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Cannabis has become a subject of increasing concern internationally, significantly impacting public health and social well-being. THC use poses risks, including adverse effects on cognitive function, mental health, and physical health 2. Moreover, long-term or heavy THC use has been associated with an increased risk of developing substance use disorders and other substance-related problems 3. Research has shown that using cannabis may increase the likelihood of transitioning to more potent drugs like cocaine and opioids 4. Additionally, individuals who use cannabis often use other substances 5. Despite the growing body of research on cannabis and THC use, there remains a gap in knowledge regarding specific psychopathological and personality characteristics associated with cannabis use 6. Furthermore, the rise of high-potency THC products has indeed raised concerns about the potential health risks associated with their use. These products contain significantly higher levels of THC than traditional cannabis, which can lead to increased intoxication and potentially more severe side effects. Therefore, monitoring and understanding the risk factors associated with cannabis use is crucial for developing effective treatment, prevention, and intervention strategies. Drug use is a growing problem in Palestine, particularly among young people and in areas of conflict and displacement 8 - The reasons for drug use are complex and include social, economic, and political factors. According to the UNODC report, drug use in Palestine is driven by a range of factors, including economic hardship, poor living conditions, and the psychological stress of living in a conflict zone However, further research is needed to fully understand the extent and impact of amphetamine use among Palestinians. Limited research has been conducted on THC use prevalence and risk factors in Palestine, but studies on general substance use patterns provide some insight. This group comprised 1. Despite the use of various drugs by Palestinians, cannabis, hashish, and marijuana were the most commonly used substances, followed by synthetic cannabinoids 8 - The lifetime prevalence of self-reported cannabis use among men aged 18—65 years was reported as These studies found that cannabis use has become a prevalent issue in Palestine, raising concerns about its impact on the health and well-being of young individuals. When Palestinian youth became aware of the harms of cannabis, both natural and synthetic, they turned to pills instead While THC has received much attention recently, little is known about its concurrent use with other drugs. The simultaneous use of cannabis and other substances can exacerbate the potential risks associated with each substance individually. It is also essential to consider the sociocultural context and specific factors contributing to these associations in Palestine and the surrounding region. Recent studies suggested a shift from cannabis to amphetamines in the northern region of the West Bank, but whether a combination of the two drugs exists is unclear 8 , It has been suggested that cannabis may prolong and intensify the sensation of euphoria associated with amphetamine-like substances 15 , which increases the risk of their combination. This alarming scenario raises the urgency of better monitoring THC in the Palestinian population. To develop effective prevention and intervention strategies, it is crucial to understand the risk factors associated with cannabis use and its co-occurrence with other substances. The aim of this study was to examine the prevalence of THC use and its associations with sociodemographic factors, as well as its potential association with the use of alcohol, tobacco, energy drinks, coffee, and other substances. The findings of this study will contribute to evidence-based interventions and public health efforts to tackle the prevalence and associated risks of cannabis use in Palestine. The study utilized a convenience sampling technique. The research conducted was centered around Palestinian men who reside in the northern region of the West Bank. As part of the study, the participants were asked to complete a self-reported substance use questionnaire that assessed their consumption of various substances, including alcohol, cigarette, waterpipe and vape smoking, energy drinks, coffee, and illicit drugs. After completing the questionnaire, the respondents provided urine samples for illicit drugs analysis. Individuals who struggle with substance use may face social marginalization, which can make it difficult for them to participate in substance use studies. Some people hesitate to participate in certain studies because they fear legal consequences or feel pressured to consent. We did not use any language that could be perceived as stigmatizing or incriminating, such as mentioning drug abuse or addiction We also clarified that participation was voluntary and that individuals had the right to decline without any negative consequences. To ensure privacy and confidentiality, we used code numbers instead of names. The recent estimates of the number of drug users is more than individuals in Palestine To minimize the potential bias from this technique and other confounding factors that can affect THC use, such as age, education level, setting, marital status, and employment status, the researchers opted to duplicate the target sample size. We invited — subjects from each of these three governorates. Medical laboratories in these governorates were used as the study setting. Participants were requested to complete a confidential self-administered questionnaire and provide urine samples. Those who were illiterate received assistance completing the questionnaire while