Psychoactive substances exposure in a university student population: a comparison between scientific literature and preliminary data collected at the University of Pavia

Psychoactive substances exposure in a university student population: a comparison between scientific literature and preliminary data collected at the University of Pavia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychoactive substances exposure in a university student population: a comparison between scientific literature and preliminary data collected at the University of Pavia Chiara Franzetti, G. Tacconelli, C. Torriani, V. Martini, M. C. Monti, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6874281/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The university environment is often associated with high levels of academic and social pressure, potentially being related to an increase in psychoactive substances use. Medical students, in particular, exhibit high levels of stress and a higher prevalence of psychiatric disorders compared to general population, potentially influencing their substance consumption patterns. Objective The present preliminary study, conducted within the "NO PANIC" project framework, aimed to analyze the prevalence, motivations, and risk factors associated with psychoactive substances use among university students enrolled in the Medicine and Surgery and Health Professions of Rehabilitation Sciences degree programs at the University of Pavia. Methods An anonymous online survey was administered to 97 students during a highly stressful academic period. The survey assessed lifetime and recent use of legal recreational substances, illicit drugs, prescription psychoactive medications, and neuroenhancers. Data on consumption patterns, motivations for use, acquisition methods, adverse effects, perceived stress levels, and psychiatric diagnoses were collected. Statistical analyses were performed to identify differences between subgroups. Results Lifetime use of legal recreational substances was reported by 97.9% of participants, with alcohol, caffeine, and nicotine being the most commonly used. Illicit drug use was reported by 51.5% of respondents, with cannabis being the most commonly used substance among students. Prescription psychoactive substances were used by 19.6% of students, with benzodiazepines and antidepressants being more prevalent among medical students. Neuroenhancer use was rare (1%). Higher stress levels and psychiatric diagnoses were significantly more common in medical students (79% and 15.8%, respectively), correlating with increased psychoactive substance use. The tested subjects as primary motivations provided stress management, anxiety reduction, and sleep improvement. Despite frequent adverse effects, 80% of users reported that substance use met their expectations. Conclusions The findings of this study highlight stress as a significant risk factor for psychoactive substance use among university students, particularly those in medical programs. This underscores the need for targeted preventive strategies and mental health support within academic settings. The study’s methodology demonstrated feasibility for broader application in future research, including biological sample analysis. university students illicit drugs psychoactive substances neuroenhancers stress Introduction and Backgroung The university environment is characterized by high levels of academic and social pressure, which significantly influence students' behaviours, potentially increasing the risk of exposure to psychoactive substances as a coping strategy ( 1 ). Such substances are widely available, and their consumption represents a growing concern. However, the currently available data, primarily based on self-reported questionnaires, could be not adequate to fully understand the phenomenon ( 2 ). The “NO PANIC” project represents a coordinated study between the Universities of Pavia and Bologna in Italy that aims to investigate the actual prevalence of psychoactive substance use among university students through the integrated analysis of self-reported data and laboratory findings. The present preliminary study, related to “NO PANIC” project, focuses on the results obtained from a survey administered to students enrolled in Medicine and Surgery and Health Professions of Rehabilitation Sciences degree programs at the University of Pavia. Cannabis is the most commonly used illicit substance in Europe. Among young adults, 2.0% report daily or near-daily use, while 15.0% have consumed Δ9-tetrahydrocannabinol (THC) based products at least once in the past year, with higher prevalence rates among males than females ( 3 ). Cocaine is the second most commonly used illicit drug in Europe after cannabis, though its prevalence varies significantly across European countries. In 2024, 2.5% of young European adults reported cocaine use. Emergency department visits for cocaine intoxication are increasing and approaching pre-pandemic levels. Cocaine use was implicated in one-fifth of overdose-related deaths in 2022 ( 3 ). Heroin remains the most abused opioid, with its use remaining stable. It was involved in 74% of overdose deaths in Europe between 2015 and 2022, sometimes in combination with other substances ( 3 ). The high availability of illicit drugs in Europe, along with an increasing number of novel psychoactive compounds and a general rise in drug purity and potency, represents an emerging health risk. The spread of new psychoactive substances (NPS), sometimes also referred to as legal highs or designer drugs , is particularly concerning ( 3 ). Lately, these newly synthesized compounds are continuously introduced to the market, thus enlarging the number of psychoactive substances available. Regarding the misuse of prescription medications, prevalence rates vary widely across European countries, ranging from 2.8–23% among adolescents, with an average prevalence of 9.2% ( 4 ). With respect to the situation in Italy, 6.6% of adolescents use psychotropic drugs without a prescription ( 5 ). The use, misuse, and abuse of psychoactive substances among university students have garnered increasing attention from institutions. Social media often emphasize the perceived positive effects of these substances over their negative consequences and potential risks. This contributes to a distorted perception of their effects, in particular when associated with other psychoactive substances ( 6 ). To fully understand the phenomenon of psychoactive substance use among university students, it is essential to investigate the associated risk factors and underlying motivations, rather than limiting the analysis to a quantitative assessment of these behaviours within the academic setting. A strong correlation exists between the use of psychoactive substances and perceived stress levels ( 1 ). The latter is closely linked to the pressure and competition experienced by students that increase during examination periods ( 7 ). Medical students, in particular, are exposed to high levels of stress due to the highly competitive and demanding academic setting. It is therefore unsurprising that the prevalence of depressive symptoms among medical students is higher than in the general population, reaching 12.9%, according to a Swedish study ( 8 ). In this context, the use of psychoactive substances should be interpreted not only as an attempt to enhance cognitive performance but also as a coping mechanism for the deep psychological distress ( 9 ). Another relevant factor, also linked to the perceived levels of academic pressure and competition, is the relationship between low self-esteem and psychoactive substance use. A negative self-perception can act both as a cause and a consequence of substance use, misuse, or abuse ( 10 ). Previous experience with illicit drugs is an additional risk factor for the use of psychoactive substances aimed at cognitive enhancement ( 1 ). Study objectives This study aims to analyze the prevalence and frequency of psychoactive substance use among students enrolled in the Medicine and Surgery and Rehabilitation Health Professions degree programs at the University of Pavia. Beyond estimating prevalence, the investigation explores factors associated with substance use, including motivations for consumption, acquisition methods, satisfaction levels, reported adverse effects, and perceived stress levels. The primary objective is to estimate the prevalence and frequency of psychoactive substance use among Medicine and Surgery and Health Professions of Rehabilitation Sciences students through the administration of an anonymous online survey. Special attention will be given to evaluating defined subgroups based on degree program and gender. Another objective is to explore the underlying motivations for substance use, frequency of consumption, perceived consequences, and attitudes toward psychoactive substances. Finally, the study will assess the strengths and limitations of the online survey tool to evaluate its effectiveness and applicability for future research. Material and Methods Study Population and Inclusion Criteria This pilot feasibility study was conducted in 2024 among students enrolled in the Degree Course in Medicine and Surgery and the Health Professions of Rehabilitation Sciences Degree Course at the University of Pavia. All regularly enrolled students in the two university programs were considered eligible for participation, provided they were at least 18 years old and had given informed consent. Exclusion criteria included conditions that could interfere with the understanding or completion of the informed consent and the questionnaire, such as intellectual disabilities, language barriers, visually impaired or blind students who were unable to read the questionnaire independently. Data Sources, Variables, and Measurement A specifically designed questionnaire was administered to university students using the Google Forms platform. The use of this digital tool allowed for an intuitive structure, divided into multiple sections, and restricted access exclusively to university students by requiring institutional email addresses for participation. Responses were collected anonymously. The questionnaire was developed based on the model used in the study by Maier et al. ( 10 ), with specific adaptations. In particular, the question regarding the frequency of substance use over the past three months was reformulated following the model adopted by Lee et al. ( 11 ). The questionnaire was organized into the following sections: Information Sheet, detailing the project description, study objectives, and data collection procedures, emphasizing anonymity. Informed Consent •, where students were required to provide explicit consent for personal data processing; refusal to consent precluded further participation. Personal Data, including gender identity and age. Academic Data, covering the degree course, year of enrolment, grade point average, any employment activities outside of the academic career, and perceived stress levels (on a scale from 1 to 5) related to study, work, and family commitments. Substance Use Section, with questions clustered into four groups based on legality and access modalities to the substances: Legal Recreational Substances (ethyl alcohol, nicotine, caffeine, theophylline); Illegal Drugs of Abuse (cannabis, synthetic cannabinoids, cocaine, amphetamines and derivatives, opiates, synthetic and semi-synthetic opioids, synthetic cathinones); Prescription Psychoactive Substances (barbiturates, benzodiazepines, antidepressants, antipsychotics, opioid analgesics, medical cannabis, and antiepileptic drugs); Neuroenhancers, either prescription-based or not (modafinil, methylphenidate). For each of the four groups, participants were asked whether they had used any of the substances listed and to specify which one(s), if applicable. Consequently, subjects reporting the use of one or more psychoactive substances were subsequently asked to: Indicate the frequency of use over the past three months; Specify the reasons for use, choosing from multiple options; Express their level of satisfaction regarding the effects obtained through substance use; Report whether the use of one or more substances had resulted in problems with family members, friends, law enforcement authorities, or had interfered with academic performance; Indicate any side effects experienced following substance use, selecting from predefined options. For the last three groups (excluding legal recreational substances), an additional question was included regarding the source of the substances. Response options included: pharmacy with medical prescription, pharmacy without prescription, family and friends, colleagues, internet, and others. A further section inquired whether the student had ever received a formal diagnosis of a psychiatric disorder requiring pharmacological treatment and, in that specific case, whether they had adhered to the prescribed regimen. The final section asked whether the student would be willing to participate in a future study involving not only the completion of a brief questionnaire but also the collection and laboratory analysis of biological samples (specifically, blood and hair). Setting The questionnaire was administered via Google Forms to two distinct student populations at different time points. The first administration involved a cohort of students enrolled in the Health Professions of Rehabilitation Sciences course at the University of Pavia (group 1); The second administration involved 50 students enrolled in the sixth year of the Medicine and Surgery course at the University of Pavia (group 2). For both groups, the questionnaire was administered during the winter examination session, a time considered to be particularly stressful for students, to assess psychoactive substances use during high-pressure periods. The first administration of the questionnaire revealed a structural issue: participants who declared any substance use were still able to respond to the subsequent questions, generating responses that were difficult to interpret. This issue was corrected before the second administration by reorganizing the questionnaire logic flow, ensuring that only those who confirmed substance use could answer subsequent questions regarding motivations, satisfaction, side effects, and acquisition modalities. This revision enhanced data accuracy by preventing irrelevant or inconsistent responses. Responses were collected anonymously via the Google Forms platform, which generated both anonymised individual responses and an aggregated report, streamlining the data analysis process. Responses from the first administration in which participants, despite denying substance use, had proceeded to answer subsequent questions, were eventually excluded. These responses were removed from the final dataset to ensure data integrity. Data Analysis To characterize the study sample and provide an overview of the variables of interest, data analysis was performed using descriptive statistics. Categorical variables were summarized by reporting absolute frequencies and percentages. In order to assess the prevalence and frequency of psychoactive substance use, as well as the motivations, consequences, and attitudes related to such use, absolute and relative frequencies were calculated both for the entire sample and within subgroups defined by gender and type of university course. Differences between groups were analyzed by applying the Chi-square test. In cases where the assumptions required for the application of the Chi-square test were not met, Fisher's exact test was used as an alternative. All statistical analyses were performed using R software, version 4.4.1. Results A total of 97 students from the University of Pavia were interviewed. 