INTRODUCTION
Contemporary young people are growing up in a world of dynamic social, cultural and technological changes, which significantly shape their attitudes, choices and behaviour. One area of particular social concern remains young people’s contact with psychoactive substances – both classic drugs and so-called “legal highs”, i.e. new psychoactive substances (NPS) [1-5]. According to the definition used in Europe by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), a NPS is a new drug or psychotropic compound in pure form or in the form of a product that is not controlled by the United Nations conventions on psychoactive drugs/compounds and that may cause health damage comparable to that resulting from the use of substances listed in the aforementioned conventions [5]. NPS include an increasing number of chemical, pharmaceutical and herbal substances that are often advertised and sold as “legal” alternatives to illegal drugs. It is estimated that NPS are a growing problem from the social, cultural, legal and political perspectives of many countries [1-3]. Their use by minors is a serious health, psychological and social problem, with the risk of long-term consequences – both at the individual and systemic level [6, 7].
Adolescence is a key stage in a young person’s development – a time of intense physical, psychological and social change, during which identity is formed and vulnerability to environmental influences increases. During this time, adolescents often engage in risky behaviour, including experimenting with psychoactive substances. Studies show that the first contacts with these substances usually occur during early (12-14 years) or late adolescence (15-17 years), with peak use occurring between the ages of 18 and 25 [8].
School age is also a time of intensive cognitive development – it is only in adolescence that young people attain the ability to think formally, crucial for making informed and responsible decisions. Meanwhile, curiosity, lack of awareness of risks and the easy availability of psychoactive substances in the environment can lead to their use, especially if young people do not receive adequate support [9].
As substances with unpredictable chemical compositions, legal highs are a particularly dangerous category. Their use is associated with numerous risks, ranging from acute reactions, such as psychomotor agitation, disorientation or loss of consciousness, to long-term neurological and psychological consequences [10, 11]. Studies point to their negative effects on the development of brain structures responsible for memory and learning, as well as an increased risk of psychiatric disorders such as depression, anxiety or psychotic episodes [12].
In the age of social media, pressure to succeed and easy access to a variety of content, adolescents are strongly influenced by external stimuli, which increases their susceptibility to risky behaviour. Therefore, the problem of underage substance use requires a comprehensive response – not only in the form of medical interventions, but above all integrated preventive, educational and therapeutic measures [13, 14]. Particularly effective are programmes based on cognitive behavioural therapy and the family approach, which help young people to understand their own emotions, addiction mechanisms and develop healthy ways of coping with difficulties [15, 16].
The specific aims of this study focus on the analysis of students’ experiences and attitudes towards psychoactive substances. These include examining the frequency of being offered drugs, the level of ability to refuse them, the age of initiation of use of legal highs, and the subjective assessment of their ease of purchase and availability in the immediate environment.
MATERIAL AND METHODS
In 2017 (May, June), a randomly selected group of 2191 secondary school students in the Wielkopolskie Voivodeship was surveyed. 2016 fully completed survey questionnaires were qualified for statistical analysis. Surveys in which respondents did not answer all questions or stopped filling them out before completion were rejected, which prevented them from qualifying for statistical analysis. The return rate of the questionnaires was 92%. The group of secondary school students consisted of 1089 (54%) girls and 927 boys (46%). In 2023 (May, June), a randomly selected, randomised group of 1346 secondary school students in the Wielkopolskie Voivodship in Poland were surveyed. A total of 1292 fully completed questionnaires obtained from secondary school students were qualified for statistical analysis. The return rate of completely completed questionnaires was 96%. The 2023 group of secondary school pupils consisted of 737 (57%) girls and 555 boys (43%).
