"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).

"Creating a bridge between public health and drug policy in the context of AAS would be a significant step towards providing adequate healthcare to this, often overlooked, group of substance consumers (Dunn et al., 2023; Piatkowski et al., 2022, 2023a).

"The Global Commission on Drug Policy recently advised governments to make harm reduction measures, including drug checking services, widely accessible (Bewley-Taylor & Tinasti, 2020; Buxton et al., 2020).

"One of the consequences of drug prohibition is the lack of knowledge regarding the composition and purity of illicit substances (Miron, 2003; Taylor et al., 2016).

"The use of APEDS was common among young males in the current study, and it was more related to the drive for muscularity and sexual orientation than symptoms of EDs. In a large national sample (N = 7401) of college and university students, including both sexes in the US (ages 18–30 years), the lifetime prevalence of the use of protein supplements and creatine was 23.8% and 7.7%, respectively [30].

"Among men who use AAS, research has found that a group identity emerges as a result of the common interests, which centre on training, diet, and the co-occurring substance use [8, 10, 56].

"Qualitative work from Ip and colleagues examined a sample of female AAS users through web-surveys [32]. Their findings demonstrated that women experience AAS use differently to men and, therefore, may have their own unique needs. More recently, Havnes et al. [33] explored the experiences and harms of women who use AAS. Their study utilised a sample of women (n = 16) aged 18 and above who reported current or past AAS use.

"The desire to achieve a thin physique has stemmed from women’s ideal bodies traditionally being considered ‘thin’ [1]. More recently, the ideal body type for women is changing and social influences (e.g. media) have been promoting athletic female beauty ideals alongside defined and muscular body shapes for women [2, 3].

"Peers and social networks are an important component of the performance and image enhancing drug (PIED) community.