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Official websites use. Share sensitive information only on official, secure websites. Janicijevic kaja. This article was submitted to Pharmaceutical Medicine and Outcomes Research, a section of the journal Frontiers in Pharmacology. Keywords: psychoactive substances, adolescent, socioeconomic factors, national health survey, Serbia. The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Adolescence is a period of transition from childhood to adulthood, characterized by efforts to achieve the objectives related to the expectations of the culture, as well as the requirements of the physical, mental, emotional, and social development. It has its own characteristics in the biological, psychological, and social terms, with a process of identity formation, the development of social, and moral norms of behavior McCabe et al. Adolescence is a period of great settings in which experimentation with psychoactive substances is common and can, in some cases, lead to the development of long-term addictive behavior Jeannin et al. Psychoactive substances include licit, illicit, and prescribed psychoactive medications. Alcohol and cigarette are among the licit and controlled drugs, while marijuana, cocaine, heroin, lysergic diethylamide LSD , crack, and ecstasy are illicit drugs Kassa et al. The use of psychoactive substances in adolescents is often associated with a socioeconomic factors, such as gender, age, type, race, ethnicity, family, and social structures, socioeconomic status of the family Gebreslassie et al. Significant risk factors for psychoactive substances use among adolescents were poor parental involvement in the child's education, conflictual family relationships, and drug abuse by the parents, friends, and neighbors Kpozehouen et al. Also, parental alcoholism, parental divorce before age 18, and parental death before age 18 increased the odds of abuse psychoactive substances Vaughan et al. Socioeconomic environment in which young people were raised as children predicts their behavior in young adulthood. Understanding this relationship, is an important step in identifying persons at risk Tobler et al. In order to identify the risk factors and protective factors associated with psychoactive substances abuse among young people, it is very important to measure how socioeconomic factors influence the attitudes and behavior of young toward the use of psychoactive substances Carter et al. The study of health of population in Serbia conducted in was the source of used data. This was the third national population health survey conducted by the Ministry of Health of the Republic of Serbia 1. Fieldwork was conducted in the period from 7 October to 30 December , which respected the legislation relating to the European Health Research—second cycle: the collection of data in the field should take at least 3 months of which at least 1 month should be in the period from September to December, or in the fall. In order to achieve a high level of quality of the collected data, to provide a high response rate of households and in order to protect the representativeness of the sample, the election, and training of interviewers had been organized prior to the commencement of field work, and also guidelines for the monitoring and control of field work were given to them. The study used the most complete population register that includes a sampling units defined within the target population—Census of Population, Households, and Dwellings in the Republic of Serbia conducted in In accordance with the recommendations for the implementation of population health research EUROSTAT, the European Health Research—Second Wave—Methodological guide EHIS wave 2, Methodological manual the National representative probability sample was used: two-stage stratified sample with a known probability of selection of sample units at every stage sampling. The mechanisms that have been used to obtain a random sample of households and respondents represent a combination of the two sampling techniques: stratification and multi-stage sampling. Health Survey of the Serbian population was carried out through interviews, anthropometric measurements, and blood pressure measurements. Three types of questionnaires were used in the survey: Questionnaire for Household—collecting information on all household members, the characteristics of the household, as well as on the characteristics of the household residence. The questionnaire had to be completed in the course of verbal communication between the interviewers and interviewees who represented the main person in the household to answer questions of interest. Self-administered questionnaire which should be filled in by each household member aged 15 and over without the participation of the interviewer. In order to respect the privacy of the subjects of research and confidentiality of information collected, all necessary steps were taken in accordance with the Law on Personal Data Protection Off. Also, interviewers needed to obtain the signed informative consent of each of the participants for accepting to participate in the survey. In research, the collection of data that identify the respondents was avoided to the greatest possible extent necessary identifiers were removed at the earliest stage of statistical analysis and replaced with code. In the Serbian National Health Survey , a total of 6, households and 13, participants aged 15 and over were interviewed. Out of total of 10, households contacted, 6, of them agreed to participate in the survey, so that the response rate of households was Out of total of 16, registered household members aged 15 and over, 14, of them agreed to be interviewed, giving a response rate of Out of this number of people who agreed to be interviewed, 13, of them accepted to complete the self-administered questionnaire response rate For the purposes of this study, we analyzed data on respondents aged 15—24 years 1, interviewed respondents. Of the independent variables, the researchers used demographic characteristics age, gender, type of settlement, region and socioeconomic status education, employment, and