Search Results (491)

In Hungary, the consumption of any alcoholic beverage before driving is illegal. A person is considered drunk if they have a blood alcohol concentration of 0.5 g per liter or more. The situation regarding drug use is also disappointing. This research analyses these effects on transport and their “outcome” by evaluating analyses based on police data, driver training data, and experimental data. The research aims to further raise awareness of the public health importance of this problem through a case–control study. Descriptive and correlational, statistical calculations were performed with a significance value of p < 0.05. Between 2019 and 2023, there were 10–13.000 drunk driving offenses and 1.000–1.300 drunk-driving accidents on the roads each year, most of which occurred in the capital and caused minor injuries. The results will be used to discover synergies to improve road safety. Full article

In recent years, the issue of drivers under the influence of medications and psychoactive substances as a cause of road accidents has gained increasing importance. This study aimed to assess the prevalence and blood concentration ranges of alcohol and psychoactive substances among drivers in northeastern Poland between 2013 and 2024. To determine the prevalence of medications and psychoactive substances in drivers’ blood, data were collected from 266 blood samples obtained from drivers (251 men and 15 women). Among these, 79 drivers died immediately, 61 drivers survived the accident, and 126 drivers were stopped for roadside checks. The presence of the studied substances was confirmed using gas chromatography combined with mass spectrometry detection (GC-MS) and liquid chromatography combined with mass spectrometry detection (LC-MS). Blood alcohol content was measured using headspace gas chromatography with a flame ionisation detector (HS-GC-FID). Psychoactive substances were detected in 152 of the 266 samples. Drivers testing positive for medications and psychoactive substances were most frequently stopped during roadside controls—67.46%. Among the total positive cases, psychoactive substances used alone or in combination included THC—46.3% (range 0.2–20 ng/mL), alcohol—26.8% (range 0.1–4.1‰), amphetamines—20.7% (range 15–2997 ng/mL), opiates—4.3% (morphine 66.0 ng/mL; methadone 174.0 ng/mL; ranges: tramadol 15.0–600.0 ng/mL; fentanyl 45.0–100.0 ng/mL), benzodiazepines—9.8% (ranges: diazepam 55.0–480.0 ng/mL; midazolam 17.0–1200.0 ng/mL; clonazepam 21.0–36.0 ng/mL), stimulants—6.10% (ranges: amphetamine 15.0–2997.0 ng/mL; cocaine 4.0–30.0 ng/mL; benzoylecgonine 38.0–602.0 ng/mL; PMMA 45.0–360.0 ng/mL; MDMA 20.0–75.0 ng/mL; mephedrone 37.5 ng/mL; alfa-PVP 120 ng/mL), psychotropic drugs—3.1% (carbamazepine 8.0–2100.0 ng/mL; zolpidem 233.0 ng/mL; citalopram 320.0 ng/mL; opipramol 220 ng/mL). The most commonly used substance among car and motorcycle drivers was THC (37.7% of car drivers and 60% of motorcyclists). Among operators of other types of vehicles, alcohol was the most frequently detected substance, present in 35% of cases. The majority of drivers (81.1%) were under the influence of a single substance. Among the drivers, 7.3% consumed alcohol in combination with at least one other substance, and 11.6% used two or more substances excluding alcohol. Among the psychoactive substances most frequently used alone or in combination with others, THC was predominant. Roadside testing, based on effects similar to alcohol intoxication, was mainly conducted on male drivers. Full article

