j for med Adli Tıp Dergisi 1018-5275 2149-0570 Adli Tıp Kurumu 10.61970/adlitip.1797752 Forensic Medicine Forensic Chemistry Adli Tıp Adli Kimya Yasal Psikoaktif Maddelerin Suistimalinde Güncel Durum: Mesleki Eğilim Yönünden Bir Bakış Current Situation in the Abuse of Legal Psychoactive Substances: A Perspective on Professional Trends https://orcid.org/0009-0004-7242-7641 Kılıç Mihriban Dilan İSTANBUL ÜNİVERSİTESİ-CERRAHPAŞA, ADLİ TIP VE ADLİ BİLİMLER ENSTİTÜSÜ https://orcid.org/0000-0001-9060-6775 Şimşek Sümeyye Zülal İSTANBUL ÜNİVERSİTESİ-CERRAHPAŞA, ADLİ TIP VE ADLİ BİLİMLER ENSTİTÜSÜ https://orcid.org/0000-0002-3670-3168 Kuloğlu Genç Merve İSTANBUL ÜNİVERSİTESİ-CERRAHPAŞA, ADLİ TIP VE ADLİ BİLİMLER ENSTİTÜSÜ https://orcid.org/0009-0009-6832-2739 Aslan Sena Nur İSTANBUL ÜNİVERSİTESİ-CERRAHPAŞA, ADLİ TIP VE ADLİ BİLİMLER ENSTİTÜSÜ Mercan Selda 04 30 2026 40 1 128 143 10 06 2025 04 24 2026 Copyright © 1985, Turkish Journal of Forensic Medicine 1985 Turkish Journal of Forensic Medicine

Madde bağımlılığı ve suistimali, günümüzde önemli bir halk sağlığı sorununu teşkil etmekte ve çeşitli meslek gruplarına özgü risk dinamikleriyle karmaşık bir boyut kazanmaktadır. Reçeteli ilaçların terapötik endikasyonların ötesinde giderek daha sık kullanılmaya başlandığı bildirilmektedir. Mesleğe özgü kalıpları ve motivasyonları anlamak, etkili önleme ve politika geliştirme için çok önemlidir. Bu derleme çalışmasında, meslek gruplarına özgü madde istismar eğilimleri ve risk faktörleri de dikkate alınarak, reçeteli ilaç suistimalinde güncel durumun araştırılması amaçlanmıştır. Sistematik derleme şeklinde yapılandırılan bu çalışmada, PubMed veritabanı kullanılarak reçeteli ilaçların suistimali, psikoaktif maddeler ve mesleki risk ile ilgili önceden tanımlanmış anahtar kelimeler (“prescription drug misuse”, “prescription drug abuse”, “occupational risk”, “legal drugs”, “prescription medication”, “workplace drug use” ve “occupational substance abuse”) kullanılarak 2015 ile 2025 yılları arasında yayınlanan çalışmalar taranmıştır. Toplam 411 literatür arasından belirlenen dahil edilme kriterlerine göre 25 çalışma incelenmiş ve ayrıntılı ele alınmıştır. İncelenen çalışmalar, sağlık çalışanları, tıp eğitimi gören öğrenciler, ulaşım sektöründe çalışanlar, güvenlik ile ilgili meslekler ve diğer meslekler şeklinde kategorize edilmiştir. Benzodiazepinler, opioid analjezikler, reçeteli uyarıcılar ve sedatif-hipnotikler en sık suistimal edilen ilaç grupları olarak öne çıkmaktadır. Suistimal sebepleri arasında stres azaltma, yorgunluk ve zaman yönetimi, performans artırma, fiziksel veya psikolojik semptomların kendi kendine tedavisinin yer aldığı tespit edilmiştir. Çalışmaların bazıları, reçeteli ilaçların suistimali ile eşzamanlı alkol veya yasa dışı madde kullanımını da bildirmiştir. Reçeteli ilaç suistimali, araştırılan diğer meslek gruplarına kıyasla sağlık meslek grubunda daha yaygın olarak görülmekte ve suistimal sebepleri mesleki faktörlerden güçlü bir şekilde etkilenmektedir. Bu bulgular, iş gücünde tıbbi olmayan ilaç kullanımıyla ilişkili riskleri azaltmak için hedefe yönelik iş sağlığı müdahalelerinin, reçete izlemenin iyileştirilmesinin ve farkındalığın artırılmasının gerekliliğini vurgulamaktadır.