ensuring their privacy. A self-reported substance use questionnaire was used 16 , identifying participants who had consumed any substance during the previous month, such as alcohol, illicit drugs, cigarette, waterpipe and vape smoking, energy drinks, and coffee. The 12 Panel Drug Test DOAT, a multi-line drug screen test, was utilized to analyze illicit drugs and their metabolites in urine, qualitatively The participant who tested positive for at least one of these drugs was classified as a drug user. The setting was categorized as urban, rural, or refugee camps. Employment status was categorized as employed and unemployed. Individuals were asked to report their substance use as current users, former users, or never users. Participants who were asked to report their illicit drug use were given the option to categorize themselves as current user, former user, or never users. Descriptive results of the background information and self-reported substance use are presented as frequencies and percentages. To test for significant relationships between categorical variables, the chi-squared test was used. The analysis took into account age, employment status, marital status, and the use of other substances such as cigarette, waterpipe and vape smoking, alcohol, energy drinks, and coffee. If a covariate had a significant p-value in the crude univariate analysis, it was included in the adjusted binary regression model. This adjustment helped to account for the potential effect of the covariate on the outcome variable and control for confounding variables. A total of individuals were personally invited to participate in the study, with — subjects being invited from each governorate. Out of the individuals invited, refused to participate in the study, while individuals Therefore, the final sample size consisted of respondents who agreed to participate and gave urine samples, forming the final sample size as shown in Table 1. The participants age ranged 16—58 years, with a median age of 28 years IQR: 22— Of the participants, The majority of the participants lived in rural areas or refugee camps Additionally, Among the participants, Regarding beverage consumption, Only 4. Additionally, 1. The urine analysis revealed the presence of benzodiazepines No other drugs tested positive Table 2. The percentage of THC users among participants was 7. The percentage of THC use among those aged 16—19 years 8. Cannabis use, like in many parts of the world, is the most commonly used illicit drug in Palestine 8 , 9 , The West Bank has experienced increased cannabis use among its youth 9 , However, few studies have addressed the prevalence and the associated factors of THC use among Palestinians. THC use in the study population was 7. These findings provide important insights into the prevalence of THC use within this specific population. Similar prevalence rates of THC use have been reported in other studies worldwide 18 , These studies highlight consistent patterns of THC use across different populations. However, it is worth noting that the current prevalence rates are lower than those self-reported in previous studies 8 , 10 - 12 , Instead, there has been an increase in the use of high-risk drugs such as benzodiazepines and amphetamines. This is an alarming situation that requires prompt action. Substance use disorders and experimentation with high-risk drugs such as opioids and cocaine are commonly associated with THC use 4 , 5. Moreover, those who frequently use cannabis are often inclined to consume other substances as well 3. There is limited local research on the combination of THC and other substances in Palestine. Recent studies indicate a shift from cannabis to amphetamines in the northern region of the West Bank, but whether the two drugs are used together is unclear 8 , This study found significant associations between THC use and alcohol consumption, benzodiazepine use, and methamphetamine use, consistent with previous international studies According to the UNODC report, there has been an increase in the trafficking of amphetamines in the region, with the drug being smuggled into the Palestinian territories It is quite alarming that methamphetamines, sometimes referred to as GG in the West Bank, are being produced and consumed as homemade narcotics in the West Bank 8. They were not regarded as illegal narcotics until 8. Moreover, almost one-quarter of HRDUs were found to have methamphetamines in their system In this study, These findings are alarming. The potential adverse effects of combining amphetamine-type stimulants ATS and cannabis use on the development of psychiatric disorders have been well-documented Studies suggest that this combination may worsen harmful effects, such as panic and paranoia while intensifying the euphoric sensation of ATS 22 , The psychotomimetic properties of methamphetamines may be modulated by cannabis through activation of the CB1 receptor, which has been associated with vulnerability to schizophrenia Moreover, using THC and amphetamines simultaneously can increase subjective effects like euphoria and agitation, leading to elevated heart rate and blood pressure, thereby exacerbating cardiovascular risks The association between amphetamines or methamphetamines and cannabis use, and the potential development of psychiatric disorders among Palestinians, is a cause for concern. In agreement with a study conducted in Jordan, THC use was associated with benzodiazepine use in this study These findings underscore the potential risks of combining THC and benzodiazepines in the area, and emphasize the need for further research in the Palestinian context. Research suggests this combination may result in intensified sedation, dizziness, confusion, and memory impairment The use and misuse of benzodiazepines