The misuse of psychoactive substances among university students has emerged as a pressing public health issue, particularly in Lebanon, where research on this phenomenon is limited. This study aimed to develop and validate scales that assess knowledge and attitudes toward Psychoactive Substance Consumption (PSC), evaluate their psychometric properties, identify factors associated with these scores, and explore the relationship between knowledge, attitudes, and PSC among university students. This cross-sectional study surveyed 414 university students from 29 institutions across Lebanon during the 2023-2024 academic year using an anonymous self-administered questionnaire. Participants were recruited via email from three prominent universities with initial Institutional Review Board (IRB) approval, and the sample was expanded through snowballing due to IRB challenges caused by economic and political crises. Exploratory Factor Analysis (EFA) was performed using SPSS to evaluate construct validity, and reliability was assessed by calculating Cronbach's alpha. EFA identified two factors for the knowledge scale with eigenvalues over 1, explaining 51.4% of the variance. The model demonstrated adequacy, with a Kaiser-Meyer-Olkin (KMO) measure of 0.864, a significant Bartlett's test of sphericity, and a high reliability (Cronbach's alpha = 0.829). Similarly, the attitude scale items converged over two factors, explaining 58.8% of the variance, with a KMO of 0.850, a significant Bartlett's test of sphericity, and good reliability (Cronbach's alpha = 0.826). The study found that greater knowledge was associated with students who had higher grades and those who were aware of the availability of psychoactive substances in nasal inhalation form. However, knowledge showed no significant correlation with attitudes (r = -0.027, p = 0.583). The multivariate analysis identified several predictors influencing knowledge and attitudes toward PSC, including academic year, financial status changes, presence of mental illness, and family history of substance-related issues. The scales developed in this study demonstrated strong reliability and validity, positioning them as effective tools for assessing knowledge and attitudes associated with psychoactive substance consumption among university students. The multivariate results underscore the impact of academic, socioeconomic, and mental health factors, suggesting the need for interventions that specifically address these determinants.
Alcohol and psychoactive substance use represent a major burden for global public health, increasing the risk of non-communicable diseases, violence, road traffic injuries, dependence, and mental disorders, and generating impacts on productivity and social welfare. This study aimed to estimate the burden of disease attributable to alcohol and other psychoactive substances in the departments of Colombia from 2016 to 2022. A burden-of-disease study was conducted using the Disability-Adjusted Life Years (DALYs) indicator, following the methodology of the World Health Organization Global Health Estimates. Official morbidity and mortality databases were used. An estimated 236,154.42 DALYs were attributable to alcohol and psychoactive substance use in Colombia during the study period, increasing from 14,158.7 DALYs in 2016 to 40,190.7 DALYs in 2022. The burden was heterogeneous across departments, with values above 1000 DALYs in Quindío (1779.5), Nariño (1624.3), and Norte de Santander (1008.0) and below 132 DALYs in La Guajira, Casanare, and Vaupés. Men accounted for 73.5% of total DALYs. The mean age of morbidity records associated with alcohol and psychoactive substance use disorders was 30.67 years in men and 32.37 years in women. The burden associated with psychoactive substance use is increasing in Colombia, with differences by sex and department of residence.
The increasing global consumption of pharmaceuticals and illicit drugs, particularly new psychoactive substances, has resulted in their continuous release into aquatic environments, raising concerns regarding potential adverse effects on ecosystems and human health. In this study, a dispersive micro-solid-phase extraction using customized extraction devices was developed in combination with liquid chromatography-high-resolution mass spectrometry for target and suspect screening, followed by sensitive quantification by liquid chromatography-tandem mass spectrometry. The extraction procedure was optimized using experimental design. Optimal conditions comprised 50 mg of Oasis MCX sorbent, 100 mL of sample (pH 2, containing 7.5% NaCl, w v⁻1), and an extraction time of 30 min. Under these conditions, limits of quantification ranged from 4.67 to 29.3 ng L⁻1, and extraction recoveries varied between 73.0% and 108% for most target analytes. Application to real wastewater samples included an initial suspect screening step by liquid chromatography-high resolution mass spectrometry using data-dependent acquisition and an untargeted data-mining workflow. The screening results revealed a broad range of compounds, including central nervous system stimulants, cardiovascular drugs, opioid analgesics, and sedatives. Quantification of selected target analytes was subsequently performed by liquid chromatography-tandem mass spectrometry. Among the investigated illicit drugs, THC and cocaine were the predominant compounds detected, whereas fentanyl was present at trace levels (6.17-14.4 ng L⁻1). The proposed workflow enables robust, sensitive monitoring of illicit drugs and pharmaceuticals in wastewater for epidemiological and environmental surveillance applications.
