Drug craving in methamphetamine use disorder (MAUD) patients is influenced by various adverse psychological problems. This study adopted network analysis to investigate the interrelationships between psychological correlates and drug craving and identify the critical pathways between them. A total of 757 men with MAUD were recruited from a drug rehabilitation center in southwest China. They completed self-report scales to measure emotion regulation, depressive symptoms, childhood trauma, and drug craving. We conducted a network analysis to assess the interaction between psychological variables and drug craving. Network structural features included network centrality, stability, and bridge strength. Results revealed positive correlations between various psychological correlates and drug craving. Limited access to emotion regulation strategies, lack of emotional awareness, and non-acceptance of emotional responses emerged as the nodes with the highest strength centrality. A bridge function analysis identified that depressive symptoms, emotional abuse, and negative reinforcement were the main bridges connecting psychological problems and drug craving. These findings support the interaction between affective factors, childhood traumatic experiences, and drug craving. Central symptoms (e.g. limited access to emotion regulation strategies) and key bridge symptoms (e.g. depressive symptoms) may serve as potential targets for intervention for MAUD patients undergoing withdrawal treatment.

Olfactory dysfunction (OD) has become increasingly prevalent since the COVID-19 pandemic, yet effective treatments remain limited. In recent years, anecdotal reports have emerged on the potential benefits of serotonergic psychedelics (lysergic acid diethylamide [LSD], psilocybin, etc.) in improving OD. To date, only one case series in the medical literature has documented this phenomenon. This study aimed to explore the potential therapeutic effects of psychedelics on OD by conducting a thematic analysis of online posts from people with self-reported OD discussing whether psychedelic use affected their OD. We analyzed 125 online posts, extracting key demographic data, anosmia cause, psychedelic type, psychedelic dosage, and reported impact on olfactory function. 108 posts (86.4%) reported improvements in smell following psychedelic use. Among those reporting improvement, 55 (50.1%) first noticed smell enhancement during their psychedelic experience, and 42 (38.8%) reported olfactory improvements persisting at least one day post-psychedelic use. No statistical relationship was identified between duration of benefit and dose for either psilocybin or LSD. These exploratory findings highlight the need for further research to determine whether serotonergic psychedelics could serve as a viable clinical treatment for OD or facilitate the development of new therapies, if the mechanisms behind these reported improvements can be elucidated.

With increasing diversity of kratom ( Korth.) products containing higher amounts of alkaloids including mitragynine and 7-hydroxymitragynine, safety becomes a public concern. The study aimed to estimate the prevalence of kratom use and to examine potential benefits and adverse effects based on kratom product formulations. A cross-sectional survey utilized a non-probabilistic nationally representative sampling with a total of 11,545 respondents of which 1,049 reported current kratom use, indicating a 9.1% prevalence. The most common kratom products used in the past 30 days were pills, gummies and powder formulations. Pain relief ( = 603, 57.5%) was the most common condition for using kratom, followed by relaxation/stress relief ( = 562, 53.6%) and boost energy ( = 520, 49.6%). The reported benefits were increased energy from tea bags and improved sleep with leaf or extract powders. A significant positive correlation was found between the increased frequency of consuming kratom shots/extract powder and pain relief ( = .009 and 0.015, respectively. A higher incidence of adverse effects was reported as the amount of kratom per dose increased with gummies/capsules/tablets/pills. The lack of standardization and consistency in kratom products results in unpredictable effects, emphasizing the need for increased research to establish reliable safety guidelines for dosage recommendations.