Substance dependence and misuse constitute a significant public health problem today and gain additional complexity due to risk dynamics specific to different occupational groups. Prescription drugs have increasingly been used beyond their therapeutic indications. Understanding occupation-specific patterns and motivations is crucial for effective prevention and policy development. This review study aims to investigate the current situation of prescription drug misuse while considering occupation-specific substance misuse tendencies and risk factors. Using the PubMed literature database, studies published between 2015 and 2025 were searched using predefined keywords (‘prescription drug misuse’, ‘prescription drug abuse’, ‘occupational risk’, ‘legal drugs’, ‘prescription medication’, ‘workplace drug use’, ‘occupational substance abuse’). Among 411 studies identified according to the defined criteria, 25 met the inclusion criteria and were included in this study. The reviewed studies were categorized into healthcare professionals, medical students, transportation sector workers, security- related professions, and other occupational groups. Benzodiazepines, opioid analgesics, prescription stimulants, and sedative-hypnotics emerged as the most commonly misused drug groups. Reasons for misuse included stress reduction, fatigue management, performance enhancement, and self-treatment of physical or psychological symptoms. Some studies also reported concurrent use of alcohol or illicit substances alongside prescription drug misuse. Prescription drug misuse appears to be more prevalent among healthcare professionals compared with other occupational groups examined, and the reasons for misuse are strongly influenced by occupational factors. These findings highlight the need for targeted occupational health interventions, improved prescription monitoring, and increased awareness to reduce risks associated with non-medical drug use in the workforce.

 Toksikoloji Bağımlılık İstismar Reçeteli ilaç Psikotrop madde Toxicology Addiction Abuse Prescription medicine Psychotropic drugs WHO. Mortality and Morbidity Statistics. In: International Classification of Diseases. 11th ed. World Health Organization; 2025. Dadak A. Anesteziyolojide Kullanılan Bağımlılık Yapan İlaçlara Karşı Farkındalık. International Journal of Social Humanities Sciences Research (JSHSR). 2019 Jan;6(46):3879–85. doi:10.26450/jshsr.1616 Al-Worafi YM. Medication abuse and misuse. In: Drug safety in developing countries. Elsevier; 2020. p. 127–35. Açıkkol M. Adli Toksilojinin Tanımı ve Tarihsel Gelişimi. In: Mercan S., Türkmen Z., eds. Adli Toksikoloji: Temel Kavramlar ve Prensipler. İstanbul Üniversitesi–Cerrahpaşa Yayınevi; 2023. p. 1. UNODC. World drug report-contemporary issues on drugs. 2024. Available at: https://www.unodc.org/unodc/en/data-and-analysis/worlddrug-report-2024.html (cited: 30 January 2025) TUBİM. Türkiye Uyuşturucu Raporu 2024. NSB Yayınları; 2024. Lessenger JE, Feinberg SD. Abuse of prescription and over-the-counter medications. The Journal of the American Board of Family Medicine. 2008;21(1):45–54. Yargıç İ. Sağlık Çalışanlarında Bağımlılıkla İlgili Sorunlar ve Çözüm Yolları. Klinik Gelişim. 2009;22(4):1–4. Weaver G, Hansen WB, Ruppert S, Tabassum QM, Hebard S, Milroy J, et al. Effects of workplace variables on workers intentions to misuse prescription opioids. J Occup Environ Med. 2023;65(11):e717–21. Yoon JM, Trinkoff AM, Selby V, Kim E. The association between selfreported substance use and work schedule characteristics among nurses: A cross-sectional study. Int J Nurs Stud. 2025;105162. Dunne EM, Striley CW, Mannes ZL, Asken BM, Ennis N, Cottler LB. Reasons for prescription opioid use while playing in the National Football League as risk factors for current use and misuse among former players. Clinical Journal of Sport Medicine. 2020;30(6):544–9. Lopes N, Tavares D, Pegado E, Raposo H, Rodrigues C. Medication use for the management of professional performance: between invisibility and social normalisation. Health Sociology Review. 