Harm reduction has largely been shaped by responses to psychoactive drug use where the most urgent harms are acute. These models focus on overdose, blood-borne viruses, and rapid-onset toxicity related harms. When applied wholesale to anabolic-androgenic steroids (AAS), they obscure the distinctive pharmacology, consumer typologies, and slow-developing physiological risks that define people who use AAS. AAS use is often chronic, patterned, and long-term. Harms are often cumulative and organ-based rather than event-based. Routes of administration carry different risk profiles, with oral formulations being more hepatotoxic and commonly falsified through mislabelling or adulteration than injectable products. Despite this, most health services position injecting as inherently higher risk, applying paradigms developed for opioids and stimulants that have not been adapted for AAS use. Using evidence across pharmacology, delivery routes, dependence trajectories, and consumer types, this paper argues for expanding harm reduction models to consider the unique needs of different populations of people who use drugs, including AAS. We draw critically on lessons from other substances as well as multiple existing approaches including structured dosing frameworks, and supply-checking infrastructures, provide practical templates for expanding adaptation to AAS. To remain evidence-based, harm reduction must evolve to be contextually relevant. We have used AAS as an example of this evolution, attempting to highlight cross-substance learnings which integrate consumer-focused tools, workforce development, and peer-led support.

Road safety threats and occupational health risk associated with psychoactive substance use and dependence risk among commercial drivers: WHO ASSIST evidence from Ghana.

Addressing the limited generalizability of previous research on nightlife and substance use, which mostly relied on convenience or venue-based samples, this study used nationally representative data from Croatian residents aged 15–64 (N = 4,988) to: (1) examine the extent and patterns of substance use among nightclub attendees, (2) identify subgroups based on nightlife attendance and illicit and new psychoactive substance use in the last year, and (3) assess predictors of cannabis dependence severity. Cannabis, cocaine, amphetamines, and ecstasy were most commonly used substances among nightclub attendees. Latent class analysis identified three distinct classes: a non-attendance/abstinent class, an occasional-attendance/cannabis-use class, and an occasional-attendance/polysubstance-use class. Class membership, together with coping and enhancement motives, significantly predicted cannabis dependence severity. Findings demonstrate substantial heterogeneity of substance use patterns among nightclub attendees and highlight the need for targeted, subgroup-specific harm reduction strategies, focusing on polysubstance use and cannabis-related risks in nightclub settings.

ABSTRACT Runaway behavior is a prevalent problem among adolescents in residential care centers and represents an opportunity to use psychoactive substances. For some adolescents in residential care centers, running away, like substance use, seems to be a strategy for regulating negative emotions. Although some studies point to emotional regulation difficulties among young runaways, to our knowledge, strategies associated with running away have not been addressed. The aim of the study is to examine associations between cognitive emotional regulation strategies and runaway behavior in adolescents in residential centers and to explore whether psychoactive substance use moderates this association. To address these objectives, 199 adolescent males (124 young runaways), aged 15–17 years, housed in residential care units, completed self-report questionnaires. Results of multivariate logistic regressions indicate that only the positive refocusing strategy was negatively associated with the presence of runaway. Moreover, the use of the positive refocusing and the refocus on planning strategies were negatively associated with the presence of runaway, but only among non-psychoactive substance using adolescents. Findings underscore the importance of helping adolescents in residential care centers develop adaptive emotional regulation strategies to prevent runaway, and the relevance of differential interventions specifically addressing the needs of substance users.

Hair analysis for drugs of abuse has gained importance in forensic science due to its ability to detect both recent and chronic use of psychoactive substances. Unlike blood or urine, hair retains toxins and metabolites over time, making it a useful tool for investigations seeking to identify patterns of prolonged use. In this regard, the most accurate and effective techniques are liquid chromatography coupled with mass spectrometry and gas chromatography; however, these require specialized equipment and more time to obtain results. Therefore, in the legal field, it is crucial that these analyses be performed following international quality standards, such as those established by ISO/IEC 17025, and that a proper chain of custody of the samples is guaranteed.

Background: Medical students often face substantial psychological stress, which can increase the risk of substance use, professional detriment, and insufficient patient care. However, substance use in medical students remains understudied in Iraq. This study highlights the prevalence, patterns, risk factors, and negative effects of substance use among medical students at the University of Baghdad. A cross-sectional study involving 414 medical students at the University of Baghdad was conducted. The questionnaire included sociodemographic variables and the Alcohol, Smoking, and Substance Involvement Screening Test to screen for psychoactive substance use. The lifetime prevalence of substance use was 38.9%. Among substance users, 42.8% used nicotine, 22.3% used sedatives, 4.3% used inhalants, and 3.1% used amphetamines, with only 27.3% reporting polysubstance use. Through multivariate logistic regression, it was identified that males are approximately 2.8 times more likely to use substances compared to females (OR: 2.8, 95% CI: 2.1–5.2, p-value < 0.001), and students with a positive family history of substance use are approximately 3.1 times more likely to use substances compared to those without (OR: 3.1, 95% CI: 2.8–7.5, p-value < 0.001). These findings underscore the importance of implementing early preventive strategies, targeted mental health interventions, and substance use awareness programs within Iraqi medical institutions.