59 students (60.8%) were enrolled in the Degree Courses within the Group 1, and 38 students (39.2%) were enrolled in the Group 2. Overall, 70 students (72.2%) self-identified as female (79.9% in Group 1 and 60.5% in Group 2), and 27 students (27.8%) identified as male (20.3% in Group 1 and 39.5% in Group 2). Students in Group 1 were aged between 19 and 29 years, with a mean academic grade ranging from 25 to 29.4 (on a 30-point scale). Among them, 13 students (22%) were in their second year of university studies and 46 students (78%) were in their third year. Additionally, 13 students (22%) in this group reported having one or more jobs outside their academic commitments. Students in Group 2 were aged between 24 and 35 years, with a mean academic grade ranging from 25 to 29.7. The majority, 34 students (89.5%), were attending the sixth year of the degree program, while 4 students (10.5%) were categorized as out-of-course (beyond the expected completion time). In Group 2, 8 students (21.1%) reported being employed alongside their academic studies. Perceived Stress Levels Students were asked to rate their perceived stress levels—related to academic workload, employment, and family obligations—on a scale from 1 (very low) to 5 (very high). Among students in Group 1, the distribution was as follows: 5 students (8.5%) reported a stress level of 2 20 students (33.9%) reported a level of 3 23 students (39%) reported a level of 4 11 students (18.6%) reported a level of 5 Among students in Group 2, the distribution was as follows: 2 students (5.3%) reported a level of 2 6 students (15.7%) reported a level of 3 21 students (55.3%) reported a level of 4 9 students (23.7%) reported a level of 5 In Group 1, 57.6% of students reported high levels of stress (levels 4 or 5); this percentage increase to 69.2% (9 out of 13) when considering only student-workers. In Group 2, 79% of students reported high stress levels (levels 4 or 5), and among student-workers, this percentage rises to 87.5% (7 out of 8). Use of Legal Recreational Substances 95 out of the 97 students (97.9%) interviewed reported having used at least once in their lifetime one or more substances classified as legal recreational substances (100% in Group 1 and 94.7% in Group 2). Among the 70 students who self-identified as female across both groups, 69 students (98.6%) reported having used one or more substances within this category. Among the 27 male students, 26 students (96.3%) reported similar use. Table 1 Absolute and relative legal recreational drugs use Total (n = 97) Female (n = 70) Male (n = 27) P-value Group 1 (n = 59) Group 2 (n = 38) P-value Alcohol (A) 89,7% (87) 90% (63) 88,9% (24) > 0.900 89,8% (53) 89,4% (34) > 0.900 Nicotine (N) 51,5% (50) 48,6% (34) 59,2% ( 16 ) 0.473 59,9% (33) 44,7% ( 17 ) 0.385 Caffeine, theopylline (C) 92,8% (90) 95,7% (67) 85,2% (23) 0.910 93,2% (55) 92,1% (35) > 0.900 None 2,1% ( 2 ) 1,4% ( 1 ) 3,7% ( 1 ) 0.381 0% 5,3% ( 2 ) 0.151 Table 2 Frequency of consumption of legal recreational drugs Never At least once monthly weekly Daily P-value Total G1 G2 Total G1 G2 Total G1 G2 Total G1 G2 Total G1 G2 A 10,3% ( 10 ) 10,2% ( 6 ) 10,5% ( 4 ) 24,7% (24) 28,8% ( 17 ) 18,4% ( 7 ) 33% (32) 37,3% (22) 26,3% ( 10 ) 28,9% (28) 23,7% ( 14 ) 36,8% ( 14 ) 3,1% ( 3 ) 0% (0) 7,9% ( 3 ) 0.108 N 58,7% (57) 61% (36) 55,3% (21) 13,4% ( 13 ) 15,2% ( 9 ) 10,5% ( 4 ) 7,2% ( 7 ) 3,4% ( 2 ) 13,1% ( 5 ) 7,2% ( 7 ) 5,1% ( 3 ) 10,5% ( 4 ) 13,4% ( 13 ) 15,2% ( 9 ) 10,5% ( 4 ) 0.321 C 7,2% ( 7 ) 8,5% ( 5 ) 5,3% ( 2 ) 6,1% ( 6 ) 8,5% ( 5 ) 2,6% ( 1 ) 16,5% ( 16 ) 11,9% ( 7 ) 23,7% ( 9 ) 9,3% ( 9 ) 13,5% ( 8 ) 2,6% ( 1 ) 60,8% (59) 57,6% (34) 65,8% (25) 0.161 Table 1 presents absolute and relative declared substance use, stratified by gender identity and group membership, while Table 2 reports the frequency of the consumption. Among the 59 students in Group 1 who reported having used at least once one or more substances included in the first category (legal recreational substances), the most frequently cited motivations were: a) to improve study efficiency and cognitive performance (46.5%); b) to reduce nervousness and anxiety (31%); c) curiosity and experimentation (15.5%); d) to manage academic pressure (12%). Among the 36 students in Group 2 who reported using substances within this category, the most frequently cited motivations were: a) to improve study efficiency and cognitive performance (47.2%); b) to reduce nervousness and anxiety (33.3%); c) to manage academic pressure (33.3%); d) to improve sleep quality and to relax (19.4%); e) to emulate peers (13.9%). Additionally, 25% of the students in Group 2 indicated that the use of these substances was associated with recreational purposes, personal enjoyment, and social contexts. With respect to the statement “The use of one or more of these substances has led to the desired effect(s)” , among the 95 students who acknowledged such use: a) 5.3% strongly agreed; b) 38.3% agreed; c) 40.4% partially agreed; d) 13.8% disagreed; e) 3.2% strongly disagreed. Regarding the statement “Substance use has caused problems with family members” 1 student from Group 1 and 1 student from Group 2 agreed and 1 student from Group 2 strongly agreed. For the statement “Substance use has caused problems with friends” 2 students from Group 2 agreed. Concerning the statement “Substance use has caused problems with academic performance” 1 student from Group 2 agreed and 1 student from Group 2 strongly agreed. The following side effects were reported among students who had used legal recreational substances: a) tachycardia (35.9%); b) sleep disturbances (33.7%); c) headache (29.3%); d) nervousness (26.1%); e) anxiety (20.6%); f) depressive symptoms (17.4%). A total of 39.1% of respondents reported not experiencing any of the listed adverse effects. The most frequently reported symptoms were consistent between both groups. The proportion of students who declared not having experienced any adverse effects was 50% in Group 1 and 22.2% in Group 2. Use of Illicit drugs Among the 97 students who completed the questionnaire, 50 students (51.5% of the total sample) reported having used at least once in their lifetime one or more substances classified as illegal drugs of abuse . Table 3 gives an overview of the prevalence of use for each specific class of substances included in the illegal drugs of abuse category, while Table 4 reports the frequency of consumption. Table 3 Absolute and relative frequencies of illict drugs use Total (n = 97) Female (n = 70) Male (n = 27) P-value Group 1 (n = 59) Group 2 (n = 38) P-value Cannabis 51,5% (50) 40% (28) 81,5% (22) 44,1% (26) 60,5% (23) Cocaine 1% ( 1 ) 1,4% ( 1 ) 0% > 0.900 1% ( 1 ) 0% > 0.900 Opiates 6,2% ( 6 ) 5,7% ( 4 ) 7,4% ( 2 ) 0.669 5,1% ( 3 ) 7,9% ( 3 ) 0.676 Opioids 0% 0% 0% - 0% 0% - Amphetamine and related derivatives 4,1% ( 4 ) 2,8% ( 2 ) 7,4% ( 2 ) 0.309 1,7% ( 1 ) 7,9% ( 3 ) 0.296 Synthetic cathinones 1% ( 1 ) 0% 3,7% ( 1 ) 0.278 0% 2,6% ( 1 ) 0.392 Synthetic opioids 0% 0% 0% - 0% 0% - None 48,4% (47) 58,6% (41) 22,2% ( 6 ) *0.015 54,2% (32) 39,5% ( 15 ) 0.212 Table 4 Frequency of consumption of illicit drugs Never At least once monthly weekly Daily Cannabis 60,8% (59) 29,9% (29) 3,1% ( 3 ) 5,1% ( 5 ) 1% ( 1 ) Cocaine 98,9% (96) 1% ( 1 ) 0% 0% 0% Opiates 95,9% (93) 4,1% ( 4 ) 0% 0% 0% Amphetamine and derivatives 95,9% (93) 4,1% ( 4 ) 0% 0% 0% Synthetic cathinones 100% (97) 0% 0% 0% 0% Excluding cannabis, 12.4% of respondents reported having used at least once in their lifetime another type of illegal substance. Specifically, this prevalence was 8.5% among students in Group 1 and 18.4% among those in Group 2. Only cannabis was reported to have been used with a monthly frequency or higher over the previous three months by 9.2% of the total respondents. When considering only those who reported having used cannabis at least once in the past three months, this percentage rises to 39.1%. Among the 50 students who reported lifetime use of one or more substances classified as illegal drugs of abuse , the following motivations were identified: a) 50% reported use out of curiosity and for experimentation (37% in Group 1; 65.2% in Group 2); b) 38% to improve sleep and relax (29.7% in Group 1; 47.8% in Group 2); c) 28% to reduce nervousness and anxiety (22.2% in Group 1; 34.8% in Group 2); d) 14% to manage academic pressure (7.4% in Group 1; 21.7% in Group 2). Only 2 students, both from Group 1, indicated that they had used these substances with the intention of improving study efficiency. In Group 1, 9 out of 27 students did not provide any motivation for the use of illegal drugs of abuse, while only 1 student in Group 2 omitted this information. With respect to the statement “The use of one or more of these substances has led to the desired effect(s)” , among the 50 students who admitted to such use: a) 6% strongly agreed; b) 36% agreed; c) 28% partially agreed; d) 14% disagreed; e) 16% strongly disagreed. In Group 1, 48.1% of students declared disagreement or strong disagreement regarding satisfaction with the effects obtained from substance use. In Group 2, 8.7% of students expressed disagreement or strong disagreement, while 91.3% reported agreement or partial agreement. Regarding the occurrence of interpersonal and academic problems related to substance use: a) 1 student in Group 1 agreed that substance use had caused problems with family members, and another student in the same group strongly agreed; b) 1 student in Group 1 strongly agreed that use had caused problems with friends; c) 1 student in Group 1 agreed that use had caused problems with academic performance; d) Additionally, 2 students partially agreed that substance use had caused issues with law enforcement authorities. The most frequently reported side effects were anxiety (14%), tachycardia (14%), appetite disturbances (10%), sleep disturbances (10%), headache (8%) and panic attacks (6%). A total of 60% of participants did not report experiencing any of the listed adverse effects (66.7% in Group 1 and 52.2% in Group 2). In Group 1, the most frequently reported symptoms were anxiety (18.5%), tachycardia (18.5%), headache (7.4%), panic attacks (7.4%). In Group 2, the most commonly reported effects were depressive symptoms (17.4%), which were not reported in Group 1, sleep disturbances (17.4%) and tachycardia, headache, and anxiety (8.7% each). Regarding the sources of acquisition, the self-declarations were the followings: a) 58% of students obtained substances from family members and friends; b) 28% from strangers; c) 8% from colleagues; d) 4% from pharmacies with a medical prescription; e) 2% from pharmacies without a prescription. Use of prescription drugs Among the 97 students who participated in the study, 19 students (19.6%) reported having used at least once one or more prescription psychoactive substances : 7 students out of 59 in Group 1 (11.9%) 12 students out of 38 in Group 2 (31.6%) Among the 70 female students, 12 (17.1%) reported having used substances from this category. Among the 27 male students, 7 (25.9%) reported lifetime use of one or more substances classified as prescription psychoactive drugs . Table 5 summarizes the consumption of individual classes of substances included in the prescription psychoactive substances category. Table 6 reports the frequency of use declared by the subjects. Table 5 Absolute and relative frequencies of prescription drugs use Total (n = 97) Female (n = 70) Male (n = 27) P-value Group 1 (n = 59) Group 2 (n = 38) P-value Benzodiazepine 13,4% ( 13 ) 12,8% ( 9 ) 14,8% ( 4 ) 0.75 5,1% ( 3 ) 26,3% ( 10 ) **0.007 Antidepressants 9,3% ( 9 ) 7,1% ( 5 ) 14,8% ( 4 ) 0.258 3,4% ( 2 ) 18,4% ( 7 ) *0.026 Antipsychotics 0% (0) 0% (0) 0% (0) - 0% (0) 0% (0) - Opioids/opiates 5,1% ( 5 ) 5,7% ( 4 ) 3,7% ( 1 ) > 0.900 6,8% ( 4 ) 2,6% ( 1 ) 0.645 Cannabis 1% ( 1 ) 1,4% ( 1 ) 0% (0) > 0.900 1,7% ( 1 ) 0% (0) > 0.900 Barbiturates 0% (0) 0% (0) 0% (0) - 0% (0) 0% (0) - Antiepileptics 1% ( 1 ) 1,4% ( 1 ) 0% (0) > 0.900 0% (0) 2,6% ( 1 ) 0.39 Hypnotics (except benzodiazepines) 1% ( 1 ) 1,4% ( 1 ) 0% (0) > 0.900 0% (0) 2,6% ( 1 ) 0.39 None 80,4% (78) 82,8% (58) 74,1% (20) 0.489 88,1% (52) 68,4% (26) *0.033 Table 6 Frequency of consumption of prescription drugs Never at least once monthly weekly daily P-value Total G1 G2 Total G1 G2 Total G1 G2 Total G1 G2 Total G1 G2 Benzodiazepines 90,7% (88) 98,3% (58) 78,9% (30) 4,1% ( 4 ) 0% 10,5% ( 4 ) 4,1% ( 4 ) 1,7% ( 1 ) 7,9% ( 3 ) 1% ( 1 ) 0% 2,6% ( 1 ) 0% 0% 0% **0.0022 Antidepressants 93,8% (91) 96,6% (57) 89,5% (34) 1% ( 1 ) 1,7% ( 1 ) 0% 2,1% ( 2 ) 1,7% ( 1 ) 2,6% ( 1 ) 0% 0% 0% 3,1% ( 3 ) 0% 7,9% ( 3 ) 0.745 Opioids/opiates 94,8% (92) 93,2% (55) 97,4% (37) 2,1% ( 2 ) 1,7% ( 1 ) 2,6% ( 1 ) 2,1% ( 2 ) 3,4% ( 2 ) 0% 0% 0% 0% 1% ( 1 ) 1,7% ( 1 ) 0% 0.8602 Cannabis 0% - - 0% - - 0% - - 0% - - 0% - - - Antiepileptics 99% (96) - 97,4% (37) 0% - 0% 1% ( 1 ) - 2,6% ( 1 ) 0% - 0% 0% - 0% - Among the 19 students who reported lifetime use of one or more substances belonging to the third category ( prescription psychoactive substances ), the following motivations were indicated: a) 68.4% for medical reasons (71.4% in Group 1; 66.7% in Group 2); b) 47.4% to improve sleep and relax (14.3% in Group 1; 66.7% in Group 2); c) 42.1% to reduce nervousness and anxiety (28.6% in Group 1; 50% in Group 2); d) additionally, students in Group 1 reported other motivations, including; e) to manage academic pressure (50%); f) to enhance study efficiency and cognitive performance (8.3%, represented by a single student); g) curiosity and experimentation (8.3%). Regarding the statement “The use of one or more of these substances has led to the desired effect(s)” all the students, except one, reported being strongly agree , agree , or partially agree . One student (from Group 1) reported being strongly disagree . The majority of students who reported using prescription psychoactive substances declared no problems with family members, friends, law enforcement, or their academic careers. A single student partially agreed with the statement “The use has led to problems with family members” , as well as “The use has led to problems with law enforcement authorities” . With regard to the statement “The use has led to problems with academic performance” 1 student agreed, 1 student strongly agreed, while 2 students partially agreed. Use of neuroenhancers This final category includes modafinil and methylphenidate, whether taken under medical prescription or self-administered. Only 1 student out of 97 declared having used a neuroenhancer, although not within the previous three months. The reported motivation for its use was to enhance study efficiency and cognitive performance. This student declared that the use of modafinil was effective for achieving the desired objective. The only adverse effect reported was the occurrence of palpitations. The substance was purchased online. Psychiatric disorders A total of 8 students (8.2% of the entire sample) reported having received a psychiatric diagnosis for which they had to undertake pharmacological treatment. Of these 2 students were part of Group 1, representing 3.4% of this subgroup. The remaining 6 students belonged to Group 2, accounting for 15.8% of that group. With respect to gender 5 students identified as female (7.1% of the 70 female students) while 3 students identified as male (11.1% of the 27 male students). Regarding adherence to the prescribed pharmacological treatment 7 students reported always complying with the prescribed dosages while 1 student (from Group 1) declared overdosages of the prescribed drug. Participation in Other Studies In order to assess the feasibility of the "NO PANIC" project, students were asked whether they would be willing to participate in a study requiring not only the completion of a questionnaire but also the collection and laboratory analysis of biological samples (hair and blood), with a guarantee of anonymity. Out of the entire sample, 60 students (61.8%) expressed their willingness to participate. Focusing specifically on students enrolled in the Degree Course in Medicine and Surgery, who will be directly involved in the "NO PANIC" project, 24 students (63.2%) declared their availability. Discussion Legal recreational substances are the most frequently consumed substances in the sample analyzed in this study. A total of 97.9% of the monitored subjects reported lifetime use of at least one substance within this category, with no significant differences observed between genders or between the two groups. In descending order of consumption, the most frequently used substances were products containing caffeine or theophylline, followed by alcoholic beverages and nicotine-based products. Nicotine use was more prevalent among male students, whereas caffeine consumption was higher among females. Minor differences were observed in alcohol consumption between genders. When comparing the two groups, the most notable difference concerned daily nicotine use, which was significantly less prevalent among medical students. However, weekly and daily alcohol consumption was more frequent among medical students, along with weekly nicotine use and daily caffeine intake. Considering a broad definition of neuroenhancement, 64.2% of the subjects reporting a lifetime use of legal recreational substances confirmed the neuroenhancement purpose for using these compounds (61% in Group 1 and 72.2% in Group 2). The difference between groups may be attributed to the higher levels of perceived stress among medical students, as identified in this study. Regarding ethyl alcohol, 89.7% of the subjects reported lifetime use. This percentage is slightly higher than the 84% reported in the ESPAD 2019 Report for Italian adolescents (European average: 79%), suggesting that most students likely had their first experiences with alcohol during their school years prior to university ( 4 ). The European Drug Report 2023 indicates a lifetime prevalence of alcohol use among Italian young adults of 93.2% ( 17 ), while Maier et al. ( 1 ) reported a 93.4% prevalence among Swiss university students—higher than that observed at the University of Pavia and significantly higher than that reported in ESPAD 2019. The present study also found that 89.7% of students had used alcohol at least once in the previous three months, with similar rates between the two groups, but higher weekly and daily consumption among Group 2 (medical students). Therefore, it can be concluded that alcohol consumption among university students in Pavia aligns closely with Italian and European averages, with the only notable difference between the groups concerning consumption frequency. 