For the purposes of the survey of secondary school students, the sample was drawn in two stages: in the first stage the school was drawn, and in the second stage the class was drawn. On the basis of data from the Register of Schools and Educational Institutions (search engine for schools and educational institutions of the Ministry of National Education; https://rspo.gov.pl/zaawansowana), secondary schools (general secondary schools, basic vocational schools, technical schools) were drawn from all secondary schools in Wielkopolskie voivodship. After obtaining consent from headmasters of educational institutions, surveys were conducted in the drawn schools.
The research tool used in the 2017 study was a survey questionnaire developed by a scientific research team established at the Chief Sanitary Inspectorate. The questionnaire was modelled on the questionnaire used in the Global School-based Student Health Survey (GSHS). It comprised 40 questions on the magnitude, frequency, prevalence, reasons for using drugs and legal highs and the consequences resulting from their consumption. The thematic questions were preceded by metric questions. The survey was carried out by interviewers from the health education cells of the State Sanitary Inspectorate. The questionnaires were completed by the pupils themselves (self-questionnaire). The surveys were conducted during parenting lessons and were voluntary and anonymous. The 2023 survey used the same survey form that was used for the 2017 survey. The survey, using such a structured survey questionnaire, was approved by the Bioethics Committee at the University of Kalisz. In 2023, the survey was conducted electronically and was implemented online via the Microsoft Forms web platform. The link and QR code for the survey was sent to the headmasters of the selected secondary schools electronically, and these were then forwarded to the class teachers of the individual classes, where the teachers passed them on to the individual students in the class, so that every student who was willing and ready to take part in the survey could complete the survey form on their smartphone. All students willing to take part in the survey completed the surveys during class time. The anonymity of the respondents and the confidentiality of the data were ensured - participants were assured that the IP address of the device from which they completed the survey would not be recorded anywhere. The Biotics Committee of the Institute of Rural Medicine in Lublin agreed to conduct the study using such a survey questionnaire.
Based on the collected data obtained from the survey of secondary school students, a statistical analysis was carried out. Data from the paper surveys (2017 survey) and the electronic survey (2023 survey) were entered into a database. These analyses were performed using the STATISTICA 12 (2017 survey) and STATISTICA 13 (2023 survey) environments. The test of discrete scale variable dependence for multi-field tables was performed using the c2 test. For continuous or ordinal scale variables, depending on the nature of the variable (e.g. fit to the distribution), the Kruskal-Wallis test or analysis of variance test was used. Test results were considered statistically significant (a result is statistically significant if the p-value is equal to or less than the significance level) if its significance level p was not greater than 0.05 (p ≤ 0.05).
RESULTS
The students surveyed reported that in most cases they had not been offered any legal highs or drugs (64.7% in 2017 vs. 69.5% in 2023). However, it is worrying that the remainder of the respondents – i.e. about one third of the respondents (35.3% vs. 30.5%) – admitted to having been offered such drugs at least once in their lives.
Some adolescents indicated that they were offered to take only legal highs (2.3% vs. 1.9%), only drugs (23.3% vs. 21.8%) or both substances at the same time (9.7% vs. 6.7%). It is noteworthy that students were far more likely to be offered drugs than legal highs – as much as 10-11 times more often (23.3% vs. 2.3% in 2017 and 21.8% vs. 1.9% in 2023).
Boys were more likely to be offered drugs or a combination of drugs and legal highs. In 2017, 24.3% of boys and 22.2% of girls were offered drugs, and some were offered both drugs and legal highs – 11.6% and 7.5% respectively. In 2023, the proportions were: drugs – 25.8% of boys vs. 18.9% of girls; drugs and legal highs – 7.4% vs. 6.2%. In contrast, girls were more likely to be confronted with an offer to take only legal highs (2017: 2.5% vs. 2.2%; 2023: 2.2% vs. 1.6%). Girls were also more likely to declare that they had never received any proposal related to the use of legal highs or drugs (2017: 67.8% girls vs. 61.9% boys; 2023: 72.7% girls vs. 65.2 boys) (Table I).