Little is known about ecstasy/MDMA use among Asian American and Pacific Islander populations. Research is important because AAPIs face unique cultural factors that may influence use. We estimated the prevalence and correlates of lifetime ecstasy/MDMA use based on a representative sample of US AAPI adults aged ≥18 from the 2015-2020 National Survey on Drug Use and Health. An estimated 5.1% of AAPI adults used ecstasy in their lifetime. Compared to males, females had higher odds of use (aOR = 1.45, 95% CI: 1.08-1.98). Compared to those aged 18-25, those aged 26-34 were at increased odds for use (aOR = 1.99, 95% CI: 1.30-3.06), while those aged ≥50 were at lower odds for use. Lifetime use of other substances including cannabis (aOR = 28.4, 95% CI: 17.1-47.2), ketamine (aOR = 10.9, 95% CI: 1.63-73.4), LSD (aOR = 3.82, 95% CI: 1.98-7.37), cocaine (aOR = 3.77, 95% CI: 2.54-5.59), psilocybin (aOR = 3.29, 95% CI: 1.75-6.16), prescription opioids (aOR = 2.43, 95% CI: 1.44-4.09), and prescription stimulants (aOR = 1.96, 95% CI: 1.29-2.99) were associated with increased odds of ecstasy/MDMA use. We estimated that over 1 in 20 AAPI adults have ever used ecstasy/MDMA. Variations by age, sex, family income, substance type, and mental health service utilization emphasize the need for targeted public health strategies.

While interest in psychedelic research has recently increased globally, little is known about use in Aotearoa New Zealand. Therefore, we sought to explore motivations, features of subjective experience, and impact of use. We also aimed to explore and compare positive, typical, and worst experiences. An online survey was completed by 997 individuals who had used at least one classical psychedelic in Aotearoa New Zealand. Worst, best, and typical experiences were compared, and logistic regression analysis was used to explore predictors of positive psychological health impact. Worst experiences differed substantially from best experiences across emotional, cognitive, and relational domains, while typical experiences more closely resembled best experiences. Motivations for use changed after initial experience, and motivations associated with different experience types varied. A higher number of psychedelic use occasions, as well as therapeutic and growth-oriented motivations, were significant predictors of positive psychological health impact. Consequences of psychedelic use were mostly positive, with best psychedelic experiences resulting in the most benefit. The findings highlight the potential of psychedelic experiences for personal growth and wellbeing and emphasize the need for an open-minded approach to drug education and policy development for the minimization of harm and maximization of benefit regarding psychedelics.

The medical utility of psychedelics has been the subject of significant scientific interest in recent years. While most of these substances remain Schedule I under the Controlled Substances Act, advancements in research have led states to consider expanding legal access, impacting primary care, where patients often seek mental health support and treatment. In July 2023 we conducted a cross-sectional survey of 770 Vermont primary care providers (PCPs) about their familiarity and concerns with psychedelics, as well as opinions on access and therapeutic value (response rate 17%). Two-thirds of respondents reported familiarity with psychedelics being used therapeutically, but less than half were aware of current regulatory statuses of LSD, psilocybin, and MDMA. Ninety-six percent were neutral or agreed that psychedelics have high therapeutic potential. The highest concerns were effects on youth, potential for psychosis, and traffic safety. Eighty-three percent were not at all or only slightly concerned about the inherent dangers of psychedelics. Seventy-seven percent were interested in further education. Overall, PCPs in Vermont, a state considering changes in access to psilocybin, are familiar with psychedelics, and cautiously optimistic about their therapeutic role. As research develops, it is important to incorporate resultant changes in policy and medicine into PCP continuing education.

The classic psychedelic psilocybin has attracted special interest across clinical and non-clinical settings as a potential tool for mental health. Despite increasing attention to challenging psychedelic experiences, few studies have explored the relevance of shame-related processes with psychedelic use. This prospective, longitudinal study involved sequential, automated, web-based surveys that collected data from 679 adults planning to use psilocybin in naturalistic settings at timepoints before and after psilocybin use. State and trait shame and feelings of guilt were collected using validated measures and assessed alongside other measurements of psychological health. Acute feelings of shame or guilt during psilocybin experiences were commonly reported (68.2% of users) and difficult to predict. Ratings of participant ability to constructively work through these feelings predicted wellbeing 2-4 weeks after psilocybin use. Psilocybin on average produced a small but significant decrease in trait shame that was maintained 2-3 months after use (Cohen's dz = 0.37). Trait shame increased in a notable minority of participants (29.8%). The activation of self-conscious emotions with psychedelics deserves further attention as a challenging experience subcategory that may be relevant to psychological outcomes. Such experiences could pose a unique and context-dependent learning condition for both therapeutic and detrimental forms of shame-related memory reconsolidation.