Background/Objectives: Recent studies have identified some concerns related to the occurrence of eye disorders in offspring of opioid-prescribed mothers, and especially so in those exposed to methadone. The aim here was to investigate, from a pharmacovigilance point of view, the association between opioid exposure during pregnancy and reported eye disorders in children. Methods: The FDA Adverse Event Reporting System (FAERS) was searched for the following: reports of eye disorders in children aged 0–17 years exposed during pregnancy to either methadone or buprenorphine; top 20 medications administered during pregnancy and associated with eventual occurrence of eye disorders in children; and reports of eye disorders in children from mothers prescribed with a range of psychotropics. Results: For 190 methadone and 79 buprenorphine cases, occurrence of eye disorders was registered as the consequence of having been exposed to these drugs in utero. After data cleaning, residual cases for methadone and buprenorphine were 17 and 15, respectively. Overall, in comparing the odds of eye disorders given methadone exposure to the odds of eye disorders given buprenorphine exposure, which represents a relative Reporting Odds Ratio (ROR) between two drugs, the relative ROR between methadone and buprenorphine was 0.59, suggesting lower odds of eye disorders for methadone compared to buprenorphine in children 0–17 years old antenatally exposed to either methadone or buprenorphine. Conversely, the ROR values resulting from a comparison of methadone- or buprenorphine-related data versus all other psychotropic drugs resulted in 0.27 (95% CI 0.16–0.48) and 0.47 (95% CI 0.26–0.85), respectively, indicating lower reporting odds of eye disorders for these molecules versus the pooled non-opioid comparator group. Medications prescribed during pregnancy which were most frequently related to the occurrence of eye disorders included the following: dupilumab (126 reports), valproate (69 reports), and ibuprofen (52 reports). Indeed, no opiates/opioids appeared among the top 20 drugs linked to eye disorders. A total of 25 and 11 unique cases were associated either with benzodiazepines or antipsychotics, respectively. Conclusions: No potential disproportionality safety signal for eye disorders associated with prenatal opioid exposure was identified. Specifically, the relative ROR indicated lower reporting odds for methadone compared to buprenorphine. The interpretation of these results is complicated by common co-exposures, polydrug interventions, and underlying maternal comorbidities, which introduce substantial confounding in real-world pharmacovigilance data. Overall, these findings highlight the importance of continued systematic post-marketing surveillance. Full article

Adverse childhood experiences (ACEs) are recognized risk factors for later substance use. Yet, data remain scarce—particularly regarding the differentiated effects of specific types of ACEs and their distinct associations with various psychoactive substances. The current study is one of the first in Lithuania to explore the associations between specific ACEs and psychoactive substance use in young adulthood (ages 18–29). This cross-sectional study included a total of 709 participants who completed an online survey. ACEs were measured using a combination of adapted ACEs items and the MACE questionnaire. Substance use was assessed using self-reported instruments: CUDIT-R (cannabis), AUDIT (alcohol), ASSIST (heavy psychoactive substances), and nicotine use. Structural equation modeling (SEM) was chosen to examine predictive relationships. Results revealed that experiences of sexual abuse and physical maltreatment in childhood predicted higher levels of alcohol use in young adulthood. Sexual abuse was positively associated with nicotine, cannabis, and heavy psychoactive substance use, while witnessing interpersonal violence was only associated with higher nicotine use. However, verbal abuse showed significant negative associations across several substance categories. No significant associations were found between family addiction history and substance use. The absence of an important relationship between family history of addiction and substance use indicates that genetic factors may be less decisive than environmental or psychosocial conditions. The main findings of this study are that ACEs are not qualitatively equivalent to one another, so it is worth examining them separately, rather than summing them. Furthermore, based on the negative associations with verbal abuse and the generally statistically negative associations, we can assume that ACEs may not be the most important factors increasing substance use. Further studies should look for other factors that influence substance use. Full article

Background/Objectives: New synthetic opioids (NSOs) like nitazenes pose significant public health risks due to their high potency and increasing prevalence. Ethyleneoxynitazene, a benzofuran-containing nitazene, recently emerged on the illicit market and was identified in seizures in Europe. Although no intoxications have been reported to date, its µ-opioid receptor activity raises concern. This study investigated the metabolism of ethyleneoxynitazene to better understand its pharmacological profile, toxicity, and detectability in clinical and forensic contexts. Methods: Ethyleneoxynitazene was incubated with cryopreserved human hepatocytes pooled from 10 donors. Metabolites were detected by liquid chromatography coupled with high-resolution tandem mass spectrometry (LC-HRMS/MS) and identified using Compound Discoverer (Thermo Scientific; Waltham, MA, USA); detection and identification were assisted by in silico metabolite predictions with BioTransformer. Results: Sixteen metabolites were identified, with major biotransformations including N-deethylation at the N,N-diethylethanamine chain, hydroxylation at the dihydrofuran ring, and dihydrofuran ring opening via oxidative cleavage, leading to the formation of the corresponding ethanoic acid. Conclusions: This study provides the first characterization of the metabolism of a nitazene without an alkoxyphenyl moiety; the absence of this particular group reflects significant differences in the pharmacokinetic and pharmacodynamic profile compared to other nitazenes. We propose N-deethyl-3′-ethanoic acid-4′-hydroxy ethyleneoxynitazene, N-deethyl-hydroxy ethyleneoxynitazene, 3′-ethanoic acid-4′-hydroxy ethyleneoxynitazene, hydroxy ethyleneoxynitazene, and N-deethyl ethyleneoxynitazene as metabolite biomarkers of ethyleneoxynitazene consumption in clinical and forensic toxicology. Given the potential activity of some metabolites and interindividual variability in metabolic pathways, further studies are warranted to refine these findings through the analysis of biological samples from multiple ethyleneoxynitazene-positive cases. Full article

