Synthetic stimulant drugs in Italy are evolving rapidly, with amphetamine-type stimulants (ATS) and synthetic cathinones (SC) representing a growing public health challenge. However, no previous study has integrated multiple surveillance indicators to assess the availability and consumption of these substances across Italy. This systematic review synthesized comprehensive evidence published between 2000 and 2023 from three monitoring indicators: drug seizures reports, wastewater-based epidemiology (WBE), and toxicological/clinical studies. Searches of Scopus, PubMed, and Google Scholar identified 969 records, of which 49 studies and reports met the inclusion criteria: 15 on drug seizures, 18 on WBE, and 16 on toxicological studies. Eligible articles were fully reviewed and summarized. Results indicated a diverse and evolving landscape, with increasing detection of synthetic cathinones and significant regional variation in ATS and SC consumption. In total, seven ATS and twenty-five SC were identified across all indicators. Amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), 4-methylethcathinone (4-MEC), and methylenedioxypyrovalerone (MDPV) were consistently detected in seizure, wastewater, and toxicological data, indicating their availability and consumption in Italy. WBE studies showed marked spatial and temporal variability in stimulant consumption, while seizure and toxicological data highlighted the increasing diversification of synthetic cathinones in the Italian drug market. Key limitations include uneven geographical coverage and methodological heterogeneity among studies. The findings demonstrate the value of integrating WBE, forensic, and law enforcement indicators to strengthen surveillance of emerging stimulant drugs in Italy.

Racial-ethnic minoritized individuals face persistent disparities in mental health service utilization, which are shaped by structural and interpersonal racism. This study examined whether racial microaggressions in counseling were indirectly associated with substance use through their impact on help-seeking intentions and psychological distress. A serial mediation model was tested using self-report data from a community-based sample of racial-ethnic minoritized adults (N = 223). Results indicated that prior experiences of racial microaggressions in counseling were associated with lower help-seeking intentions, which in turn were linked to greater psychological distress and increased substance use. Although the total effect of racial microaggressions on substance use was not significant, the indirect pathway was significant, underscoring the importance of examining mediating mechanisms that impact substance use outcomes. These findings highlight how interpersonal racism in therapeutic settings may contribute to adverse mental health outcomes and emphasize the need for culturally humble, affirming mental health care. Implications for clinical practice and equity are discussed using frameworks from Critical Race Theory and the Social Determinants of Health framework.

Overdose rates among Black men have increased fourfold since 2015. Several systemic factors contribute to Black men's opioid use outcomes, including the impact of the carceral system. Given the heightened risk of opioid overdose upon release from incarceration, there is a need to examine the structural impact of incarceration on opioid use among Black men. Thus, the current study examines the incarceration experiences of 20 Black men who use opioids to better understand how these experiences influence their drug use. The reflexive thematic analysis revealed five key themes: (1) Socialization of Carceral Systems Throughout Development, (2) Varied relationships of Opioids While Incarcerated, (3) Access to Treatment Programs/Resources While Incarcerated, (4) Cycle of Incarceration, Racism, and Illicit Opioid Use, and (5) No Implication. These themes and respective subthemes demonstrate the significant and pervasive impact of the carceral system on Black men's opioid use experiences and trajectories, for many shaping patterns of opioid use during incarceration and following release. Considerations for researchers and practitioners are provided based on the study findings.

The use of ketamine as a treatment for mood disorders continues to grow in popularity. However, the differences between individuals consuming ketamine within clinical settings and those self-medicating in casual, non-clinical settings has not been yet characterized. Using the 2023 Global Psychedelic Survey, this study aimed to examine the demographic and clinical characteristics, as well as the self-reported effectiveness and hallucination-related side effects, of ketamine use by comparing individuals using ketamine with and without medical supervision. Compared to clinical ketamine consumers (n = 238), non-clinical consumers (n = 222) were more experienced in use of various psychedelic (p < .0001) and non-psychedelic recreational substances (p < .001), and lifetime use of ketamine (p < .0001). Both groups presented with similar mild depression and anxiety symptoms at the time of the survey collection (p = .22, p = .46). Ketamine was similarly and highly rated in effectiveness within both groups when rated on a scale of 0-100 (83.3 ± 15.0 clinical, 81.2 ± 16.6 non-clinical; p = .45). Non-clinical consumers presented higher odds of reporting long-term hallucinations following ketamine use (OR = 2.58, 95% CI: 1.08-6.31). The results of this study indicate a high self-reported effectiveness of ketamine in clinical and non-clinical settings while emphasizing the potential risks of side effects when used without medical supervision.