The world is witnessing a pharmaceutical opioid crisis, and in Africa's version, the nonmedical use of Tramadol is prevalent in vulnerable populations. However, data on the factors promoting nonmedical use of Tramadol in slums is generally lacking. The study explored the factors that promote the nonmedical use of Tramadol among urban slum-dwelling youth in the Asokore Mampong Municipality, Ghana. This qualitative study recruited 20 nonmedical Tramadol users from Asawase and Aboabo in the Asokore Mampong Municipality as participants. Data were gathered through face-to-face, in-depth interviews via the snowball sampling technique. Data were analyzed using themes and direct quotations. The study observed that Tramadol was used in quantities exceeding what is medically acceptable many times daily and in combination with other substances with psychoactive properties. Tramadol use was informed by its efficacy in providing physical (reducing tiredness, pain relief, and sexual enhancement) and psychological (mood enhancement) benefits. Easy accessibility and affordability of Tramadol, coupled with lax measures in checking substance use, contribute to its nonmedical use with other substances. The extent of abuse of Tramadol in the study setting needs urgent attention. Educational programs on substance use, counseling interventions, and effective drug monitoring and surveillance are required to curb the menace.

Amphetamine-type stimulants (including methamphetamine) are the second most frequently used illicit substances, after cannabis worldwide. The treatment dropout rate is higher among stimulant users than in the case of any other substance. Younger age, greater severity of the substance use disorder, lower motivation to change, and greater mental health problems are among the predictors of treatment dropout. Research showed that a brief intervention with cognitive-behavioral strategies and motivational interviewing addresses the most paramount issues. This paper investigates the differences between the individuals who dropped out and those who remained in the intervention. Twenty-one participants dropped out from the intervention, and 32 remained in the intervention. The analyzed variables included illicit substance use, severity of methamphetamine dependence, alcohol use (with distinction between spirits, wine and beer), motivation to change (readiness for change questionnaire), depressive and generalized anxiety symptoms, life satisfaction and self-efficacy. The results showed no differences between the two investigated groups except for beer consumed 30 days before the intervention. (the drop-out group consumed statistically more beer). The results showed that there is a need for further investigation since none of the substance use or person-specific characteristics differentiated dropping out from remaining in the intervention.

An interesting aspect of entity encounters during psychedelic experiences is their ability to transform one's religious beliefs. However, little is known about sex differences in these transformations. This study investigates sex differences in changes in religious beliefs before and after an entity encounter among ayahuasca users. Data were collected via an anonymous Internet-based survey ( = 415;  = 38.53,  = 11.39; male = 60.5%). Descriptive analyses, binary logistic regression, and two-proportion z-tests were conducted. Before the entity encounter, males were significantly more likely to identify as atheists (OR = 2.889,  = .001) and less likely to identify as having religious beliefs (OR = 0.453,  < .001) compared to females. After the entity encounter, no significant sex differences in religious beliefs were found (s >0.05). Comparing changes before and after the experience, both sex groups showed decreases in atheism and agnosticism and increases in religious beliefs, with males exhibiting larger changes. Specifically, the proportion of males identifying as religious significantly increased from before to after the entity encounter ( = 3.49,  < .001), whereas the increase for females was not statistically significant. Findings suggest sex is associated with perceived changes in religious beliefs among ayahuasca users reporting an entity encounter, highlighting the importance of considering sex in psychedelic research and its impact on spirituality and related outcomes.

