"Importantly, trenbolone was discussed as having the most deleterious consequences for users which fits with extant work [7]. The data suggests a number of psychosocial harms arising for trenbolone users including the increased social vigilance required which may lead to social difficulties. Specifically, participants reported a decline in patience and attributed trenbolone to being responsible.

"Harms surrounding AAS [Anabolic-Androgenic Steroids] are mostly discussed in general terms, while specific differences between compounds are seldom discussed. Underwood [7] posits that there is a need, particularly regarding trenbolone, to discuss individual compounds.

"Among the synthesized articles, the five most frequently cited characteristics and components of a PHA were the following (also see Table 6 for illustrative quotes):

"During the 16-month study period between June 2019 and November 2021 (June 2019–mid-March 2020 and June 2021–November 2021), 6% of our sample of people who used drugs daily in Vancouver reported having had their drugs seized by police without arrest at least once in the past 6 months.

"Among 995 participants who were interviewed in 2019–2021, 63 (6.3%) had their drugs seized by police at least once in the past 6 months. In multivariable analyses, factors significantly associated with drug seizure included: homelessness (adjusted odds ratio [AOR]: 1.98; 95% confidence interval [CI] 1.09–3.61), working in the unregulated drug market (AOR: 4.93; 95% CI 2.87–8.49), and naloxone administration (AOR: 2.15; 95% CI 1.23–3.76). In 2009–2012, 67.8% reported having obtained new drugs immediately after having their drugs seized by police.

"In this cross-sectional study of primary care patients in a state with legal recreational cannabis use, CUD was common among patients who used cannabis, with 21% having CUD and 6% having moderate to severe CUD. Patients who used cannabis for medical reasons only were mostly older and likely to use applied products. Patients who reported any nonmedical use were at greatest risk of moderate to severe CUD (7.2% to 7.5%). While the prevalence of moderate to severe CUD was lowest among patients who reported medical use only (1.3%), 13.4% met criteria for mild, moderate, or severe CUD.

"The primary care sample of patients who used cannabis (n = 1463 patient respondents weighted to primary care population who used cannabis) was predominantly middle-aged (weighted mean [SD] age, 47.4 [16.8] years); female (748 [weighted proportion, 61.9%] vs 715 male [weighted proportion, 38.1%]), and commercially insured (935 [61.1%]) (Table 1).