51.1% of the participants reported lifetime use of nicotine. This is slightly lower than the 55% reported by ESPAD 2019 for Italian adolescents (European average: 41%), but closely aligned with the 55% prevalence reported in the European Drug ( 17 ). In this sample, nicotine use was more common among male students (consistent with the ESPAD 2019 European average, but not with the Italian data, where prevalence is higher among females) and among students in Group 1. While it may seem that medical students use nicotine less frequently, no significant differences were found between groups regarding habitual use (weekly and daily), which overall was 24.5%, consistent with the adult Italian population ( 12 ) and lower than that found among adolescents ( 4 ). This may suggest a decline in smoking habits with increasing age or a lower propensity to smoke among students choosing certain academic paths. Caffeine was the most commonly used substance across all those investigated. Female students were more frequently involved in caffeine consumption compared to male students, with no significant differences between Groups 1 and 2. Daily or almost daily caffeine consumption, reported by 60% of respondents, was more prevalent among medical students (65.8% versus 57.6% in Group 1) and among female students (64.3% versus 51.8% in males). Illegal Drugs of Abuse More than half (51.5%) of participants reported lifetime use of illegal drugs of abuse. However, while high prevalence in the legal recreational substances category reflects significant use of all substances included, in this second group, the most frequently substance used is cannabis. Excluding cannabis, the lifetime prevalence of illegal drug use drops significantly to 12.4%. This consumption pattern, with cannabis being the most frequently used illegal drug, aligns with data from Swiss university students, as reported by Maier et al. ( 1 ), where the overall prevalence of illegal drug use was 44.3%, but decreased to 7.8% when excluding cannabis. Similar trends are reflected in ESPAD 2019 and the European Drug Report 2023, which indicate that 28% of Italian adolescents have used illegal drugs at least once, with 27% reporting cannabis use ( 4 ). Among young adults, similar consumption patterns are observed, although with higher prevalence rates. This study also highlighted that illegal drug use was more prevalent among male students, with percentages more than double those of female students for cannabis and amphetamines (and their derivatives). When comparing Groups 1 and 2, declared use of all substances (except cocaine) was higher among medical students. This may be explained by higher levels of perceived stress and the potential stress-relieving and mood-enhancing effects of cannabis and opioids. Curiosity and experimentation emerged as the most frequently cited motivation for illegal drug use (25%), whereas among Swiss university students ( 1 ) the improvement of academic performance predominates. Neuroenhancement was cited as a motivation by 22% of subjects. In the third group of substances analyzed, which includes psychoactive substances obtainable through medical prescription, overall consumption was more prevalent among male students. Antidepressants use among males was more than two times higher than the one declared by female students, whereas opioids consumption appears more common among females. Notably, only female students reported the use of antiepileptic drugs, medical cannabis, and non-benzodiazepine hypnotics. An analysis of differences between the two groups revealed that benzodiazepine and antidepressant use was significantly more frequent among medical students, while students enrolled in rehabilitation sciences showed a higher prevalence of opioid analgesic consumption. It is worth highlighting that the use of benzodiazepines in association with antidepressants was generally on a daily basis, whereas benzodiazepines alone were used on a weekly basis. In this context, a decisive role may be attributed to the higher prevalence of depressive symptoms and elevated stress levels reported by medical students. This interpretation is supported by the reasons provided for substance use: improving sleep and relaxation, reducing nervousness and anxiety, and managing the pressure associated with academic performance were collectively cited by 66.7% of students in Group 2, compared to 28.6% in Group 1. However, it remains important to highlight that the most frequently cited reason for use was healthcare, reported by 68.4% of students overall (71.4% in Group 1; 66.7% in Group 2). It is also necessary to consider the possibility that the lower number of distinct reasons indicated by students in Group 1 may be due to their perception of medical reasons as encompassing the other motivations such as sleep improvement, relaxation, and stress management. Among the 19 students who reported lifetime use of one or more of the substances listed, only medical students cited additional motivations, such as managing academic pressure (50%), enhancing study efficiency and cognitive performance (8.3%, corresponding to a single student), and curiosity or experimentation (8.3%). Thus, stress appears to be a significant motivating factor underlying the use of these substances by medical students. A single male student (1%), enrolled in the Faculty of Medicine, reported having used modafinil at least once in his lifetime. The reason provided for consumption was to enhance study efficiency. No participants reported having used methylphenidate. A 2011 German study investigating the non-medical use of substances for neuroenhancement among university students found that only 0.8% had used modafinil or methylphenidate, that is consistent with our findings ( 13 ). Another German study reported that 1% of university students had used methylphenidate ( 14 ). Maier et al. presented slightly different results: among Swiss university students, the lifetime prevalence of modafinil use was 0.4%, while methylphenidate use was reported at 5.8% ( 1 ). On the contrary, data from the United States indicate significantly higher prevalence rates. An American systematic review reported that the prevalence of nonprescribed stimulant use among university students ranged from 5–35% ( 15 ), while another study documented an 8% prevalence rate ( 16 ). Based on these findings, it can be concluded that the use of modafinil and methylphenidate is considerably more widespread in the United States compared to Europe. Our sample appears to align closely with data reported for German university students. The data collected regarding students who have received a diagnosis of psychiatric disorders requiring pharmacological treatment indicate a higher prevalence of such conditions among medical students in the population examined in this study. Furthermore, when analyzing the reasons underlying substance use, stress management, anxiety reduction, and sleep improvement were more frequently cited by medical students. It is also noteworthy that while 20% of the students perceived academic pressure as a potential reason for using these psychoactive substances, only 5% of the analyzed population declared a substance use in order to manage competitive pressure. The greatest difference between the two groups concerning adverse effects associated with psychoactive substance use was observed in the incidence of depressive symptoms, reported by 20% of medical students compared to 6.4% of students in rehabilitation sciences courses. Maier et al. reported similar adverse effects in their study, albeit with slightly different prevalence rates: among Swiss students, the most frequently reported side effects included nervousness, sleep disturbances, and headaches, followed by depressive symptoms, appetite disorders, and tachycardia ( 1 ). Overall, in 4 out of 5 cases, the expectations underlying the use of psychoactive substances are reported to be partially or fully achieved, despite the frequent occurrence of adverse effects associated with their consumption. To date, it appears of interest to focus on one of the primary risk factors for the use of psychoactive substances that has been repeatedly highlighted throughout this discussion: stress. Indeed, stress emerged from our study as a particularly prevalent issue within the university population, and higher among medical students. As evidenced by our survey findings, 57.6% of students enrolled in rehabilitation sciences programs reported high levels of perceived stress and pressure, a percentage that rises to 79% among medical students. This issue is more evident among student-workers. This observation is corroborated by the higher prevalence of psychiatric disorder diagnoses recorded in our study population among medical students (15.8%), compared to 3.4% in Group 1. It is clear that stress, along with the anxiety and depressive symptoms, constitutes a fundamental driver for the use of those psychoactive substances that, through their depressant effects on the central nervous system, enable students to relax, improve sleep quality, and enhance mood. This is consistent with our finding of a strong association between elevated stress levels and the consumption of alcohol, cannabis, opioids, and benzodiazepines. Study limitations One limitation, already mentioned in the Methods section, concerns the initial structure of the questionnaire administered to the first group of students. In this version, even participants who declared no substance use were still able to proceed to subsequent sections of the questionnaire and answer questions regarding motivations, satisfaction, and side effects. This resulted in greater complexity during data analysis, as it was necessary to identify and exclude all responses provided by individuals who had denied any substance use. To address this issue, the questionnaire structure was subsequently reorganized to prevent respondents who denied the use of substances in a specific category from accessing further questions related to that category. This adjustment streamlined the data analysis process and allowed some students to complete the questionnaire more quickly. Indeed, it is important to reduce the time required to complete the questionnaire in order to prevent a decrease in respondents’ attention, which could negatively impact on the reliability and accuracy of the answers provided. Another limitation of the present study is the absence of an in-depth investigation into the specific motivations, degree of satisfaction, and adverse effects associated with the use of individual substances. However, the submission to a such detailed document would have significantly increased the time required to complete the questionnaire. In addition, the questionnaire needed a dedicated section exploring the psychological factors associated with psychoactive substance use. No validated scales for assessing self-esteem, resilience, coping strategies, or self-efficacy were included. This decision was made to maintain a shorter completion time for the survey and minimize respondent fatigue. A further critical issue was identified during the questionnaire administration to the first group. The survey was conducted in a university lecture hall at the University of Pavia, prior to the start of a written exam. Given the large number of students present in the room, there was a potential risk that someone could observe and read the responses of nearby students. This concern may have discouraged some participants from providing truthful answers due to the fear of being "discovered". In the forthcoming "NO PANIC" project, specific measures will be implemented to address this problem and ensure greater confidentiality and comfort for participants. Questionnaires will be administered at the end of exam sessions, with respondents seated at appropriately spaced workstations and a limited number of students present simultaneously, to promote a more private and reassuring environment. Conclusions The population investigated in this study consisted of university students enrolled in Degree Courses in Medicine and Surgery and in Rehabilitation Health Sciences. The questionnaire was administered anonymously and was accepted by the majority of the target population, suggesting a limited selection bias, which typically represents one of the major methodological limitations in this type of survey-based research. Among legal psychoactive substances, ethanol, caffeine, and nicotine were found to be widely used by the study population. Regarding prescription psychotropic medications, benzodiazepines and antidepressants accounted for the majority of the reported use. Another expected and confirmed result concerns the prevalence of illegal drugs, with cannabis as the most frequently used illicit substance among young university students. With regard to perceived stress levels, the study observed that medical students reported higher levels of stress compared to students enrolled in Rehabilitation Health Sciences Professions. This finding suggests a potentially greater predisposition among medical students to the use of psychotropic substances aimed at producing relaxation effects and counteracting stress-inducing situations. Specifically, higher rates of cannabis, benzodiazepine, and antidepressant use were observed among medical students. Several results from this study are consistent with findings reported in studies conducted on similar populations within Europe and Switzerland. Abbreviations ESPAD European School Survey Project on Alcohol and other Drugs NO PANIC New and Old Psychoactive drugs Abuse and Neuroenhancers use Investigation among Current university students THC Tetrahydrocannabinol Declarations Ethics approval and consent to participate The research was conducted in accordance with the Declaration of Helsinki and conforms to generally accepted scientific principles. All enrolled students were considered eligible for participation if they had given informed consent for personal data processing; refusal to consent precluded participation. The survey represents the preliminary study of the PRIN NO PANIC Project (20228X4E7W) that was submitted to the ethical committee “Comitato Etico Territoriale Lombardia 6”, that approved the project (protocol number: 0044240/24). Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. An English version of the questionnaire developed for this study is available as supplementary file. Competing interests The authors declare that they have no competing interests. Funding The authors declare that they have no sources of funding for the research. Authors’ contributions CF, GT e LM contributed to data collection. CT e MCM contributed to statistical analysis. VM and JPP contributed to the review of the article. All authors contributed to the writing of the manuscript, read and approved the final manuscript Acknowledgments Not applicable References Maier LJ et al. To dope or not to dope: Neuroenhancement with prescription drugs and drugs of abuse among Swiss university students. PLoS ONE, 2013 8, e77967. Steinhoff A., et al., When Substance Use Is Underreported: Comparing Self-Reports and Hair Toxicology in an UrbanCohort of Young Adults, Journal of the American Academy of Child & Adolescent Psychiatry, 62 (7), 2023, pp. 791–804. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). (2024). European drug report 2024: Trends and developments. Retrieved from https://www.euda.europa.eu/publications/european-drug-report/2024_en ESPAD Group. (2019). ESPAD report 2019: Results from the European school survey project on alcohol and other drugs. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Retrieved from https://www.euda.europa.eu/publications/joint-publications/espad-report-2019_en ESPAD®Italia. 2023 – Navigare il Futuro: dipendenze, comportamenti e stili di vita tra gli studenti italiani. Rapporto di Ricerca sulla diffusione dei comportamenti a rischio fra gli studenti delle scuole superiori di secondo grado. Partridge BJ, et al. Smart drugs as common as coffee: media hype about neuroenhancement. PLoS ONE. 2011;6:e28416. Van Hal G, et al. Popping smart pills: Prescription stimulant misuse by university and college students in Flanders, in European. J Public Health. 2013;23(Suppl 1):122. Dahlin M et al. Stress and depression among medical students: A cross- sectional study, in Medical education, vol. 39, n. 6, 2005, pp. 594–604. Hyman SM et al. Stress-Related Factors in Cannabis Use and Misuse: Implications for Prevention and Treatment, in Journal of Substance Abuse Treatment, 36, 2009, pp. 400–13. Maier LJ et al. The use of prescription drugs and drugs of abuse for neuroenhancement in Europe, in European Psychologist, vol. 20, n. 3, 2015, pp. 155–166. 15 Lee et al., The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries, in Journal of psychiatric research, 165 (2023), pp. 16–27. Istituto Superiore di Sanità, Sorveglianza PASSI. Abitudine al fumo Periodo 2022–2023. https://www.epicentro.iss.it/passi/dati/fumo#:~:text=Dal%202018%20 PASSI%20ha%20iniziato,3%2C4%25%20nel%202023. Franke AG et al. Non-medical use of prescription stimulants and illicit use of stimulants for cognitive enhancement in pupils and students in Germany, in Pharmacopsychiatry, 44, (2011), pp. 60–6. Middendorff E et al. Forms of stress compensation and performance enhancement in students, Hannover, HIS, 2012. 25 Wilens TE, et al. Misuse and diversion of stimulants prescribed for ADHD: A systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008;47:21–31. Wong SHM et al. Prevalence and Correlates of Prescription Stimulant Misuse Among US college students: results from a national survey. in J Clin Psychiatry, 84 (1), 2022. Statistical Bulletin. 2023 — prevalence of drug use, Alcohol, Lifetime prevalence. All adults (15–64) https://www.euda.europa.eu/data/stats2023/gps_en#displayTable:GPS-127 Additional Declarations No competing interests reported. Supplementary Files Questionnaire.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6874281","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484736712,"identity":"a80c1fcf-d6f0-4a5a-962f-9449f757d3da","order_by":0,"name":"Chiara Franzetti","email":"data:image/png;base64,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","orcid":"","institution":"Chiara Franzetti, University of Pavia","correspondingAuthor":true,"prefix":"","firstName":"Chiara","middleName":"","lastName":"Franzetti","suffix":""},{"id":484736713,"identity":"33750cc5-a29b-45a7-bcb9-7e035f0f65f9","order_by":1,"name":"G. Tacconelli","email":"","orcid":"","institution":"University of Pavia","correspondingAuthor":false,"prefix":"","firstName":"G.","middleName":"","lastName":"Tacconelli","suffix":""},{"id":484736714,"identity":"2c5359df-71b3-41e0-a688-5ac8032480f4","order_by":2,"name":"C. Torriani","email":"","orcid":"","institution":"Camilla Torriani, University of Pavia","correspondingAuthor":false,"prefix":"","firstName":"C.","middleName":"","lastName":"Torriani","suffix":""},{"id":484736715,"identity":"62b360d6-3fa1-45e8-86ae-c07cf17962d4","order_by":3,"name":"V. Martini","email":"","orcid":"","institution":"Valentina Martini, University of Pavia","correspondingAuthor":false,"prefix":"","firstName":"V.","middleName":"","lastName":"Martini","suffix":""},{"id":484736716,"identity":"768adff0-6c31-4d5a-9049-868bcb8ee982","order_by":4,"name":"M. C. Monti","email":"","orcid":"","institution":"University of Pavia","correspondingAuthor":false,"prefix":"","firstName":"M.","middleName":"C.","lastName":"Monti","suffix":""},{"id":484736717,"identity":"195d6921-26cb-4477-896a-1098ad4176c3","order_by":5,"name":"Jennifer Paola Pascali","email":"","orcid":"","institution":"University of Bologna","correspondingAuthor":false,"prefix":"","firstName":"Jennifer","middleName":"Paola","lastName":"Pascali","suffix":""},{"id":484736718,"identity":"05c0d99a-f498-4605-960e-9c1ec56426c2","order_by":6,"name":"L. Morini","email":"","orcid":"","institution":"Luca Morini, University of Pavia","correspondingAuthor":false,"prefix":"","firstName":"L.","middleName":"","lastName":"Morini","suffix":""}],"badges":[],"createdAt":"2025-06-11 18:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6874281/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6874281/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107489433,"identity":"ea6cf462-368d-4fe5-a9ea-ddff0351f0f5","added_by":"auto","created_at":"2026-04-22 02:47:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":831041,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6874281/v1/54517766-9268-41c7-a759-a1d5d6677f68.pdf"},{"id":86789290,"identity":"a9fedb8a-0bb3-4fb3-bf6a-a0eecf2c5147","added_by":"auto","created_at":"2025-07-15 14:37:49","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":39949,"visible":true,"origin":"","legend":"","description":"","filename":"Questionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-6874281/v1/c08178c35f6361b2bb476b15.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychoactive substances exposure in a university student population: a comparison between scientific literature and preliminary data collected at the University of Pavia","fulltext":[{"header":"Introduction and Backgroung","content":"\u003cp\u003eThe university environment is characterized by high levels of academic and social pressure, which significantly influence students' behaviours, potentially increasing the risk of exposure to psychoactive substances as a coping strategy (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSuch substances are widely available, and their consumption represents a growing concern. However, the currently available data, primarily based on self-reported questionnaires, could be not adequate to fully understand the phenomenon (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe \u0026ldquo;NO PANIC\u0026rdquo; project represents a coordinated study between the Universities of Pavia and Bologna in Italy that aims to investigate the actual prevalence of psychoactive substance use among university students through the integrated analysis of self-reported data and laboratory findings. The present preliminary study, related to \u0026ldquo;NO PANIC\u0026rdquo; project, focuses on the results obtained from a survey administered to students enrolled in Medicine and Surgery and Health Professions of Rehabilitation Sciences degree programs at the University of Pavia.\u003c/p\u003e\u003cp\u003eCannabis is the most commonly used illicit substance in Europe. Among young adults, 2.0% report daily or near-daily use, while 15.0% have consumed Δ9-tetrahydrocannabinol (THC) based products at least once in the past year, with higher prevalence rates among males than females (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Cocaine is the second most commonly used illicit drug in Europe after cannabis, though its prevalence varies significantly across European countries. In 2024, 2.5% of young European adults reported cocaine use. Emergency department visits for cocaine intoxication are increasing and approaching pre-pandemic levels. Cocaine use was implicated in one-fifth of overdose-related deaths in 2022 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Heroin remains the most abused opioid, with its use remaining stable. It was involved in 74% of overdose deaths in Europe between 2015 and 2022, sometimes in combination with other substances (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The high availability of illicit drugs in Europe, along with an increasing number of novel psychoactive compounds and a general rise in drug purity and potency, represents an emerging health risk. The spread of new psychoactive substances (NPS), sometimes also referred to as \u003cem\u003elegal highs\u003c/em\u003e or \u003cem\u003edesigner drugs\u003c/em\u003e, is particularly concerning (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Lately, these newly synthesized compounds are continuously introduced to the market, thus enlarging the number of psychoactive substances available. Regarding the misuse of prescription medications, prevalence rates vary widely across European countries, ranging from 2.8\u0026ndash;23% among adolescents, with an average prevalence of 9.2% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). With respect to the situation in Italy, 6.6% of adolescents use psychotropic drugs without a prescription (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The use, misuse, and abuse of psychoactive substances among university students have garnered increasing attention from institutions. Social media often emphasize the perceived positive effects of these substances over their negative consequences and potential risks. This contributes to a distorted perception of their effects, in particular when associated with other psychoactive substances (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo fully understand the phenomenon of psychoactive substance use among university students, it is essential to investigate the associated risk factors and underlying motivations, rather than limiting the analysis to a quantitative assessment of these behaviours within the academic setting. A strong correlation exists between the use of psychoactive substances and perceived stress levels (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The latter is closely linked to the pressure and competition experienced by students that increase during examination periods (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMedical students, in particular, are exposed to high levels of stress due to the highly competitive and demanding academic setting. It is therefore unsurprising that the prevalence of depressive symptoms among medical students is higher than in the general population, reaching 12.9%, according to a Swedish study (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In this context, the use of psychoactive substances should be interpreted not only as an attempt to enhance cognitive performance but also as a coping mechanism for the deep psychological distress (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnother relevant factor, also linked to the perceived levels of academic pressure and competition, is the relationship between low self-esteem and psychoactive substance use. A negative self-perception can act both as a cause and a consequence of substance use, misuse, or abuse (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Previous experience with illicit drugs is an additional risk factor for the use of psychoactive substances aimed at cognitive enhancement (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eStudy objectives\u003c/h3\u003e\n\u003cp\u003eThis study aims to analyze the prevalence and frequency of psychoactive substance use among students enrolled in the Medicine and Surgery and Rehabilitation Health Professions degree programs at the University of Pavia. Beyond estimating prevalence, the investigation explores factors associated with substance use, including motivations for consumption, acquisition methods, satisfaction levels, reported adverse effects, and perceived stress levels.\u003c/p\u003e\u003cp\u003eThe primary objective is to estimate the prevalence and frequency of psychoactive substance use among Medicine and Surgery and Health Professions of Rehabilitation Sciences students through the administration of an anonymous online survey. Special attention will be given to evaluating defined subgroups based on degree program and gender.\u003c/p\u003e\u003cp\u003eAnother objective is to explore the underlying motivations for substance use, frequency of consumption, perceived consequences, and attitudes toward psychoactive substances.\u003c/p\u003e\u003cp\u003eFinally, the study will assess the strengths and limitations of the online survey tool to evaluate its effectiveness and applicability for future research.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eStudy Population and Inclusion Criteria\u003c/h2\u003e\u003cp\u003eThis pilot feasibility study was conducted in 2024 among students enrolled in the Degree Course in Medicine and Surgery and the Health Professions of Rehabilitation Sciences Degree Course at the University of Pavia.\u003c/p\u003e\u003cp\u003eAll regularly enrolled students in the two university programs were considered eligible for participation, provided they were at least 18 years old and had given informed consent. Exclusion criteria included conditions that could interfere with the understanding or completion of the informed consent and the questionnaire, such as intellectual disabilities, language barriers, visually impaired or blind students who were unable to read the questionnaire independently.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Sources, Variables, and Measurement\u003c/h3\u003e\n\u003cp\u003eA specifically designed questionnaire was administered to university students using the Google Forms platform. The use of this digital tool allowed for an intuitive structure, divided into multiple sections, and restricted access exclusively to university students by requiring institutional email addresses for participation. Responses were collected anonymously.\u003c/p\u003e\u003cp\u003eThe questionnaire was developed based on the model used in the study by Maier et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), with specific adaptations. In particular, the question regarding the frequency of substance use over the past three months was reformulated following the model adopted by Lee et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe questionnaire was organized into the following sections:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eInformation Sheet, detailing the project description, study objectives, and data collection procedures, emphasizing anonymity.