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%%%%  Remarks: This template is provided to aid authors with the preparation
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\begin{document}


\section*{Supplementary Material}
\label{sec:supplementary}

\subsection*{Substance classification}

Self-reported and toxicologically confirmed substances were categorized into pharmacologically meaningful groups to facilitate analysis. The following classification scheme was applied:

\begin{itemize}
    \item \textbf{Stimulants:} amphetamine, methamphetamine, cocaine, and MDMA.
    \item \textbf{Opioids:} heroin, morphine, methadone, fentanyl, tramadol, and other opiate derivatives.
    \item \textbf{Sedatives:} benzodiazepines, GHB/GBL, pregabalin, and ketamine.
    \item \textbf{New psychoactive substances (NPS):} synthetic cathinones and synthetic cannabinoids.
    \item \textbf{THC}
    \item \textbf{Hallucinogens:} LSD and psilocybin-containing mushrooms.
    \item \textbf{Ethanol}
\end{itemize}

\subsection*{Toxicological analyses}

At TUM, urine analyses were conducted for all patients using an AU480 chemistry analyzer (Beckman Coulter, Brea, CA, USA) \citep{beckmancoulter_AU480} with an immunoassay test panel. The panel included amphetamines/MDMA, benzoylecgonine (cocaine metabolite), buprenorphine, barbiturates, benzodiazepines, delta-9-THC, ethanol, ethyl glucuronide, methadone metabolite (2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine), fentanyl, GHB, opiates, pregabalin, and synthetic cannabinoids (Spice-1, Spice-2, Spice-3). Dipstick tests were additionally used for selected substances such as LSD, ketamine, or tilidine. Between 2014 and mid-2020, online solid-phase extraction (SPE) high-performance liquid chromatography with diode array detection (HPLC-DAD; TOX.I.S. II, Shimadzu, Kyoto, Japan) was applied to identify substances not covered by the immunoassay and to allow for differentiation. This method enabled the detection of oxycodone, tilidine, tramadol, zolpidem, zopiclone, certain cathinones/phenethylamines, and ketamine.

At LMU, urine drug screening was performed using immunoassays. Benzodiazepines, amphetamines, cocaine, opiates, methadone, buprenorphine, and THC were analyzed with the CEDIA Drug Screening Assay (Thermo Fisher Scientific, Waltham, MA, USA). Fentanyl was measured using the ARK Fentanyl Assay (Specialty Diagnostix GmbH, Bad Homburg, Germany). All assays were carried out on the Indiko Plus analyzer (Thermo Fisher Scientific, Waltham, MA, USA) \citep{thermofisher_IndikoPlus}.



%\bmhead{Acknowledgements}

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%\begin{appendices}

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