Psychedelics have the potential to induce profound alterations in cognition, emotionality, and sensory perception. The quality and intensity of these subjective effects exhibit high intra- and inter-individual variability, which can potentially be accounted for by the variability in contexts in which psychedelics are used. Therefore, the aim of the present cross-sectional study was to investigate how internal and external contextual factors are related to the subjective intensity of psychedelic-induced ego dissolution experiences. Participants completed an online survey in which they reported their motivations for past use of psychedelic substances, and the frequency of use in different environments and social contexts. Additionally, participants completed the Ego Dissolution Inventory to evaluate the intensity of past ego dissolution experiences. Robust linear regression analysis was performed on data from 862 psychedelics users (701 had used LSD and 553 had used psilocybin mushrooms); this revealed that participants consuming psychedelics for spiritual or self-healing purposes reported more intense, while those motivated by curiosity reported less intense ego dissolution experiences. However, the social context and physical environment did not exhibit robust associations with the reported ego dissolution. Therefore, our study enhances understanding of how set and setting factors relate to psychedelic-induced ego dissolution experiences in naturalistic contexts.

Kratom () is a medicinal plant in Southeast Asia. While studies continue to highlight kratom's utility among poly-drug users, its context of use and therapeutic relevance appears opaque. This review evaluated studies reporting the therapeutic benefits of kratom use among poly-drug users in Southeast Asia, as perceived by the users. A literature search was conducted and only articles that narrated kratom use in poly-drug users in Southeast Asia were selected. A total of nine articles were reviewed. All the surveys were designed as cross-sectional studies and most ( = 7/9) originated from Malaysia. There were no significant differences in the context and motives of kratom use among poly-drug users in Southeast Asia. Kratom was reportedly ingested for a variety of purposes, but largely as an affordable substitute to opiates and amphetamine-type stimulants. Poly-drug users commonly use kratom to self-manage substance use disorder or drug dependence, decrease drug intake, alleviate withdrawal, and for its rejuvenating effects. Co-consumption was not associated with health issues. While these preliminary studies provided important empirical insights, the limitations in their design, sample selection, and focus underscore the need for further studies, including clinical studies, to establish the safety and claimed therapeutic value of kratom in poly-drug users.

The durability of ayahuasca's effects on mental health and the influence of clinical diagnoses on therapeutic response is unclear. Adults with no prior exposure to ayahuasca ( = 66) participating in neo-shamanic ayahuasca ceremonies completed questionnaires at baseline, 7 days, and 1, 6, and 12 months. Mixed models were used to characterize temporal trajectories in mental health, alcohol and cannabis use, affect, personality, spirituality, and relationships and examine the longevity of effects in individuals with and without a depressive or anxiety disorder. After multiple comparison correction, ayahuasca use was associated with decreases in depression, anxiety, stress, negative affect, negative emotionality, acceptance of external influence, and self-alienation at all time points. Improvements in mental health, self-efficacy, and spirituality were observed up to 12 months post-ceremony. Individuals with depression and anxiety diagnoses maintained significant symptom reductions, whereas those without a diagnosis experienced short-term benefits. Decreases in alcohol and cannabis use were only observed at month 1. Naturalistic ayahuasca use was associated with persisting improvements in mental health and wellbeing, with the largest magnitude of symptom reduction observed in those diagnosed with a depressive or anxiety disorder. Differing trajectories of change were identified across psychological constructs, suggestive of both enhancement and attenuation of gains over time.

The study aims to assess cannabis dependency among individuals who cultivate cannabis for medical and/or recreational purposes. Participants included growers who cultivated cannabis for personal use, social supply, caregiving activities, or illegal sales. Between December 2020 and August 2021, we conducted an online cross-sectional survey among Georgian cannabis growers. We used the International Cannabis Cultivation Questionnaire to measure the purpose of growing cannabis and the Severity of Dependence Scale (SDS). Logistic regression analysis was used to assess factors associated with cannabis dependency. Out of 218 cannabis growers, 193 (88.5%) grew cannabis for their personal use. Among participants, 132 (68%) used cannabis for recreational and 61 (32%) used it for medical purposes. The overall prevalence of cannabis use dependency was 37.7%. In multiple logistic regression analysis, medical users (AOR 0.39, P-value < .05) had lower odds of developing dependency compared to recreational users. Growers who used cannabis for medical purposes were more likely to consume it on a daily or almost daily basis. The majority of Georgian (illegal) cannabis growers use their products for their personal consumption, mostly for recreational purposes. This group had a higher odd of developing cannabis dependency compared to those growers who use cannabis for the medical purposes.