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u0026bull;, where students were required to provide explicit consent for personal data processing; refusal to consent precluded further participation.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePersonal Data, including gender identity and age.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAcademic Data, covering the degree course, year of enrolment, grade point average, any employment activities outside of the academic career, and perceived stress levels (on a scale from 1 to 5) related to study, work, and family commitments.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSubstance Use Section, with questions clustered into four groups based on legality and access modalities to the substances:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eLegal Recreational Substances (ethyl alcohol, nicotine, caffeine, theophylline);\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIllegal Drugs of Abuse (cannabis, synthetic cannabinoids, cocaine, amphetamines and derivatives, opiates, synthetic and semi-synthetic opioids, synthetic cathinones);\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePrescription Psychoactive Substances (barbiturates, benzodiazepines, antidepressants, antipsychotics, opioid analgesics, medical cannabis, and antiepileptic drugs);\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eNeuroenhancers, either prescription-based or not (modafinil, methylphenidate).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e For each of the four groups, participants were asked whether they had used any of the substances listed and to specify which one(s), if applicable. Consequently, subjects reporting the use of one or more psychoactive substances were subsequently asked to:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eIndicate the frequency of use over the past three months;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSpecify the reasons for use, choosing from multiple options;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e Express their level of satisfaction regarding the effects obtained through substance use;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eReport whether the use of one or more substances had resulted in problems with family members, friends, law enforcement authorities, or had interfered with academic performance;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIndicate any side effects experienced following substance use, selecting from predefined options.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eFor the last three groups (excluding legal recreational substances), an additional question was included regarding the source of the substances. Response options included: pharmacy with medical prescription, pharmacy without prescription, family and friends, colleagues, internet, and others.\u003c/p\u003e\u003cp\u003eA further section inquired whether the student had ever received a formal diagnosis of a psychiatric disorder requiring pharmacological treatment and, in that specific case, whether they had adhered to the prescribed regimen.\u003c/p\u003e\u003cp\u003eThe final section asked whether the student would be willing to participate in a future study involving not only the completion of a brief questionnaire but also the collection and laboratory analysis of biological samples (specifically, blood and hair).\u003c/p\u003e\n\u003ch3\u003eSetting\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was administered via Google Forms to two distinct student populations at different time points.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThe first administration involved a cohort of students enrolled in the Health Professions of Rehabilitation Sciences course at the University of Pavia (group 1);\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe second administration involved 50 students enrolled in the sixth year of the Medicine and Surgery course at the University of Pavia (group 2).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eFor both groups, the questionnaire was administered during the winter examination session, a time considered to be particularly stressful for students, to assess psychoactive substances use during high-pressure periods. The first administration of the questionnaire revealed a structural issue: participants who declared any substance use were still able to respond to the subsequent questions, generating responses that were difficult to interpret. This issue was corrected before the second administration by reorganizing the questionnaire logic flow, ensuring that only those who confirmed substance use could answer subsequent questions regarding motivations, satisfaction, side effects, and acquisition modalities. This revision enhanced data accuracy by preventing irrelevant or inconsistent responses.\u003c/p\u003e\u003cp\u003eResponses were collected anonymously via the Google Forms platform, which generated both anonymised individual responses and an aggregated report, streamlining the data analysis process.\u003c/p\u003e\u003cp\u003e Responses from the first administration in which participants, despite denying substance use, had proceeded to answer subsequent questions, were eventually excluded. These responses were removed from the final dataset to ensure data integrity.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eTo characterize the study sample and provide an overview of the variables of interest, data analysis was performed using descriptive statistics. Categorical variables were summarized by reporting absolute frequencies and percentages.\u003c/p\u003e\u003cp\u003eIn order to assess the prevalence and frequency of psychoactive substance use, as well as the motivations, consequences, and attitudes related to such use, absolute and relative frequencies were calculated both for the entire sample and within subgroups defined by gender and type of university course.\u003c/p\u003e\u003cp\u003eDifferences between groups were analyzed by applying the Chi-square test. In cases where the assumptions required for the application of the Chi-square test were not met, Fisher's exact test was used as an alternative.\u003c/p\u003e\u003cp\u003eAll statistical analyses were performed using R software, version 4.4.1.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 97 students from the University of Pavia were interviewed. 59 students (60.8%) were enrolled in the Degree Courses within the Group 1, and 38 students (39.2%) were enrolled in the Group 2. Overall, 70 students (72.2%) self-identified as female (79.9% in Group 1 and 60.5% in Group 2), and 27 students (27.8%) identified as male (20.3% in Group 1 and 39.5% in Group 2). Students in Group 1 were aged between 19 and 29 years, with a mean academic grade ranging from 25 to 29.4 (on a 30-point scale). Among them, 13 students (22%) were in their second year of university studies and 46 students (78%) were in their third year. Additionally, 13 students (22%) in this group reported having one or more jobs outside their academic commitments. Students in Group 2 were aged between 24 and 35 years, with a mean academic grade ranging from 25 to 29.7. The majority, 34 students (89.5%), were attending the sixth year of the degree program, while 4 students (10.5%) were categorized as out-of-course (beyond the expected completion time). In Group 2, 8 students (21.1%) reported being employed alongside their academic studies.\u003c/p\u003e\n\u003ch3\u003ePerceived Stress Levels\u003c/h3\u003e\n\u003cp\u003eStudents were asked to rate their perceived stress levels\u0026mdash;related to academic workload, employment, and family obligations\u0026mdash;on a scale from 1 (very low) to 5 (very high).\u003c/p\u003e\u003cp\u003eAmong students in Group 1, the distribution was as follows:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e5 students (8.5%) reported a stress level of 2\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e20 students (33.9%) reported a level of 3\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e23 students (39%) reported a level of 4\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e11 students (18.6%) reported a level of 5\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eAmong students in Group 2, the distribution was as follows:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e2 students (5.3%) reported a level of 2\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e6 students (15.7%) reported a level of 3\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e21 students (55.3%) reported a level of 4\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e9 students (23.7%) reported a level of 5\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eIn Group 1, 57.6% of students reported high levels of stress (levels 4 or 5); this percentage increase to 69.2% (9 out of 13) when considering only student-workers. In Group 2, 79% of students reported high stress levels (levels 4 or 5), and among student-workers, this percentage rises to 87.5% (7 out of 8).\u003c/p\u003e\n\u003ch3\u003eUse of Legal Recreational Substances\u003c/h3\u003e\n\u003cp\u003e95 out of the 97 students (97.9%) interviewed reported having used at least once in their lifetime one or more substances classified as legal recreational substances (100% in Group 1 and 94.7% in Group 2). Among the 70 students who self-identified as female across both groups, 69 students (98.6%) reported having used one or more substances within this category. Among the 27 male students, 26 students (96.3%) reported similar use.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAbsolute and relative legal recreational drugs use\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;70)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGroup 1 (n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eGroup 2 (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol (A)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89,7% (87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90% (63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88,9% (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.900\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e89,8% (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e89,4% (34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.900\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNicotine (N)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51,5% (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48,6% (34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59,2% (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.473\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e59,9% (33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e44,7% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.385\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCaffeine, theopylline (C)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e92,8% (90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95,7% (67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85,2% (23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.910\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e93,2% (55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e92,1% (35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.900\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,1% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,4% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,7% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.381\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5,3% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.151\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of consumption of legal recreational drugs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"17\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eAt least once\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e\u003cp\u003emonthly\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e\u003cp\u003eweekly\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c16\" namest=\"c14\"\u003e\u003cp\u003eDaily\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c17\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c16\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10,3% (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10,2% (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10,5% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24,7% (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28,8% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18,4% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e33% (32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e37,3% (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e26,3% (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e28,9% (28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e23,7% (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e36,8% (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e3,1% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e7,9% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c17\"\u003e\u003cp\u003e0.108\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58,7% (57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61% (36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55,3% (21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13,4% (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15,2% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10,5% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7,2% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3,4% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e13,1% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e7,2% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e5,1% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e10,5% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e13,4% (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e15,2% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e10,5% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c17\"\u003e\u003cp\u003e0.321\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eC\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7,2% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8,5% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,3% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6,1%\u003c/p\u003e\u003cp\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8,5% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,6% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16,5% (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e11,9% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e23,7% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e9,3% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e13,5% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e2,6% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e60,8% (59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e57,6% (34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e65,8% (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c17\"\u003e\u003cp\u003e0.161\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents absolute and relative declared substance use, stratified by gender identity and group membership, while Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e reports the frequency of the consumption.\u003c/p\u003e\u003cp\u003eAmong the 59 students in Group 1 who reported having used at least once one or more substances included in the first category (legal recreational substances), the most frequently cited motivations were: a) to improve study efficiency and cognitive performance (46.5%); b) to reduce nervousness and anxiety (31%); c) curiosity and experimentation (15.5%); d) to manage academic pressure (12%). Among the 36 students in Group 2 who reported using substances within this category, the most frequently cited motivations were: a) to improve study efficiency and cognitive performance (47.2%); b) to reduce nervousness and anxiety (33.3%); c) to manage academic pressure (33.3%); d) to improve sleep quality and to relax (19.4%); e) to emulate peers (13.9%).