Due to the psychotropic properties of kratom (Mitragyna speciosa), further studies are needed to measure its neurobiological impacts. This exploratory study employed resting-state functional magnetic resonance imaging (rs-fMRI) to examine alterations in brain activity and functional connectivity (FC) among kratom users. A total of 43 respondents were recruited (22 regular kratom users and 21 healthy controls). RS-fMRI data were acquired using a 1.5T GE Signa HDxt scanner. Preprocessing and analysis were performed with Statistical Parametric Mapping 12 (SPM 12) and CONN toolbox. Group differences in the low-frequency fluctuations (LFFs) and FC were examined. Kratom users exhibited reduced LFF in brain regions critical to the default mode network (DMN), cognitive control, and self-referential processing, including the precuneus, superior frontal gyrus, and cerebellar and cingulate cortices. They also showed increased FC between salience and cerebellar networks, specifically in the posterior cerebellum, and left rostral prefrontal cortex (RPFC). Chronic kratom consumption may alter brain activity, especially in areas linked to the DMN, cognition, and reward processing. Enhanced FC between salience and cerebellar networks may reflect compensatory mechanisms or adaptations to kratom's effects. Further research is crucial to elucidate the underlying mechanisms and potential implications for cognitive function and addictive behaviors.

Cannabigerol (CBG) and the acidic form of CBG (cannabigerolic acid, CBGA) are becoming increasingly more available and popular, with pre-clinical rodent research suggesting these compounds have an array of therapeutic effects. However, there have been few clinical trials or surveys examining their effects in humans. We conducted a survey of 239 CBG/CBGA users to assess the medical conditions they use CBG/CBGA to manage, as well as their perceived efficacy and satisfaction with CBG/CBGA for managing these conditions. Participants also reported on their typical use patterns (e.g. typical dose), their perceived time to feel effects, and duration of those effects. The top five conditions participants reported using CBG/CBGA to manage were insomnia/disturbed sleep (62%), inflammatory chronic pain (44%), anxiety (33%), episodic pain (29%), and neuropathic chronic pain (28%), with participants generally reporting that CBG/CBGA "slightly improves" to "much improves" their symptoms. Participants reported typically using a dose of 10-12 mg of CBG and they indicated that they feel effects within 15-60 min of oral ingestion and that these effects persist for 4-6 h. These findings will help inform consumers of CBG as well as researchers designing clinical trials to investigate the effects of CBG on humans in a more objective manner.

Psychedelic experiences often evoke a sense of familiarity, an experiential quality that has received little empirical attention despite its potential therapeutic and cognitive significance. This study examined psychedelic-evoked familiarity in comparison to non-drug-induced forms of familiarity, including autobiographical and déjà vu experiences. An anonymous online survey was administered to 1050 participants, who completed the Sense of Familiarity Questionnaire (SOFQ) and psycho-emotional ratings for at least one of three experiences: Psychedelic, Autobiographical, or Déjà Vu. Across all SOFQ items, Psychedelic experiences were rated significantly higher in familiarity, particularly within the "Familiarity with Transcendent Features" category. Psychedelic experiences were also associated with greater emotional intensity, novelty, and comfort, with no increased anxiety, relative to the other experience types. Classic psychedelics generally elicited strong familiarity, while psycho-emotional responses varied across psychedelic types. Most participants described the familiarity as authentic and positively impactful, and approximately half reported enduring effects such as emotional transformation, interconnectedness, and reduced fear of death. These findings suggest that psychedelic-evoked familiarity is phenomenologically different from autobiographical and déjà vu familiarity. Psychedelic-evoked familiarity warrants further investigation to determine whether it serves as a phenomenological driver of the enduring psychological and existential benefits associated with psychedelic experiences.