Earlier studies have documented psychoactive substance use and nicotine exposure among commercial drivers in Ghana. However, those studies relied solely on self-reported questionnaires, which are prone to recall and response bias. This study aimed to provide a more accurate estimate by using a chromatographic immunoassay urine drug test. This exploratory cross-sectional study was conducted between January and August 2024 in the Tamale metropolitan area of Ghana. The study included 70 consenting commercial drivers aged from 26 to 78 years. Sociodemographic, anthropometric and occupational factors were collected using a semi-structured questionnaire. Urine samples were then obtained from the participants and tested for Amphetamine (AMP), Barbiturates (BAR), Benzodiazepines (BZO), Cocaine (COC), Tetrahydrocannabinol (THC), Morphine (MOP), Opiates (OPI), nicotine exposure using Cotinine (COT), Tramadol (TML), and Tricyclic Antidepressants (TCA) using the 10-panel Multi-Drug One Step chromatographic immunoassay test kit. The total urine prevalence of psychoactive substances and nicotine exposure was 61.4%, consisting of COT (37.1%), THC (24.3%), BZO (11.4%), Tramadol (5.7%) and AMP (2.9%). While the self-reported smoking prevalence was 10%, the urine cotinine prevalence was 37.1%. In addition, 14(20%) of the urine samples tested positive for two substances. Contrary to expectations, commercial drivers with no history of accident were more likely to test positive for TML [AOR = 8.667(95%CI: 1.025-73.249)], or two substances [AOR = 5.000(95%CI: 1.051-23.789)]. The urine samples of commercial drivers tested positive for psychoactive substances and nicotine exposure. However, positivity for a psychoactive substance or nicotine exposure may not be associated with a history of road traffic accidents. Further studies are recommended.
The rapid emergence and structural diversity of New Psychoactive Substances (NPS) challenge toxicological screening, which usually relies on targeted detection of known compounds. To address this limitation, we developed a novel, database-independent analytical workflow capable of anticipating unknown or emerging NPS in complex biological matrices. A comprehensive workflow combining sample preparation, orthogonal liquid chromatography, and high-resolution tandem mass spectrometry (LC-HRMS/MS) was developed for the identification of new structures and their metabolites. Three extraction protocols were benchmarked in both reversed-phase (RP-LC) and hydrophilic interaction (HILIC) chromatographic modes to maximize analyte coverage. The method was optimized using 77 drug standards and extended to a mixture of 122 compounds (Mix122) to build an Anchor-Based Molecular Network (ABMN). Biological samples from presumed NPS consumers were integrated into the reference network to connect patient-derived features with anchor compounds. Data were processed with MZmine for feature extraction, MetGem for molecular networking, and SIRIUS for in silico structure prediction. Protocol P1 (protein precipitation and analyte concentration) provided the best extraction, recovering 90% of analytes with high chromatographic quality. P1 achieved the lowest limit of identification, enabling MS/MS acquisition for 100% of compounds at 50 ng/mL, 97% at 5 ng/mL, and 42% at 0.5 ng/mL. RP-LC and HILIC proved complementary, improving analyte coverage. The Mix122 dataset yielded chemically coherent clusters, supporting integration of clinical samples. Several structurally related analogues such as bromazolam, fluoromethamphetamine, or MDPHP were identified. The ABMN-based LC-HRMS/MS strategy provides a robust and transferable analytical platform for comprehensive and sensitive screening of unknown NPS, even at trace levels down to 1 ng/mL.