\u003c/p\u003e\u003cp\u003eAdditionally, 25% of the students in Group 2 indicated that the use of these substances was associated with recreational purposes, personal enjoyment, and social contexts.\u003c/p\u003e\u003cp\u003eWith respect to the statement \u003cem\u003e\u0026ldquo;The use of one or more of these substances has led to the desired effect(s)\u0026rdquo;\u003c/em\u003e, among the 95 students who acknowledged such use: a) 5.3% strongly agreed; b) 38.3% agreed; c) 40.4% partially agreed; d) 13.8% disagreed; e) 3.2% strongly disagreed. Regarding the statement \u003cem\u003e\u0026ldquo;Substance use has caused problems with family members\u0026rdquo;\u003c/em\u003e 1 student from Group 1 and 1 student from Group 2 agreed and 1 student from Group 2 strongly agreed. For the statement \u003cem\u003e\u0026ldquo;Substance use has caused problems with friends\u0026rdquo;\u003c/em\u003e 2 students from Group 2 agreed. Concerning the statement \u003cem\u003e\u0026ldquo;Substance use has caused problems with academic performance\u0026rdquo;\u003c/em\u003e 1 student from Group 2 agreed and 1 student from Group 2 strongly agreed.\u003c/p\u003e\u003cp\u003eThe following side effects were reported among students who had used legal recreational substances: a) tachycardia (35.9%); b) sleep disturbances (33.7%); c) headache (29.3%); d) nervousness (26.1%); e) anxiety (20.6%); f) depressive symptoms (17.4%). A total of 39.1% of respondents reported not experiencing any of the listed adverse effects. The most frequently reported symptoms were consistent between both groups. The proportion of students who declared not having experienced any adverse effects was 50% in Group 1 and 22.2% in Group 2.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eUse of Illicit drugs\u003c/h2\u003e\u003cp\u003eAmong the 97 students who completed the questionnaire, 50 students (51.5% of the total sample) reported having used at least once in their lifetime one or more substances classified as \u003cem\u003eillegal drugs of abuse\u003c/em\u003e. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e gives an overview of the prevalence of use for each specific class of substances included in the \u003cem\u003eillegal drugs of abuse\u003c/em\u003e category, while Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e reports the frequency of consumption.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAbsolute and relative frequencies of illict drugs use\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;70)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGroup 1 (n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eGroup 2 (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCannabis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51,5% (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40% (28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81,5% (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e44,1% (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e60,5% (23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCocaine\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,4% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.900\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.900\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOpiates\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6,2% (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5,7% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7,4% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.669\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,1% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7,9% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.676\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOpioids\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAmphetamine and related derivatives\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,1% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,8% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7,4% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,7% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7,9% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.296\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSynthetic cathinones\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,7% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,6% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.392\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSynthetic opioids\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48,4% (47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58,6% (41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22,2% (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e*0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e54,2% (32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e39,5% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.212\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of consumption of illicit drugs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAt least once\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003emonthly\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eweekly\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDaily\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCannabis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60,8% (59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29,9% (29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,1% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5,1% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCocaine\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98,9% (96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOpiates\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95,9% (93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,1% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAmphetamine and derivatives\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95,9% (93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,1% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSynthetic cathinones\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100% (97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eExcluding cannabis, 12.4% of respondents reported having used at least once in their lifetime another type of illegal substance. Specifically, this prevalence was 8.5% among students in Group 1 and 18.4% among those in Group 2. Only cannabis was reported to have been used with a monthly frequency or higher over the previous three months by 9.2% of the total respondents. When considering only those who reported having used cannabis at least once in the past three months, this percentage rises to 39.1%.\u003c/p\u003e\u003cp\u003eAmong the 50 students who reported lifetime use of one or more substances classified as \u003cem\u003eillegal drugs of abuse\u003c/em\u003e, the following motivations were identified: a) 50% reported use out of curiosity and for experimentation (37% in Group 1; 65.2% in Group 2); b) 38% to improve sleep and relax (29.7% in Group 1; 47.8% in Group 2); c) 28% to reduce nervousness and anxiety (22.2% in Group 1; 34.8% in Group 2); d) 14% to manage academic pressure (7.4% in Group 1; 21.7% in Group 2). Only 2 students, both from Group 1, indicated that they had used these substances with the intention of improving study efficiency. In Group 1, 9 out of 27 students did not provide any motivation for the use of illegal drugs of abuse, while only 1 student in Group 2 omitted this information. With respect to the statement \u003cem\u003e\u0026ldquo;The use of one or more of these substances has led to the desired effect(s)\u0026rdquo;\u003c/em\u003e, among the 50 students who admitted to such use: a) 6% strongly agreed; b) 36% agreed; c) 28% partially agreed; d) 14% disagreed; e) 16% strongly disagreed. In Group 1, 48.1% of students declared disagreement or strong disagreement regarding satisfaction with the effects obtained from substance use.\u003c/p\u003e\u003cp\u003eIn Group 2, 8.7% of students expressed disagreement or strong disagreement, while 91.3% reported agreement or partial agreement.\u003c/p\u003e\u003cp\u003eRegarding the occurrence of interpersonal and academic problems related to substance use: a) 1 student in Group 1 agreed that substance use had caused problems with family members, and another student in the same group strongly agreed; b) 1 student in Group 1 strongly agreed that use had caused problems with friends; c) 1 student in Group 1 agreed that use had caused problems with academic performance; d) Additionally, 2 students partially agreed that substance use had caused issues with law enforcement authorities. The most frequently reported side effects were anxiety (14%), tachycardia (14%), appetite disturbances (10%), sleep disturbances (10%), headache (8%) and panic attacks (6%).\u003c/p\u003e\u003cp\u003eA total of 60% of participants did not report experiencing any of the listed adverse effects (66.7% in Group 1 and 52.2% in Group 2). In Group 1, the most frequently reported symptoms were anxiety (18.5%), tachycardia (18.5%), headache (7.4%), panic attacks (7.4%). In Group 2, the most commonly reported effects were depressive symptoms (17.4%), which were not reported in Group 1, sleep disturbances (17.4%) and tachycardia, headache, and anxiety (8.7% each). Regarding the sources of acquisition, the self-declarations were the followings: a) 58% of students obtained substances from family members and friends; b) 28% from strangers; c) 8% from colleagues; d) 4% from pharmacies with a medical prescription; e) 2% from pharmacies without a prescription.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eUse of prescription drugs\u003c/h2\u003e\u003cp\u003eAmong the 97 students who participated in the study, 19 students (19.6%) reported having used at least once one or more \u003cem\u003eprescription psychoactive substances\u003c/em\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e7 students out of 59 in Group 1 (11.9%)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e12 students out of 38 in Group 2 (31.6%)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eAmong the 70 female students, 12 (17.1%) reported having used substances from this category. Among the 27 male students, 7 (25.9%) reported lifetime use of one or more substances classified as \u003cem\u003eprescription psychoactive drugs\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e summarizes the consumption of individual classes of substances included in the \u003cem\u003eprescription psychoactive substances\u003c/em\u003e category. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e reports the frequency of use declared by the subjects.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAbsolute and relative frequencies of prescription drugs use\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;70)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGroup 1 (n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eGroup 2 (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBenzodiazepine\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13,4% (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12,8% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14,8% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,1% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26,3% (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e**0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAntidepressants\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9,3% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7,1% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14,8% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.258\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,4% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18,4% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e*0.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAntipsychotics\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOpioids/opiates\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5,1% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5,7% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,7% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.900\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6,8% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,6% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.645\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCannabis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,4% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.900\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,7% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.900\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBarbiturates\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAntiepileptics\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,4% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.900\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,6% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypnotics (except benzodiazepines)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,4% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.900\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,6% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80,4% (78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82,8% (58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74,1% (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.489\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e88,1% (52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e68,4% (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e*0.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of consumption of prescription drugs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"18\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eat least once\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c11\" namest=\"c8\"\u003e\u003cp\u003emonthly\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003eweekly\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c17\" namest=\"c15\"\u003e\u003cp\u003edaily\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c18\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c16\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c17\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBenzodiazepines\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90,7% (88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98,3% (58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78,9% (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4,1% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10,5% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4,1% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e1,7% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e7,9% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e2,6% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e**0.0022\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAntidepressants\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93,8% (91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96,6% (57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89,5% (34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,7% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,1% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e1,7% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2,6% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e3,1% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e7,9% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e0.745\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOpioids/opiates\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94,8% (92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93,2% (55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97,4% (37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,1% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,7% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,6% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,1% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e3,4% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1,7% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e0.8602\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCannabis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAntiepileptics\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99% (96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97,4% (37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2,6% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong the 19 students who reported lifetime use of one or more substances belonging to the third category (\u003cem\u003eprescription psychoactive substances\u003c/em\u003e), the following motivations were indicated: a) 68.4% for medical reasons (71.4% in Group 1; 66.7% in Group 2); b) 47.4% to improve sleep and relax (14.3% in Group 1; 66.7% in Group 2); c) 42.1% to reduce nervousness and anxiety (28.6% in Group 1; 50% in Group 2); d) additionally, students in Group 1 reported other motivations, including; e) to manage academic pressure (50%); f) to enhance study efficiency and cognitive performance (8.3%, represented by a single student); g) curiosity and experimentation (8.3%). Regarding the statement \u003cem\u003e\u0026ldquo;The use of one or more of these substances has led to the desired effect(s)\u0026rdquo;\u003c/em\u003e all the students, except one, reported being \u003cem\u003estrongly agree\u003c/em\u003e, \u003cem\u003eagree\u003c/em\u003e, or \u003cem\u003epartially agree\u003c/em\u003e. One student (from Group 1) reported being \u003cem\u003estrongly disagree\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eThe majority of students who reported using prescription psychoactive substances declared no problems with family members, friends, law enforcement, or their academic careers.