.9%), despair (27.1%), psychiatric disorders (17.1%), social isolation (17.9%), increased violence (23.4%), and an increased risk of overdose and suicide (11.4%). Furthermore, there was a significant correlation between education level, religion, and knowledge of psychoactive substances (P ˂ 0.05). Conclusion: The study findings indicate that the misuse of psychoactive substances is prevalent among the surveyed population, with adverse effects on mental health, heightened risk of engaging in illegal activities, and increased likelihood of overdose and suicide fatalities. As a result, we recommend that the university and other religious organizations undertake a suitable drug education campaign.

Prevalence and Factors Associated with Psychoactive Substance Misuse among Heavy Goods Vehicle Drivers in Cotonou, Benin

Prevalence and Factors Associated with Psychoactive Substance Misuse among Heavy Goods Vehicle Drivers in Cotonou, Benin

Patterns of Psychoactive Substance Misuse in Undergraduate University Students: The Case of Mekelle University, Ethiopia

Background: Substance misuse is a public health concern among University students. Understanding the critical times and places for substance misuse among University students helps to inform effective preventive strategies. However, there is a dearth of studies in Ethiopian Universities on this topic. Here, we aimed to explore the patterns of psychoactive substance misuse, specifically about time and places, among undergraduate students at Mekelle University. Subject and Methods: An explorative qualitative study design was conducted in 2017. Five focus-group discussions among substance user students followed by eleven in-depth interviews with the user and non-user students, proctors, and a bar owners were conducted. In addition, four key informant researchers were involved. Participants were purposefully selected. The data were audio taped, transcribed verbatim and imported into Atlas.ti qualitative data analysis software version 7.5 for coding and analysis. Data were analyzed inductively to capture the emerging themes. Results: Our study showed that students consume alcohol in the evenings, on weekend days, holidays, after exams and at celebrations; smoke cigarettes after waking in the morning and after eating lunch. Concurrent substance use like smoking cigarettes, chewing Khat and drinking alcohol was evident. Khat chewing was reported mainly around noon, in the afternoon and on weekends. Substance use generally peaks at weekends, at the start and end of academic semesters, and when graduation approaches. However, students who become addicted may continue using substances. Students easily accessed and used substances around and inside the gates of the campuses. Conclusion: Event-specific celebrations are linked with substance misuse among University students. The ease with which students can access substances around the campuses increases the likelihood of substance misuse. Proactive interventions that include the provision of alcohol-free recreational alternatives to events on campus, high-risk substance misuse surveillance, tobacco cessation interventions, and promoting plain packaging are recommended.

Drug misuse by teenagers in schools in Benin and genetic polymorphism of cytochrome p450: interest and perspectives of cytochrome p450 genotyping

The misuse of psychoactive substances by students is a reality in Beninese schools. These students are exposed to experimentation with these substances with or without prescriptions. The systematic genotyping of cytochromes in these students and in general in subjects exposed to the use of psychoactive substances would be an asset in their therapeutic management and more specifically in the adaptation of dosages and will also allow us to add a particular touch during sensitizations on the experimentation of substances. To achieve this, we checked the availability of drugs that metabolize by cytochromes 2D6 and 3A4 and that are in pharmacies in Benin. What would happen when they consume one or more substances that are metabolized by two cytochrome? PharmGKB is a pharmacogenomics knowledge base that provides information on how human genetic variation affects drug response by collecting information on clinically relevant gene-drug associations and genotype-phenotype relationships. For dosage individualization in therapeutics, the use of the PharmGKB knowledge base preceded by cytochrome genotyping in exposed subjects are assets that clinicians should make use of today for disease treatment.

Flipped detection of psychoactive substances in complex mixtures using handheld Raman spectroscopy coupled to chemometrics

AbstractNew psychoactive substance (NPS) misuse represents a critical social and health problem. Herein, a novel flipped approach is presented for the detection of psychoactive substances in complex mixtures using portable Raman spectroscopy. This consists firstly of evaluating the spectral dissimilarities of an NPS product to its constituent adulterants followed by detection of the NPS by means of key spectral signatures. To demonstrate it, three structurally diverse NPS and four commonly used adulterants were selected. A Design‐of‐Experiments guided approach was employed to determine the composition of simulate street samples, ranging from binary to quinary mixtures of varying concentrations. Spectra were acquired for all mixtures using a portable Raman spectrometer and examined using projection analysis on model systems, developed via principal component analysis using reference materials. For all 21 mixtures investigated, the innovative ‘flipped’ methodology resulted in isolated and unequivocal detection of the NPS. Interestingly, the NPS signatures were consistent across all mixtures investigated and were 1712, 1000, and 777/1022 cm−1 for 5F‐PB‐22, phenibut, and N‐Me‐2‐AI containing samples, respectively. Thus indicating that the developed model systems could be applicable to structural analogs. NPS were detected to concentrations as low as 6.0% w/w. This flipped methodology was benchmarked to the instrument's output algorithms and outperformed these in terms of NPS detection, particularly for low concentration ternary and quinary mixtures. As a result, this study represents a critical change in the conceptualization of novel approaches for the detection of psychoactive substances and further denotes a blueprint for the development of detection methodologies of target analytes in complex mixtures.