Many young adults use vaping products to vape both nicotine and cannabis. Yet, there is a dearth of understanding on their motives for use and risk perceptions of vaping that could have significant clinical implications for designing interventions. In this study, social media was used to recruit 97 young adults aged 15-25 who reported vaping in the past month. Participants completed an online survey assessing vaping behaviors, perceived risks of vaping, and interest in treatment. Descriptive statistics and differences between participants vaping nicotine only and those vaping nicotine and cannabis (dual use) are reported. Vaping was found to be frequent and consistent among all participants, reported on average 25 of the past 30 days. Half of participants reported vaping nicotine only (n = 48, 49.5%) and half reported dual use (n = 49, 50.5%). Participants vaping nicotine only were more likely to perceive vaping as less harmful than smoking (65.9% vs 39.6%; p = .01) and were less likely to report concerns about the negative health consequences of nicotine vaping (Mean (SD): 6.6(2.5) vs 7.7(1.3); p = .01). Two thirds of participants reported interest in quitting, however less than 5% reported receiving treatment. These findings underscore the diverse motives and risk perceptions that shape frequent and dual vaping behaviors and can inform tailored treatment efforts.

This qualitative study examines self-reported experiences with 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) shared on Reddit to explore subjective reports, contextual influences, and perceived effects. A total of 120 posts from 24 discussion threads were purposively selected and thematically analyzed using an inductive, constructivist approach. The analysis resulted in 48 codes, which were grouped into seven categories: Administration Methods, Dosage, and Tolerance; Experiential and transformative effects; Pharmacological specificity and interaction; Risk, adverse effects, and harm reduction; Socio-cultural and contextual factors; Support, preparation and integration; and Therapeutic and health-related effects. Users described individualized dosing strategies and a distinct tolerance profile compared to other psychedelics. Narratives emphasized introspective, emotionally cathartic, and spiritually unifying experiences that were often viewed as transformative life events. A preparatory context, supportive environment, and sustained integration practices were seen as essential. Users were aware of pharmacological interactions, particularly with serotonergic medications, and emphasized harm‑minimization measures such as the presence of a trusted sitter. Socio-cultural narratives about the origins, traditions, and ethics of 5-MeO-DMT shaped perceptions and motivation. These findings contribute to the literature on real-world use of psychedelics by highlighting the interplay of pharmacology, personal mind-set, and cultural context, and providing information on harm reduction, preparation, integration, and future research priorities.

Simultaneous alcohol and cannabis (i.e. marijuana; [SAM]) use is prevalent among college students and is linked to greater negative consequences than using alcohol or cannabis alone or using both substances concurrently. While certain sociodemographic factors are associated with alcohol and cannabis use individually, little is known about which sociodemographic factors are associated with SAM use specifically. The present study examined several sociodemographic variables potentially associated with SAM use in a large, ethnically/racially diverse multi-site sample of college students (n = 3655, 69.7% women, 51% White). Significant differences were not found for most sociodemographic factors between groups differing in endorsement of past-year SAM use. However, students who lived at home with parents or relatives and those living on-campus were both less likely to report engaging in past-year SAM use than those living in off-campus housing. Regarding differences in SAM use frequency, age, gender, race, fraternity/sorority membership, and residency status were significantly associated with frequency of SAM use, whereby older, White, fraternity/sorority members, or students identifying as men were more likely to engage in frequent SAM. Conversely, living with parents or relatives or on campus made it less likely that students would endorse frequent SAM use relative to living off-campus. These findings underscore important sociodemographic factors in understanding, and developing interventions for, problematic SAM use among college students.

This study explores hallucinogen use, comparing adults with and without a recent history of justice involvement. While past research finds that justice-involved adults are more prone to health problems and substance use behaviors, less attention has been paid to hallucinogen use. Using data from 2021 to 2024 National Survey on Drug Use and Health, we assessed the association between past-year justice involvement and hallucinogen use among U.S. adults. Logistic regression models include demographic characteristics, health-related measures, and other types of substance use. Results indicate that hallucinogen use continues to increase, particularly among adults with recent justice involvement. While both poor health and substance use behaviors were significantly associated with hallucinogen use, once other types of substance use were included in the analysis there was no longer a significant difference in hallucinogen use based on justice involvement. Lastly, we identified several differences in correlates of hallucinogen use among adults with and without justice involvement. Research on hallucinogens is important as some states have moved to decriminalize use and prevalence has increased in recent years. Given the increased risk for poor health and substance use among adults with criminal justice contact, research in this area is important.