\u003c/p\u003e\u003cp\u003eA single student partially agreed with the statement \u003cem\u003e\u0026ldquo;The use has led to problems with family members\u0026rdquo;\u003c/em\u003e, as well as \u003cem\u003e\u0026ldquo;The use has led to problems with law enforcement authorities\u0026rdquo;\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eWith regard to the statement \u003cem\u003e\u0026ldquo;The use has led to problems with academic performance\u0026rdquo;\u003c/em\u003e 1 student agreed, 1 student strongly agreed, while 2 students partially agreed.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eUse of neuroenhancers\u003c/h2\u003e\u003cp\u003eThis final category includes modafinil and methylphenidate, whether taken under medical prescription or self-administered. Only 1 student out of 97 declared having used a neuroenhancer, although not within the previous three months. The reported motivation for its use was to enhance study efficiency and cognitive performance. This student declared that the use of modafinil was effective for achieving the desired objective. The only adverse effect reported was the occurrence of palpitations. The substance was purchased online.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003ePsychiatric disorders\u003c/h2\u003e\u003cp\u003eA total of 8 students (8.2% of the entire sample) reported having received a psychiatric diagnosis for which they had to undertake pharmacological treatment. Of these 2 students were part of Group 1, representing 3.4% of this subgroup. The remaining 6 students belonged to Group 2, accounting for 15.8% of that group. With respect to gender 5 students identified as female (7.1% of the 70 female students) while 3 students identified as male (11.1% of the 27 male students). Regarding adherence to the prescribed pharmacological treatment 7 students reported always complying with the prescribed dosages while 1 student (from Group 1) declared overdosages of the prescribed drug.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eParticipation in Other Studies\u003c/h2\u003e\u003cp\u003eIn order to assess the feasibility of the \"NO PANIC\" project, students were asked whether they would be willing to participate in a study requiring not only the completion of a questionnaire but also the collection and laboratory analysis of biological samples (hair and blood), with a guarantee of anonymity. Out of the entire sample, 60 students (61.8%) expressed their willingness to participate. Focusing specifically on students enrolled in the Degree Course in Medicine and Surgery, who will be directly involved in the \"NO PANIC\" project, 24 students (63.2%) declared their availability.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eLegal recreational substances are the most frequently consumed substances in the sample analyzed in this study. A total of 97.9% of the monitored subjects reported lifetime use of at least one substance within this category, with no significant differences observed between genders or between the two groups. In descending order of consumption, the most frequently used substances were products containing caffeine or theophylline, followed by alcoholic beverages and nicotine-based products.\u003c/p\u003e\u003cp\u003eNicotine use was more prevalent among male students, whereas caffeine consumption was higher among females. Minor differences were observed in alcohol consumption between genders. When comparing the two groups, the most notable difference concerned daily nicotine use, which was significantly less prevalent among medical students. However, weekly and daily alcohol consumption was more frequent among medical students, along with weekly nicotine use and daily caffeine intake.\u003c/p\u003e\u003cp\u003eConsidering a broad definition of neuroenhancement, 64.2% of the subjects reporting a lifetime use of legal recreational substances confirmed the neuroenhancement purpose for using these compounds (61% in Group 1 and 72.2% in Group 2). The difference between groups may be attributed to the higher levels of perceived stress among medical students, as identified in this study.\u003c/p\u003e\u003cp\u003eRegarding ethyl alcohol, 89.7% of the subjects reported lifetime use. This percentage is slightly higher than the 84% reported in the ESPAD 2019 Report for Italian adolescents (European average: 79%), suggesting that most students likely had their first experiences with alcohol during their school years prior to university (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The European Drug Report 2023 indicates a lifetime prevalence of alcohol use among Italian young adults of 93.2% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), while Maier et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) reported a 93.4% prevalence among Swiss university students\u0026mdash;higher than that observed at the University of Pavia and significantly higher than that reported in ESPAD 2019.\u003c/p\u003e\u003cp\u003eThe present study also found that 89.7% of students had used alcohol at least once in the previous three months, with similar rates between the two groups, but higher weekly and daily consumption among Group 2 (medical students). Therefore, it can be concluded that alcohol consumption among university students in Pavia aligns closely with Italian and European averages, with the only notable difference between the groups concerning consumption frequency.\u003c/p\u003e\u003cp\u003e51.1% of the participants reported lifetime use of nicotine. This is slightly lower than the 55% reported by ESPAD 2019 for Italian adolescents (European average: 41%), but closely aligned with the 55% prevalence reported in the European Drug (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In this sample, nicotine use was more common among male students (consistent with the ESPAD 2019 European average, but not with the Italian data, where prevalence is higher among females) and among students in Group 1. While it may seem that medical students use nicotine less frequently, no significant differences were found between groups regarding habitual use (weekly and daily), which overall was 24.5%, consistent with the adult Italian population (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and lower than that found among adolescents (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This may suggest a decline in smoking habits with increasing age or a lower propensity to smoke among students choosing certain academic paths.\u003c/p\u003e\u003cp\u003eCaffeine was the most commonly used substance across all those investigated. Female students were more frequently involved in caffeine consumption compared to male students, with no significant differences between Groups 1 and 2. Daily or almost daily caffeine consumption, reported by 60% of respondents, was more prevalent among medical students (65.8% versus 57.6% in Group 1) and among female students (64.3% versus 51.8% in males).\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eIllegal Drugs of Abuse\u003c/h2\u003e\u003cp\u003eMore than half (51.5%) of participants reported lifetime use of illegal drugs of abuse. However, while high prevalence in the legal recreational substances category reflects significant use of all substances included, in this second group, the most frequently substance used is cannabis. Excluding cannabis, the lifetime prevalence of illegal drug use drops significantly to 12.4%. This consumption pattern, with cannabis being the most frequently used illegal drug, aligns with data from Swiss university students, as reported by Maier et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), where the overall prevalence of illegal drug use was 44.3%, but decreased to 7.8% when excluding cannabis. Similar trends are reflected in ESPAD 2019 and the European Drug Report 2023, which indicate that 28% of Italian adolescents have used illegal drugs at least once, with 27% reporting cannabis use (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Among young adults, similar consumption patterns are observed, although with higher prevalence rates. This study also highlighted that illegal drug use was more prevalent among male students, with percentages more than double those of female students for cannabis and amphetamines (and their derivatives). When comparing Groups 1 and 2, declared use of all substances (except cocaine) was higher among medical students. This may be explained by higher levels of perceived stress and the potential stress-relieving and mood-enhancing effects of cannabis and opioids. Curiosity and experimentation emerged as the most frequently cited motivation for illegal drug use (25%), whereas among Swiss university students (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the improvement of academic performance predominates. Neuroenhancement was cited as a motivation by 22% of subjects.\u003c/p\u003e\u003cp\u003eIn the third group of substances analyzed, which includes psychoactive substances obtainable through medical prescription, overall consumption was more prevalent among male students. Antidepressants use among males was more than two times higher than the one declared by female students, whereas opioids consumption appears more common among females. Notably, only female students reported the use of antiepileptic drugs, medical cannabis, and non-benzodiazepine hypnotics.\u003c/p\u003e\u003cp\u003eAn analysis of differences between the two groups revealed that benzodiazepine and antidepressant use was significantly more frequent among medical students, while students enrolled in rehabilitation sciences showed a higher prevalence of opioid analgesic consumption. It is worth highlighting that the use of benzodiazepines in association with antidepressants was generally on a daily basis, whereas benzodiazepines alone were used on a weekly basis.\u003c/p\u003e\u003cp\u003eIn this context, a decisive role may be attributed to the higher prevalence of depressive symptoms and elevated stress levels reported by medical students. This interpretation is supported by the reasons provided for substance use: improving sleep and relaxation, reducing nervousness and anxiety, and managing the pressure associated with academic performance were collectively cited by 66.7% of students in Group 2, compared to 28.6% in Group 1. However, it remains important to highlight that the most frequently cited reason for use was healthcare, reported by 68.4% of students overall (71.4% in Group 1; 66.7% in Group 2).\u003c/p\u003e\u003cp\u003eIt is also necessary to consider the possibility that the lower number of distinct reasons indicated by students in Group 1 may be due to their perception of medical reasons as encompassing the other motivations such as sleep improvement, relaxation, and stress management.\u003c/p\u003e\u003cp\u003eAmong the 19 students who reported lifetime use of one or more of the substances listed, only medical students cited additional motivations, such as managing academic pressure (50%), enhancing study efficiency and cognitive performance (8.3%, corresponding to a single student), and curiosity or experimentation (8.3%). Thus, stress appears to be a significant motivating factor underlying the use of these substances by medical students.\u003c/p\u003e\u003cp\u003eA single male student (1%), enrolled in the Faculty of Medicine, reported having used modafinil at least once in his lifetime. The reason provided for consumption was to enhance study efficiency. No participants reported having used methylphenidate.\u003c/p\u003e\u003cp\u003eA 2011 German study investigating the non-medical use of substances for neuroenhancement among university students found that only 0.8% had used modafinil or methylphenidate, that is consistent with our findings (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Another German study reported that 1% of university students had used methylphenidate (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMaier et al. presented slightly different results: among Swiss university students, the lifetime prevalence of modafinil use was 0.4%, while methylphenidate use was reported at 5.8% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). On the contrary, data from the United States indicate significantly higher prevalence rates. An American systematic review reported that the prevalence of nonprescribed stimulant use among university students ranged from 5\u0026ndash;35% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), while another study documented an 8% prevalence rate (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Based on these findings, it can be concluded that the use of modafinil and methylphenidate is considerably more widespread in the United States compared to Europe. Our sample appears to align closely with data reported for German university students.\u003c/p\u003e\u003cp\u003eThe data collected regarding students who have received a diagnosis of psychiatric disorders requiring pharmacological treatment indicate a higher prevalence of such conditions among medical students in the population examined in this study.\u003c/p\u003e\u003cp\u003eFurthermore, when analyzing the reasons underlying substance use, stress management, anxiety reduction, and sleep improvement were more frequently cited by medical students.\u003c/p\u003e\u003cp\u003eIt is also noteworthy that while 20% of the students perceived academic pressure as a potential reason for using these psychoactive substances, only 5% of the analyzed population declared a substance use in order to manage competitive pressure.\u003c/p\u003e\u003cp\u003eThe greatest difference between the two groups concerning adverse effects associated with psychoactive substance use was observed in the incidence of depressive symptoms, reported by 20% of medical students compared to 6.4% of students in rehabilitation sciences courses. Maier et al. reported similar adverse effects in their study, albeit with slightly different prevalence rates: among Swiss students, the most frequently reported side effects included nervousness, sleep disturbances, and headaches, followed by depressive symptoms, appetite disorders, and tachycardia (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOverall, in 4 out of 5 cases, the expectations underlying the use of psychoactive substances are reported to be partially or fully achieved, despite the frequent occurrence of adverse effects associated with their consumption.