1
|
Mackay A, Downey LA, Arunogiri S, Ogeil RP, Hayley AC. Trait anger as a predictor of dangerous driving behaviour amongst people who use methamphetamine. ACCIDENT; ANALYSIS AND PREVENTION 2024; 204:107634. [PMID: 38795421 DOI: 10.1016/j.aap.2024.107634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Despite increased prevalence of methamphetamine in road trauma, it remains unclear how its use translates to an increased risk of traffic-related harm. Exploration of psychosocial factors may thus help identify relevant predictors of dangerous driving behaviour among people who regularly consume methamphetamine. METHODS Licenced individuals who report predominant and sustained methamphetamine use (at least 1-time/month for 6 months at heaviest use) were recruited from the Australian community and via targeted campaign (Eastern Health). Psychosocial, substance use and driving behaviour data (Dula Dangerous Driving Index, DDDI) were collected via a secure anonymous online forced-entry survey platform (Qualtrics). RESULTS Seventy-seven individuals (65.5 % male) aged between 20-50 years [mean = 29.7, ± Standard Deviation (SD) 6.1] were included. Most (90 %) respondents met criteria for problematic methamphetamine use [Severity of Dependency Scale (SDS) score ≥ 5], and 75 % were high-risk alcohol consumers [Alcohol Use Disorders Identification Test (AUDIT-C) score ≥ 4 for men and ≥ 3 for women]. On average, age of first methamphetamine use occurred at 23.3 years (±5.2). A best-possible subset's regression selection method with dangerous driving behaviour as the dependent variable determined the model with three predictors (alcohol use, substance dependence severity and trait anger) as most parsimonious. After controlling for substance use, trait anger strongly and positively predicted dangerous driving behaviour as measured by the DDDI ([F(3,74) = 26.06, p < .001, adjusted R2 = 0.50, Cohens f2 = 0.42). DISCUSSION AND CONCLUSIONS Trait anger is a strong predictor of risky driving among road users who use methamphetamine. Interactions between stable negative-emotional and situational traffic and driving-related factors may increase risk of harm through greater engagement in risk-taking behaviour.
Collapse
Affiliation(s)
- Aaron Mackay
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Luke A Downey
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Australia; Institute for Breathing and Sleep, Austin Health Hospital, Melbourne, Australia
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Rowan P Ogeil
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Amie C Hayley
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Australia; Institute for Breathing and Sleep, Austin Health Hospital, Melbourne, Australia; International Council for Alcohol, Drugs and Traffic Safety (ICADTS), Australia.
| |
Collapse
|
2
|
Heide G, Jamt REG, Fainberg-Sandbu J, Øiestad ÅML, Høiseth G. Driving under the influence of cocaine and MDMA: Relationship between blood concentrations and results from clinical test of impairment. J Anal Toxicol 2024; 48:380-387. [PMID: 38613441 PMCID: PMC11165640 DOI: 10.1093/jat/bkae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/15/2024] Open
Abstract
The general use of cocaine is increasing in recent years, while the trend for 3,4-methylenedioxymethamphetamine (MDMA) is less clear. The relationship between blood concentrations and impairment is poorly understood, which complicates interpretation. The aims of this study were to report prevalence and blood concentrations of cocaine and MDMA in drugged drivers, and to investigate the relationship between blood concentrations and impairment. Samples of whole blood were collected from apprehended drivers in the period 2000-2022, and a clinical test of impairment (CTI) was simultaneously performed. The samples were initially analyzed for cocaine and MDMA using gas chromatography-mass spectrometry (until 2009 and 2012, respectively), and later using ultra-high-performance liquid chromatography-tandem mass spectrometry. Overall, cocaine was detected in 2,331 cases and MDMA in 2,569 cases. There were 377 and 85 mono cases of cocaine and MDMA, respectively. In the mono cases, the median cocaine concentration was 0.09 mg/L (range: 0.02-1.15 mg/L), and 54% of the drivers were clinically impaired. The median MDMA concentration was 0.19 mg/L (range: 0.04-1.36 mg/L), and 38% were clinically impaired. There was a statistically significant difference in the median cocaine concentration between drivers assessed as not impaired (0.07 mg/L) and drivers assessed as impaired (0.10 mg/L) (P = 0.009). There was also a significant effect of the blood concentration of cocaine (adjusted odds ratio [aOR] = 6.42, 95% confidence interval [CI] = 1.13-36.53, P = 0.036) and driving during the evening/night-time (aOR = 2.17, 95% CI = 1.34-3.51, P = 0.002) on the probability of being assessed as impaired on the CTI. No significant differences were found for MDMA. Many drivers are not assessed as impaired on a CTI following cocaine or especially MDMA use. For cocaine, a relationship between blood concentrations and impairment was demonstrated, but this could not be shown for MDMA.