Psychedelic-assisted therapy (PAT) is increasingly recognized as a potential novel treatment for substance use disorder (SUD). As evidence continues to grow, the successful implementation of this modality into clinical practice will depend significantly on the perceptions and attitudes of mental healthcare professionals. Accordingly, a systematic review was conducted to provide a comprehensive overview of the scientific literature on how professionals view the use of psychedelics for the treatment of SUD. A systematic search was performed across six databases, including PubMed, MEDLINE, PsycINFO, Academic Search Premier, CINAHL, and SocIndex. A total of six studies were identified with a total of 966 participants. Findings revealed that the majority of mental healthcare professionals hold a cautiously optimistic attitude toward PAT. Moreover, a minority expressed hesitancy and critical perspectives, citing concerns about safety, efficacy, and the practical challenges of integrating PAT into existing clinical frameworks. Finally, the results indicate that knowledge and familiarity with PAT were key predictors of a more positive outlook. Given the current limited level of knowledge among professionals, these findings underscore a significant need for targeted education and training. Addressing these barriers is essential to facilitate the effective and responsible integration of PAT into standard clinical care for SUD.
In forensic toxicology (FT), drug of abuse (DoA) screening is essential yet challenging. This study presents a vendor-based, high-resolution (HR) LC-MS/MS blood screening method implemented without in‑house optimization, in comparison to immunoassay-based and low-resolution (LR) urine screening approaches simultaneous to (semi)quantification. The HR-method allows detection of more than 3000 analytes, including DoAs, drugs and suspected new psychoactive substances (NPS). Following protein precipitation, analytes qualitatively identified in 500 authentic whole-blood samples using the HR-method were qualitatively compared with results from the immunoassay and LR urine screening. Additionally, 82 common DoAs and drugs were (semi)quantitatively validated according to ANSI and GTFCh guidelines and quantitative performance was assessed against a fully validated targeted LC-MS/MS method (MRM mode). In total, the HR-method detected 819 (83%) of the 994 analytes identified by the LR urine screening. Substances not captured by the HR approach typically showed concentrations below the identification limit and/or were of negligible relevance in FT. The HR blood screening detected 66% of all cases positive for THC and/or its metabolites, whereas the LR urine screening failed to detect these compounds entirely. Incorporation of the HighResNPS® database enabled the tentative identification of 14 NPS. Seventy-four (90%) of the 82 DoAs demonstrated accuracy within ± 30%, precision (CV) ≤ 30% and quantitative results of 100 authentic cases were consistent with those from the targeted LC-MS/MS method which is generally considered the gold standard for quantification. Overall, the HR blood screening is superior to the LR urine screening for most analyte classes, enabling simultaneous detection of DoAs, their metabolites and NPS. The semi-quantitative validation of 74 drugs and the quantitative comparison confirmed the method's reliability in distinguishing between subtherapeutic, therapeutic and toxic concentrations without the need for drug class-specific optimization, thereby saving time, effort and costs. This untargeted approach combines screening with (semi)quantification while supporting routine workflows, research applications and retrospective analysis of new emerging substances.
This study presents a novel, integrated micro-solid-phase extraction/miniature mass spectrometry (micro-SPE/mini-MS) platform designed for the rapid, on-site quantification of conventional illicit drugs and emerging new psychoactive substances (NPS) in human hair. The system addresses the critical need for laboratory-grade accuracy in field settings by coupling a streamlined, mixed-mode cation exchange (MCX) pipette-tip micro-SPE protocol with a miniaturized mass spectrometer utilizing paper-capillary spray (PCS) ionization. The method targets three conventional illicit drugs, methamphetamine (MA), 3,4-methylenedioxymethamphetamine (MDMA), and ketamine (KET), and three new NPS, etomidate (ETM), isopropoxate (IPX), and 2-oxo-PCE. By systematically optimizing the micro-SPE enrichment and mini-MS parameters, we achieved significant mitigation of matrix effects, yielding impressive limits of detection (LOD, 1-3 ng/mL in hair extract) and robust linearity (R² ≥ 0.9917). The entire analytical workflow, from sample preparation to result, is completed within 5 min, offering a drastic reduction in turnaround time compared to traditional chromatography-based methods. Validation using authentic hair samples previously confirmed by laboratory LC-MS/MS demonstrated superior quantitative consistency, with relative errors maintained within 15%. By bridging the gap between rigorous laboratory confirmation and point-of-need screening, this field-deployable platform represents a significant advancement in forensic toxicology, workplace drug testing, and clinical diagnostics.
