Categorization of psychoactive substances into “hard drugs” and “soft drugs”: a critical review of terminology used in current scientific literature

Hazardous Materials from Threats to Safety: Molecularly Imprinted Polymers as Versatile Safeguarding Platforms

Hazards associated with highly dangerous pollutants/contaminants in water, air, and land resources, as well as food, are serious threats to public health and the environment. Thus, it is imperative to detect or decontaminate, as risk-control strategies, the possible harmful substances sensitively and efficiently. In this context, due to their capacity to be specifically designed for various types of hazardous compounds, the synthesis and use of molecularly imprinted polymers (MIPs) have become widespread. By molecular imprinting, affinity sites with complementary shape, size, and functionality can be created for any template molecule. MIPs' unique functions in response to external factors have attracted researchers to develop a broad range of MIP-based sensors with increased sensitivity, specificity, and selectivity of the recognition element toward target hazardous compounds. Therefore, this paper comprehensively reviews the very recent progress of MIPs and smart polymer applications for sensing or decontamination of hazardous compounds (e.g., drugs, explosives, and biological or chemical agents) in various fields from 2020 to 2024, providing researchers with a rapid tool for investigating the latest research status.

Risk for Ecstasy Use Disorder and Other Substance Use Among International Users of Recreational Ecstasy/Molly/MDMA

Ecstasy/Molly/MDMA is a widely used substance often taken in combination with other drugs in different contexts. The current study assessed ecstasy use patterns, concurrent substance use and the context of ecstasy use among an international sample of adults (N = 1,732). Participants were 87% white, 81% male, 42% college educated, 72% employed, with a mean age of 25.7 (SD = 8.3). Using the modified UNCOPE, risk for ecstasy use disorder was 22% overall, and significantly higher among younger individuals and those with greater frequency and quantity of use. Participants reporting risky ecstasy use endorsed significantly higher use of alcohol, nicotine/tobacco, cannabis, cocaine, amphetamine, benzodiazepines, and ketamine compared to those at lower risk. Great Britain (aOR = 1.86; 95% CI [1.24, 2.81]) and Nordic countries (aOR = 1.97; 95% CI [1.11, 3.47]) were approximately 2 times more likely to exhibit risk for ecstasy use disorder than the United States, Canada, Germany, and Australia/New Zealand. Taking ecstasy at home emerged as a common setting followed by electronic dance music events and music festivals. The UNCOPE may be a useful clinical tool for detecting problematic ecstasy use. Harm reduction interventions for ecstasy should target young people, substance co-administration, and context of use.

Recreational substance use among international travellers

BACKGROUND

Drug tourism reflects the expanding illicit drug market, posing health risks in unfamiliar travel settings. Existing knowledge specifically addressing substance use among international travellers is sparse and has not been reviewed to date. This review aimed to describe the recreational substance abuse in international travellers.

METHODS

A literature search was conducted on PubMed, Google Scholar and Scopus using keywords related to recreational substances and international travellers. A total of 11 021 articles were reviewed, charted and summarized for the evidence on prevalence, patterns and characteristics of substance abuse and their health- and non-health-related problems on international travellers.

RESULTS

A total of 58 articles were included. Most were cross-sectional studies and review articles. In total, 20 articles addressed the prevalence of substance abuse in travellers, 33 looked at characteristics and patterns of substance abuse in travellers and 39 investigated the health- and non-health-related problems from substance abuse. Estimated prevalence of recreational substances abuse varied from 0.7% to 55.0%. Rates of substances abuse were 9.45-34.5% for cannabis, 20.4-35.9% for alcohol intoxication, 2.82-40.5% for MDMA, 2-22.2% for cocaine, 2-15% for psychedelic agents and 2% for methamphetamine. The prevalence varied according to travellers' characteristics and travel destinations. Direct health problems included neuropsychiatric problems. Indirect problems included accident and unintentional injuries, crime and violence, risky sexual behaviours and sexual violence and blood-borne infections. Non-health-related problems included air rage, deportation and violation of local laws.

