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Official websites use. Share sensitive information only on official, secure websites. This article was submitted to Addictive Disorders, a section of the journal Frontiers in Psychiatry. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s 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. Background: Prescription drug misuse and its related risks are considered a worldwide public health issue. Current trends show that the extent of such phenomenon may not be limited to subjects with psychiatric disorders, as it also spreads to dance party and nightclub attendees, who often consume prescription drugs in combination with alcohol and psychoactive substances. This study aims to report the sociodemographic data and the psychiatric and clinical features of a sample of clubbers reporting prescription drugs use. Methods: Patients admitted to the psychiatry ward of the Can Misses Hospital in Ibiza were recruited for the study during a span of four consecutive years — The inclusion criteria were age 18—75 years old and the intake of psychoactive substances or more than five alcohol units during the previous 24 h. Substance use habits, psychopathological features, and use of unprescribed pharmaceuticals were investigated. Results: A total of subjects with psychoactive substance intoxication were recruited for the study. Conclusions: The use of prescription drugs is also common among clubbers, usually characterized by low propensity to be prescribed benzodiazepines, antipsychotics, or antidepressants. Prescription drugs may be an alternative to classic and novel psychoactive compounds or may be used to tamper and self-medicate the effects determined by the use of substances. Party goers should be adequately informed about possible risks of co-intake of psychoactive substances and prescription drugs to prevent serious medical and psychiatric consequences. Keywords: prescription drugs, novel psychoactive substance NPS , club drugs, psychopathology, substance usage disorders SUDs. Prescription drug misuse and related risks, including co-ingestion with recreational drugs, have recently risen as a worldwide public health phenomenon. They may involve a variety of medical and social consequences that require effective public health policies to counteract such habit, as well as continuous updates for health professionals to promote education and harm reduction 1 , 2. Prescription medicine misuse or non-medical use is commonly defined as the use of medications without a prescription or in a manner other than prescribed 3. This includes a number of conditions, such as using these compounds for purposes other than the medical condition they were prescribed for i. In , 14 countries in EU reported on the non-medical use of such compounds 5. Current trends show that the extent of prescription drug misuse is not limited to subjects with psychiatric disorders or co-occurring substance use disorders SUDs. In this context, the phenomenon of co-ingesting prescription drugs in order to imitate, potentiate, modulate, or counteract the effects of prohibited psychoactive substances has been increasingly reported 8. This trend involves not only novel highly potent opioid, such as fentanyl and its derivatives, or designer benzodiazepines but also antipsychotics, antidepressants, stimulants, performance-enhancing drugs PEDs , hormones, vitamins, beta-blockers, gabapentinoids and over-the-counter OTC drugs 8. For example, students and workers may consume attention deficit hyperactivity disorder ADHD medications such as methylphenidate to improve their academic performance or working tasks 1. Furthermore, compounds such as benzodiazepines e. With regard to the nightlife and clubbing scene, the situation shows peculiar characteristics. The growing offer of novel and traditional prescription drugs has found a fertile ground in this scenario. Summer holiday periods in popular resorts have historically represented an opportunity for excesses and experimentation, especially among young people who find an environment in which hedonistic partying is socially accepted and drugs are typically easily available Alcohol use, particularly during binge drinking, and psychoactive substance use are commonly reported among festival-goers and clubbers in holiday resorts; practices such as poly-substance abuse and prescription drug misuse have also been reported 13 — The use of a variety of pharmaceuticals including benzodiazepines 17 , 18 , stimulants 19 , 20 , opioids 21 , antidepressants 8 , and sedatives such as GHB 22 has been associated to dance music party attendees. Such heterogeneous cohort of compounds, presented in different forms and with various ways of intake e. Nevertheless, pharmaceuticals are often perceived as less harmful and less stigmatizing than illicit drugs, particularly among young people, partly due to these substances' legitimate medical purposes 23 , Moreover, information on the actions of these drugs is widely available in package inserts, advertisements, and on the internet; therefore, their effects including adverse reactions and dosages are considered more predictable Such phenomenon is further complicated by the rise on the nightlife market of novel psychoactive substances NPS. A number of these substances were originally developed as research chemicals and diverted for recreational purposes, as they often mimic the pharmacological effect of traditional drugs of abuse or popular prescription drugs 4. Their effects and related risks are often unknown to both users and health professionals, due to the scarcity of evidence-based information regarding their toxicological profiles and to the ever-changing nature of this market 7 , 26 — Nevertheless, growing evidence reported potential acute and chronic psychiatric risks associated to NPS consumption, including confusion; paranoid thoughts; auditory and visual hallucinations; dissociation; delusions of reference, persecution, grandeur, and jealousy; cognitive impairment; hypomanic states; aggressiveness and irritability; violence; and suicidal thoughts 8 , 29 — The current dynamic of recreational substance use is a serious matter of concern for