Etomidate and its analogs can produce euphoria and addiction, and their recent abuse has led to an increasing number of poisoning and fatal cases. Thus, they are classified as controlled psychotropic drugs. This work proposed small-sized wood aerogel-supported zirconium metal-organic framework (UiO-66) particles for the extraction of trace etomidate and its analogs from urine and e-cigarette samples. Owing to the removal of lignin and hemicellulose, the delignified wood aerogel exhibited enhanced internal pore structures and exposed functional groups, which facilitated the immobilization of more UiO-66 crystals and achieved a high loading efficiency of 61.3 %. The lightweight UiO-66/wood aerogel composite enables facile separation, avoiding UiO-66 powder leakage while retaining its adsorption capacity. The composite was mechanically stable and kept commendable reusability over nine consecutive cycles. Benefiting from its high specific surface area and multiple chemical interactions with target drugs, the extraction method achieved enrichment factors of 22.9-30.0. Key factors influencing extraction-including solution pH, extraction time, the type and volume of desorption solvent, and desorption time-were investigated. Under the optimal conditions, the UiO-66/wood aerogel-based micro-solid phase extraction coupled with GC-MS method showed wide linear ranges and good precision (1.1%-3.2% for intra-day; 3.4%-5.1% for inter-day). The limits of detection and quantification were in the range of 0.02-0.04 μg/L and 0.05-0.1 μg/L, respectively. The recoveries for the urine and e-cigarette oil samples ranged from 86.2%-110.2% and 80.1%-107.9%, respectively. This method is eco-friendly, simple, and sensitive for the determination of new psychotropic drugs in clinical and forensic applications.
The rapid emergence of novel psychoactive substances (NPS) poses a significant challenge for forensic toxicology and public health. While blood and urine enable rapid detection for early warning systems, long-term monitoring is essential for retrospective exposure assessment and temporal trend analysis. In this context, hair represents a valuable biological matrix; however, multi-class NPS determination remains difficult due to their chemical diversity and typically low concentrations. In this work, we targeted 12 synthetic opioids, 8 synthetic cathinones, 3 dissociatives, 3 designer benzodiazepines, 3 hallucinogens, and 2 synthetic cannabinoids. Sample preparation included a three-step wash procedure (water, methanol, and ethyl acetate), followed by simultaneous pulverization and methanolic extraction of 20 mg of hair, using an Omni Ruptor bead-mill homogenizer (10 cycles, 40 s at 4.5 m/s with dwell periods; total time ∼43 min). After centrifugation (5000 rpm, 10 min), extracts were evaporated under nitrogen stream at 40°C (20 psi) and reconstituted in 100 µl of 90:10 (v/v) water/acetonitrile, both containing 0.1% formic acid, followed by filtration. Chromatographic separation was achieved by liquid chromatography on a Kinetex C18 column (100 × 2.1 mm, 1.7 µm) using gradient elution with a total runtime of 10 min. Identification and quantitation were performed by tandem mass spectrometry in positive electrospray ionization using multiple reaction monitoring with quantifier and qualifier transitions. The method was validated according to ANSI/ASB Standard 036. Linearity was demonstrated from 5 to 500 pg/mg. Intra- and inter-day precision were <20% and bias within ±20% for most analytes, with no significant carryover or interferences observed. Matrix effects were observed but consistent across analytes, allowing reliable quantitation. Application to authentic hair samples from electronic music festival attendees in Europe and Brazil confirmed the presence of emerging NPS. This integrated pulverization-extraction approach enables rapid, robust multi-class NPS detection in hair for biomonitoring and forensic applications.