CONCLUSION

Substance abuse among international travellers is an underestimated problem that requires intervention. These findings emphasize the importance of addressing this issue to mitigate both health and well-being problems among travellers whilst promoting safer and more responsible travel experiences. In the context of travel health practices, practitioners should counsel travellers whose itineraries may include substance abuse, informing them about associated risks and consequences.

Hard drugs use and tooth wear: a scoping review

OBJECTIVES

This study aims to map evidence on the relationship between hard drug use and dental wear. The scoping review is guided by the question: What is the relationship between hard drug consumption and dental wear?

MATERIALS AND METHODS

Adhering to PRISMA-ScR guidelines, searches were conducted across PubMed, Embase, and four databases in March 2024. Inclusion criteria included studies investigating the association between hard drug use and dental wear, regardless of publication date or language. Data were presented through narrative exposition, tables, and a conceptual framework.

RESULTS

Twenty-eight studies (four case-control, three cross-sectional, five case reports, and sixteen literature reviews) were included. Among case-control studies, 75% observed an association between drug use and dental erosion; however, no cross-sectional studies demonstrated this association. Despite questionable quality, reviews established connections between drug use and dental erosion. Studies aimed to elucidate potential causes for dental erosion.

CONCLUSIONS

Analysis suggests a potential link between hard drug use and dental wear, though indirect. Factors like bruxism and reduced salivary pH may contribute to dental wear among drug users. Further investigation through primary studies exploring this relationship is necessary.

CLINICAL RELEVANCE

Dentists should focus not only on clinical characteristics of dental wear but also on mediating factors such as bruxism and decreased salivary pH associated with drug use. This holistic approach allows for a deeper understanding of dental wear mechanisms, enabling targeted preventive and therapeutic interventions.

Childhood social capital and drug use disorder in adulthood: A retrospective study on antecedent determinants of the type of drug use

Based on a sample of Danish adults who were enroled in treatment for drug use disorders as a prerequisite for qualifying for receiving unemployment benefits, we analyse the relationship between low social capital in childhood (LSCC) and the type of drug use in adulthood. The type of drug use is measured by distinguishing between those who were treated for using hard drugs (e.g., heroin and cocaine) and those who were treated for using soft drugs (cannabis). Extracting data from the initial treatment registration report, social capital is operationalised into seven different LSCC categories, and the total number of LSCC (the LSCC score) is recorded. Based on logistic regressions, the LSCC score shows a strong graded dose-response relationship with hard drug use. With each additional LSCC, the probability of being treated for hard drug use increases with 9%. Parental child abuse is the most important single predictor of being treated for hard drug use. Having been parentally abused as a child raises the probability by 32%. The results hold after controlling for age, initiation age, and number of years of drug use, all of which show a significant reversed U-shaped relationship with hard drug use.

Assessing the relationship between drug use initiation age and racial characteristics

Initiating drug use in adolescence is associated with greater risk of drug misuse and dependence in adulthood and co-occurring mental health disorders. Initiating drug use in adulthood has been linked to higher-risk drug use networks and primary use of "harder drugs". The aim of our research is to examine racial/ethnic differences in age at drug use initiation and its relationship with adult outcomes. Based on data from the 2019 National Survey on Drug Use and Health (NSDUH), we used survey-weighted Poisson regression models with robust variance to identify associations between racial characteristics, age at drug use initiation, and three adult outcomes - past year polydrug use, substance use, and mental illness - adjusting for individual-level characteristics. Among 25,986 respondents who ever used drugs and reported their drug use initiation age, Asian-Americans reported the oldest drug use initiation age (19.5) on average, while Native Americans reported the youngest initiation age (16.6). While there were no significant differences in type of drug used during onset by race or ethnicity, generally, individuals start to use inhalants at the earliest age (17.4), while the misuse of sedatives is initiated at the oldest age (46.4). Initiation during late adolescence was associated with greater likelihood of a substance use disorder diagnosis, mental health diagnoses, and polydrug use in adulthood. Drug use prevention interventions should be tailored and accessible during adolescence to delay onset. Interventions that are culturally sensitive, screen for vulnerability to drug use, and offer age-appropriate services should be prioritized.