The vast majority of students declare that they would refuse a legal high if someone offered them one. In 2017, a total of 94.6% of respondents declared such an attitude (including 84.5% “definitely yes” and 10.1% “rather yes”), while in 2023, 93.7% did so (84.0% and 9.7% respectively). These results are similar, which may indicate a continued high level of declared assertiveness on this issue. What is worrying, however, is the increase in the percentage of pupils who declare that they would rather not or definitely not refuse. In 2017, they accounted for a total of 2.5% of respondents (1.6% “definitely not” and 0.9% “rather not”), while in 2023 they already accounted for 3.5% (2.1% “definitely not” and 1.4% “rather not”).
Just over 2% of pupils in both editions of the survey could not clearly state their attitude – the answer ‘don’t know’ was indicated by 2.8% of respondents in 2017 and 2.9% in 2023. Analysis of the data shows that the differences in responses between girls and boys are small – e.g. in 2017, 85.0% of girls and 84.2% of boys declared that they would “definitely” refuse a legal high; in 2023, the proportion was 84.0% each in both groups (Table II).
Our own research shows that adolescents initiate the use of legal highs at a very young age. In the 2017 study, the average age at which adolescents used legal highs for the first time was 14.2 years, while in 2023 it decreased slightly and is now 13.8 years, a difference of only 0.4 per cent. It is noteworthy that in both the group of adolescents surveyed in 2017 and in 2023 there were individuals who declared that their first episode of using legal highs took place at the age of 7.
Among the students who had ever used legal highs by the time of the survey, more than half of the respondents in the 2017 survey, i.e. 53.3% and an even higher proportion of the students in the 2023 survey, i.e. 71.8%, had taken/tried them only once in their lifetime. The study also shows that, in the perspective of the few years separating the surveys (2017 vs. 2023), the percentage of pupils who admitted that they had tried legal highs 2-5 times (23.2% vs. 9.7%) decreased and the percentage of pupils who had tried legal highs 6 or more times also decreased (23.2% vs. 18.5%).
Girls were more likely than boys to declare a single use of legal highs – 57.9% of girls versus 50.7% of boys in 2017 and 73.3% versus 70.0% in 2023. In 2017, the percentages of girls and boys who had used legal highs 2-5 times were comparable (22.3% vs. 23.6%). In 2023, however, this proportion was higher in girls (12.1% vs. 7.0%). Among both boys and girls, there was a decrease in the proportion of those who had used legal highs 6 times or more – in girls from 19.8% to 14.7% and in boys from 25.7% to 23.0% (Table III).
When asked about the availability of legal highs in their place of residence, in both editions of the survey, almost half of the students (48.9% in 2017 and 51.5% in 2023) answered that they “don’t know” – which may indicate a lack of knowledge or distance from the issue. Nearly one in three students surveyed (29.6% in 2017 and 27.0% in 2023) stated that legal highs are not available in their environment (“rather not” or “definitely not”). However, pupils’ responses show that some of them have access to legal highs in their neighbourhood, admitted so on average by as many as one in five pupils surveyed (“rather yes” or “definitely yes”) – 21.5% in 2017 and 21.6% in 2023.
On the subject of the availability of legal highs in the vicinity of their residence, girls are currently more informed – in this group there has been an increase in the percentage of those who admit that legal highs are reachable for them, i.e. “definitely yes” (4.7% in 2017 vs. 7.3% in 2023) and “rather yes” (15.6% vs. 16.0%). In the group of boys surveyed, this trend is reversed – boys are now less likely than in the 2017 survey to admit that legal highs in their area are easily attainable (Table IV).
In the survey questionnaires, students were asked about where it is possible to purchase legal highs in the area where they live. Most respondents indicated the answer “don’t know” – 71.4% of respondents in 2017 and 74.6% in 2023. This means that the vast majority of students are unable to clearly assess the availability of these substances in their neighbourhood.