public health institutions worldwide. In particular, the threats posed by psychoactive compounds and concomitant prescription drug misuse require updated policies provided by local and supranational regulatory agencies, as well as appropriate approaches by health professional, to prevent negative outcomes and reduce associated harms 32 , including deaths In such context, Ibiza and the Balearic Islands, two of the most popular destinations with nightlife resorts for summer holidays in Europe, may be considered as an interesting real-life scenario to explore such phenomenon. Previous studies confirmed a higher prevalence of risky behaviors for both residents and tourists in Ibiza, including problematic alcohol use, substance use, and sexual disinhibition 34 — Moreover, it has been reported that traffickers and dealers have introduced NPS and pharmaceuticals into the Ibiza drug market to test new compounds and drug combinations on unaware customers This study aimed to assess patients admitted to the psychiatric ward of the Can Misses Hospital in Ibiza for psychoactive substance intoxication, in order to 1 identify which psychotropic prescription drugs are mostly involved in cases of concomitant psychoactive substance use and 2 report the psychopathological features and patterns of consumption associated to prescription drug use in a nightlife resort setting. Patients admitted to the psychiatry ward of the Can Misses Hospital in Ibiza during summer when nightclubs are open May—October were recruited for the study during a span of four consecutive years — The subjects were evaluated according to the DSM-5 diagnostic classification. The inclusion criteria were age 18—75 years old and the intake of psychoactive substances or more than five alcohol units i. Clinical conditions such as delirium tremens , epilepsy, liver encephalopathy, dementia, and other neurological diseases, severe cardiac failure, diabetes mellitus, severe liver impairment, kidney failure, or neoplastic diseases were among the exclusion criteria, as the presence of such conditions could present a confounding factor. Demographic age, gender, family, and nationality and socioeconomic data living status, job status, and level of education were collected, as well as recent and past medical and psychiatric history, current pharmacological treatment, and alcohol and substance use habits including NPS , with a specific focus on prescription drugs misuse. Among these, recent and lifetime use of benzodiazepines e. TLFB was used to identify the main substance of abuse for each patient. The subjects were divided in three macro-groups according to the TLFB and the results of the urinalysis: psychostimulants e. This classification was derived from our previous reports on the topic 7 , Data collection was carried out in an anonymous and confidential way; all participants received a detailed explanation of the design of the study and a written informed consent was systematically obtained from every subject, according to the Declaration of Helsinki. Majorcan local ethics committee also gave approval to the study. The urine samples were extracted with a solid-phase cartridge Oasis MCX , and the obtained solution was evaporated until dry and reconstituted with mobile phase. The method was validated according to WADA guidelines and for a screening method in antidoping test defining selectivity, limit of detection LOD , recovery, carry over, and repeatability Independent samples t -test was used to determine whether or not there was a significant difference in scale scores between subjects who abused and subjects who did not abuse prescription drugs. One-way analysis of variance ANOVA followed by Tukey's post-hoc test was used to assess whether or not there was a significant difference in scale scores among subjects who abused different classes of prescription drugs. The median age of the patients was Nine patients were full-time or part-time students 8. All the subjects of the sample were diagnosed with substance intoxication at admission. These results will be described in a separate manuscript The most commonly reported compounds were benzodiazepines, which were used by 32 subjects. Table 1 presents the complete information on the type of pharmaceuticals reported by users. Prescription drug misuse was reported for 8 psychodepressor e. The percentage for each group of substance users is reported in Figure 1. According to their lifetime use of specific compounds, prescription drug consumption without medical supervision was reported by 31 stimulant users, 21 cannabinoid users, 10 depressor users, 7 opioid users, 7 empathogen—entactogen users, 5 dissociative users, and 1 psychedelic user. Therefore, our results show that such use is not only limited to subjects with psychiatric disorders and co-occurring SUD but can also involve subjects who are usually not considered as typical psychoactive substance users. This data pave the way for serious considerations on the possible pharmacological interactions with alcohol and other substances, as well as on other short- and long-term consequences, both physical and psychiatric. As users may concomitantly consume various prescription drugs and substances of abuse, an increased risk of drug—drug interactions may be observed, both pharmacokinetic e. This involves not only depressors, such as benzodiazepines, opioids, and alcohol, but also stimulant drugs commonly used by clubbers. For example, metabolic pathways of synthetic cathinones, antidepressants, and ADHD medications have been shown to overlap, including metabolism via cytochrome P enzymes and their inhibition Benzodiazepines were the most prevalent class of prescription drugs reported in our sample. This confirms the data from Messina et al. In terms of preventive strategies, the use of benzodiazepines in the context of a multiple substance use could be dangerous as it causes respiratory depression and risk of overdoses, specifically in combination with opiates, alcohol, ketamine and derivatives, and inhalants 18 , 43 , Specific policies and harm-reduction approaches should be advised for these potentially lethal combinations, particularly with the intake of large amounts of long half-life