Is the Effect of Parenting on Substance Use among Adolescents and Young Adults Context Dependent? Evidence from Ten Countries of Southeastern Europe

Related to some inconsistent evidence in the literature, the current study tested the links between three parenting styles and four measures of substance use in samples of adolescents and young adults from ten, socio-economically diverse countries in Southeastern Europe (N = 10,909, 50.3% males, Mage = 21.70, SD = 4.5); it also tested whether these links were moderated by a measure of social progress. Results indicated that only authoritative parenting style was negatively associated with substance use; both authoritarian and permissive parenting styles were positively associated with substance use. The country-level effect on substance use was modest, yet significant; it explained between 1% and 4% of the total variance. Findings also provided some evidence of a moderation effects by social progress. Exploratory follow-up HLM analyses also provided evidence of significant country level social progress effects on alcohol use, soft drug use, and hard drug use; however, no significant cross-level interactions effects were found. Key study implications include positive effects by both authoritarian and permissive parenting on young adult substance use, but importantly, negative ones by authoritative parenting. Findings have important implications for potential intervention and prevention efforts, in addition to addressing potential country-level differences.

Differences in Offending Behaviors, Aggression, Substance Use, and Mental Health Problems between Male Drug Dealers and Non-Drug Dealers in Belgian Youth Detention Centers

This study investigated whether drug dealing juvenile offenders in Belgium differ from non-drug dealers in levels of violent and non-violent offending behaviors, aggression, substance use, and mental health needs. The current study examined data from 226 16- to 17-year-old male juvenile offenders. Information relating to drug dealing, substance use, and mental health needs were collected through self-report questionnaires. A structured diagnostic interview was used to collect information about past violent and non-violent behaviors. Chi-square tests and multivariate analysis of variance compared non-dealers and dealers and explored if hard-drug dealers and soft-drug dealers differed from each other. Relative to non-drug dealers, drug dealers engaged in more violent offending behaviors, exhibited higher levels of aggression, substance use and oppositional defiant problems, and displayed lower levels of anxiety. Soft- and hard-drug dealers did not differ from each other. To conclude, detained drug dealers are characterized by severe antisocial behavior.

Internalizing and externalizing pathways to high-risk substance use and geographic location in Australian adolescents

One specific instantiation of the storm-and-stress view of adolescence is the idea that “normal” adolescence involves high-risk substance use behaviors. However, although uptake of some substance use behaviors is more common during adolescence than other life stages, it is clear that not all adolescents engage in risky substance use—and among those who do, there is much variation in emotional, behavioral, and contextual precursors of this behavior. One such set of predictors forms the internalizing pathway to substance use disorder, whereby internalizing symptoms in childhood such as negative affect and anxiety set off a chain of consequences culminating in high-risk substance use in late adolescence. However, findings linking internalizing symptoms to substance use are mixed, and it is clear that this link varies across adolescents and contexts. One heretofore unanswered question is whether and how geographic location, specifically whether the adolescent lives in an urban or rural location, moderates this link. The current report is a secondary analysis of data from the Longitudinal Study of Australian Children (LSAC; N = 2,285), in which we examined the link between internalizing symptoms in childhood and initiation of substance use through age 19. Using a multiple event process survival mixture model (MEPSUM), we identified three trajectories of substance use initiation in adolescence: one (65.7% of the sample) characterized by near-complete abstinence until late adolescence, another (27.2%) by earlier initiation of alcohol, nicotine, and cannabis, and another (7.2%) by early initiation of these substances and later initiation of more hazardous drugs such as cocaine and methamphetamine. Although childhood externalizing symptoms increased the risk of being in the second or third class, internalizing symptoms decreased risk when rural and non-rural adolescents were considered together. Few effects of rurality were found, but the negative relationship between internalizing at age 10 and high-risk substance use was only observed among non-rural adolescents. This finding, which was inconsistent with our initial predictions that rurality might confer higher risk for substance use, instead suggests a potentially protective effect of internalizing symptoms for engagement in risky substance use which may differ based on an adolescent’s geographical context.