\u003c/p\u003e\u003cp\u003eTo date, it appears of interest to focus on one of the primary risk factors for the use of psychoactive substances that has been repeatedly highlighted throughout this discussion: stress. Indeed, stress emerged from our study as a particularly prevalent issue within the university population, and higher among medical students. As evidenced by our survey findings, 57.6% of students enrolled in rehabilitation sciences programs reported high levels of perceived stress and pressure, a percentage that rises to 79% among medical students. This issue is more evident among student-workers.\u003c/p\u003e\u003cp\u003eThis observation is corroborated by the higher prevalence of psychiatric disorder diagnoses recorded in our study population among medical students (15.8%), compared to 3.4% in Group 1.\u003c/p\u003e\u003cp\u003eIt is clear that stress, along with the anxiety and depressive symptoms, constitutes a fundamental driver for the use of those psychoactive substances that, through their depressant effects on the central nervous system, enable students to relax, improve sleep quality, and enhance mood. This is consistent with our finding of a strong association between elevated stress levels and the consumption of alcohol, cannabis, opioids, and benzodiazepines.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eStudy limitations\u003c/h2\u003e\u003cp\u003eOne limitation, already mentioned in the Methods section, concerns the initial structure of the questionnaire administered to the first group of students. In this version, even participants who declared no substance use were still able to proceed to subsequent sections of the questionnaire and answer questions regarding motivations, satisfaction, and side effects. This resulted in greater complexity during data analysis, as it was necessary to identify and exclude all responses provided by individuals who had denied any substance use.\u003c/p\u003e\u003cp\u003eTo address this issue, the questionnaire structure was subsequently reorganized to prevent respondents who denied the use of substances in a specific category from accessing further questions related to that category. This adjustment streamlined the data analysis process and allowed some students to complete the questionnaire more quickly. Indeed, it is important to reduce the time required to complete the questionnaire in order to prevent a decrease in respondents\u0026rsquo; attention, which could negatively impact on the reliability and accuracy of the answers provided.\u003c/p\u003e\u003cp\u003eAnother limitation of the present study is the absence of an in-depth investigation into the specific motivations, degree of satisfaction, and adverse effects associated with the use of individual substances. However, the submission to a such detailed document would have significantly increased the time required to complete the questionnaire.\u003c/p\u003e\u003cp\u003eIn addition, the questionnaire needed a dedicated section exploring the psychological factors associated with psychoactive substance use. No validated scales for assessing self-esteem, resilience, coping strategies, or self-efficacy were included. This decision was made to maintain a shorter completion time for the survey and minimize respondent fatigue.\u003c/p\u003e\u003cp\u003eA further critical issue was identified during the questionnaire administration to the first group. The survey was conducted in a university lecture hall at the University of Pavia, prior to the start of a written exam. Given the large number of students present in the room, there was a potential risk that someone could observe and read the responses of nearby students. This concern may have discouraged some participants from providing truthful answers due to the fear of being \"discovered\".\u003c/p\u003e\u003cp\u003eIn the forthcoming \"NO PANIC\" project, specific measures will be implemented to address this problem and ensure greater confidentiality and comfort for participants. Questionnaires will be administered at the end of exam sessions, with respondents seated at appropriately spaced workstations and a limited number of students present simultaneously, to promote a more private and reassuring environment.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe population investigated in this study consisted of university students enrolled in Degree Courses in Medicine and Surgery and in Rehabilitation Health Sciences. The questionnaire was administered anonymously and was accepted by the majority of the target population, suggesting a limited selection bias, which typically represents one of the major methodological limitations in this type of survey-based research. Among legal psychoactive substances, ethanol, caffeine, and nicotine were found to be widely used by the study population. Regarding prescription psychotropic medications, benzodiazepines and antidepressants accounted for the majority of the reported use. Another expected and confirmed result concerns the prevalence of illegal drugs, with cannabis as the most frequently used illicit substance among young university students. With regard to perceived stress levels, the study observed that medical students reported higher levels of stress compared to students enrolled in Rehabilitation Health Sciences Professions. This finding suggests a potentially greater predisposition among medical students to the use of psychotropic substances aimed at producing relaxation effects and counteracting stress-inducing situations. Specifically, higher rates of cannabis, benzodiazepine, and antidepressant use were observed among medical students. Several results from this study are consistent with findings reported in studies conducted on similar populations within Europe and Switzerland.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eESPAD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEuropean School Survey Project on Alcohol and other Drugs\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNO PANIC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNew and Old Psychoactive drugs Abuse and Neuroenhancers use Investigation among Current university students\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTHC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTetrahydrocannabinol\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted in accordance with the Declaration of Helsinki and conforms to generally accepted scientific principles.\u003c/p\u003e\n\u003cp\u003eAll enrolled students were considered eligible for participation if they had given informed consent for personal data processing; refusal to consent precluded participation. The survey represents the preliminary study of the PRIN NO PANIC Project (20228X4E7W) that was submitted to the ethical committee \u0026ldquo;Comitato Etico Territoriale Lombardia 6\u0026rdquo;, that approved the project (protocol number: 0044240/24).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eAn English version of the questionnaire developed for this study is available as supplementary file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no sources of funding for the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCF, GT e LM contributed to data collection.\u003c/p\u003e\n\u003cp\u003eCT e MCM contributed to statistical analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVM and JPP contributed to the review of the article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the writing of the manuscript, read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMaier LJ et al. To dope or not to dope: Neuroenhancement with prescription drugs and drugs of abuse among Swiss university students. PLoS ONE, 2013 8, e77967.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSteinhoff A., et al., When Substance Use Is Underreported: Comparing Self-Reports and Hair Toxicology in an UrbanCohort of Young Adults, Journal of the American Academy of Child \u0026amp; Adolescent Psychiatry, 62 (7), 2023, pp. 791\u0026ndash;804.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEuropean Monitoring Centre for Drugs and Drug Addiction (EMCDDA). (2024). European drug report 2024: Trends and developments. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.euda.europa.eu/publications/european-drug-report/2024_en\u003c/span\u003e\u003cspan address=\"https://www.euda.europa.eu/publications/european-drug-report/2024_en\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eESPAD Group. (2019). ESPAD report 2019: Results from the European school survey project on alcohol and other drugs. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.euda.europa.eu/publications/joint-publications/espad-report-2019_en\u003c/span\u003e\u003cspan address=\"https://www.euda.europa.eu/publications/joint-publications/espad-report-2019_en\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eESPAD\u0026reg;Italia. 2023 \u0026ndash; Navigare il Futuro: dipendenze, comportamenti e stili di vita tra gli studenti italiani. Rapporto di Ricerca sulla diffusione dei comportamenti a rischio fra gli studenti delle scuole superiori di secondo grado.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePartridge BJ, et al. Smart drugs as common as coffee: media hype about neuroenhancement. PLoS ONE. 2011;6:e28416.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVan Hal G, et al. Popping smart pills: Prescription stimulant misuse by university and college students in Flanders, in European. J Public Health. 2013;23(Suppl 1):122.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDahlin M et al. Stress and depression among medical students: A cross- sectional study, in Medical education, vol. 39, n. 6, 2005, pp. 594\u0026ndash;604.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHyman SM et al. Stress-Related Factors in Cannabis Use and Misuse: Implications for Prevention and Treatment, in Journal of Substance Abuse Treatment, 36, 2009, pp. 400\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaier LJ et al. The use of prescription drugs and drugs of abuse for neuroenhancement in Europe, in European Psychologist, vol. 20, n. 3, 2015, pp. 155\u0026ndash;166.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e15 Lee et al., The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries, in Journal of psychiatric research, 165 (2023), pp. 16\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIstituto Superiore di Sanit\u0026agrave;, Sorveglianza PASSI. Abitudine al fumo Periodo 2022\u0026ndash;2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.epicentro.iss.it/passi/dati/fumo#:~:text=Dal%202018%20\u003c/span\u003e\u003cspan address=\"https://www.epicentro.iss.it/passi/dati/fumo#:~:text=Dal%202018%20\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePASSI%20ha%20iniziato,3%2C4%25%20nel%202023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFranke AG et al. Non-medical use of prescription stimulants and illicit use of stimulants for cognitive enhancement in pupils and students in Germany, in Pharmacopsychiatry, 44, (2011), pp. 60\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiddendorff E et al. Forms of stress compensation and performance enhancement in students, Hannover, HIS, 2012.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e25 Wilens TE, et al. Misuse and diversion of stimulants prescribed for ADHD: A systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008;47:21\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWong SHM et al. Prevalence and Correlates of Prescription Stimulant Misuse Among US college students: results from a national survey. in J Clin Psychiatry, 84 (1), 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStatistical Bulletin. 2023 \u0026mdash; prevalence of drug use, Alcohol, Lifetime prevalence. All adults (15\u0026ndash;64) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.euda.europa.eu/data/stats2023/gps_en#displayTable:GPS-127\u003c/span\u003e\u003cspan address=\"https://www.euda.europa.eu/data/stats2023/gps_en#displayTable:GPS-127\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"university students, illicit drugs, psychoactive substances, neuroenhancers, stress","lastPublishedDoi":"10.21203/rs.3.rs-6874281/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6874281/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe university environment is often associated with high levels of academic and social pressure, potentially being related to an increase in psychoactive substances use. Medical students, in particular, exhibit high levels of stress and a higher prevalence of psychiatric disorders compared to general population, potentially influencing their substance consumption patterns.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThe present preliminary study, conducted within the \"NO PANIC\" project framework, aimed to analyze the prevalence, motivations, and risk factors associated with psychoactive substances use among university students enrolled in the Medicine and Surgery and Health Professions of Rehabilitation Sciences degree programs at the University of Pavia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eAn anonymous online survey was administered to 97 students during a highly stressful academic period. The survey assessed lifetime and recent use of legal recreational substances, illicit drugs, prescription psychoactive medications, and neuroenhancers. Data on consumption patterns, motivations for use, acquisition methods, adverse effects, perceived stress levels, and psychiatric diagnoses were collected. Statistical analyses were performed to identify differences between subgroups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eLifetime use of legal recreational substances was reported by 97.9% of participants, with alcohol, caffeine, and nicotine being the most commonly used. Illicit drug use was reported by 51.5% of respondents, with cannabis being the most commonly used substance among students. Prescription psychoactive substances were used by 19.6% of students, with benzodiazepines and antidepressants being more prevalent among medical students. Neuroenhancer use was rare (1%). Higher stress levels and psychiatric diagnoses were significantly more common in medical students (79% and 15.8%, respectively), correlating with increased psychoactive substance use. The tested subjects as primary motivations provided stress management, anxiety reduction, and sleep improvement. Despite frequent adverse effects, 80% of users reported that substance use met their expectations.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe findings of this study highlight stress as a significant risk factor for psychoactive substance use among university students, particularly those in medical programs. This underscores the need for targeted preventive strategies and mental health support within academic settings. The study\u0026rsquo;s methodology demonstrated feasibility for broader application in future research, including biological sample analysis.\u003c/p\u003e","manuscriptTitle":"Psychoactive substances exposure in a university student population: a comparison between scientific literature and preliminary data collected at the University of Pavia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 14:29:44","doi":"10.21203/rs.3.rs-6874281/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3710054-3708-4248-8ef7-b56828863e89","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-21T07:27:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-15 14:29:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6874281","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6874281","identity":"rs-6874281","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}