The evolution of European legislation on doping: new challenges in the age of NPS.

The fight against doping in sport, formally started in 1960 with the constitution of the International Olympic Committee (IOC) and culminated in 1999 with the birth of the World Anti-Doping Agency (WADA), commissioned to chair various activities, including the publication of the annual list of prohibited substances and methods for doping. In Europe, as early as 1967, the Committee of Ministers of the Council of Europe adopted a resolution to stigmatise the intake of substances foreign to the body for the sole purpose of artificially and unfairly influencing sports performance. In 2002, the Council of Europe adopted an Additional Protocol to the 1989 Strasbourg Convention against Doping to ensure mutual recognition of doping controls and to strengthen the enforcement of the Convention. In Italy, the Law of 14 December 2000 n. 376 "Discipline of the health protection of sports activities and the fight against doping", defines doping as "the administration or intake of drugs or biologically or pharmacologically active substances and the adoption or submission to medical practices not justified by pathological conditions and suitable to modify the psychophysical or biological conditions of the organism in order to alter the athletic performance of athletes". The same law regulates the use of drugs or biologically or pharmacologically active substances and update an annual list in agreement with WADA. The article aims to analyse the legislation from a national perspective, offering as complete a view as possible of the current situation.

The targeted analysis of New Psychoactive Substances in oral fluid through chromatographic-spectrometric methods: review of recent findings.

OBJECTIVE: The oral fluid was demonstrated as an effective matrix to assess drug consumption in forensic settings. Recently, the increasing number of intoxications related to New Psychoactive Substances raised the attention of the scientific community. To this concern, different analytical methods to detect and quantify NPS in oral fluids were developed and validated, most of them based on hyphenated techniques. MATERIALS AND METHODS: A broad-ranging search was conducted on multidisciplinary research databases using "New Psychoactive Substances", "oral fluid", "toxicological analysis", "analytical method", "targeted method", "HPLC-MS/MS", "GC-MS", "GC-MS/MS" alone or in combination as search strings. All research articles published between 2017 and 2021 were considered. RESULTS: Different chromatographic-spectrometric methods to detect and quantify the NPS in oral fluid were reported in the literature. The classes of NPS explored were synthetic cannabinoids, synthetic cathinones, new designer benzodiazepines, synthetic opioids, fentanyl analogues, tryptamines, and phenethylamines. The most used technique was HPLC-MS/MS due to the sensitivity and high throughput. The GC-MS technique was preferred for synthetic cannabinoids, anyway different HPLC-MS/MS methods were developed. Moreover, the LC-HRMS technique was applied for the development of an analytical assay to detect new synthetic opioids and fentanyl analogues. CONCLUSIONS: The analytical interest on oral fluid as an effective matrix to assess drug exposure is increasing. The hyphenated techniques were demonstrated effective in the detection of NPS in oral fluids. The most suitable techniques are HPLC-MS/MS due to the sensitivity and the possibility to include different classes of substances in a single analytical run.

Opioid epidemic spread from Northern and Eastern Europe to Mediterranean Area.

ABSTRACT: The addiction to illicit opioid and the misuse of prescription synthetic opioids pain relievers and fentanyl analogs generated an opioid epidemic in North America over the last two decades that affected public health with a constantly rising number of overdoses deaths. This health treat moved to Europe with a significant increase starting from 2015 involving mainly norther and eastern countries and finally also the Mediterranean area. The "lock down" isolation and economic recession caused by COVID-19 pandemic showed a resurgence in opioid use and harms.

Uterus transplant update: innovative fertility solutions and the widening horizons of bioengineering.

Uterus transplantation (UTx) aimed at restoring fertility for women suffering from uterine factor infertility has been making significant strides over the past years, leading to the first successful outcome of live birth in 2014. Nonetheless, the ethical issues raised by such a procreative option are uniquely complex and multifaceted. UTx presents unique features, and the most significant risks it entails are the multiple surgeries required and the need for immunosuppressive drugs to prevent organ rejection. Post-transplantation immunosuppressive therapy, rejection monitoring, and immune tolerance are all crucial aspects That affect UTx outcomes and ensuing pregnancy success rates. In time, an alternative tool might become clinically available that could solve all those issues: tissue engineering relying on a combination of cells, biomaterials, and growth factors that harness the body's innate ability to regenerate and repair reproductive organs. Mastering such techniques could lead in the medium-long term to the creation of a bioengineered uterus for the purpose of transplantation, based on scaffolds derived from decellularized organs or tissues that can be recellularized by several types of autologous somatic/stem cells, in particular for uterine tissue engineering.

Is the issue of Chemsex changing?

In this letter, which is meant as a response to the letter titled "Sex enhancers: challenges, threats and the need for targeted measures", the Authors discuss the evolution of Chemsex phenomenon towards at least two directions: firstly, the use of psychoactive and non-psychoactive substances usually implicated in Chemsex, such as GHB/GBL, ketamine, mephedrone and other synthetic cathinones and erectile dysfunction medications, is currently accompanied by the use of illicit opioids, which have recently been indicated as a new serious health threat for consumers. In addition, as reported by the last European Drug report, the simultaneous use of illicit benzodiazepines with non-medical opioids misuse has also been observed. Secondly, strictly linked to the rising use of non-medical opioids is the risk of transition towards heroine followed by the adoption of risky injection practices frequently accompanied by high-risk sexual behaviors. In this sense, the current definition of the phenomenon as "the voluntary intake of certain psychoactive and non- psychoactive drugs in the context of sex parties and sexual intercourses with the intention of facilitating and/or enhancing the sexual encounter mostly among men who have sex with other men (MSM)" has been expanded to "heterosexual chemsex".

The unethicality of doping in sports.

Performance enhancing drug use in sport arguably constitutes a crisis, and as such, targeted measures are needed in order to stem it. Substance abuse in professional sports and competitions has besmirched many world-class athletes' reputations and standing, in addition to jeopardizing their health. Furthermore, there are many instances of amateur athletes and school-aged competitors who have taken to using such substances as well, significantly exacerbating the overall picture. The widespread acknowledgement of the potentially life-threatening consequences of performance-enhancing drug use has prodded sports organizations and governments into cooperating on many different levels to preserve the ethical grounding and soundness of sport competitions; unlawful substance abuse is in fact liable to undermine the very core of fairness in competition. Doping, along with various forms of cheating, has been recorded throughout the history of sport: prohibition in itself is all but ineffective without reliable and systematic detection strategies and enforcement of sanctions.