Deviant Peer Association as a Predictor of Development of Risk for Selling Illicit Drugs: Are Effects Age-Graded?

Illicit drug sales present a public health issue that results in proliferation of drug use–related problems, like overdose deaths, stemming from use of illicit drugs. However, there remain gaps in understanding of psychosocial and developmental processes involved with predicting drug sales. Deviant peer association presents one potential risk factor for selling drugs and this relationship may be age-graded. This study examined deviant peer association as a predictor of risk for selling drugs and investigated whether salience of this relationship depended on when exposure to deviant peers occurred. The Pathways to Desistance data were analyzed. Mixed effects logistic regression models were utilized to examine the effects of deviant peer association on odds of selling illicit drugs and cross-level interactions with age variables. Findings indicated that association with deviant peers increased odds of selling illicit drugs. This relationship diminished as participants aged through adolescence, but later increased in magnitude as participants aged.

Unstructured Socializing with Peers, Low Self-Control, and Substance Use

Research consistently finds that unstructured socializing with peers and low self-control are both positively associated with substance use among adolescents. However, largely absent from the literature is a consideration of whether unstructured socializing with peers and low self-control have differential and interactive effects when predicting usage of different classifications of drugs. The current study addresses these issues using data collected on a statewide sample of middle school and high school students who participated in the 2017 Florida Youth Substance Abuse Survey. Results indicate that (1) unstructured socializing with peers is a stronger predictor of soft drug use than low self-control, (2) low self-control is a stronger predictor of hard drug use than unstructured socializing with peers, and (3) the effect of unstructured socializing on both soft and hard drug use is diminished among adolescents who are lower in self-control.

Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies

BACKGROUND

Existential distress is a significant source of suffering for patients facing life-threatening illness. Psychedelic-Assisted Therapies (PAT) are novel treatments that have shown promise in treating existential distress, but openness to providing PAT may be limited by stigma surrounding psychedelics and the paucity of education regarding their medical use. How PAT might be integrated into existing treatments for existential distress within palliative care remains underexplored.

METHODS

The present study aimed to elucidate the attitudes of palliative care clinicians regarding treatments for existential distress, including PAT. We recruited palliative care physicians, advanced practice nurses, and spiritual and psychological care providers from multiple US sites using purposive and snowball sampling methods. Attitudes toward PAT were unknown prior to study involvement. Semi-structured interviews targeted at current approaches to existential distress and attitudes toward PAT were analyzed for thematic content.

RESULTS

Nineteen respondents (seven physicians, four advanced practice nurses, four chaplains, three social workers, and one psychologist) were interviewed. Identified themes were 1) Existential distress is a common experience that is frequently insufficiently treated within the current treatment framework; 2) Palliative care providers ultimately see existential distress as a psychosocial-spiritual problem that evades medicalized approaches; 3) Palliative care providers believe PAT hold promise for treating existential distress but that a stronger evidence base is needed; 4) Because PAT do not currently fit existing models of existential distress treatment, barriers remain.

CONCLUSIONS

PAT is seen as a potentially powerful tool to treat refractory existential distress. Larger clinical trials and educational outreach are needed to clarify treatment targets and address safety concerns. Further work to adapt PAT to palliative care settings should emphasize collaboration with spiritual care as well as mental health providers and seek to address unresolved concerns about equitable access.