To identify the patterns and trends in prescription drug use and misuse in patients on opioid agonist treatment. We used data from the OPPIDUM programme, which collects data from patients attending substance abuse treatment facilities. Data collected include use of psychoactive prescription drugs in the past week. In this cross-sectional study, we included patients aged at least 18 years, on opioid agonist treatment and reporting psychoactive prescription drug use in the past week from 2014 to 2023. The outcome was psychoactive prescription drug misuse (i.e., abuse and/or dependence, illegal acquisition and diverted route of administration) in the past week. We conducted disproportionality analyses to identify prescription drugs associated with misuse. We calculated the prevalence of use and misuse for each prescription drug to estimate trends. We included 9631 patients. Misuse was disproportionately reported for morphine (e.g., diverted route of administration: n =580; reporting odds ratio: 224.4 [95% confidence interval: 178.8, 281.7]), methylphenidate (e.g., diverted route of administration: 149; 31.6 [24.1, 41.4]), oxycodone (e.g., diverted route of administration: 24; 20.2 [11.1, 36.8]), clonazepam (e.g., illegal acquisition: 48; 6.0 [4.0, 9.0]) and fentanyl (e.g., diverted route of administration: 6; 5.8 [2.3, 14.8]). Trends in misuse paralleled trends in use for most prescription drugs. The sharpest increase in misuse included abuse and/or dependence (+2366%, from 0.9 per 1000 patients in 2014 to 23.0 per 1000 patients in 2023) for pregabalin. Conversely, the sharpest decrease in misuse included illegal acquisition (-59%, from 82.1 per 1000 patients in 2014 to 33.9 per 1000 patients in 2023) for morphine. In this population, prescription drug misuse primarily included opioid analgesics and increasingly pregabalin. Given the risk of opioid overdose, access to take-home naloxone should be further improved.

Former Philippine President Rodrigo Duterte (2016-2022) launched the War on Drugs, a campaign spearheaded by Oplan Tokhang and linked to an estimated 12,000 to 30,000 deaths. Despite compelling evidence of human rights violations and violence against people, war on drugs was still supported among the people. Hence, the qualitative study addresses a critical gap on how the Filipino use language to adopt, resist, or negotiate dehumanization to justify or challenge the punitive measures of Duterte's War on Drugs. Drawing from the eight (8) interview data, the analysis identified four (4) dominant interpretative repertoires: (1) the pathologization and criminalization of Psychoactive Substance Use Disorders (PSUDs), (2) the framing of the War on Drugs as protective, ineffective, or unjust, (3) justice as either redemptive or retributive, and (4) media as a key determinant of public perception. The study highlights how discourse not only reflects but also reproduces the political and moral boundaries that define who is worthy of care and who becomes disposable. It underscores the urgent need to reframe substance use as a public health issue rooted in structural conditions, and to humanize PSUDs in both policy and public dialogue.

Psychoactive substance use (PSU) is a growing public health concern, particularly among young adults in high-risk occupations such as artisanal and small-scale gold mining (ASGM). Despite the increasing attention to substance use and its mental health implications globally, limited evidence exists on the patterns and drivers of PSU among young miners in Ghana. This study examined the patterns, drivers, and mental health implications of psychoactive substance use among young artisanal and small-scale gold miners in Ghana. A cross-sectional survey was conducted with 332 miners aged 18 to 35 years (mean age = 28.82; 84.3% male), selected through purposive sampling. Data were analyzed using descriptive statistics, ANOVA, and post-hoc tests in SPSS version 25. Substance use was highly prevalent among participants, with energy drinks (86.7%) and alcohol (43.4%) being the most commonly used substances. Lower usage was reported for cigarettes (15.7%), marijuana (13.3%), tobacco (7.2%), and tramadol (6.0%). PSU was significantly associated with gender and marital status. Participants who frequently consumed alcohol and energy drinks exhibited higher levels of depression, anxiety, and stress. Major drivers of PSU included occupational pressures, harsh working conditions, and the need to manage stress. The study highlights psychoactive substance use as a serious mental health issue among young ASGM workers in Ghana. There is an urgent need for targeted mental health education and support programs within mining communities. Integrating such interventions into occupational health policies could enhance miners' well-being and reduce substance-related harm.