well-being index. Participants' age was categorized in to two age groups 15—19 years; 20—24 years. Gender is coded as male and female, place of residence as urban and rural, regions of Belgrade, Vojvodina, Sumadija, Western, Southern, and Eastern Serbia. Variables that reflect the socioeconomic situation are education, which is designated as higher, secondary, and elementary, employment status as employed and unemployed and household. The Wealth Index is based on household assets and housing characteristics, such as the possession of color TV set, cell phone, refrigerator, dish washer, washing machine, PC, AC, car, construction material of floors, roofs and walls, the number of bedrooms per household member, type of drinking water resources, and sanitation facility as well as heating fuel and Internet access. Based on the Wealth Index, households were classified into five groups of equal size—quintiles: 1 the poorest Q1 , 2 poorer Q2 , 3 middle Q3 , 4 richer Q4 , and 5 the richest Q5. For the purposes of this paper, respondents were classified into three socio-economic categories: poor class, middle class, and rich class. As the dependent variable in this analysis were used: cigarette smoking daily and occasional , alcohol abuse, and abuse of other psychoactive substances drugs and illicit drugs. Data has been uploaded as Excel file while questionnaires are in PDF formats. Readers can retrieve and reuse publicly available information by visiting links given above. The highest percentage of respondents has completed secondary education In relation to the employment status the highest percentage belongs to the group of inactive or unemployment population More than half of the respondents live in urban areas When it comes to well-being index, the largest percentage of respondents belongs to the rich class The study depicted that in the past 12 months of the study period The prevalence of illicit psychoactive substances such as cannabis, ecstasy, LSD, cocaine, crack, heroin was 0. Binary logistic regression analysis has not shown a statistically significant impact of examined factors on the prevalence of cigarettes smoking. Results of binary logistic regression showed that alcohol consumption can be determined by age, gender, education, type of settlement, well-being index physical, and psychological violence. The prevalence of alcohol consumption in men is Respondents with higher education have Young people who live in urban areas are 1. Members of poor class for Also those who assess their health as good to make less frequently by Bivariate logistic regression analysis showing socioeconomic correlates of psychoactive substance abuse by adolescents in Serbia. Psychoactive substances abuse represents a significant problem of the individual, family, and society, leaving a lot of effects on mental and physical health Milovanovic et al. There are also significant costs borne by society due to the direct and indirect consequences of abuse and dependence on certain substances Jakovljevic et al. Drug abuse is a global problem, and methods of use and consequences of individual and socio-cultural are specific. The consequences of the abuse of substances may be various: education and unemployment, reduced work productivity, poor health, higher rates of human immunodeficiency-HIV and hepatitis B, C infections Jakovljevic et al. According to the World Health Organization, alcohol, and tobacco are the most commonly abused substances World Health Organization, , Eastern Europe and the Balkans region report the high rates of alcohol abuse Jovanovic and Jakovljevic, Alcohol abuse is a health problem that significantly contributes to the global disability liver-diseases, cardiovascular diseases, traffic accidents, fights, murders, suicides; Jakovljevic et al. Psychoactive substances present a great challenge of public health issue worldwide particularly regarding to the social vulnerable population of adolescents Jakovljevic et al. According to the results of the Serbian National Health Survey, distribution of smoking in adults population was Aforementioned dataset showed that there are significant differences in the abuse of psychoactive substances among young people in Serbia, depending on the demographic and socioeconomic characteristics of the respondents. They are consistent with the findings of other studies that show that there is no difference between the sexes for cigarette smoking and experimentation with drugs. It is more connected with young men. Young people of lower age groups and those who attend the school are negatively associated with the abuse of cigarette, alcohol, and illicit drugs Patrick et al. Other studies have shown that young people with low levels of education are regarded as high risk for consumption psychoactive substances Quek et al. Anxiety, low self-esteem, and self-control, as well as the low level of parental control also poses a risk for abuse belt Roy et al. Characteristics of mental health, such as loneliness and insomnia are positively associated with the abuse of tobacco, alcohol, and illicit drugs. The lack of a friend is a positive correlation with the abuse of tobacco, and illicit drugs, and the negative with the abuse of alcohol Malta et al. Also young people who abuse psychoactive substances, are more likely to have higher levels of psychological stress and decreased levels of self-efficacy to resist peer pressure Champion et al. Other studies have in turn shown that the lower the level of education of parents associated with a higher risk of psychoactive substances abuse Johnston et al. Heavy episodic drinking are frequent among young people who live in incomplete families Patrick et al. Some studies have shown that there is no significant difference in substance abuse between urban and rural areas, but there is the presence of higher levels of knowledge about the psychoactive substances in urban areas Martinotti et al. Many studies that have investigated the correlation of demographic and socioeconomic variables with the abuse of psychoactive substances have shown that high degree of religiosity, higher parent's education living with one or both parents