Ecstasy-type drugs are the most frequently seized synthetic drugs in Brazil, usually containing a mixture of MDMA and its analog MDA. In recent years, an increasing number of samples have been found to contain only MDA, possibly reflecting shifts in the synthetic routes of ecstasy-type substances during the COVID-19 pandemic. However, the exclusive use of MDA remains poorly characterized, and its toxicological profile is still not fully understood. Data from chemical analyses of drug seizures in Rio Grande do Sul, Southern Brazil, were reviewed. In addition, blood and urine samples collected from clinical and forensic cases involving ecstasy use were analyzed by LC-MS/MS. MDA was detected in 31.1% of seized drug samples, surpassing MDMA, which accounted for 25.6%. A marked rise in MDA detections was observed after 2020, peaking at 52.6% of seizures in 2023. In addition, sixteen clinical and four postmortem cases involving MDMA and/or MDA were documented, with MDA predominating from 2021 onwards. The study identified a higher prevalence of MDA compared to MDMA, indicating a shift in ecstasy use patterns in Brazil. This finding underscores the need for robust analytical approaches and sustained toxicological monitoring to support drug surveillance and public health policies.
Anxiety disorders are chronic health conditions affecting the quality of life of millions of people. Psilocin, the active moiety of psilocybin, provides an anxiolytic effect; however, when orally administered as psilocybin, it only offers a moderate level of bioavailability and less predictable pharmacokinetics, potentially making effects after absorption variable and increasing the risk of adverse hallucinations, depending on the dose. As such, we investigated a recently developed stable salt of psilocin, psilocin mucate (L-130), which delivers increased bioavailability and, thus, more precise control of therapeutic levels. We examined factors related to L-130's safety, as well as its effectiveness in addressing anxiety at a commonly used macro dose level, along with dosing schedules similar to those noted in the literature. Clinical assessments and blood analyses suggest psilocin mucate is safe and has no toxicological effects. Compared to vehicle controls, daily dosing of L-130 led to significant reductions in cortisol levels and improved performances on several anxiety-related behavioral tasks: the Elevated Plus Maze, the Open Field Test, and the Novel Object Recognition Task. However, weekly dosing did not generally produce significant results. Overall, daily dosing of L-130 was able to produce anxiolytic behaviors, but larger studies are needed to determine optimal doses and dosing schedules.
Psychedelic experiences have been associated with improved quality of life, but many studies rely on samples of enthusiasts, raising concerns about selection bias. This study examined whether self-reported quality-of-life impact differed between a convenience sample of psychedelic enthusiasts and a general population sample recruited through Prolific, and whether sample differences persisted after controlling for mindset, setting, motivation, and personality. A total of N = 1,182 participants (N = 583 enthusiasts; N = 599 general sample) with prior psychedelic experience completed an online survey assessing perceived impact, contextual factors, motivation for use, and Big Five personality. Between-group differences were analyzed using Welch's t-tests, Pearson´s chi-squared tests and Mann-Whitney-Wilcoxon tests. A Type III ANCOVA was used to assess whether sample differences in quality-of-life impact remained after controlling for relevant covariates. Enthusiasts reported significantly greater quality-of-life impact (d = 0.84), higher openness, extraversion and agreeableness, more favorable mindsets and settings, and a higher frequency of personal growth motives. In the ANCOVA, sample membership was the strongest predictor of quality-of-life impact, followed by setting, motivation, openness, and mindset. These findings provide empirical clarification of how enthusiast-leaning recruitment strategies can shape reported outcomes in psychedelic research. Results underscore the need to consider sampling frames when interpreting reported benefits and to prioritize representative recruitment in future psychedelic research.
The use of traditional medicinal plants in therapeutic settings has gained increasing attention for their potential in mental health and addiction treatment. This study explores the ethnomedical use of Brunfelsia grandiflora (chiric sanango) within the therapeutic framework of the Takiwasi Center in the Peruvian Amazon, where it is integrated into strict plant-based dietary regimens ("dietas") to support addiction recovery and psychological well-being. The research combines data from semi-structured interviews with therapists, traditional healers, and other staff members, along with patient-reported experience data from the institution's database. A total of 74 case reports were analyzed to assess both the physiological and psychological effects of chiric. Findings indicate that the plant induces notable physical effects, including numbness, tingling, dizziness, and cold sensations, while also facilitating deep psychological introspection, emotional processing, and enhanced social engagement. Participants frequently reported shifts from distressing emotions to states of clarity, acceptance, and resilience. These effects suggest that chiric sanango may serve as an important adjunct in psychotherapy and addiction treatment. This study highlights the intersection of Amazonian ethnomedicine and modern therapeutic practices, emphasizing the need for further pharmacological and clinical investigations into the psychoactive properties of B. grandiflora and its potential role in mental health interventions.
