Off-label prescribing is widespread among pediatricians, and it is unlikely that this trend will soon be bound by a uniform legal framework. This is necessitated by the fact that there are four variables: the patient’s health condition, the physician’s experience and knowledge, the legislative measures (laws, directives, guidelines, and recommendations), and finally, the pharmaceutical industry. There is considerable concern worldwide about the use of off-label medicines in children. We may call it an enormous global problem that is much talked about and written about; however, we should not forget that the goal around which everyone should unite is the patient’s life. For healthcare providers, the most important thing will always be the health and preservation of the patient’s life, particularly when it comes to children with life-threatening conditions in neonatal and pediatric intensive care units (NICU and PICU). The study aimed to examine the prevalence of off-label drug use in pediatrics. Literature research was conducted, and we included studies from 2012 to 2022 that evaluated off-label drug prevalence in various pediatric patient populations.

A new 'family” of drugs, the piperazines, has emerged on the European drug market as new designer drugs for the last few years. The key members of the group that have been used for non-medical recreational purposes are BZP (Benzylpiperazine, A2, Frenzy, Nemesis), TFMPP (1-[3-(trifluoro-methyl)phenyl]piperazine), mCPP (meta-chlorophenylpiperazine, 1-(3-Chlorophenyl)-piperazine). Piperazines are psychoactive drugs and clearly not without risks. With stimulant effects comparable to amphetamines but with a lower potency and differential global scheduling status, they have been sold as a supposed legal alternative to ecstasy. Currently, in Bulgaria these piperazines are not controlled drugs. Other European countries have banned or are going to ban some piperazines. This review provides a summary of current knowledge on recreational piperazines, the current situation in the Bulgaria and the experience in some countries.