reduces the chance to abuse, while high the socioeconomic status of the family increases the likelihood of psychoactive substances use Goodman and Huang, ; Hanson and Chen, ; Schoenborn and Adams, Children who come from wealthier families with higher socioeconomic status may be at increased risk for the abuse psychoactive substances which can be explained by the fact that their experience more pressure achievement combined with isolation of parents who have careers more demanding. In addition, parents with higher socioeconomic status in comparison with those in the lower socioeconomic status families can have positions that are tolerant of the substance abuse Luthar and Goldstein, The higher income families may be related to the use of psychoactive substances because of increased access to, or to buy the substance and have a social association with others who also have financial resources. On the other hand, a lower revenue may be associated with the abuse of psychoactive substances such mechanism of survival due to increased stress and less access to alternative actions that can be a focal point for preventive strategies Goodman and Huang, Despite worldwide concern and education about psychoactive substances, many adolescents have limited awareness of their adverse consequences Oshodi et al. Preventive activities should be carried out through the development of specific programs to promote healthy lifestyles, strengthening the implementation of existing programs, and the promotion of prevention through various forms of educational activities, including peer education, supporting youth initiatives for the implementation of actions aimed at the affirmation of healthy lifestyles, develop social skills, informing young people, and parents about the risks of consuming psychoactive substances through school programs and workshops in schools, identification, and reduction of risk factors in the school environment. In perceiving the frequency of using illegal drugs, it should take in mind specific limited researches of health in national population, because the drugs abuse, as social non acceptable behavior endanger sincerity of patients during answering these questions. All authors listed, have made substantial, direct and intellectual contribution to the work and approved it for publication. KJ and SMR drafted the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. As a library, NLM provides access to scientific literature. Front Pharmacol. Find articles by Katarina M Janicijevic. Find articles by Sanja S Kocic. Find articles by Svetlana R Radevic. Find articles by Mirjana R Jovanovic. Find articles by Snezana M Radovanovic. Sherif, University of Tripoli, Libya. Received Apr 27; Accepted May 26; Collection date Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Gender a. Education b. Emplyment status c. Type of settlement d. Well-being index e. Self-assessed health f. Exposure to physical violence in the family, in school, on the street. Exposure to psychological violence in the family, in school, on the street.

Hidden panels, counterfeit bottles, fentanyl: A year of buying drugs in Mexican pharmacies

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That pretense faded seconds later, when she was asked for controlled medications — and got on her hands and knees to pop open a hidden panel under the counter. She rooted around for a minute and emerged with two sealed bottles. In pharmacy after pharmacy in this Mexican resort city, workers offered similar assurances, but time and again the pills proved to be fakes. There were oxycodone pills that tested positive for heroin and over-the-counter cough medicine, and Vicodin tablets that turned out to be fentanyl. Pills sold as Adderall were sometimes methamphetamine or caffeine, and sometimes simply an appetite suppressant. Others denied ever selling medications they had in fact sold just minutes or hours earlier. Last month, reporters visited dozens of drugstores in Mexico to interview pharmacy workers and piece together a fuller picture of the counterfeit medication problem The Times has been investigating for nearly a year. Despite pharmacy raids by Mexican authorities and a warning from the U. State Department, the latest round of testing found that fake medications appear even more plentiful at independent drugstores and regional chains in tourist hot spots and border towns now than earlier this year. Some of the counterfeits are now more sophisticated, and lab testing found a wider array of substances in them than previously documented. And the latest reporting in Puerto Vallarta and Cabo San Lucas found that workers at small chains and individual pharmacies alike often went to great lengths to convince potential customers of the safety and efficacy of their counterfeit wares. The Times is not naming independent pharmacies or workers due to safety concerns, including the threat of violence. After visiting 10 vacation spots and border towns across Mexico this year, reporters used drug-testing strips and later lab testingto show that travelers who shop at pharmacies there risk unwittingly buying pills tainted with powerful drugs, including fentanyl, heroin, meth and MDMA — also known as ecstasy. In February, The Times reported that some drugstores in Tijuana and the Los Cabos area were selling loose pills over the counter, passing off tablets containing fentanyl and meth as expensive brand-name medications, including Percocet and Adderall. A team of UCLA researchers, including Goodman-Meza, reported similar findings in four unnamed cities in northwestern Mexico around the same time. But U. Later, reporters showed that several stores and at least a few regional chains had begun selling tainted medications by the bottle, in elaborate packaging that was sometimes indistinguishable from the real thing. A few medications were consistently legitimate, including the opioid painkiller tramadol and the ADHD pill methylphenidate, best known as Ritalin. But some medications were almost always counterfeit. Testing showed that 9 in 10 pills sold as Adderall, six in 10 pills sold as oxycodone, and 7 in 10 pills sold as hydrocodone were