Synthetic cannabinoids are the most numerous group of new psychoactive substances (NPSs) in Europe. The diversity and quantity of newly emerging synthetic cannabinoids make it difficult to monitor intoxications with these compounds, especially in view of their stability after biological material collection. In this study, 17 NPSs were analyzed to determine their stability in whole blood and dry blood spots (DBSs). The samples were stored at room temperature (DBS), 4 °C (DBS and whole blood), and -20 °C (whole blood). Analyses were performed using ultra-high-performance liquid chromatography coupled with tandem mass spectrometry. The stability study lasted 365 days, monitoring the degradation rate of analytes. Moreover, the effect of chemical structure on analyte stability was assessed. Results proved that the stability of analytes depended on both storage conditions and their chemical structure. Four compounds showed better long-term stability in DBS samples, whereas seven of the tested compounds exhibited significantly better long-term stability in whole blood samples. Studies indicate a strong correlation between the stability of synthetic cannabinoids and both their chemical structure and storage conditions. DBS cards can provide equal or enhanced stability compared to whole blood, which makes it advisable to collect biological material in both forms to help maximize analytical options in forensic and toxicological investigations.
Despite the therapeutic potential of ketamine (KET) as a psychoactive drug, off-dose use or abuse may lead to irreversible consequences, ranging from mild to severe dependency, cardiovascular complications, and even death. Thus, its accurate detection in human biological samples is essential. In this study, a novel opto-electrochemical sensor is developed based on a scalable indium tin oxide (ITO) surface modified with molecularly imprinted polymer (MIP) using β-cyclodextrin (β.CD) and polyaniline (PANI) for the selective detection of KET. In the embedded sensing interface, the β.CD serves as a host molecule to form specific cavities for KET entrapment, and PANI acts as an electrochromic material. This strategy enables visual detection via vivid color changes that correspond to KET concentration, along with electrochemical outputs. The sensor exhibits a linear response range from 1 to 700 nM, with a detection limit of 0.33 nM (S/N = 3) and a limit of quantification of 3.3 nM (± 0.002 nM) across electrochemical, optical, and RGB signals. Selectivity tests against structurally similar drugs confirm negligible cross-reactivity toward KET. Real sample analysis in human urine and saliva, with recoveries between 99.45% and 101.68%, validates the sensor's reliability. The dual-mode capability-electrochemical and visual-combined with green chemistry compliance (AGREE score: 0.84) promises the sensor's potential to provide technical support for point-of-care applications in clinical diagnostics and forensic medicine.
U.S. military veterans face an elevated suicide risk compared to the general population. Both the use and misuse of tranquilizers (i.e. several classes of medications that treat anxiety and muscle spasms via central nervous system action, including benzodiazepines) have been associated with suicidal thoughts and behaviors among veterans. However, it remains unclear whether risk varies across different patterns of tranquilizer use. Participants included 12,584 U.S. military veterans (13.0% female; 78.1% non-Hispanic White; 49.3% age 65 and older), from the 2015-2019 National Survey on Drug Use and Health (NSDUH). Tranquilizer use without misuse was associated with greater odds of suicidal ideation and planning, relative to nonuse (p's < 0.01). Tranquilizer misuse was associated with greater odds of suicide ideation, planning, and attempts compared to nonuse (p's < 0.01). Relative to use without misuse, tranquilizer misuse was associated with greater odds of suicide ideation, planning, and attempts (p's < 0.01). These results support a graded association between tranquilizer use/misuse and suicidal thoughts and behaviors, suggesting that risk for suicide-related outcomes may increase from no use, to use without misuse, to misuse. Future research should explore the clinical utility of addressing tranquilizer use/misuse as part of targeted suicide prevention strategies among veterans.