At the same time, there is a noticeable increase in the percentage of young people who believe that legal highs are available from a dealer – from 16.1 per cent in 2017 to 19.6 per cent in 2023. This may indicate a growing belief among young people that contact with illegal sources of purchase is possible in their surroundings. A small proportion of adolescents say that there are no such places where they can get legal highs where they live and that they have to buy them online (6.7% in 2017 vs. 5.0% in 2023) (Table V).
DISCUSSION
Young people’s attitudes and behaviours towards psychoactive substances in the two surveys (2017 vs. 2023) are partly similar, but also different in many aspects, which shows that the problem of young people’s perception of psychoactive substances, including drugs and legal highs, and their use is very complex and may undergo specific changes in a short period of time. It is difficult to predict how these trends will change over the next few years or decade, so it becomes necessary to constantly update knowledge (including keeping up to date with youth culture and social media) and conduct systematic research on this important issue.
Over the period analysed, a decrease was observed in the percentage of students who had ever been offered to take psychoactive substances. The percentage of respondents declaring that they had been offered both legal highs and drugs fell from 9.7% in 2017 to 6.7% in 2023, while for drugs only it fell from 23.3% to 21.8% and for legal highs from 2.3% to 1.9%. This change is part of a general trend also noted in research by the National Centre for Addiction Prevention (NCPU), according to which the percentage of students who had been offered legal highs in the past 12 months decreased from 16% in 2010 to just 2% in 2021 [17]. A 2014 survey of secondary school students in Australia (average age 14.9 years) found that 12% of respondents had been offered the use of NPS, and almost half of respondents said they had ever heard of such drugs [18]. The percentage of students who were offered drugs in the 2017 self-reported study is similar to the results obtained in the same year (19.8%) and in 2021 (13.9%) in the US Youth Risk Behavior Surveillance System (YRBSS) programme. Among other things, this project analysed the percentage of students in grades 9-12 who said they had been offered drugs on school premises in the past 12 months [19].
Despite the positive trend, it is worth noting that about one third of students (35.3% in 2017, 30.5% in 2023) still declare that they have ever been offered psychoactive substances. The high percentage of contact with drugs (more than 20%) indicates that, despite the decrease in rates, these substances are still relatively common among young people.
The average age of initiation in the use of these substances has decreased slightly, from 14.2 years in 2017 to 13.8 years in 2023. Although the difference is small, the fact that both studies reported cases of use of legal highs as early as 7 years of age is of great concern and points to the need to target prevention efforts to increasingly younger groups.
At the same time, the data show positive changes in the frequency of use of legal highs. The percentage of students who used these substances 2-5 times fell from 23.2% to 9.7%, and the number of those who did so 6 times or more also decreased – from 23.2% to 18.5%. In contrast, the proportion of young people declaring one-time use of legal highs increased – from 53.6% in 2017 to 71.8% in 2023 – which may reflect the more incidental than regular nature of their use of these drugs. Gender differences are also noticeable. Girls were more likely than boys to declare one-time use (e.g. in 2023 – 73.3 per cent of girls against 70.0 per cent of boys), but were also more likely to admit to using 2-5 times, which may indicate changing patterns of experimentation with substances. The European ESPAD survey conducted in 2019 shows that 5.3% of secondary school students admitted to having used ‘legal highs’ at least once in their lives [20].
In another study of pupils aged 11-18 in Serbia, only just under 2% of pupils admitted to having used legal highs at least once in their lifetime [21].
Assertiveness towards the offer to take legal highs remains high, with more than 93% of respondents in both editions of the survey declaring that they would refuse. Although the increase in the number of those who would not be able to refuse (from 1.6% to 2.1%) seems small, it is an important warning signal. It is also worth highlighting the lack of significant differences between girls and boys in this respect.
