"Motives for using methamphetamine with heroin/fentanyl can be conceptualized as forming three thematic categories: ‘intrinsic use’, representing the inherent pleasure of the combination or self-medication of particular conditions; ‘opioid assisting use’ in which methamphetamine helped manage existing heroin/fentanyl use and ‘reluctant or indifferent use’. All 30 individuals had some experience using methamphetamine, whether separately or combined with heroin.

"The role of co-use of heroin and methamphetamine in overdose requires greater exploration. Intentional co-use of heroin and methamphetamine is increasing in the US, whether in simultaneous injection as a ‘goofball’, sequential injection or other combined modes, including smoking and snorting.

"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.