Acceptance of Drug Use Mediates Future Hard Drug Use Among At-Risk Adolescent Marijuana, Tobacco, and Alcohol Users

Alternative high school (AHS) students typically report higher levels of alcohol and other drug use compared to students attending traditional high schools. Greater use of such drugs as heroin, methamphetamines, and cocaine in this at-risk population may be driven, in part, by a greater latitude of acceptance toward substance use in general, which may accelerate the transition from gateway drugs to hard drugs. Seven hundred seventy-seven adolescents (mean age 16.6; 56% female) were recruited from alternative high schools throughout Southern California. To understand the factors that may lead AHS students to use hard drugs, a model was tested in order to determine if AHS students' latitude of acceptance toward substance use was a mediator between the relationship of past use of gateway drugs and future use of hard drugs. Latitude of acceptance was found to be a statistically significant mediator of future hard drug use (b = 0.03, 95% confidence intervals = 0.01 to 0.05) among gateway drug users. An individual's latitude of acceptance to various drug use behaviors may be consistent with societal norms. However, after exposure to, or use of, gateway drugs, attitudes that are more permissive toward hard drug use may be encountered, the acceptance of hard drugs may expand, and the use of hard drugs may escalate. Interventions designed to reduce the use of hard drugs among at-risk youth may be more persuasive by crafting messages that are within the latitude of acceptance of the target population and prevent the acceptance of hard drug use.

The cost of opioid use disorder and the value of aversion

BACKGROUND

The objective of this study was twofold. First, to update and estimate the economic burden of opioid use disorder (OUD) to the U.S. from the perspectives of the healthcare sector, taxpayer, and society, overall and by age. Second, to estimate the mean present value of averting an OUD, overall and by age, for use in economic evaluations of prevention-focused interventions.

METHODS

This was a retrospective secondary analysis using 2018 data from the National Survey on Drug Use and Health, and the CDC WONDER Database on all U.S. persons, at least 12 years old, with an OUD, or who died of opioid overdose. Total OUD-related costs were estimated according to age and stakeholder perspective. Mean costs weighted by insurance type and the probability of mortality were estimated for each age, then used to estimate the mean present value of OUD aversion according to age and stakeholder perspective.

RESULTS

The total annual OUD-related costs to the U.S. in 2018 were $786.8 billion to society, $93 billion to taxpayers, and $89.1 billion to the healthcare sector. The mean present value of averting an OUD, across all ages, was $2.2 million, $325,125, and $244,030 from the societal, taxpayer, and healthcare sector perspectives, respectively.

CONCLUSIONS AND RELEVANCE

The age-specific values of averting an OUD allow for more robust and targeted economic evaluations of competing interventions to reduce the burden of opioids on multiple stakeholders. The rise in the annual OUD-related cost largely reflects the increase in overdose deaths attributable to synthetic opioids (e.g., fentanyl).

Cannabis knowledge and implications for health: Considerations regarding the legalization of non-medical cannabis

Cannabis contains over a hundred of different cannabinoids, of which Δ⁹-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most well studied. The use of high-potency cannabis, containing high concentrations of THC and low concentrations of CBD, has been linked to adverse health outcomes, particularly for adolescents and young adults. Recently, an increase in cannabis potency has been observed in jurisdictions that legalized the sale of cannabis for non-medical purposes. Moreover, an increase of cannabis use and cannabis-related emergency treatment have also been observed in these jurisdictions. At the same time, risk perception regarding cannabis use has decreased in these populations. Trivializing language and an increased appearance of commercial cannabis in the public space may lead to a generalized underestimation of the risks of cannabis use. New regulation models principally focus on the creation of a legal cannabis market economy, the diversion of profits from illegal markets, and the reduction of costs associated with prohibition. However, an approach that specifically focuses on the rights to the health and safety of the individual should be considered in order to reduce the risks associated with cannabis legalization. Such an approach should promote and protect individual and social health and safety, establish a strict quality control of legal cannabis products regulated according to THC and CBD content, and eliminate all sorts of incentives to use, thus providing a more consistent, sustainable, and ethical framework for the legalization of non-medical cannabis use.