compounds, such as diazepam. Furthermore, a number of novel designer benzodiazepines, with undisclosed toxicological profiles and variable potencies, have recently been made available in the drug market. They are developed in order to mimic prescription benzodiazepines and Z-drugs, but they may lead users to adverse events of various severities, particularly if used in combination with other substances 4 , 45 , Among the different categories of substances, psychodepressors were the most commonly associated with the use of prescription drugs, whereas only a small percentage of psychodysleptic users reported such habit. The typology of subject using psychodysleptics such as LSD, psilocybin, MDMA, ayahuasca, and other plants, is characterized by the search for a strong inner experience, spirituality, and high level of emotionality 47 , The use of benzodiazepines and antipsychotics can inhibit or temper the perception of these experiences and therefore may not be chosen by users. With regard to antidepressants, which can determine affective blunting and enhance the distance from emotional experiences, the same consideration can be reported. This finding emphasizes how those patients are the most vulnerable in terms of psychopathological load. In this regard, those who report taking prescription drugs may actually be the subjects with a psychiatric history. A prescription drug may have already been tested for therapeutic purposes and therefore may have made the patient more accustomed to its use out of indication. Moreover, the high level of depression is an issue that needs to be considered and can represent a significant suicidal risk factor in people who misuse alcohol and psychoactive substances. In fact, the use of psychotropics can represent an additional risk factor, given the possibility of a consistent increase in the levels of impulsivity, violence, and self-directed aggression due to such drugs. Therefore, it is very relevant to evaluate these patients and to put specific strategies in place to manage these psychopathological manifestations, with a specific focus on the prevention of anti-conservative behaviors. A further point of interest, although expected, is the presence of high levels of depressive symptoms on the Hamilton scale in relation to the use of antidepressants without a specific medical prescription. For this reason, a shared strategy could be justified, even more than in other types of patients with dual disorders. Conversely, methylphenidate use was associated with lower scores at the Hamilton depression scale. This prescription drug with stimulant properties 49 , 50 , usually indicated for attention deficit hyperactivity disorder, can probably be chosen by users of psychostimulants as a cheaper alternative to cocaine and amphetamine. In the short run, it could also show some antidepressant properties, thus explaining the data observed at the HAM-D. The detection of methylphenidate among the prescription drugs reported in our sample may indicate some level of comorbidity between adult ADHD and SUD, as recently reported In terms of the role of the discharge psychiatric diagnosis, alcohol or substance use disorder showed a high prevalence, although the diagnoses of schizophrenia and bipolar spectrum disorder were also significantly reported. In some cases, the presence of a psychiatric comorbidity could justify the use of prescription drugs such as antidepressants, mood stabilizers, and benzodiazepines. Limitations of this study are represented by a low and heterogeneous sample size, with a high prevalence of benzodiazepine as the main prescription drug. Moreover, although the target of the study is that of young clubbers, a significant subgroup of participants were middle-aged adults. In conclusion, in this study, we have highlighted how the use of prescription drugs is common also among clubbers and disco-goers. These subjects usually do not have a previous psychiatric history and share a low propensity to be prescribed with benzodiazepines, antipsychotics, and antidepressants by a mental health professional. These data confirm that prescription drugs may be an alternative for classic and novel psychoactive compounds, may be used to modulate and temper the experience, and, in some cases, may be used to reduce the negative effects determined by the use of substances. From the treatment prospective and as a useful preventive strategy, a specific psycho-education process should be indicated for subjects at risk. Party-goers should be adequately informed about the possible risks of co-intake of NPS, classical substances, and prescription drugs to prevent serious medical and psychiatric consequences. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. MdG and AN wrote the manuscript. SS and LT performed the statistical analysis. AB and DD performed literature search about the topic and elaborated all the ethical procedures required for the study approval in both countries. GM coordinated all the study processes. All authors contributed to the article and approved the submitted version. 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. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Front Psychiatry. Find articles by Massimo di Giannantonio. Find articles by Attilio Negri. Find articles by Stefania Schiavone. Find articles by Chiara Vannini. Find articles by Mauro Pettorruso. Find articles by Fabio De-Giorgio. Find articles by Valeria Verrastro. Find articles by Luigia Trabace. Find articles by Mariangela Corbo. Find articles by Rossella Gottardo. Find articles by Cristian Camuto. Find articles by Monica Mazzarino. Find articles by Andrea Barra. Find articles by Domenico De Berardis. Find articles by Juan Iglesias Lopez. Find articles by Cristina Merino Del Villar. Find articles by Fabrizio Schifano. Find articles by Giovanni Martinotti. Received Aug 7; Accepted Nov 16; Collection date The most common substances used by patients who declared prescription drug misuse. 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. Benzodiazepines e. Antidepressants e. Antipsychotics e. Anticonvulsants e. Opioid derivatives and synthetic opioids e.

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