in search of relaxation or forgetting stress-related thoughts and feelings, is common It is important to investigate the reasons behind their usage among Palestinians, individually and in combination with THC. In addition, studies found that simultaneous use of cannabis and alcohol was associated with increased impaired motor coordination, heart rate, impaired judgment, and higher levels of subjective intoxication 29 , It is possible that the high prevalence of THC use, either alone or in combination with other substances, may be linked to various factors, such as higher rates of mental health issues or other variables that have not yet been thoroughly examined in this study. Further research on Palestinians is necessary to investigate the motivations behind and potential side effects of combining THC with alcohol or benzodiazepines. A more comprehensive understanding of the effects of these substances on Palestinians, would enable individuals to make more informed decisions when it comes to substance use. Considering the sociocultural context and specific factors contributing to the associations between THC and other drugs in Palestine and the surrounding region, is important for developing effective prevention and intervention strategies tailored to the needs of the Palestinian population. This study found that individuals with higher education level, such as those who have completed undergraduate studies, were more likely to use THC than those who were illiterate. This finding aligns with international literature, as studies have shown an association between higher education level and increased substance use among specific populations However, it is crucial to consider the unique sociocultural factors that may influence this association in the Palestinian context. Other reasons for drug use, including social, economic, and political factors, need to be studied. The prevalence of drug use among young people in Palestine is influenced by the cultural stigma surrounding seeking help for mental health issues 13 , 9. This stigma and the high therapy costs often prevent drug users from accessing the necessary support 13 , 9. To address this issue, it is crucial to establish accessible counseling services and create a stigma-free environment that encourages individuals to seek assistance. Prevention efforts, education on substance misuse, and confidential support and treatment options, are essential components of a comprehensive approach to addressing drug use in Palestine. Targeted prevention programs are needed to address the specific challenges faced by this population. This study has some limitations. The results of cannabis use could be underestimated in this study for several reasons. First, the test does not detect synthetic THC. Moreover, a negative result may not necessarily indicate drug-free urine. However, it can be obtained when the drug is present but below the detection cut-off level or due to the short halflife time of the drug in the body. Finally, the high rejection rate could add to the underestimated results. This study is cross-sectional; thus, we cannot determine the causality or the direction of observed associations. While convenience sampling can effectively recruit study participants, it does not necessarily guarantee that the sample represents the studied population. Moreover, the test does not distinguish between drug use and misuse and certain medications. Therefore, it is crucial to conduct further research on the usage of THC and other substances among females. Moreover, the high prevalence of THC use alone or in combination, could be associated with several factors, including higher rates of mental health problems or other factors that have not yet been fully explored in this study. The study did not evaluate mental health symptoms or diagnoses of psychiatric conditions like depression and anxiety. Individuals with multiple psychiatric conditions are at a higher risk of polysubstance use, which may have impacted the results of this study. Despite these limitations, this is the first screening research based on urine tests that measured the prevalence of THC use and its association with other substances in the West Bank. The findings from this study demonstrated a substantially increased frequency of substance use among Palestinians. The use of cannabis products among Palestinians is often linked to other drugs, highlighting the potential for polysubstance use and its implications for individual health outcomes. THC use associated with methamphetamines and the use of alcohol, amphetamines, and benzodiazepines, highlighted a new challenge for the health system with new emerging health issues. Additionally, individuals with higher education level were more likely to use THC. These findings align with international studies, indicating consistent patterns of substance use behaviors. However, further research is needed to comprehensively explore THC use in Palestine and the surrounding region, considering the unique sociocultural factors that may influence these behaviors. Investigating the reasons behind substance use among Palestinians, individually and in combination with THC, is important. Recent Articles Archive of Issues About. Archive of Issues. Instructions to Authors. Editorial Policies. Recent Articles. Cannabis use associated with high-risk drug use among Palestinians: An emerging health risk. Basma Damiri 1. Saed Bilbeisi 2. Majdeddin MohammedAli 3. Mohab Najjar 4. Basma Damiri. Introduction: The West Bank has seen an increase in cannabis use, but there are few studies on the prevalence and factors associated with tetrahydrocannabinol THC use among Palestinians. The aim of this study was to examine the prevalence of THC use and its associations with sociodemographic factors and