2024;33(3):358–75. Albawardi IM, Abdullah LAA, Alzouri FS, Aldar HM, Al-Shiban MA, AlBakr DM, et al. Self-prescription with psychotropic medications by healthcare professionals working at mental health institutions in Saudi Arabia. J Family Community Med. 2024;31(3):230–6. Sales P, Murphy F, Murphy S, Lau N. Burning the candle at both ends: Motivations for non-medical prescription stimulant use in the American workplace. Drugs: Education, Prevention and Policy. 2019;26(4):301–8. Alsubaie S, Zarbah A, Alqahtani A, Abdullah AS, Aledrees NS. Prevalence of pregabalin (Lyrica) abuse among healthcare professionals in Asser Province Saudi Arabia. Int J Ment Health Psychiatry. 2020;6:2. Trinkoff AM, Selby VL, Han K, Baek H, Steele J, Edwin HS, et al. The prevalence of substance use and substance use problems in registered nurses: Estimates from the nurse worklife and wellness study. J Nurs Regul. 2022;12(4):35–46. Hoopsick RA, Las S, Sun R. Differential effects of healthcare worker burnout on psychotropic medication use and misuse by occupational level. Soc Psychiatry Psychiatr Epidemiol. 2024;59(4):669–79. Roncero C, Bravo-Grande JL, Andrés-Olivera P, Peña M, Treceño C, González-Pelaez P, et al. Benzodiazepine Misuse Among Health Care Workers: The Effect of Sleep Disorders on Work Performance. J Clin Med. 2025;14(12):4266. Agberotimi SF, Asagba RB, Oduaran C, Folorunso SO. Non-medical use of pharmaceutical drugs at workplace among skilled workers. J Subst Use. 2020;25(6):658–62. Harker N, Erasmus J, Lucas W, Deitz D, Brooke-Sumner C. ‘I Was Present but I Was Absent’: Perceptions and Experiences of the NonMedical Use of Prescription or over the Counter Medication among Employed South African Women. Int J Environ Res Public Health. 2022;19(12):7151. Kim C, Han K, Trinkoff AM, Baek H. Workplace access, burnout, and prescription drug misuse among Korean hospital nurses: a cross-sectional study. BMC Nurs. 2024;23(1):368. Ogeil RP, Barger LK, Lockley SW, O’Brien CS, Sullivan JP, Qadri S, et al. Cross-sectional analysis of sleep-promoting and wake-promoting drug use on health, fatigue-related error, and near-crashes in police officers. BMJ Open. 2018;8(9):e022041. Zahavi E, Lev-Shalem L, Yehoshua I, Adler L. Methylphenidate use and misuse among medical residents in Israel: a cross-sectional study. Hum Resour Health. 2023;21(1):5. Carmona Araújo A, Casal RJ, Goulão J, Martins AP. Misuse of psychoactive medicines and its consequences in the European Union–a scoping review. J Subst Use. 2024;29(4):629–40. Sansgiry SS, Bhansali AH, Bapat SS, Xu Q. Abuse of over-the-counter medicines: a pharmacist’s perspective. Integr Pharm Res Pract. 2016;1–6. Roy S, Charreteur R, Peries M, Kheloufi F, Eiden C, Nagot N, et al. Abuse and misuse of second‐generation antipsychotics: an analysis using VigiBase, the World Health Organisation pharmacovigilance database. Br J Clin Pharmacol. 2022;88(10):4646–53. Futenma K, Asaoka S, Takaesu Y, Komada Y, Ishikawa J, Murakoshi A, et al. Impact of hypnotics use on daytime function and factors associated with usage by female shift work nurses. Sleep Med. 2015;16(5):604–11. Yunusa U, Bello UL, Idris M, Haddad MM, Adamu D. Determinants of substance abuse among commercial bus drivers in Kano Metropolis, Kano State, Nigeria. American Journal of Nursing Science. 2017;6(2):125–30. Boulton M, O’Connell KA. Nursing students’ perceived faculty support, stress, and substance misuse. Journal of Nursing Education. 2017;56(7):404–11. Papazisis G, Tsakiridis I, Siafis S. Nonmedical use of prescription drugs among medical students and the relationship with illicit drug, tobacco, and alcohol use. Subst Abuse. 2018;12:1178221818802298. Ke YT, Feng IJ, Hsu CC, Wang JJ, Su SB, Huang CC, et al. Nurses have a four-fold risk for overdose of sedatives, hypnotics, and antipsychotics than other healthcare providers in Taiwan. PLoS One. 2018;13(8):e0202004. Kirkpatrick ZA, Boyd CJ. Stimulant use among undergraduate nursing students. J Addict Nurs. 2018;29(2):84–9. Danso M, Anto F. Factors associated with tramadol abuse: A crosssectional study among commercial drivers and assistants in the Accra metropolitan area of Ghana. Drugs-Real World Outcomes. 