Effective medical practice relies on solid theoretical and technical training, interpersonal competence, and emotional intelligence, competencies that begin to develop during undergraduate education. Medical students, however, are exposed to intense academic and social demands marked by constant expectations of productivity and excellence, consistent with Byung-Chul Han’s concept of the “fatigue society.” In this context, reduced sleep and psychological strain have become increasingly common, driven by the pursuit of high academic performance and curricular distinction. Concurrently, interest in cognitive enhancement—defined as the use of psychoactive substances by healthy individuals to improve concentration and productivity—has expanded as a coping strategy for academic overload. This integrative literature review examines the relationship between performance pressure, sleep quality, and psychotropic substance use among medical students. The analyzed studies indicate that sleep deprivation and poor sleep quality are consistently associated with mood disturbances, cognitive impairment, memory deficits, and reduced overall well-being. Additionally, non-prescribed use of stimulants, anxiolytics, and antidepressants is frequently reported, despite evidence linking these practices to dependence, adverse effects, masking of anxiety and depressive symptoms, and potential declines in academic performance. The literature suggests that contemporary hyperproductivity culture reinforces a harmful cycle of self-demand, sleep restriction, and pharmacological compensation. These findings highlight the importance of institutional support, early identification of psychological distress, and the promotion of non-pharmacological strategies to protect mental health and sleep quality. Addressing these factors is essential to foster balanced medical training and safeguard the well-being of future physicians.

ABSTRACT Psychoactive substances influence mood, cognition, and personality, with emerging synthetic drugs presenting new challenges. This study examines the impact of psychoactive drug use on the development of dissociative identity disorder (DID), comparing alcohol and drug abusers. A total of 120 participants (60 alcohol abusers, 60 drug abusers) from Suman Ellen Trust in Bangalore were assessed using standardized psychological instruments, including the Addiction Severity Index, Dissociative Disorders Interview Schedule, Drug Abuse Screening Test, and Dissociative Experiences Scale. A mixed-methods approach was employed, incorporating both quantitative (ANOVA, Pearson correlation) and qualitative (thematic analysis) methodologies to analyze dissociative symptoms and substance use patterns. Findings revealed a significant difference in DID prevalence between alcohol and drug abusers (F = 55.88, p < .01), with drug abuse showing a strong positive correlation with dissociative symptoms (r = 0.790, p < .01). The study highlights the need for integrated clinical approaches addressing both substance use disorders and dissociative pathology. Future research should focus on longitudinal studies to clarify causal mechanisms and develop targeted intervention strategies.

The use of psychoactive substances is present in different political and socio-cultural contexts. The harm reduction can be a strategy that can prevent its abuse and provide solutions that validate the autonomy of individuals. Thus, less formal proposals for teaching, but which prioritize drug education, forms of consumption and harm reduction methods were used through different pedagogical paths to bring participants closer to the themes, creating learning environments and helping them to make autonomous decisions, generating a better relationship between drugs and society. The extension activities carried out addressed the use and abuse of marijuana, alcohol, nicotine and LSD through films, emotionally immersing viewers in the subject; in lectures, exposing technical and scientific information on mechanisms of action and social factors; and in conversation circles, bringing proximity to the exchange of information, establishing a horizontal dispersion of knowledge. This highlights the importance of tackling the issue of psychoactive drugs, which is neglected in the face of national policies and can be worked on in extension activities, reaching places that are difficult to access and providing information in a welcoming way that can be easily disseminated in society.

Chemsex refers to the use of psychoactive substances, such as GHB, methamphetamine, and poppers, to enhance sexual experiences, predominantly among men who have sex with men and transgender individuals in LGBT+ communities. The practice is associated with increased risks, including sexually transmitted infections, substance dependence, overdose, and cardiac arrest. We present a fatal case of cardiac arrest following chemsex, where high levels of GHB and methamphetamine were detected. This highlights the severe health consequences and the need for targeted support and harm reduction strategies.

Response to "Letter to Editor reply: Non-invasive liver fibrosis screening and referral patterns in women with dependence due to psychoactive substance use: A single-centre retrospective study".

Interpreting fibrosis markers in psychoactive substance use disorders: Key confounders to consider.

Response to "Letter to Editor reply: Non-invasive liver fibrosis screening and referral patterns in women with dependence due to psychoactive substance use: A single-centre retrospective study".

Letter to editor reply: Non-invasive liver fibrosis screening and referral patterns in women with dependence due to psychoactive substance use: A single-centre retrospective study.