Physical-mental health comorbidity: A population-based cross-sectional study

BackgroundMultimorbidity is associated with physical-mental health comorbidity (PMHC). However, the scope of overlap between physical and mental conditions, associated factors, as well as types of mental illness involved are not well described in Eastern Europe. This study aims to assess the PMHC burden in the Estonian population.MethodsIn this population-based cross-sectional study we obtained health claims data for 55 chronic conditions from the Estonian Health Insurance Fund (EHIF) database, which captures data for all publicly insured individuals (n = 1 240 927 or 94.1% of the total population as of 31 December 2017). We assessed the period-prevalence (3 years) of chronic physical and mental health disorders, as well as associations between them, by age and sex.ResultsHalf of the individuals (49.1% (95% CI 49.0–49.3)) had one or more chronic conditions. Mental health disorders (MHD) were present in 8.1% (8.1–8.2) of individuals, being higher among older age groups, women, and individuals with a higher number of physical conditions. PMHC was present in 6.2% (6.1–6.2) of the study population, and 13.1% (13.0–13.2) of the subjects with any chronic physical disorder also presented with at least one MHD. Dominating MHDs among PMHC patients were anxiety and depression. The prevalence of MHD was positively correlated with the number of physical disorders. We observed variation in the type of MHD as the number of physical comorbidities increased. The prevalence of anxiety, depression, and mental and behavioral disorders due to the misuse of alcohol and other psychoactive substances increased as physical comorbidities increased, but the prevalence of schizophrenia and dementia decreased with each additional physical disease. After adjusting for age and sex, this negative association changed the sign to a positive association in the case of dementia and mental and behavioral disorders due to psychoactive substance misuse.ConclusionsThe burden of physical-mental comorbidity in the Estonian population is relatively high. Further research is required to identify clusters of overlapping physical and mental disorders as well as the interactions between these conditions. Public health interventions may include structural changes to health care delivery, such as an increased emphasis on integrated care models that reduce barriers to mental health care.

Determinants of timely access to Specialized Mental Health Services and maintenance of a link with primary care: a cross-sectional study

BackgroundAlthough access to specialized services is one of the main components of the study of paths to mental health care worldwide, the factors related to the continuity of the patient’s link with Primary Care after admission to a Specialized Mental Health Services still need to be explored in greater depth. Thus, this study aimed to evaluate the determinants of timely access to Specialized Mental Health Services (outcome 1) and maintenance of a link with Primary Care after patients’ admission (outcome 2).MethodsThis is a cross-sectional study, conducted with 341 users of Specialized Mental Health Services at outpatient and community level in a medium-sized city in Brazil between August and November 2019. Associations between the outcomes and the other variables were explored with the use of Poisson regression models with robust variance estimators.ResultsFactors positively associated with timely access were the diagnosis of psychosis or psychoactive substance misuse. The inversely associated factors with this outcome were higher income, having their need for mental health care identified in an appointment for general complaints, having been referred to the current service by Primary Care, having attended the current service for up to 3 years and delay until the first appointment (in a previous service). Regarding the maintenance of a link with Primary Care, factors positively associated were being referred to the current service by Primary Care or private service and receiving visits from Community Health Agents. The inversely associated factors with this outcome were male sex, being employed, having a diagnosis of psychosis or psychoactive substance misuse, and a greater perception of social support.ConclusionsIn addition to individual factors, factors related to the organization of services and the referral between them stood out in influencing both the access and maintenance of the patients’ link with Primary Care. Thus, this study reinforces the idea that integration between Primary Care and Specialized Mental Health Services should be strengthened, both to reduce waiting times for between-service referrals and benefit of care continuity.