Little is known about whether smokers consistently show implicit liking attitudes and approach tendencies toward smoking in various smoking-related settings. This study aimed to examine the effects of static object and dynamic action cues associated with cigarettes on the liking and approach components of implicit attitudes toward smoking. Three experiments were conducted using a modified paradigm of the Brief Implicit Association Test (BIAT). In each experiment, participants were required to complete both the liking-BIAT and approach-BIAT. Experiment 1 showed that smokers exhibited fewer negative attitudes and more approach tendencies toward smoking than nonsmokers. Experiment 2 showed that neither liking nor approach tendencies of implicit attitudes toward smoking differed significantly in smoking-related and neutral situations among smokers. Experiment 3 showed that smokers exhibited more approach tendencies toward smoking under dynamic action cues associated with cigarettes than that under static object cues, whereas implicit liking attitudes were not significantly different under these two settings. The present results suggested that the approach component of implicit attitudes was more sensitive to smoking-related settings, including cues of cigarette-offering action, than implicit liking attitudes, which increased the understanding of distinct activation mechanisms of different components of implicit attitudes toward smoking.

Recreational use and misuse of nitrous oxide (NO) have increased in recent years among young people. The objective of present study was to assess the frequency and the clinical characteristics of NO use disorder (NUD) in a sample of health professions students. An online survey was distributed to health professions students. Age; sex; frequency (day/week/month/year/lifetime) of NO use, DSM-5 criteria for NUD; history of mental health treatment; and current use of antidepressant medication were systematically collected. All participants completed the French version of Alcohol Use Disorders Identification Test (AUDIT), and Cannabis Abuse Screening Test (CAST). A total of 2067 students (mean age 21.7 ± 2.6 years, 74.9% female) completed the survey. A total of 38.2% ( = 790) reported lifetime NO use. Among the 6.6% ( = 137) who fulfilled the DSM-5 criteria for current NUD, 5.5% ( = 114) had mild disorder, 0.8% ( = 16) had moderate disorder ( = 16) and 0.3% ( = 7) had severe disorder. Participants with NUD more frequently reported AUDIT scores > 12 (suggesting alcohol dependence), blackouts, a history of mental health treatment, and current use of antidepressants than did those without NUD. Longitudinal studies using structured interviews are needed to investigate potential associations between NUD and alcohol use disorders or psychiatric disorders in the general population.

Psychedelic drugs are currently being explored for their therapeutic potential for a variety of health conditions. The recent increased public interest in psychedelics necessitates empirical investigation into motivations for use among users as well as how motivations may change over time. We asked a large sample of participants reporting naturalistic psychedelic use ( = 1221) about their motivations for using psychedelics initially (i.e. their first time) as well as currently. We found that motivations for psychedelic use change substantially over time, with initial use typically for recreation or exploration, and later use more for therapeutic or personal growth reasons, including managing mental health conditions, growing spiritually, connecting with nature, improving creativity, and managing trauma. These results highlight the distinct and shifting motivations for engaging in psychedelic use. Although the study was limited by a retrospective design, it is the first to show that motivations for using psychedelics may change over time, with initial use focused on recreation and curiosity but subsequent use more motivated by self-improvement (e.g. enhancing relationships and health). Future prospective designs and qualitative interviews may aid in further elucidating the mechanisms underlying these shifts in motivations over time.

