Abstract Background Artificial intelligence (AI) is becoming increasingly integrated into medical education and clinical practice. Junior medical staff often act as first-line responders in substance-related presentations, yet their perceptions of drug-related harm are not well characterised. It is unclear how their assessments compare with harm ratings generated by emerging AI tools. This study aimed to compare final-year medical students’ harm ratings of recreational drugs and alcohol to users and society with those generated by ChatGPT. Methods 110 final-year medical students (59.1% response rate) rated the harmfulness of 28 recreational drugs to individual users on a 1–10 scale and ranked seven drug classes for societal harm. ChatGPT-4 (paid subscription version) generated 40 response sets in five conversations through repeated administration of the same survey. Discrepancies in harm ratings to users and rankings of societal harm were analysed descriptively. Results Students rated their drug harm knowledge at 5.8/10 (SD 1.7) and their education on drug harm at 5.3/10 (SD 1.8). ChatGPT rated its drug harm knowledge at 8.3/10 (SD 1.2). The mean harm-to-user scores across the 28 substances were 6.7 (SD 1.8) for students and 6.4 (SD 0.8) across the repeated ChatGPT response sets. Both groups identified heroin, crack cocaine, and fentanyl as the most harmful substances. Differences were observed for less harmful substances: students rated snus (smokeless tobacco), laughing gas, and cannabis least harmful, whereas ChatGPT rated magic mushrooms, DMT/ayahuasca, and LSD least harmful. ChatGPT ratings were more similar to those of previously published expert panels. Conclusions Students and ChatGPT strongly agreed on the most harmful substances but differed in their assessments of moderately and minimally harmful drugs. These differences suggest that perceptions of drug harm are shaped not only by pharmacology and toxicity but also by social and cultural context, local patterns of use, clinical exposure and experience, and medical training. AI may be of limited value when the evidence base is sparse, contested, or difficult to trace. The lower confidence among students suggests that further research is needed to better understand educational needs in drug-harm assessment and the critical appraisal of AI-generated evidence.
Abstract Background The interrelationship between unemployment and substance use disorders, especially opioid use disorders, is complex, and basic epidemiological data are lacking both in Germany and elsewhere. This study aimed to evaluate the prevalence rates of opioid use disorder, work ability, and associated factors among unemployed individuals with opioid use disorder who underwent socio-medical assessment by the Medical Service (MS) of the Federal Employment Agency (FEA). Methods All socio-medical assessments conducted between 2016 and 2021 ( N = 4,249,028) were extracted from the FEA database and analyzed with respect to relevant sociodemographic characteristics, opioid use disorder (ICD-10 F11.x diagnosis) and work ability. Descriptive statistics were used to summarize the data. Results A total of 4,249,028 unemployed individuals were assessed. Of these, 22,683 clients (0.5%) met an F11.x diagnosis (primary or secondary); mostly opioid dependence ( N = 20,506; 94.3%). The number of diagnoses increased over time (2016–2021). Mean age was 40.7 ± 9.4 years. Overall, 15,065 (73.5%) were male and 5,441 (26.5%) were female. For individuals with a secondary diagnosis of F11.x, most frequent psychiatric comorbidities were alcohol dependence (27.8%), polysubstance use (17.6%), schizophrenia (8.8%), depression episode (8.3%) or recurrent depression (5.9%) and persistent pain disorder (6.1%). Regarding daily work capacity, 58.3% ( n = 11,962) of individuals were able to work less than 3 h per day, 10.0% ( n = 2,051) were able to work 3–6 h per day, and 17.4% ( n = 3,568) were able to work more than 6 h per day. Conclusions The number of unemployed individuals with opioid dependence in Germany has increased over time, and most are unable to work more than three hours per day. The most frequent psychiatric comorbidities were other substance use disorders, particularly alcohol use disorder, schizophrenia, and depression. Somatic comorbidities, with the exception of chronic viral hepatitis, were recorded less frequently. Tailored interventions and closer collaboration between employment agencies and mental health care providers are needed to improve the psychosocial integration of this population.