Comparing intentions to reduce substance use and willingness to seek help among transgender and cisgender participants from the global drug survey

AimsTo describe and compare psychoactive substance misuse help-seeking among transgender (trans) and cisgender (cis) participants from a large multi-national cross-sectional survey.BackgroundTrans people experience stressors related to their minority status which have been associated with increased rates of psychoactive substance use and related harm. Despite this, there is a paucity of evidence relating to the treatment needs of trans people who use psychoactive substances, beyond a small body of literature describing a culture of transphobic hostility in general substance misuse services. This paper aims to describe and compare psychoactive substance misuse help-seeking among trans and cis participants from a large multi-national cross-sectional survey.MethodOver 180,000 participants, recruited from the world's largest annual survey of drug use - the Global Drug Survey (GDS) - during 2018 and 2019, reported use of a range of psychoactive substances in the preceding 12 months. Five gender groups (118,157 cis men, 64,319 cis women, 369 trans men, 353 trans women and 1,857 non-binary people) were compared, using Chi-square and z-tests with Bonferroni correction, on items relating to the desire to use less psychoactive substances and the need to seek help to achieve this. Respondents from GDS 2018 were also assessed for substance dependence. Binary logistic regression was used to compare gender groups on self-reported substance dependence to frame the help-seeking analyses.ResultTrans respondents (n = 1,710) to GDS 2018 were significantly more likely than cis respondents to report use of illicit substances (OR = 1.66-2.93) and dependence on cannabis (OR = 2.39), alcohol (OR = 3.28) and novel psychoactive substances (OR = 4.60). In the combined GDS 2018 and 2019 dataset, there were no significant differences between trans (n = 2,579) and cis (n = 182,476) participants on the desire to reduce substance use. However, among those who did report wanting to use less, non-binary people and trans women were most likely to want help to achieve this.ConclusionTrans respondents reported a greater need for help with reducing substance use than cis respondents. Given the deficit of specialist services for psychoactive substance users who are trans, there is a need for a more thorough understanding of the barriers and facilitators to their engagement in general substance misuse services. In the interim, substance misuse service providers require education about gender minority status to help meet the needs of trans clients.

Coronavirus lockdown: Excessive alcohol consumption and illicit substance use in DUI subjects

Objective This study investigates the consequences of the SarS-CoV-2 outbreak and of the resulting control measures on alcohol and illicit substance use in a high-risk population for substance-related disorders, utilizing an integrated medico-legal and toxicological approach. Methods The research was structured as a retrospective case-control study of subjects found to be driving under the influence (DUI) of alcohol and/or other psychoactive substances who were examined for driver’s license regranting. Alcohol and/or drug use was assessed by comparing cases examined in the period from May to August 2020 (immediately after the lockdown in Italy) to control subjects examined in the same period in 2019. DUI subjects were examined by an integrated approach, descriptive analyses were conducted, and significance was determined by chi-square and Mann-Whitney tests. Variables linked to the pandemic outbreak and resulting lockdown were investigated as predictive factors in determining unfitness to drive. Results Cases (281) were significantly different from controls (261) concerning the judgment of unfitness to drive (p<.001) and had more subjects with chronic excessive alcohol use and/or illicit substance use. The two groups were rather homogeneous concerning the other variables, except for a difference in blood alcohol concentration (BAC) at the time of DUI (p = .027). No statistical association was found between the investigated variables linked to the lockdown and the judgment of unfitness to drive. Conclusions Chronic excessive alcohol consumption and illicit substance use were more frequently observed in cases, which suggests a possible correlation between the pandemic/lockdown restrictions and an increase in psychoactive substance misuse. While these potentially correlative factors are discussed in this article, they require further study. If confirmed, the results should be considered in forensic and clinical settings.

Overview of the major classes of new psychoactive substances, psychoactive effects, analytical determination and conformational analysis of selected illegal drugs

Abstract The misuse of psychoactive substances is attracting a great deal of attention from the general public. An increase use of psychoactive substances is observed among young people who do not have enough awareness of the harmful effects of these substances. Easy access to illicit drugs at low cost and lack of effective means of routine screening for new psychoactive substances (NPS) have contributed to the rapid increase in their use. New research and evidence suggest that drug use can cause a variety of adverse psychological and physiological effects on human health (anxiety, panic, paranoia, psychosis, and seizures). We describe different classes of these NPS drugs with emphasis on the methods used to identify them and the identification of their metabolites in biological specimens. This is the first review that thoroughly gives the literature on both natural and synthetic illegal drugs with old known data and very hot new topics and investigations, which enables the researcher to use it as a starting point in the literature exploration and planning of the own research. For the first time, the conformational analysis was done for selected illegal drugs, giving rise to the search of the biologically active conformations both theoretically and using lab experiments.

Consequences of COVID-19 Lockdown on the Misuse and Marketing of Addictive Substances and New Psychoactive Substances.