This mixed-methods study investigated the role of medicinal cannabis use among younger adults who live in rural communities and experience high levels of cumulative social disadvantage (CSD). Results are based on cross-sectional surveys and online interviews with 153 younger adults (18-35-years old) in rural California. We assessed participants' levels of CSD (high, medium, and low) and examined associations with perceived general physical and mental health and with medicinal use of cannabis (MUC). Qualitative analyses were then conducted to better understand the roles of cannabis use in the lives of study participants with high versus low CSD. High CSD was associated with perceived poorer physical and mental health and with MUC, but not past month general cannabis use. Qualitative findings emphasized the significant role of MUC for rural young people with high CSD to reduce stress and manage physical and mental health. Findings suggest the need to address CSD inequities in rural communities, such as increasing access to health care, to reduce health inequities and the reliance on cannabis use for managing mental and physical health.

There are currently no evidence-based treatment guidelines for antisocial personality disorder (ASPD). Instead, treatment typically focuses on comorbid conditions. There is currently no literature documenting cases or research, theoretical or otherwise of using ketamine-assisted therapy or any other psychedelic therapy in cases of ASPD. In this case report, a 43-year-old man seeking ketamine-assisted psychotherapy (KAP) for alcoholism and depression was diagnosed with comorbid antisocial personality disorder. A series of psycholytic (low dose) ketamine therapy sessions and other integrative approaches over the course of 3 years results in resolution of severe alcoholism, reduction in violent thoughts about people and the world, and a reduction in depression symptoms. With additional precautions, utilizing a ketamine-assisted psychotherapy approach led to clinical improvements in depression, alcohol abuse, and ASPD traits.

As psilocybin awaits approval by the Food and Drug Administration (FDA), scholars debate whether psychedelic-assisted psychotherapy should be required when prescribing this medicine. Here, we report the case of a patient who underwent a psilocybin experience without psychedelic-assisted psychotherapy, resulting in inpatient psychiatric admission. This case underscores the importance of taking psilocybin in controlled clinical settings. Moreover, we discuss how psychedelic-assisted psychotherapy could have altered the outcome of her experience and the role of experiential learning in psychedelics for potential prescribers.

This study explores the psychotic-like experiences (PLEs) associated with recreational ketamine use among young adults. Ketamine, initially introduced as an anesthetic, is now widely used recreationally for its dissociative effects, raising concerns about its impact on mental health. Ten participants aged 18-24, who used ketamine recreationally multiple times a week, were assessed using the Community Assessment of Psychic Experiences (CAPE-42). Results showed a significant positive correlation between the frequency of ketamine use and PLEs, with no significant impact from other substances like THC, MDMA, and alcohol. These findings confirm ketamine's potential to induce psychotic-like symptoms by antagonizing NMDA receptors, similar to schizophrenia. The study underscores the need for preventive measures and targeted interventions to address the mental health risks of frequent ketamine use, particularly among young adults. However, limitations such as the small sample size and reliance on self-reported data suggest that further research is needed to establish causality and examine long-term effects. Overall, this study highlights the significant association between recreational ketamine use and increased PLEs, emphasizing the importance of early detection and intervention strategies.

The increasing acceptance of cannabis use, and policy changes in several jurisdictions has led researchers and public health experts to call for a standard cannabis dose. Standard dosing units are useful tools for regulation, substance use guidelines, data collection, consistency of research, as a means of communicating low-risk recommendations and dose-related effects, and for self-monitoring. Efforts to standardize cannabis dose have focused on cannabinoid content without considering tolerance or mode. Cannabis users with diverse motivations for use and varying experience rated low, medium, and high doses across seven modes of use. The participants ( = 1368; 42% female) were 18-93 years of age ( = 31.64,  = 14.70) who had a cannabis use history. The Index of Cannabis Equivalence (ICE) identified the following low-dose cannabis equivalencies: two puffs on a joint, pipe, herbal or concentrate vaporizer is equivalent to one hit on a bong, a 5 mg/THC edible, and ¼ dab of a concentrate. These findings are based on responses from users with lower tolerance, which may limit generalizability to those with higher tolerance. The ICE proposes standardized cannabis doses through user-derived ratings across different administration routes. The meaningful standardization of units of cannabis products in a manner similar to what has been achieved for alcohol represents a valuable step in establishing standard doses across different modes of cannabis administration.