Background/Objectives: Attentional bias toward drug-related cues is a characteristic of drug dependence and plays a detrimental role during drug withdrawal. The present study examined attentional bias in female individuals with drug dependence. We focused on its temporal and spatial characteristics using drug-related and negative emotion dot-probe tasks. Methods: Fifty-one female participants with drug dependence (mean age = 24.71 ± 7.58 years) took part in the study. These participants were primarily dependent on methamphetamine and novel psychoactive substances. They completed tasks with two cue exposure durations (500 ms and 2000 ms) under three spatial conditions: match, mismatch, and neutral. Results: Results indicated that a global attentional bias toward drug-related cues, rather than a location-specific bias, was evident during the short cue exposure (500 ms), regardless of spatial alignment (ps < 0.05), whereas no bias was observed during the sustained attention stage (2000 ms). No attentional bias was observed for negative emotional stimuli, highlighting the stimulus-specific nature of this effect. Conclusions: These findings further support the incentive sensitization model of addiction, showing that interference from drug-related items, regardless of the specific orientation of attention, primarily drives short cue exposure attentional bias in females. Full article

Background: Driving is a coordinated psychomotor activity that involves reaction time, attention, and decision-making. Psychoactive substances such as 2-phenylethylamine (PEA) derivatives and opioids may affect these functions and contribute to traffic safety. This systematic review revealed the effects of the selected PEA derivatives and opioids on psychomotor performance among drivers and potential road safety outcomes. Methods: The review followed PRISMA 2020 standards. Using the PICO method, we conducted a systematic search in Embase, PubMed, and Web of Science (2000–2025). Included studies involved adult participants and quantified the effect of PEA derivatives or opioids on driving-related psychomotor function. Thirty-one articles, such as randomized controlled trials, crossover studies, observational studies, and simulator-based studies, were examined. Risk of bias was evaluated using the RoB2 tool. Results: Evidence indicates therapeutic amphetamine and methylphenidate doses can enhance psychomotor function and safety in patients with ADHD. Recreational or high-dose use of methamphetamine and MDMA is associated with impaired coordination, variable speed, and increased impulsivity. Opioid effects are tolerance- and dose-dependent. Small therapeutic doses of fentanyl in chronically treated patients do not notably impair driving. On the other hand, methadone and tramadol commonly cause somnolence, retardation of reaction, and increased accident risk. Conclusions: The impact of opioids and PEA derivatives on psychomotor function is multifactorial, depending on dose, time, route of administration, and patient status. These substances can either improve or impair driving safety. The findings confirm the need for individual-specific pharmacotherapy treatment. They also highlight the importance of further studies to formulate evidence-based clinical and legislative guidelines. Full article

Background and Objectives: While sleep paralysis (SP) is a well-defined disorder, its pathophysiology and causes remain elusive. We aimed to assess the prevalence of sleep paralysis among higher education students and determine factors associated with SP with a focus on psychoactive substance and medication use. Materials and Methods: We conducted a cross-sectional online survey across higher education institutions in Lithuania, asking students to report the occurrence and frequency of SP as well as its characteristics and self-rated sleep quality alongside demographic data and history of medication and psychoactive substance use. Subgroup comparisons and correlation analyses were performed in search of factors associated with reported SP. Results: The study sample consisted of 275 respondents aged 22.9 ± 4.7 years (240, 87.3% female), 119 (43.3%) of whom reported having experienced SP (average age at first episode 16.4 ± 4.2 years), with 87 (73.1%) more than once. The phenomenology of SP episodes included mostly visual, auditory, sensory, or olfactory hallucinations (73, 61.3%), feelings of fear or anxiety (56, 47.1%), incubus-like phenomena (17, 14.3%), and autonomic symptoms (6, 5.0%). Having experienced SP was associated with the use of antidepressants or recreational stimulant use (χ² = 5.258, p = 0.022) as well as higher alcohol intake (Z = −3.568, p < 0.001) and lower self-rated sleep quality (Z = −2.413, p = 0.016). Earlier age of onset, hallucinations during paralysis, specific time of manifestation during the night, and overall nightmare frequency were related to the recurrence of SP. Respondents tied SP episodes mostly to stress or anxiety (55, 46.2%), the supine sleeping position (31, 26.1%), disturbed sleep cycles (28, 23.5%), and emotional or traumatic experiences (28, 23.5%). Conclusions: Our study suggests that SP is prevalent among students with a tendency to recur. We report a correlational association between SP and the use of antidepressants or stimulant drugs, suggesting the need to further explore the possible role of psychoactive agents in this disorder. Full article