OPINION article Front. Psychiatry, 23 October 2020Sec. Addictive Disorders Volume 11 - 2020 | https://doi.org/10.3389/fpsyt.2020.584462

Gatekeeper Perspectives on Substance Misuse Among a Muslim Community in Southwestern Ontario, Canada

ABSTRACT This study was conducted during 2018 with 20 community leaders and professionals from within one Muslim community in Canada: Imams, physicians, police officers, social workers, and teachers, who serve as gatekeepers to treatment for Muslims who are seeking support for addiction. Major themes revealed were i) The Impact of Islam on responses to psychoactive substance use and misuse, ii) The influence of family and community on responses to psychoactive drug use and misuse, and iii) Barriers Muslims face in seeking help for substance misuse. The influence of faith was identified as a source of both protection and burden due to different interpretations of Islam and negative cultural beliefs which fuel stigma and shame. The greatest protective factors were also often the reasons preventing individuals from seeking treatment. Recommendations for future action to address this community issue are provided.

Psychiatric Disorders in Patients With a Diagnosis of Celiac Disease During Childhood From 1973 to 2016

Few studies have explored the link between childhood celiac disease and long-term psychiatric comorbidities. We performed a population-based cohort study of associations between childhood celiac disease and psychiatric disorders and investigated whether risk persists into adulthood. We performed a nationwide study in Sweden using data from the Epidemiology Strengthened by histoPathology Reports in Sweden cohort. In this cohort, 19,186 children with a diagnosis of biopsy-verified celiac disease from 1973 through 2016 were identified from Sweden's 28 pathology departments. Each patient was matched with as many as 5 reference children (controls, n= 94,249). Data on psychiatric disorders were obtained from the patient register. We used Cox proportional modeling to estimate hazard ratios (HRs). During a median follow-up period of 12.3 years, 3174 children (16.5%) with celiac disease received a new diagnosis of a psychiatric disorder, compared with 13,286 controls (14.1%). Corresponding incidence rates were 12.2 per 1000 person-years (95% CI, 11.8-12.7) vs 10.3 per 1000 person-years (95% Cl, 10.2-10.5). Childhood celiac disease was associated with a 19% increase in risk of any psychiatric disorder (95% CI, 1.14-1.23); the increase in risk was observed in all childhood age groups. The highest HRs were seen in the first year after celiac diagnosis (HR, 1.70; 95% CI, 1.41-2.05). The risk increase persisted into adulthood (age, >18 y: HR, 1.11; 95% CI, 1.04-1.17). We found increased risks of mood disorders (HR, 1.20; 95% CI, 1.12-1.28), anxiety disorders (HR, 1.12; 95% CI, 1.06-1.19), eating disorders (HR, 1.34; 95% CI, 1.18-1.51), attention deficit hyperactivity disorder (HR, 1.29; 95% CI, 1.20-1.39), and autism spectrum disorder (HR, 1.47; 95% CI, 1.32-1.64). We found no statistically significant risk increase for psychotic disorders, psychoactive substance misuse, behavioral disorders, personality disorders, suicide attempt, or suicide. Celiac disease also was linked to an increased use of psychiatric drugs (HR, 1.34; 95% CI, 1.24-1.43). A conditional logistic regression found that psychiatric disorders also were more common before a diagnosis of celiac disease (odds ratio, 1.56; 95% CI, 1.39-1.76). Childhood celiac disease is associated with an increased risk of subsequent psychiatric disorders, which persists into adulthood. Mental health surveillance should be integral in the care of celiac disease.

Troubles de l’usage de substances et addictions chez les soignants

Carers also use psychoactive substances and sometimes at work. The risks of use and especially the misuse of psychoactive substances at work take characteristics in health area. Often silent or concealed, substance use disorders of health professionals justify identifying, screening, care and prevention through comprehensive institutional programs involving supervision team.

Characteristics, service use and mortality of clusters of multimorbid patients in England: a population-based study