Opioid dependence is a public health concern in New Zealand, with limited treatment options beyond opioid substitution therapy (OST). Ibogaine, a psychoactive alkaloid with reported anti-withdrawal and anti-craving effects for opioid dependence, is legally available by prescription in New Zealand, offering a context for exploring user experiences. A qualitative collective case study design was used to examine the experiences and motivations of 10 opioid-dependent individuals who used ibogaine for opioid detoxification. Participants were recruited through ibogaine networks, OST services, and snowball sampling. Semi-structured interviews were conducted and analyzed using an inductive thematic analysis approach, informed by an interpretive, experiential framework. Analysis focused on how participants understood their motivations, treatment processes, safety practices, and post-treatment outcomes. Seven themes were identified: "Desperation to be opioid free," "motivations for using ibogaine," "safety conscious and support seeking," "improving ibogaine practices," "effects of treatment on depression and anxiety," "effects of treatment on dependence," and "the spiritual effect." Participants associated ibogaine treatment with rapid detoxification, improved mood, reduced anxiety, and periods of sustained abstinence, though relapse occurred in some cases. Preparation, medical screening, and post-treatment psychosocial support were critical to positive outcomes. This study adds to the literature by documenting experiences of ibogaine use, with implications for clinical practice, policy, and future research.
The ongoing substance use crisis in the United States involves a broad range of illicit and prescription drugs, including opioids, stimulants, sedatives, and various psychoactive and non-psychoactive compounds. Traditional surveillance methods rely on self-reported data, which could lead to bias and recall inconsistencies. Wastewater-based epidemiology has emerged as a powerful, non-invasive tool for monitoring community-level drug use, offering near real-time estimates and the potential to serve as an early warning system. However, challenges such as analyte degradation, wastewater variability, and matrix effects can affect data quality and comparability across regions. This study presents a standardized, practical workflow for multi-drug (n = 52) detection in wastewater, aiming to minimize analyte loss and improve reproducibility. Composite samples were collected from multiple U.S. cities, transported on ice, and extracted using solid-phase extraction. Extraction efficiencies were compared using Oasis Hydrophilic-Lipophilic-Balanced and Mixed-mode Cation-Exchange (MCX) cartridges, with the MCX sorbent providing complementary reversed-phase and cation-exchange interactions that enabled the retention of chemically diverse compounds across multiple drug classes. Analysis was performed with an Ultra-High-Performance Liquid Chromatography system coupled to a triple quadrupole mass spectrometer, in which the instrument parameters and critical methodological considerations, including sample handling, transport, column selection, and method validation, are detailed. This work contributes to the development of a robust, scalable protocol for multi-drug surveillance in wastewater, supporting timely, data-driven public health responses and informing national drug policy efforts.
Cannabis use has been associated with persistent perceptual disturbances, but systematic clinical characterization remains limited, particularly regarding multimodal sensory involvement. To characterize persistent perceptual disturbances following cannabis use, focusing on symptom profiles, temporal patterns, and clinical features. This exploratory observational study was conducted across the Valle d'Aosta and Piemonte regions of Italy between 2020 and 2025. We characterized 13 patients with persistent visual/auditory symptoms following cannabis exposure through comprehensive clinical assessment, neurological examination, neuroimaging, and standardized questionnaires. Given the small sample size, analysis focused on clinical characterization rather than statistical inference. Thirteen patients (10 males, mean age 24.3 ± 4.1 years) had used natural cannabis (69.2%) or synthetic cannabinoids (30.8%). Visual snow was universal (100%), with high rates of trailing phenomena (92.3%), halos (84.6%), and color changes (76.9%). A novel finding was the presence of auditory hypersensitivity in 61.5% of patients. Symptoms emerged at a mean of 3.2 ± 2.4 weeks following cannabis cessation. All neurological investigations were normal. Comorbid anxiety disorders were present in 84.6% of patients; functional impairment was severe in 30.8%, moderate in 46.2%, and mild in 23.1%. This exploratory study describes persistent multimodal sensory disturbances in patients after cannabis exposure. Consistent visual snow, frequent auditory hypersensitivity, and normal neurological investigations suggest a distinct phenotype warranting systematic investigation. While preliminary and requiring validation in larger samples, these findings highlight a potentially underrecognized cannabis complication meriting clinical attention.