Background: A large number of substance use disorders are increasingly associated with complex clinical presentations and unknown mental and medical risks, presenting a growing challenge for mental health worldwide. Research exploring the interplay between substance use and psychiatric disorders remains limited in Eastern Europe. Objectives: We investigated the demographic and clinical features of 203 patients admitted to a major Romanian psychiatric hospital, aiming to clarify the patterns of dual diagnosis and symptomatology within this vulnerable population. Results: Cannabis, novel psychoactive substances and unknown substances were the most commonly used drugs. Psychiatric comorbidity was rather the rule than the exception within our group. Cluster analysis revealed three distinct symptom profiles: manic/psychotic, negative affective and disorganized. While individual drug type did not independently predict symptom severity or readmission risk, a significant interaction effect between drug use and psychiatric comorbidity influenced symptom cluster membership. Conclusions: These findings highlight the complexity and heterogeneity of dual diagnoses and underline the importance of an integrated, multidisciplinary approach in addiction medicine. Full article

Caffeine is one of the most widely consumed psychoactive substances globally and is a common component of daily diets, particularly among women of reproductive age. Numerous in vitro and in vivo studies have indicated potential adverse effects of prenatal caffeine exposure, including disturbances in fetal growth, metabolic dysregulation, organ malformations, and neurodevelopmental alterations. These findings suggest that caffeine may influence multiple physiological pathways during gestation, including epigenetic modifications and metabolic programming. However, evidence from human studies remains heterogeneous and often inconclusive. Recent cohort studies and meta-analyses have reported that moderate maternal caffeine intake is not significantly associated with increased risks of gestational diabetes mellitus, gestational hypertension, or preeclampsia, although higher intake levels have been linked to anemia, preterm birth, and low birth weight in some populations. Furthermore, emerging data suggest potential associations between prenatal caffeine exposure and early neurodevelopmental outcomes, including behavioral changes, subtle structural brain differences, and alterations in offspring metabolic health and obesity risk. Despite these findings, the magnitude and clinical relevance of these effects remain uncertain, partly due to variability in caffeine sources, dosages, study designs, and reliance on self-reported intake. This review aims to synthesize current evidence on maternal caffeine consumption, its impact on pregnancy complications, fetal development, and long-term child health outcomes. By integrating experimental and clinical data, the study provides a comprehensive overview that may assist clinicians and healthcare professionals in counseling pregnant women regarding caffeine intake and potential risks. Full article

(1) Background: Caffeine is one of the most widely consumed psychoactive substances. Its safety profile and short half-life make it an ideal drug model for studying the pharmacokinetics of caffeine. This study aimed to develop a method for determination of caffeine in a small volume of saliva (200 µL). (2) Methods: Solid-phase extraction was employed to isolate caffeine from saliva, followed by quantitative analysis using liquid chromatography coupled with diode-array detection. Chromatographic separation was achieved on a C18 column, using a gradient mobile phase of acetonitrile and 0.1% formic acid. (3) Results: The method was validated for selectivity, linearity, precision, and accuracy. Linearity was established over the range of 10–10,000 ng/mL (R² = 0.995). The coefficients of variation for intra- and inter-day precision for the three tested caffeine concentrations did not exceed 12.11%. Recovery from spiked saliva samples exceeded 90.53%. The developed method was applied to preliminary studies to follow the pharmacokinetics of caffeine in saliva. The concentration of the substance was studied in the saliva obtained from a volunteer after espresso consumption. (4) Conclusions: The developed method will offer a reliable approach for non-invasive caffeine monitoring in clinical and research applications. Full article