its potential association with the use of alcohol, tobacco, energy drinks, coffee, and also other illicit drugs. Methods: Male Palestinians from the West Bank were invited to give urine samples in a cross-sectional study in The study employed a self-reported questionnaire to identify participants who were current users in the last 30 days, including alcohol, illicit drugs, tobacco smoking, energy drinks, and coffee. Results: The response rate was THC was found in 7. THC use associated with other drugs presents a new challenge for the health system with new emerging health issues. Further research is needed to comprehensively explore THC use in Palestine and the surrounding region, taking into account the unique sociocultural factors that may influence these behaviors. Study tool, validity, reliability, and operational definitions Participants were requested to complete a confidential self-administered questionnaire and provide urine samples. Statistical analysis Descriptive results of the background information and self-reported substance use are presented as frequencies and percentages. RESULTS A total of individuals were personally invited to participate in the study, with — subjects being invited from each governorate. Self-reported substance use and urine test results for illicit drugs Among the participants, Logistic regression, crude analysis, of substance use and other factors associated with THC use The percentage of THC users among participants was 7. THC: deltatetrahydrocannabinol. AOR: adjusted odds ratio; adjusted for age and education level. Limitations This study has some limitations. Participants provided informed consent. The data supporting this research is available from the author s on reasonable request. UNODC; Accessed January 11, Google Scholar. Adverse health effects of marijuana use. N Engl J Med. Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Dick DM, Agrawal A. The genetics of alcohol and other drug dependence. Alcohol Res Health. Alcohol, tobacco, and marijuana consumption is associated with increased odds of same-day substance co- and tri-use. Drug Alcohol Depend. Addiction and the brain: the role of neurotransmitters in the cause and treatment of drug dependence. Young adult sequelae of adolescent cannabis use: an integrative analysis. Lancet Psychiatry. Drug use and possession, emerging of new psychoactive substances in the West Bank, Palestine. Egypt J Forensic Sci. Substance use among Palestinian youth in the West Bank, Palestine: a qualitative investigation. BMC Public Health. Pattern of substance use among schoolchildren in Palestine: a cross-sectional study. Damiri B, Daraghma M. The epidemiology of substance use in the West Bank: Who is at risk?. J Ethn Subst Abuse. Damiri BR. International Journal of Mental Health and Addiction. Palestinian National Institute of Public Health. Palestinian National Institute of Public Health; Accessed Janaury 11, Perspectives of frontline professionals on palestinian children living with sibling and parental drug use in the West Bank and Gaza Strip. Int J Ment Health Addiction 4 — The combined effect of marihuana and dextroamphetamine. Ann N Y Acad Sci. Substance use by university students in the West Bank: a cross-sectional study. The Lancet. Gender differences in medication use and cigarette smoking cessation: results from the International Tobacco Control Four Country Survey. Nicotine Tob Res. The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst injured drivers and their role in driver culpability: part ii: the relationship between drug prevalence and drug concentration, and driver culpability. Accid Anal Prev. Hall W, Solowij N. Adverse effects of cannabis. Effects of marihuana-dextroamphetamine combination. Clin Pharmacol Ther. MDMA: interactions with other psychoactive drugs. Pharmacol Biochem Behav. Cannabinoid receptor 1 gene CNR1 and susceptibility to a quantitative phenotype for hebephrenic schizophrenia. Prevalence and correlates of substance use among psychiatric inpatients. Perspect Psychiatr Care. National Institute on Drug Abuse. Cannabis Marijuana DrugFacts. NIH; Benzodiazepine use and misuse among adults in the United States. Psychiatr Serv. Controlled cannabis vaporizer administration: blood and plasma cannabinoids with and without alcohol. Clin Chem. Effects of cannabis use status on cognitive function, in males with schizophrenia. Psychiatry Res. Differentiating between sensation seeking and impulsivity through their mediated relations with alcohol use and problems. Addict Behav. Send by email. Keywords index. Table of contents. 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BY Maria Pappa. So generally speaking, you should be careful who you talk to. Random street dealers may be an easy solution but no one can guarantee the quality of the product and there is a high risk of getting arrested. Covid fuelled a major increase in substance abuse worldwide and Greece is no exception. Different groups are doing different kinds of drugs. The youth prefer weed. MDMA and ketamine are more popular in the club scene. Raves are full with hallucinogens while the gay community has a thing for crystal meth at sex parties. The only drug that everyone seems to agree on is cocaine. Photography by Alex Mihai. Berlin The Lowdown on Drugs in Berlin. Jamaica The Lowdown on Drugs in Jamaica. More from Drugs. Find someone you can trust and keep wary of strangers when buying your party drugs. The Lowdown on Drugs in Jamaica Recreational drugs are illegal in Jamaica, and contrary to popular belief, that includes weed. The Lowdown on Drugs in New York City Weed is legal in the city, when it comes to other drugs, know your source or skip it. What's The Lowdown on Drugs in Barbados?

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