2021;8(3):33747. Sousa GS de, Fitzsimons MG, Mueller A, Quintão VC, Simões CM. Drug abuse amongst anesthetists in Brazil: a national survey. Brazilian Journal of Anesthesiology (English Edition). 2021. doi:10.1016/j.bjane.2021.03.006 Baum M, Sattler S, Reimann M. Towards an understanding of how stress and resources affect the nonmedical use of prescription drugs for performance enhancement among employees. Current Psychology. 2023;42(6):4784–801. Chasek C, Watanabe‐Galloway S, Rutt R, Olson A, Yoder A. A crosssectional study of alcohol, opioid use, and anxiety in agriculturally based occupations. The Journal of Rural Health. 2023;39(4):816–23. Lehnus KS, Fordyce PS, McMillan MW. Electronic survey investigating UK veterinarians’ perceptions of the potential for veterinary prescription medication misuse or abuse. Vet Anaesth Analg. 2024;51(1):16–25. Lin MW, Wong SW, Cheng Y. Psychosocial Work Conditions, Mental Distress, Burnout, and Hypnotic Use among Healthcare and Social Workers: A Comparative Analysis with General Employees. J Occup Environ Med. 2023;10–1097. Altarifi AA, Obeidat O, Guzu A, Said A, Albakheet M, Makkawi A, et al. Pregabalin and gabapentin abuse among university students in Jordan: A cross sectional study. Electronic Journal of General Medicine. 2024;21(1). Sabe M, Pillinger T, Kaiser S, Chen C, Taipale H, Tanskanen A, et al. Half a century of research on antipsychotics and schizophrenia: A scientometric study of hotspots, nodes, bursts, and trends. Neurosci Biobehav Rev. 2022;136:104608. McKean A, Monasterio E. Off-label use of atypical antipsychotics: cause for concern? CNS Drugs. 2012;26(5):383–90. Nielsen S, Bruno R, Schenk S. Non-medical and illicit use of psychoactive drugs. Springer; 2017. Stogios N, Smith E, Bowden S, Tran V, Asgariroozbehani R, McIntyre WB, et al. Metabolic adverse effects of off-label use of second-generation antipsychotics in the adult population: a systematic review and meta analysis. Neuropsychopharmacology. 2022;47(3):664–72. Evoy KE, Teng C, Encarnacion VG, Frescas B, Hakim J, Saklad S, et al. Comparison of quetiapine abuse and misuse reports to the FDA adverse event reporting system with other second-generation antipsychotics. Subst Abuse. 2019;13:1178221819844205. Mattson ME, Albright VA, Yoon J, Council CL. Emergency department visits involving misuse and abuse of the antipsychotic quetiapine: results from the Drug Abuse Warning Network (DAWN). Subst Abuse. 2015;9:SART-S22233. Chiappini S, Schifano F. Is there a potential of misuse for quetiapine?: Literature review and analysis of the European Medicines Agency/European Medicines Agency Adverse Drug Reactions’ Database. J Clin Psychopharmacol. 2018;38(1):72–9. Uppsala Monitoring Centre. VigiBase. 2025 Available at: https://whoumc.org/vigibase/ (cited: 22 Apr 2025) Fudin HR, Babin JL, Hong LT, Ku J, May AL, Wisner A, et al. Drugs of Abuse. Side Effects of Drugs Annual. 1st ed. Elsevier B.V.; 2018. 2989 p. doi:10.1016/bs.seda.2018.08.015 Gross SR, Marshall EJ, Wolff K. Substance misuse among health care workers: National survey of occupational physicians. Occup Med (Chic Ill). 2012;62(4):254–60. doi:10.1093/occmed/kqs027 PubMed PMID: 22661661. Polles AG, Williams MK, Phalin BR, Teitelbaum S, Merlo LJ. Neuropsychological impairment associated with substance use by physicians. J Neurol Sci. 2020;411(August 2019):116714. doi:10.1016/j.jns.2020.116714 PubMed PMID: 32036159. EUDA. European Drug Report 2024: Trends and Developments. 2024. Available at: https://emcdda.europa.eu/publications/european-drugreport/2024. (cited: 22 January 2025) Annagür BB. A nurse with pethidine addiction. European Journal of General Medicine. 