BACKGROUND:Substance use disorders are an increasingly prevalent issue in today's society, and they can be caused by prescription of drugs with addictive potential. Patients with incurable diseases often experience severe symptoms and require medications with the potential to cause dependence. For patients with a predisposition to addiction, this can lead to the development of a substance use disorder, further reducing their quality of life. METHODOLOGY:Over a period of six months, all patients newly admitted to the palliative care unit were screened for unusual medication use. If the initial survey, which used the 'Short Questionnaire on Medication Use', revealed abnormal results, the WHO-ASSIST V3.0 questionnaire was administered to identify substance use disorders and the extent of dependence. RESULTS:A total of 181 patients were admitted to the palliative care unit during the survey period. Of these, the initial screening could not be performed in 119 patients (65.7%) due to accompanying circumstances. Of the 62 patients who were included in the study, 15 (24.2%) had an elevated score on the 'Short Questionnaire on Medication Use'. The WHO-ASSIST V3.0 questionnaire indicated positive consumption of alcohol in 100% of cases, opioids in 86.7% of cases, tobacco in 73.3% of cases, and sedatives and sleeping pills in 53.3% of cases. Most respondents were at moderate risk of dependence, with only one person at high risk of opioid use. However, further treatment for a substance use disorder was not deemed to be clinically relevant for any of the patients. CONCLUSION:This survey found that routinely screening palliative care patients for substance use disorders did not provide any clinically relevant information for further treatment of the examined cohort. Given the high level of stress often experienced by people with incurable diseases, the extent to which screening is helpful or merely an unnecessary burden should be considered. As other surveys have shown that palliative care patients with substance use disorders benefit from treatment, follow-up studies should investigate how to identify patients at risk specifically.
Tobacco marketing shapes consumer perceptions, particularly among young people. Despite regulatory restrictions, subtle tactics may continue to mislead youth and young adults. This study examines how specific features in cigarette and e-cigarette ads affect perceived harm and addictiveness among 18-20-year-olds. We recruited 1,708 U.S. participants aged 18–20 across two survey waves (2022–2023). Participants viewed randomized cigarette and e-cigarette ads and rated perceived harm and addictiveness. Ads (n = 221) were coded for youth-relevant features. Mixed-effects logistic regression assessed associations between ad features and perceptions, adjusting for demographics, tobacco use, brand familiarity, and wave. For e-cigarette ads, flavors and gift promotions were associated with a lower likelihood of inaccurate harm perceptions, while sweepstakes, social media engagement, and socialization themes were linked to a higher likelihood of inaccurate harm perceptions. In cigarette ads, use cues and pleasure claims were linked to a lower likelihood of inaccurate harm perceptions, whereas gift promotions were linked to a higher likelihood of misperceptions. Regarding addiction, price promotions and use cues in e-cigarette ads were associated with a lower likelihood of inaccurate addiction perceptions, while sweepstakes, social media engagement, and socialization themes were linked to a higher likelihood of inaccurate addiction perceptions. For cigarette ads, only use cues predicted a lower likelihood of inaccurate addiction perceptions. Advertising features can influence young adults’ misperceptions of nicotine and tobacco product risks. Specifically, sweepstakes, social media engagement, and youth-oriented socialization themes may obscure harm and addictiveness, especially for e-cigarettes. Findings support comprehensive regulation to address misleading marketing.
Abstract Background Care navigators are increasingly incorporated into medication for opioid use disorder (MOUD) treatment programs to address barriers to care and support patient engagement and retention. Prior research has largely focused on patient outcomes or program effectiveness, with limited attention to how frontline staff experience the integration of care navigators into routine treatment workflows. This study aimed to examine staff perceptions of care navigator roles and identify organizational and policy-relevant factors influencing their implementation. Methods We conducted a qualitative study of staff perceptions of care navigators embedded in medication for opioid use disorder treatment centers participating in the HEALing Communities Study in Kentucky, USA. Semi-structured interviews were conducted with clinical and administrative staff working in participating treatment centers. Interviews explored experiences with care navigator integration, perceived impacts on patient engagement and team functioning, and implementation challenges. Data were analyzed using thematic analysis guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and the Practical, Robust Implementation and Sustainability Model. Results Staff described care navigators as filling critical service gaps by helping patients address practical challenges that commonly disrupt treatment engagement, including transportation barriers, housing instability, and navigating health and social services. These efforts were viewed as supporting sustained engagement in treatment with medication for opioid use disorder. Participants also reported improved team morale and reduced burnout following care navigator integration. However, staff identified persistent implementation challenges, including unclear role boundaries, scheduling constraints, and misalignment between organizational cultures. Clear differentiation between care navigators, targeted case managers, and peer support specialists was consistently identified as necessary to support effective collaboration. Conclusions Findings suggest that care navigators may enhance engagement and workforce capacity in medication for opioid use disorder treatment settings, particularly when focused on addressing practical barriers to care. At the same time, variability in role definition and organizational fit limited effectiveness in some settings. These results highlight the importance of clear role delineation, stable funding, and implementation planning when integrating non-clinical navigation roles. Future research should incorporate patient perspectives and examine how policy and organizational contexts shape implementation and outcomes. Trial registration ClinicalTrials.gov Identifier: NCT04111939 (registered March 26, 2019).