Kratom is a psychoactive herbal substance derived from a tree indigenous to Southeast Asia that provides both stimulant and analgesic (opioid agonist) effects. It is currently available in most areas of the United States and has potential for misuse/abuse. The proper treatment of kratom use disorder is not widely defined, but prior case reports and case series purport that sublingual buprenorphine/naloxone is an effective treatment. Pain management clinical pharmacist practitioners (CPPs) are uniquely equipped to work as independent providers and implement the treatment of many disease states including kratom use disorder. We present a case report of a patient who was referred to the CPP-run pain pharmacotherapy clinic for management of chronic lower back pain and shoulder pain in the setting of long-term kratom use. While collaborating with the patient's primary care provider, it was determined that buprenorphine/naloxone would be started to treat his chronic pain and kratom use disorder/dependence. The pain CPP led, planned, and performed the induction of buprenorphine/naloxone and frequently followed up with the patient to reassess his symptoms. The buprenorphine/naloxone, along with other pharmacologic and nonpharmacologic treatments, successfully managed his pain and other symptoms without significant withdrawal or return of cravings.

As psychedelic use increases, understanding how demographic and behavioral factors influence the effects of psychedelics is essential for both research and public health. This cross-sectional retrospective study examined 365 people who currently use psilocybin, analyzing differences in acute experiences, psychological outcomes, and substance co-use patterns. Participants were categorized into young (18-25), middle-aged (26-54), and older (55-77) adults. Results showed that younger participants reported significantly more adverse experiences while older adults had milder effects. Despite differences in adverse experiences, age did not significantly impact mystical experiences, psychological insight, or psychological outcomes. Polysubstance use patterns also varied by age, as younger adults were more likely to co-use nicotine with psilocybin. Cannabis co-use specifically was associated with greater perceived improvements in quality of life, anxiety, depression, and alcohol abuse, suggesting potential synergies between psilocybin and THC. These findings emphasize that age and cannabis co-use may modulate aspects of psilocybin's acute effects and therapeutic outcomes. Given the increasing legalization and accessibility of psychedelics, future research should further investigate mechanisms underlying individual differences and assess the impact of polysubstance use with psychedelics.

Few studies have examined perceptions of psilocybin for use in a mental health context. In two studies involving independent samples (total N = 1,102), we examined the intentions to use psilocybin in a mental health context in relation to psychotherapy, psychiatric medication, and natural versus synthetic options. We also examined potential predictors of the intentions to use psilocybin. In Study 1, we found that participants had significantly lower intentions to use psilocybin in a mental health context versus psychotherapy and traditional psychiatric medications. We also found that males reported being more open to using psilocybin as compared to females whereas females reported being more open than males to using psychotherapy. Finally, psilocybin use intentions were negatively associated with age, and positively associated with mindfulness, narcissism, and current self-reported depression. In Study 2, we found that participants had stronger intentions to use a natural version of psilocybin isolated from mushrooms as compared to an identical synthetic version or a synthetic psilocybin analog that elicits the same biological effects (i.e. the three types of psilocybin or psilocybin-like compounds currently of interest). Overall, these studies provide novel insights into the factors that might influence psilocybin use in a mental health context if FDA-approved.

There is still inconsistency in psychedelic research across the United States. There are gaps in our understanding of the psychedelic community's perception of topics including reasons for use and set/setting. The goal is to utilize these findings to produce better quantitative research, to ask the right questions of the right communities. This qualitative study organized focus groups from people who use psychedelics for: 1) recreational/spiritual and 2) mental health reasons. We conducted 10 focus groups with 29 people. The data were analyzed using Grounded Theory. A primary coder (JJ) inductively coded the transcribed audio recordings, and a secondary coder (CJ) deductively coded the data using JJ's codebook. Four themes emerged. We learned that people who use for recreational reasons often still use with purposive intent. Secondly, there is evidence of preparation and integration with their use. In those that use for mental health reasons, it was not uncommon to have a history of prior psychedelic use, and those individuals also had concerns about access to psychedelics for others who needed mental health treatment. These themes provide useful information for researchers to develop data collection tools for harm reduction and therapy techniques that are grounded in community perspectives and supportive literature.