2012;9(1):59–61. doi:10.29333/ejgm/82557 Fry RA, Fry LE, Castanelli DJ. A retrospective survey of substance abuse in anaesthetists in Australia and New Zealand from 2004 to 2013. Anaesth Intensive Care. 2015;43(1):111–7. doi:10.1177/0310057x1504300117 PubMed PMID: 25579298. Thumma A, Mfoafo K, Babanejad N, Omidian A, Omidi Y, Omidian H. Abuse potential of fentanyl and fentanyl analogues. Bioimpacts. 2024;14(6):27691. CDC. Drug overdose deaths in the U.S. top 100,000 annually. 2021. Available at: https://www.cdc.gov/nchs/pressroom/releases/20211117.html (cited 25 February 2026) CDC. Provisional drug overdose death counts. 2025. Available at: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm (cited 25 February 2026) Miotto K, Cho AK, Khalil MA, Blanco K, Sasaki JD, Rawson R. Trends in Tramadol: Pharmacology, Metabolism, and Misuse. Anesth Analg. 2017;124(1):44–51. PubMed PMID: 27861439.doi:10.1213/ANE.0000000000001683 Le AB, Urban-Wojcik E, Seewald M, Mezuk BR. The Relationship Between Workplace Drug Policies, Opioid Misuse, and Psychological Distress: Evidence From the 2020 National Survey on Drug Use and Health. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy. 2024;34(1):22–37. Kuloğlu Genç Merve, Tekin Bülbül T, Şimşek SZ, Arslan Z, Zengin S,, Türkmen Z. Toksik maddelerin sınıflandırılması. In: Mercan S., Türkmen Z., eds. Adli Toksikoloji: Temel Kavramlar ve Prensipler. İstanbul Üniversitesi–Cerrahpaşa Yayınevi; 2023. p. 33–57. doi:10.5152/6404 Magnotti S, Beatty A, Bickford E, Channell I, Weyandt L. Prescription stimulant misuse among nursing students: a systematic review. J Addict Nurs. 2023;34(3):216–23. Edinoff AN, Nix CA, McNeil SE, Wagner SE, Johnson CA, Williams BC, et al. Prescription stimulants in college and medical students: A narrative review of misuse, cognitive impact, and adverse effects. Psychiatry international. 2022;3(3):221–35. Evoy KE, Sadrameli S, Contreras J, Covvey JR, Peckham AM, Morrison MD. Abuse and misuse of pregabalin and gabapentin: a systematic review update. Drugs. 2021;81:125–56. Evoy KE, Peckham AM, Covvey JR, Tidgewell KJ. Gabapentinoid pharmacology in the context of emerging misuse liability. The Journal of Clinical Pharmacology. 2021;61:S89–99. Ali R, Van Hout MC, Al-Mahaireh M, Wazaify M. Community pharmacists’ experience of gabapentin misuse and abuse: A quantitative study from Jordan. J Ethn Subst Abuse. 2025;24(1):40–56. Brown EN, Purdon PL, Van Dort CJ. General Anesthesia and Altered States of Arousal: A Systems Neuroscience Analysis. Annu Rev Neurosci. 2011 Jul;34(1):601–28. doi:10.1146/annurev-neuro-060909-153200 Morgan CJA, Curran HV, (ISCD) ISC on D. Ketamine use: a review. Addiction. 2012;107(1):27–38. Dinis-Oliveira RJ. Metabolism and metabolomics of ketamine: a toxicological approach. Forensic Sci Res. 2017;2(1):2–10. Sharma A, Choudhary C, Vardhan G, Kumar V, Dhamija P, Kumar A. Unsettling trend: The alarming rise of human abuse of veterinary drugs and its consequences. J Family Med Prim Care. 2024;13(8):2823–5. Aronson JK. Propofol. Meyler’s side effects of drugs. Elsevier; 2016. p. 988–1016. doi:10.1016/B978-0-444-53717-1.01355-X Burnett GW, Taree A, Martin L, Bryson EO. Propofol misuse in medical professions: a scoping review. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2023;70(3):395–405. Al-Maaz S, Abu-Dahab R, Shawagfeh M, Wazaify M. Prevalence and pattern of substance use and misuse among anesthesia health-care personnel in Jordan. J Subst Use. 2019;24(3):317–22. doi:10.1080/1465 9891.2019.1570366 Telusca N, Ganguly K, Jeter C, Newmark JL. Substance Abuse Among Healthcare Professionals. Subst Abus. 2015;503–13. doi:10.1007/978-14939-1951-2_37 Kenna GA, Lewis DC. Risk factors for alcohol and other drug use by healthcare professionals. Subst Abuse Treat Prev Policy. 2008 Dec;3(1):3. doi:10.1186/1747-597X-3-3 Ögel K. Özel Popülasyonlar. In: Ögel K, ed. Sigara, Alkol ve Madde Kullanım bozuklukları: Tanı, Tedavi ve Önleme. İstanbul: Yeniden Yayınları; 2010. Mercan S, Açıkkol M. Madde kullanımının kolaylaştırdığı suçlar: maddeler ve etkileri; deliller ve analizleri. Turkiye Klinikleri Journal of Forensic Medicine and Forensic Sciences. 2014;11(2):78–96