fake. Overall, 26 samples contained methamphetamine and 29 contained fentanyl. In March, authorities in Mexico inspected more than pharmacies in Los Cabos and nearby La Paz, closing nine in Los Cabos for a variety of violations. In June, another series of pharmacy raids in Los Cabos resulted in four arrests and the seizure of cash and nearly 25, pills. But less than 24 hours earlier, the same store had sold three loose pills — purported to be Percocet, Vicodin and Adderall — and one bottle labeled as Adderall. Laboratory testing showed both painkillers were fentanyl, the tablet sold as Adderall was methamphetamine, and the bottle of supposed Adderall contained capsules of an appetite suppressant called clobenzorex. Finally, authorities shut down 31 pharmacies and seized more than 4, boxes of medication during recent raids in Ensenada, where officials said some of the pills probably contained fentanyl. At a Puerto Vallarta pharmacy near bustling Playa de los Muertos last month, a clerk said she had no controlled substances for sale before offering a warning. Others said they stopped offering controlled medications immediately after the sweeps, but soon resumed sales. The Times could not independently verify their claims, and officials did not respond to requests for comment. There were no opioid painkillers in stock, but reporters bought a bottle of supposed Adderall. Aside from the glut of willing sellers and suppliers, another roadblock to reining in the sale of counterfeit pills in Mexico is the constant demand — often from Americans looking for medications that may be cheaper or easier to get than in the U. He had recently been prescribed Adderall in the U. Shopping for narcotic medications in pharmacies in Mexico often means listening to workers explain that bottles stashed in hidden compartments and loose pills kept in unlabeled plastic bags contain legitimate medications. But the painkillers purchased from that pharmacy tested positive for fentanyl, and the supposed ADHD medications were made of methamphetamine. At a Puerto Vallarta outpost of a drugstore chain that sold reporters fake medications, Ed Sheeran was crooning through tinny speakers about having faith in what he sees. The clerk claimed the pharmacy did not stock counterfeit pills. On two separate trips to Puerto Vallarta, reporters visited several stores in that same regional chain, and repeatedly purchased pills sold as Adderall that tested positive for methamphetamine. Another was a bottle that a young worker pulled from a locked hiding spot. In addition to concealing illicit wares and offering empty assurances about safety, pharmacy workers seemed choosy about their customers. Several residents said the stores would sell narcotic medications over the counter only to foreign tourists. At one drugstore, when a reporter started speaking Spanish, the clerk grew suspicious. At a Puerto Vallarta location of the prominent national chain Farmacias Similares, a worker said only customers with prescriptions could buy controlled medications. Other pharmacies, she said, would sell them without a prescription — depending on who you are. Only to foreigners. Organized crime experts say that Mexican drug cartels are almost certainly involved in making the sophisticated counterfeit medications. But it is unclear exactly how the pills end up on pharmacy shelves or in hidden compartments behind the counter. Workers at other stores suggested their pills came from California, but also could not name a supplier. Most did not respond to repeated messages inquiring about the counterfeit goods or the suppliers who provided them. One worker who did respond said he knew the Cabo pharmacy where he worked did not sell opioid painkillers because he was one of only two people who worked there. When a reporter explained that the store had sold fentanyl-tainted pills weeks earlier, his tone shifted. Instead of denial, some responded with fear. Watch L. Times Today at 7 p. Before joining the Los Angeles Times in , she spent nearly seven years in Texas, first covering criminal justice for the Houston Chronicle and then covering prisons for the Marshall Project. Previously, she wrote narrative pieces with a strong emphasis on the Latino community and others that make up the diversity of L. She joined The Times in Connor Sheets is an investigative and enterprise reporter at the Los Angeles Times. De Los. Times Everywhere. For Subscribers. All Sections. About Us. B2B Publishing. Hot Property. Times Events. Times Store. Special Supplements. Share via Close extra sharing options. Many pharmacies in Puerto Vallarta and other tourist-friendly parts of Mexico continue to sell fake medications to unsuspecting foreigners. Reporters visited 10 vacation spots and border towns across Mexico this year and bought controlled prescription medications from pharmacies. Tests showed many pills were tainted with powerful drugs including fentanyl, heroin, meth and MDMA. Many pills purchased by reporters in Mexico this year were lab-tested to confirm the initial findings from testing strips. A pharmacy in Cabo San Lucas advertises its wares to English-speaking visitors. Many also sell controlled medications — or counterfeit versions of them — upon request. In Puerto Vallarta, several pharmacies were raided by Mexican authorities in recent months, drugstore employees say. Officials would not elaborate on or confirm their accounts. A Mexican pharmacy offers a wide array of powerful medications over the counter. Earlier in , drugstores in Mexico tended to sell counterfeits of controlled medications as loose pills — but the fakes are increasingly sold by the bottle in convincing packaging. VIDEO More to Read. Chinese chemical manufacturer is targeted by federal prosecutors trying to stop flow of fentanyl. Old newspaper boxes are being used to distribute the overdose reversal drug naxolone. An industrial chemical is showing up in fentanyl in the U. Keri Blakinger. Brittny Mejia. Connor Sheets. More From the Los Angeles Times. California Navy identifies two aviators killed in crash near Mt. Rainier as California natives.

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