In terms of the availability of legal highs, the data show a clear downward trend in the perceived ease of obtaining them. More and more students declare a lack of knowledge about local sources of purchase – as many as 74.6% in 2023 could not indicate where they could be purchased, and almost half of the respondents did not know if legal highs were available in their area. At the same time, however, invariably around 21% of young people admit that such sources exist in their neighbourhood. An interesting phenomenon here is the gender discrepancy – in 2023 a higher proportion of girls than boys claimed that legal highs were available in their neighbourhood, which may indicate differences in perception of the peer environment.
The number of students indicating dealers as a possible source of purchasing legal highs has increased, from 16.1% to 19.6%. At the same time, the share of those considering the Internet as the main distribution channel has decreased (from 6.7% to 5.0%). Thus, it seems that although awareness of the ways of obtaining legal highs is limited, the perception of direct sales as the main source is increasing. Similar correlations were noted in the ESPAD survey. In 2019, only 1.7% of respondents made these purchases via the internet, compared to 3.1% of respondents in 2015 [18].
Against the background of the Polish data, it is worth noting similar phenomena observed in international studies. In the United States, the Monitoring the Future programme from 1992 to 2023 showed a significant decline in the number of students, aged 14-18, finding it easy to obtain drugs – regardless of the type of substance [22]. Research conducted in collaboration with the National Centre for Addiction Prevention also indicates a declining sense of accessibility, with the proportion of secondary school students finding it easy to buy legal highs decreasing from 13% in 2018 to 7% in 2021 [15].
Despite the general decline in perceived accessibility, a significant proportion of young people are still exposed to offers of legal highs or drugs – although the number of pupils who said they had received such an offer decreased from 35.3% to 30.5%.
The data collected indicate the simultaneous occurrence of several phenomena: a reduction in the age of initiation, an increase in the incidental nature of use, a relatively high level of assertiveness and a decreasing sense of availability of these substances. While these trends can be interpreted as the result of effective prevention activities, there is still a need to strengthen educational activities, especially among the youngest, and to monitor changing patterns of use of legal highs, also in terms of gender and sources of acquisition [23].
CONCLUSIONS
Based on the analysis of the 2017 and 2023 data, it can be concluded that young people’s contact with psychoactive substances is gradually decreasing. Both the percentage of pupils who have been offered legal highs or drugs and the number of regular users have decreased. At the same time, a decrease in the age of initiation has been noticed, which indicates the need to target prevention to younger groups.
The majority of young people are highly assertive when offered to use legal highs, although the slight increase in those unable to refuse is a warning signal. The perceived availability of legal highs has also declined – more and more students do not know where to buy them, although one in five respondents still indicate their presence in their neighbourhood. The importance of dealers as a source of purchase is increasing, while the role of the internet in this respect is marginal.
The variation of responses by gender and the changing patterns of behaviour show that the problem is dynamic and requires further research and actions tailored to the needs of young people.
DISCLOSURE
The authors report no conflict of interest.
References
1. Potter GR, Chatwin C. Not particularly special: critiquing ‘NPS’ as a category of drugs. Drugs Educ Prev Pol 2018; 25(4): 329-336.
2.
Tracy DK, Wood DM, Baumeister D. Novel psychoactive substances: types, mechanisms of action, and effects. BMJ 2017; 356: i6848. DOI: 10.1136/bmj.i6848.
3.
Krabseth HM, Tuv SS, Strand MC, et al. Novel psychoactive substances. Tidsskr Nor Laegeforen 2016; 136(8): 714-717.
4.
Higgins K, O’Neill N, O’Hara L, et al. New psychoactives within polydrug use trajectories-evidence from a mixed-method longitudinal study. Addiction 2021; 116(9): 2454-2462.
5.
European Drug Report 2024: Trends and developments. Available from: https://www.euda.europa.eu/publications/european-drug-report/2024_en (accessed: 20 May 2025).
6.
Mdege ND, Meader N, Lloyd C, et al. The novel psychoactive substances in the UK project: empirical and conceptual review work to produce research recommendations. Southampton (UK): NIHR Journals Library, 201728678463.
7.
