Designer drugs (DD), also known as synthetic drugs or novel psychoactive substances (NPS), are chemically engineered substances that are created to mimic the effects of controlled drugs or to produce new psychoactive effects [1]. These substances have slightly different chemical formulas from their controlled drugs for intention of bypassing legal restrictions thus called “legal highs” [2]. Designer drugs can come in various forms, including pills, powders, crystals, and liquids, and they may be marketed and sold under different names as “research chemicals”, “bath salts”, “plant food”. These substances pose significant health risks as their chemical composition and potency can vary widely, leading to unpredictable and potentially harmful effects on the user's physical and mental well-being. Due to their constantly evolving nature, designer drugs present challenges for regulatory authorities and healthcare professionals in terms of detection, regulation, and providing appropriate medical interventions [1, 2].
The problem of substance abuse is rapidly escalating public health concern worldwide. According to the United Nations Office on Drugs and Crime, an estimated 13.2 million individuals engaged in drug injection in 2021, reflecting an 18% increase compared to the previous year (11.2 million) [2]. The most reported drugs were cannabis, opioids (especially heroin), and amphetamine-type stimulants like methamphetamine. These statistics indicate that approximately one in every 17 individuals worldwide used drugs in 2021, signifying a 23% rise compared to a decade ago. However, despite these alarming numbers, only 1 in 5 individuals with drug use disorders received necessary treatment, leaving many in need without adequate support [2].
In Egypt, various epidemiological studies have been conducted to investigate the prevalence of psychoactive drugs among students in different cities [3–6]. Recent research in 2020 revealed that the regular use of these substances among Egyptian adolescents was reported at 1.5% [7]. Consumption of designer drugs among these young individuals has negative effects on society, who bears the economic costs of drug abuse and increased mortality and morbidity. During the adolescence maturity period, areas of the brain that are associated with emotions and reward systems develop those associated with executive functioning, judgment, and decision-making. This period results in an increase tendency towards engaging in risky and impulsive behaviors such as drug abuse, specifically, designer drugs; due to low prices and ease of access in common places such as schools and universities [8]. There are numerous variables that have contributed to the quick growth of this subculture, but the simplicity with which these agents may be obtained on the Internet, at parties and night clubs, and in head shops is undoubtedly the most notable [9, 10].
The first synthetic cannabinoids SC was created in 1964 as a synthetic form of Delta-9-tetrahydrocannabinol (THC) 9-THC by Gaoni and Mechoulam [11]. Recently, the European monitoring center for drugs and drug addiction noted that there are more than 450 have been introduced since 2004 [12]. The European Union-funded Psychonaut Online Mapping Project conducted a global electronic survey to monitor the emergence of new psychoactive substances, often referred to as "legal highs." The survey revealed a documentation of over 410 substances or products, which included 121 herbal compounds, 153 chemical compounds, and 140 combinations. [13]
Cathinone (e.g., mephedrone, methylone, and methylenedioxypyrovalerone, often referred to as “bath salts“ or “flakka”); synthetic cannabinoids (SCs; e.g., Spice); Ecstasy (3,4 methylenedioxymethamphetamine, MDMA) and synthetic hallucinogens (25I-NBOMe, or N-bomb, LSD) are examples of such products [14]. In Egypt, synthetic marijuana is the commonest designer drugs. Strox and voodoo are the new Egyptian versions of SC that hit the market in the past several years. Strox is a “spice” that is mixed with considerable amount of atropine and/or ketamine and other unidentified additives [15].
Due to the criticality of awareness about these drugs and its role in reducing the spread of these drugs, knowledge and awareness about designer drugs has been assessed in several research articles [16–18]. The acquisition of a high level of knowledge and awareness regarding psychoactive substances is crucial for healthcare professionals, especially those in the medical field, as they play a vital role in addressing such cases within the community. Many studies have consistently identified knowledge gaps among medical students, highlighting the pressing need to prioritize this subject in medical school curricula [19, 20]. Furthermore, research has underscored the existence of knowledge gaps among physicians, emphasizing their need for accessible and up-to-date medical resources pertaining to emerging substances [21]. Recognizing and addressing these knowledge gaps is essential to empower medical personnel in effectively managing the challenges associated with evolving substances and ensuring the provision of optimal care to patients and the community at large.
Therefore, the aim of this study is to assess the knowledge, awareness and perception of medical students in Cairo University regarding designer drugs, to identify the sources from which they acquire such knowledge and investigate their attitude relevant observable behavioral-pattern.