Background: despite the significant number of studies devoted to the study of compliance and its role in the recovery process, existing assessment methods often demonstrate limited prognostic potential. The aim of study: to investigate the specificity and differences of resourcefulness and resilience as factors of compliance in patients with qualitatively different mental disorders. Patients and Methods: using the Resourcefulness for Recovery Inventory Scale, the Emotional Intelligence (EmIn) Questionnaire developed by D.V. Lyusin, and the Toronto Alexithymia Scale (TAS-20), 120 patients aged 18–25 years (mean age 22 ± 3.5 years) were examined. The sample was divided into four equal diagnostic groups: patients with neurotic, stress-related and somatoform disorders (F40–F48), with emotionally unstable borderline personality disorder (F60.31), with schizophrenia (F20), with mental disorders and behavioral disorders associated with the use of psychoactive substances (F10–F19). Statistical analysis was performed using the Welch criterion and correlation analysis (Spearman). Results: significant differences were found between the groups in the level of resourcefulness and stability (RRI), emotional intelligence (EmIn) and alexithymia (TAS-20). Correlation analysis showed the presence of significant two-way relationships between emotional intelligence (EmIn) and factors contributing to recovery (RRI), as well as two-way positive correlations between the level of alexithymia (TAS-20) and the ability to recover (RRI). Conclusion: it has been established that patients with neurotic disorders and borderline personality disorder have a higher ability for compliance and recovery compared to patients dependent on psychoactive substances and patients with schizophrenia. These results can be used in the elaboration of psychotherapeutic strategies aimed at increasing compliance and treatment effectiveness through the development of resourcefulness and emotional regulation.

BackgroundeHealth is an increasingly used method of health care in the field of psycho-oncology. While many reports highlight the positive impact of psychological eHealth tools, some patients refuse to use them.ObjectiveThis study aimed to expand knowledge of the motivation and psychoemotional functioning of patients who consciously refuse to use eHealth technology in the form of a mobile psycho-oncology app offered as part of a clinical trial. To our knowledge, this is the first study to address this topic.MethodsA retrospective cross-sectional study was conducted between December 2022 and February 2023 to investigate the reasons why 56 patients with breast cancer refused to use the psycho-oncology mobile app offered as part of a clinical trial by the Breast Cancer Unit. The primary aim of the study was to analyze patients’ self-reported reasons for not engaging with the app, while also exploring their psychoemotional functioning, including stress levels (measured using the distress thermometer), personality traits (measured using the Ten-Item Personality Inventory), coping strategies (measured using the Coping Orientation to Problems Experienced Questionnaire), and Self-efficacy (measured using the General Self-Efficacy Scale). Participants in this study declined the app intervention but agreed to participate in this separate observational study, indicating that their refusal was related to the app itself rather than to participation in clinical research in general.ResultsThe patients experienced a clinically meaningful elevation in stress levels (mean 5, SD 2.1 points) and Self-efficacy (mean 32.1, SD 5.1 points). Among 5 dimensions of personality traits, patients scored highest in Agreeableness (mean 6.5, SD 0.8 stens) and Conscientiousness (mean 6.4, SD 0.9) and lowest in Neuroticism (mean 3.4, SD 1.8) (other dimensions: Extraversion [mean 5.8, SD 1.6 stens] and Openness to Experiences [mean 4.4, SD 1.5 stens]). In terms of coping with stress, patients most frequently used the strategies of Active Coping (mean 2.6, SD 0.5 points), Acceptance (mean 2.6, SD 0.6 points), and Seeking Emotional Support (mean 2.6, SD 0.6 points), and least frequently used the strategies of Psychoactive Substance Use (mean 0.2, SD 0.6 points) and Restraint (mean 0.5, SD 0.7 points). Patient responses regarding refusal to participate in app testing were divided into four categories: (1) Focus on Life Outside the Disease, (2) Focus on Disease and Treatment, (3) Denial Mechanism, and (4) Technical Issues. Statistically significant differences were found between the groups. The Focus on Life Outside the Disease group of patients had higher levels of Self-efficacy, lower Neuroticism, and more frequent use of the Positive reevaluation strategy compared to the other groups.ConclusionsOur patients’ decision not to use the eHealth psycho-oncology app was mainly influenced by characteristics suggesting better emotional coping with the disease and treatment. These factors were significantly more influential than other factors studied, particularly those related to technology. Assessing reasons for opting out of eHealth and associated psychomotional functioning may be important for improving patients’ adoption of eHealth solutions.

Letter to Editor: Non-invasive liver fibrosis screening and referral patterns in women with dependence due to psychoactive substance use: A single-centre retrospective study.