Cannabidiol (CBD) is a chemical produced by the cannabis plant that acts as an allosteric modulator of cannabinoid receptors resulting in non-competitive receptor antagonism in the central nervous system. This mechanism of action leads to anti-convulsant, anti-anxiety, and analgesic properties with minimal psycho-activity, which has led to significant interest in the use of CBD as a medication. Legislation around cannabis has changed in recent years, with many states permitting the use of CBD-based products as “medication” without approval from the Federal Drug Administration. This has led to a proliferation of products with associated marketing claims that are often unsubstantiated. This review summarizes the evidence for cannabidiol as a medical treatment, focusing on epilepsy, mental health, behavioral and substance use disorders occurring in pediatric and adolescent populations for which information is available. CBD preparations have been approved by the FDA to treat epilepsy in childhood; no other indications currently exist, and the literature remains inconclusive. Few adverse effects related to CBD use have been reported. However, endogenous cannabinoids play an important role in guiding brain development, and the long-term impact of modulating the endocannabinoid system during periods of brain growth during childhood and adolescence is unknown. While there is excitement about the potential for the development of CBD medications, currently, there is very limited information about the long-term safety of CBD, especially in children and adolescents, and caution is recommended regarding the use of unregulated, unapproved CBD preparations that are currently available over the counter. Full article

Background: Chemsex, the intentional use of psychoactive substances to enhance sexual experiences, is an emerging public health issue in Brazil, associated with increased risks of sexually transmitted infections and complex psychosocial vulnerabilities. Despite the universal coverage provided by the Unified Health System (SUS), individuals who practice chemsex often encounter barriers to healthcare, including stigma, discrimination, and a lack of specialized services. To date, no comprehensive reviews appear to synthesize evidence on how this population accesses healthcare in the Brazilian context; existing knowledge remains fragmented across individual studies. Objectives: The aim is to map and synthesize the available evidence regarding access to health services among people who engage in chemsex in Brazil, identifying health needs, professional demands, barriers, and facilitators. Methods: The protocol follows the Joanna Briggs Institute methodology for scoping reviews and PRISMA-ScR guidelines. A systematic search will be conducted in MEDLINE (PubMed), Embase, Scopus, SciELO, and LILACS for studies published between 2014 and 2024 in Portuguese, English, or Spanish. Data will be summarized using descriptive and narrative synthesis, presented in tables and thematic categories. Studies will be included if they address chemsex or sexualized drug use in Brazil and report on healthcare access, regardless of gender identity, sexual orientation, or drug type. Studies that do not address chemsex, focus on drug use outside a sexual context, or are unrelated to Brazil will be excluded. Expected results: The review is expected to identify key barriers and facilitators to healthcare access, highlight knowledge gaps for underrepresented groups, and support recommendations for research, policy, and practice to improve care for people engaging in chemsex in Brazil. By focusing on an underexplored intersection of drug use, sexuality, and healthcare access in Latin America, this study aims to provide an innovative contribution to public health literature. Full article

Background/Objectives: Epigenetics refers to heritable modifications in gene expression that do not involve changes to the DNA sequence. Among these, DNA methylation, histone modifications, and non-coding RNAs play a key role in regulating gene activity and are influenced by environmental factors, including exposure to psychoactive substances. In recent years, it has been hypothesized that such alterations may serve as molecular markers with forensic relevance. This systematic review aims to evaluate whether current evidence supports the use of drug-induced epigenetic changes as potential toxicological fingerprints in human subjects. Methods: A systematic literature search was conducted following PRISMA guidelines, including articles published on PubMed between 1 January, 2010, and 31 December, 2025. Only studies conducted on human samples and published in English were considered; animal studies and articles lacking epigenetic data were excluded. Results: Forty-two studies met the inclusion criteria. The most commonly investigated substances (alcohol, cocaine, methamphetamine, cannabis, and opioids) were found to induce specific and, in some cases, persistent epigenetic changes. These include alterations in CpG methylation in promoter regions, variations in miRNA expression, and modulation of epigenetic enzymes. Such changes were observed in brain tissue, blood cells, and semen, with evidence of persistence even after drug cessation. Conclusions: Current evidence confirms that psychoactive substance use is associated with specific epigenetic modifications. However, forensic application remains limited due to confounding factors such as age, co-exposures, and post-mortem interval. Further standardized research is necessary to validate their use as forensic biomarkers. Full article