Collegiate Substance Use: A Tale of Differential Risk and Coping

INTRODUCTION

Young adults reporting combined alcohol and marijuana use indicate greater frequency of other substances, binge drinking rates, and alcohol-related negative consequences. Emotion regulation (ER) difficulties are linked to alcohol use and abuse, with effects commonly attributed to increased mindfulness and distress tolerance abilities. Evidence is mixed, however, regarding the interactive impact of substance use and mindfulness facets on mental health outcomes.

METHODS

The current study utilized a cross-sectional design to examine mental health outcomes predicted by ER and mindfulness facets in 229 college students across three substance use categories (no use; alcohol/marijuana; illicit use with alcohol/marijuana).

RESULTS

For participants reporting no substance use, linear stepwise regressions found that Non-Judging was significantly related to reduced anxiety, while Acting with Awareness was related to greater anxiety; for those reporting alcohol/marijuana use only, Non-Judging significantly related to lower stress and anxiety; for those reporting illicit substance use with alcohol/marijuana, Acting with Awareness was related to lower stress. Describing was related to higher distress across groups, and Observing was not significantly related to any aspect of mental health across groups. ER difficulties were positively related to depression, anxiety and stress across substance use groups, with one exception: ER difficulty was not significantly associated with depression for no use.

DISCUSSION

Mindfulness interventions should focus on certain facets, such as Non-Judging, in order to improve psychological functioning across various groups of substance use. Additionally, ER difficulties are closely linked to alcohol, marijuana, and illicit drug use.

The Effect of Marijuana Legalization on the Trajectories of Hard Drug–Related Hospitalizations: A Growth Curve Analysis of the County-Level State Inpatient Database in Washington, 2009–2015

Two antithetical arguments have raised controversies over the effect of recreational marijuana legalization on hard drug use. The gateway perspective posits that marijuana use diffuses hard drug use; however, recent studies argue that marijuana legalization displaces hard drug use. This study examines these conflicting arguments by investigating temporal patterns of hard drug–related hospitalizations (HDHs) before and after marijuana legalization. Using county-level State Inpatient Database data from Washington State for the years 2009–2015, along with other federal data sources, this study assesses temporal changes in HDH using growth curve modeling. Initial findings show support for the displacement perspective, though controlling for other county-level factors (education and economic change) indicates that the legalization of recreational marijuana may be a gateway toward harder drugs. Considering the economic situation of the United States during the study period, this study concludes that marijuana legalization functioned as a gateway toward increased hard drug use.

Using polytomous latent class analysis to compare patterns of substance use and co-occurring health-risk behaviors between students in alternative and mainstream high schools

INTRODUCTION

Alternative high school (AHS) students, an understudied and underserved population, experience educational, social, and health disparities relative to students in mainstream high schools. Disparities in single types of substance use are particularly high, yet no known studies have compared patterns of substance use or relationships between these patterns and other health-risk behaviors between AHS and mainstream high schools.

METHODS

Using data from the Texas Alternative School Health Survey (n = 515; mean age 17.1 years, 49% male, 59% Hispanic, 23% White, 15% Black) and the Texas Youth Risk Behavior Survey (n = 2,113; mean age 16 years, 47% male, 64% Hispanic, 22% White, 7% Black), we used latent class analyses to compare patterns of substance use in AHSs and mainstream high schools. We used latent class regression to examine relationships between patterns of substance use and involvement in other health-risk behaviors in each school setting.

RESULTS

Students in AHSs and mainstream high schools had similar patterns of substance use, and youth in higher risk categories engaged in higher levels of other health-risk behaviors. A substantially greater proportion of AHS students, however, fell into the moderate and high use categories, in support of continuing disparities for AHS students.

CONCLUSIONS

Additional support is needed in AHSs to address the prevalence of high-risk patterns of substance use and associated health-risk behaviors. For example, ongoing public health surveillance is needed in AHSs, just as is done in mainstream high schools, to monitor trends in substance use and impact of policies and interventions.