This study is a survey-type, cross-sectional study conducted in Brazil ( = 517), with online data collection taking place from April to June 2022. The main objective of this study was to evaluate the death anxiety in users and non-users of psychedelics. To this end, we also assessed the validity and reliability of the Death Anxiety Scale in Brazil. The following instruments were used for data collection: a questionnaire for sociodemographic characterization, Death Anxiety Scale, Death Transcendence Scale, and Spiritual Well-Being Scale. Our main results indicated the following: 1) increased death anxiety is associated with never or almost never having used psychedelics; 2) death transcendence, especially creative and religious factors, was the only constant variable in all the explanatory models of the variation in death anxiety; 3) there is a negative relationship between death anxiety and mystical and religious factors of death transcendence. We interpret these results as follows: it's not psychedelics that reduce death anxiety - psychedelics can favor the experience of transcending death. And it's the possibility of transcending death, (idea of continuity beyond physical death, taking both spiritual and symbolic forms) that helps reduce death anxiety. These findings offer valuable insights into the role of psychedelics in human mortality perception.

Co-occurring substance use disorders are common in medical settings, yet limited literature exists on concomitant pharmacological management. We present a case where low-dose buprenorphine induction (LDBI) and rapid phenobarbital taper were performed concurrently in a hospital setting to manage co-occurring opioid dependence (on chronic methadone maintenance therapy) and benzodiazepine dependence (prescribed alprazolam). The simultaneous management was well-tolerated and completed with minimal complications, successfully enabling candidacy for the patient's preferred disposition.

Non-medical use of nitrous oxide (NO) is becoming increasingly popular globally, yet little data exists regarding NO in Aotearoa New Zealand. We aimed to explore patterns of use and harm in those who consume NO in Aotearoa, and related knowledge, perceptions and attitudes of those with and without NO experience. A convenience sample of people with NO experience ( = 466) and without ( = 510) completed an online survey about NO. Most with NO experience reported infrequent and low-dose consumption. Harm reduction behaviors were utilized by most consumers, and reports of adverse effects were relatively low. Self-reported acute or chronic harm (primarily psychological) was reported by only 5.8% of the NO sample, whilst 9.2% reported ever experiencing persistent numbness (5.2% in the past 12 months). Self-reported knowledge about NO varied and was greater in those with NO experience. NO knowledge was generally poor, although more accurate in those with NO experience. Attitudes generally differed between those with and without NO experience, and perceived harmfulness and experience significantly contributed to attitudes regarding NO legality. Findings underscore the relative safety of NO when used recreationally, but also highlight the need for greater drug education around potential risks of NO use and harm reduction.

Portugal is commonly recognized as one of the best drug policy examples in the world. Nonetheless, contrasts between drug use risks in rural vs urban settings in the country is an understudied topic, even if its specific challenges are commonly affirmed, both by professionals and people who use drugs (PWUD). The aim of this study was to compare rural and urban environments concerning socio-sanitary services availability; illegal drugs availability; risk behaviors related to drug use; stigma associated with illicit drug use; and social support. Additionally, specific harm reduction challenges and recommendations for improvement were explored. A qualitative study with two focus groups involving people who use drugs, outreach workers and local decision-makers was conducted. Distinct scenarios and challenges in both settings were found: In large cities, a significantly higher specialized service coverage than in rural areas was described. In rural settings, a higher number of drug-related risks, higher levels of stigma and lower availability of human and material resources were mentioned, although being associated with higher levels of informal social support and more proximal relationships with harm reduction teams. This study emphasizes the need for a harm reduction paradigm strongly focused on environmental risk determinants, as much as in individual ones.