BackgroundMultimorbidity is associated with mortality and service use, with specific types of multimorbidity having differential effects. Additionally, multimorbidity is often negatively associated with participation in research cohorts. Therefore, we set out to identify clusters of multimorbidity patients and how they are differentially associated with mortality and service use across age groups in a population-representative sample.MethodsLinked primary and secondary care electronic health records contributed by 382 general practices in England to the Clinical Practice Research Datalink (CPRD) were used. The study included a representative set of multimorbid adults (18 years old or more, N = 113,211) with two or more long-term conditions (a total of 38 conditions were included). A random set of 80% of the multimorbid patients (N = 90,571) were stratified by age groups and clustered using latent class analysis. Consistency between obtained multimorbidity phenotypes, classification quality and associations with demographic characteristics and primary outcomes (GP consultations, hospitalisations, regular medications and mortality) was validated in the remaining 20% of multimorbid patients (N = 22,640).ResultsWe identified 20 patient clusters across four age strata. The clusters with the highest mortality comprised psychoactive substance and alcohol misuse (aged 18–64); coronary heart disease, depression and pain (aged 65–84); and coronary heart disease, heart failure and atrial fibrillation (aged 85+). The clusters with the highest service use coincided with those with the highest mortality for people aged over 65. For people aged 18–64, the cluster with the highest service use comprised depression, anxiety and pain. The majority of 85+-year-old multimorbid patients belonged to the cluster with the lowest service use and mortality for that age range. Pain featured in 13 clusters.ConclusionsThis work has highlighted patterns of multimorbidity that have implications for health services. These include the importance of psychoactive substance and alcohol misuse in people under the age of 65, of co-morbid depression and coronary heart disease in people aged 65–84 and of cardiovascular disease in people aged 85+.

A Brief History of the Collaboration between Dr Nathan Gillespie and Professor Nick Martin Including Personal Reflections

This article describes Dr Nathan Gillespie's PhD training and supervision under Professor Nick Martin and their ongoing collaborations. Drs Gillespie and Martin have collaborated on numerous biometrical genetic analyses applied to cross-sectional and longitudinal twin data, combined molecular and phenotypic modeling, as well as genomewide meta-analyses of psychoactive substance use and misuse. Dr Gillespie remains an active collaborator with Professor Martin, including ongoing data collection, analysis and publications related to the Brisbane Longitudinal Twin Study.

Comparing intentions to reduce substance use and willingness to seek help among transgender and cisgender participants from the Global Drug Survey

IntroductionTransgender (trans) people experience stressors related to their minority status which have been associated with increased rates of psychoactive substance use and related harm. Despite this, there is a paucity of evidence relating to the treatment needs of trans people who use psychoactive substances, beyond a small body of literature describing a culture of transphobic hostility in general substance misuse services. This paper aims to describe and compare psychoactive substance misuse help-seeking among trans and cisgender (cis) participants from a large multi-national cross-sectional survey. MethodsOver 180,000 participants, recruited from the world's largest annual survey of drug use - the Global Drug Survey - during 2018 and 2019, reported use of a range of psychoactive substances in the preceding 12 months. Five gender groups (118,157 cis men, 64,319 cis women, 369 trans men, 353 trans women and 1857 non-binary people) were compared on items relating to the desire to use less psychoactive substances and the need to seek help to achieve this. ResultsTrans respondents (n = 1710) to GDS 2018 were significantly more likely to report use of illicit substances (OR = 1.66–2.93) and dependence on cannabis (OR = 2.39) and alcohol (OR = 3.28). In the combined GDS 2018 and 2019 dataset, there were no significant differences between trans (n = 2579) and cis (n = 182,476) participants on the desire to reduce substance use. However, among those who did report wanting to use less, trans participants were more likely to want help to achieve this. ConclusionTrans respondents reported a greater need for help with reducing substance use than cis respondents. Given the deficit of specialist services for psychoactive substance users who are trans, there is a need for a more thorough understanding of the barriers and facilitators to their engagement in general substance misuse services. In the interim, substance misuse service providers require education about gender minority status to help meet the needs of trans clients.

Paramedics working in a prison-based healthcare setting: an exploratory mixed methods study.

Background:Prison healthcare departments recently started recruiting paramedics to assist in dealing with a rise in medical emergencies largely attributed to an aging prison population and an increase in novel psychoactive substance misuse. There has been little research investigating the paramedic role in this setting. This study aims to explore the strengths and limitations of employing paramedics within the prison healthcare setting from the perspectives of non-paramedic colleagues.Methods:An exploratory mixed methods study was conducted in a UK category B remand prison, focusing on the opinions and observations of current healthcare and custodial staff. Paper questionnaires were completed by 32 members of staff and semi-structured interviews were conducted with two participants.Results:Seven global themes were identified within the qualitative data: management of medical responses; effect of a specialist role; effect on ambulance escorts; contribution to professionalism within the department; effect on the role of other healthcare staff; prisoner interaction with paramedics; and difficulties encountered in role implementation. Of the 32 participants, 31 believe paramedics have had an overall positive effect on the provision of healthcare, with a variety of reasons explored.Conclusion:In a small exploratory study, it is suggested that paramedics possess the relevant skills and training to offer a meaningful contribution to the provision of prison healthcare; however, further research is required to explore the full scope of their contribution in this setting.