Zygo M, Pawłowska B, Potembska E, Kapka-Skrzypczak L. Use of psychoactive substances by young people reporting suicidal thoughts, plans, and attempts in the context of sociodemographic factors. J Health Inequal 2020; 6(1): 27-31.
8.
Benschop A, Urbán R, Kapitány-Fövény M, et al. Why do people use new psychoactive substances? Development of a new measurement tool in six European countries. J Psychopharmacol 2020; 34(6): 600-611.
9.
Wieczorek Ł, Dąbrowska K, Bujalski M. Motives for using new psychoactive substances in three groups of Polish users: nightlife, marginalised and active on the Internet. Psychiatr Pol 2022; 56(3): 453-470.
10.
Schifano F, Napoletano F, Chiappini S, et al. New/emerging psychoactive substances and associated psychopathological consequences. Psychol Med 2021; 51(1): 30-42.
11.
Subeliani D, Otiashvili D, Kutelia L, et al. Patterns of use of new psychoactive substances and perceived benefits and negative effects: results of online survey in Georgia (country). J Substance Use 2019; 25(3): 324-329.
12.
Becker ABC, Lüken LM, Kelker L, et al. Cognitive profiles of adolescent inpatients with substance use disorder. Children (Basel) 2022; 9(5): 756. DOI: 10.3390/children9050756.
13.
Orsolini L, Chiappini S, Corkery JM, et al. The use of new psychoactive substances (NPS) in young people and their role in mental health care: a systematic review. Expert Rev Neurother 2019; 19(12): 1253-1264.
14.
Tubman L, Mullen N, Tracy DK. Fifteen-minute consultation: recognition and management of the child or young person who has ingested a novel psychoactive substance. Arch Dis Child Educ Pract Ed 2020; 105(6): 336-341.
15.
Baranowska AS. Risky behaviors of teenagers. J Educ Health Sport 2016; 6(6): 517-530.
16.
Pisarska A, Ostaszewski K, Greń J, Bobrowski KJ. The prevalence and factors associated with drug use among secondary school students. Mokotow Study 2020. Alcohol Drug Addict 2022; 35(2): 113-140.
17.
National Centre for Counteracting Addictions. Report 2023 addictions in Poland. New psychoactive substances. Available from: https://kcpu.gov.pl/wp-content/uploads/2024/03/Raport- 2023-wersja-Internetowa.pdf (accessed: 20 May 2025).
18.
Champion KE, Teesson M, Newton NC. Patterns and correlates of new psychoactive substance use in a sample of Australian high school students. Drug Alcohol Rev 2016; 35(3): 338-344.
19.
Centers for Diseas Control and Prevention. High School Youth Risk Behavior Survey, 2021. Available from: https://nccd.cdc.gov/youthonline/app/Results.aspx?LID=UT (accessed: 20 May 2025).
20.
ESPAD. Alcohol and drug use among school students. Report on nationwide surveys conducted in 2019. Available from: http://www.espad.org/espad-report-2019 (accessed: 20 May 2025).
21.
Kelečević I, Gugleta L, Vejnović AM, Mijatović Jovin V. New synthetic compounds with psychoactive action-preliminary results among primary and high school students on the territory of Novi Sad. Medicines (Basel) 2025; 12(1): 6. DOI:10.3390/medicines12010006.
22.
Miech RA, Johnston LD, Patrick M, et al. Monitoring the Future national survey results on drug use, 1975-2023: overview and detailed results for secondary school students. Monitoring the Future Monograph Series. Institute for Social Research, University of Michigan, Ann Arbor. Available from: https://monitoringthefuture.org/results/annual-reports/ (accessed: 20 May 2025).
23.
Champion KE, Newton NC, Stapinski LA, Teesson M. Effectiveness of a universal internet-based prevention program for ecstasy and new psychoactive substances: a cluster randomized controlled trial. Addiction 2016; 111(8): 1396-1405.
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