Recent research on the potential therapeutic value of psychedelic substances has led to changes in media representation and drug policy in some U.S. states. Yet, little is known about lay perceptions of these substances. The current study aimed to describe health perceptions of psychedelic substances, test differences in perceptions of therapeutic vs. recreational use of psychedelic substances, and determine if such perceptions vary by use experience. Participants ( = 309) completed an online within-subjects experiment in which they responded to measures of positive and negative perceptions of therapeutic and recreational use of psychedelics. Endorsement of positive and negative health perceptions of psychedelics was moderate to strong. Recreational use was perceived as having more negative health consequences, while therapeutic use was perceived as having more positive health consequences. Participants who reported lifetime psychedelic use (40.7%) perceived both recreational and therapeutic uses as having more positive health consequences, and this pattern was consistent across most perception domains. The outcomes suggest that public perceptions of use may change based on reason for use. This information may aid in filling current gaps in knowledge and identifying potential targets for public health communications, and such approaches may benefit from considering prior use experience.

The ever-changing landscape surrounding legality and accessibility of psychedelics and their increasing popularity make it imperative to better understand the nature of psychedelic use by the general population. To this end, 1,486 eligible respondents ( = 29.58, 67.1% male) residing in the United States completed an online survey designed to assess the types of psychedelics used, methods of administration and dosing, frequency of use, intentions for use, context/environments in which they are used, perceived acute effects, frequency of those effects and distress about them, and their perceived residual effects and distress about them. Respondents predominantly endorsed using MDMA, LSD, DMT, and psilocybin. The predominant methods of administration were oral. Most reported using psychedelics for recreational purposes. The most endorsed acute effects were hallucinations, increased heart rate, positive mood, and visual tracers, while the most endorsed residual effects were headaches/migraine, dry mouth, nausea, hallucinations, and anxiety. Participants were most distressed by negative mood states, vomiting, and nausea when under the acute effects of psychedelics, but mean distress ratings were low. These results can help inform clinical trials, reform policy regarding legal access to psychedelics, and track changes in these metrics as sociocultural and legal landscapes continue to shift.

New legal frameworks for supervised psychedelic services are emerging, with Oregon and Colorado implementing programs to train and license psilocybin facilitators. This study describes Oregon's early psilocybin facilitator workforce and assesses state-approved training programs. The Open Psychedelic Evaluation Nexus (OPEN) reviewed Oregon Health Authority-approved training programs and surveyed facilitators who had completed or were enrolled in these programs between July and November 2023. Data collection included a review of public listings, contact with training programs, and facilitator survey. Results indicated that in the 16 active training programs, the mean tuition was $9,359 and half offered diversity scholarships. Survey respondents ( = 106) were relatively diverse; many had an existing healthcare license. The majority reported that training expenses were a moderate-to-severe financial strain. Most were satisfied with training. The mean planned price for a session was $1,388 and the most common areas of specialization were trauma, mental disorders, consciousness exploration, and spirituality. Facilitators requested ongoing training opportunities. In conclusion, Oregon's emerging psilocybin facilitator workforce and training programs are in early development. These findings are crucial for informing future policy and training program development to support a diverse and effective workforce.

Cannabidiol (CBD) has a wide spectrum of potential therapeutic use and is growing in popularity. However, there is a need to characterize users, as associated benefits and risks may differ depending on the pattern of use. This study explored the characteristics of French and Italian CBD users according to their primary reason to use it. We analyzed data from an online survey of French ( = 1164) and Italian ( = 2608) cannabidiol users. We compared their characteristics according to their primary reason to use CBD, and identified correlates of therapeutic use with logistic regressions. In both countries, users' characteristics differed according to their reasons to use CBD. Reporting therapeutic use was associated with daily CBD use and nonsmoking routes of administration in both countries. User profiles differed according to their primary reason to use it. However, similarities in characteristics were found between both countries for users who used CBD for therapeutic reasons. Accordingly, analyzing the reasons to use CBD would appear to be a pertinent way to characterize users and identify their unmet needs in terms of self-care.