Collapse
Affiliation(s)
- Gunhild Heide
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway
| | | | - Jonas Fainberg-Sandbu
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway
| | - Åse Marit Leere Øiestad
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway
| | - Gudrun Høiseth
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway
- Center for Psychopharmacology, Diakonhjemmet Hospital, Forskningsveien 13, Oslo 0373, Norway
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blinderen, Oslo 0318, Norway
| |
Collapse
|
3
|
Åhman A, Wingren CJ, Håkansson A. Causes and circumstances of death in stimulant and opioid use-A comparative study. PLoS One 2024; 19:e0297838. [PMID: 38324514 PMCID: PMC10849257 DOI: 10.1371/journal.pone.0297838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
AIMS To investigate the individual characteristics, causes and circumstances around deaths in stimulant use, and to examine how individuals who died with stimulants in their body differ from individuals who died with opioids in their body. METHODS This study includes individuals who died during the years 2000-2018 and underwent a forensic autopsy at Forensic Medicine in Lund, Skåne County, Sweden. All individuals over 18 years of age with stimulants (n = 310), opioids (n = 2,039) or both stimulants and opioids (n = 385) in the body at the time of death, were included. The three groups were assessed regarding gender, age, place of death, BMI, other substances detected in forensic toxicological analysis, organ weights and underlying and contributing causes of death. The data were analysed by frequency and proportion calculations, cross-tabulations and comparisons of medians. RESULTS The median age at death of the study population (n = 2,734) was 45.5 years (interquartile range ☯IQR] 32-60 years) and 73.2% were men. The most common cause of death in the stimulant group was suicide (26.8%), higher proportion compared to the opioid group (20.8%) (p = 0.017) and in the polysubstance group accidental poisoning (38.2%), higher proportion compared to the opioid group (18.0%) (p<0.001). Death by transport accidents was significantly associated with the stimulant group (p<0.001) as well as death by other accidents (p = 0.016). CONCLUSIONS Individuals who died with stimulants in their body died at a higher rate from suicide, transport accidents and other accidents, compared to individuals who died with opioids in their body. This study indicates the need to identify and prevent psychiatric conditions, elevated suicide risk, and risk-taking behaviors among people who use stimulants.
Collapse
Affiliation(s)
- Ada Åhman
- Department of Clinical Sciences Lund, Lund University, Psychiatry, Lund, Sweden
| | - Carl Johan Wingren
- Unit for Forensic Medicine, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Lund University, Psychiatry, Lund, Sweden
| |
Collapse
|
4
|
Bråthen CC, Jørgenrud BM, Bogstrand ST, Gjerde H, Rosseland LA, Kristiansen T. Prevalence of use and impairment from drugs and alcohol among trauma patients: A national prospective observational study. Injury 2023; 54:111160. [PMID: 37944451 DOI: 10.1016/j.injury.2023.111160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Being under the influence of psychoactive substances increases the risk of involvement in and dying from a traumatic event. The study is a prospective population-based observational study that aims to determine the prevalence of use and likely impairment from psychoactive substances among patients with suspected severe traumatic injury. METHOD This study was conducted at 35 of 38 Norwegian trauma hospitals from 1 March 2019 to 29 February 2020. All trauma admissions for patients aged ≥ 16 years admitted via trauma team activation during the study period were eligible for inclusion. Blood samples collected on admission were analysed for alcohol, benzodiazepines, benzodiazepine-like hypnotics (Z-drugs), opioids, stimulants, and cannabis (tetrahydrocannabinol). RESULTS Of the 4878 trauma admissions included, psychoactive substances were detected in 1714 (35 %) and in 771 (45 %) of these, a combination of two or more psychoactive substances was detected. Regarding the level of impairment, 1373 (28 %) admissions revealed a concentration of one or more psychoactive substances indicating likely impairment, and 1052 (22 %) highly impairment. Alcohol was found in 1009 (21 %) admissions, benzodiazepines and Z-drugs in 613 (13 %), opioids in 467 (10 %), cannabis in 352 (7 %), and stimulants in 371 (8 %). Men aged 27-43 years and patients with violence-related trauma had the highest prevalence of psychoactive substance use with respectively 424 (50 %) and 275 (80 %) testing positive for one or more compounds. CONCLUSION The results revealed psychoactive substances in 35 % of trauma admissions, 80 % of which were likely impaired at the time of traumatic injury. A combination of several psychoactive substances was common, and younger males and patients with violence-related injuries were most often impaired. Injury prevention strategies should focus on high-risk groups and involve the prescription of controlled substances. We should consider toxicological screening in trauma admissions and incorporation of toxicological data into trauma registries.
Collapse
Affiliation(s)
- Camilla C Bråthen
- Department of Acute Medicine, Division of Elverum-Hamar, Innlandet Hospital Trust, 2381 Brumunddal, Norway; Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway.
| | - Benedicte M Jørgenrud
- Department of Forensic Sciences, Division of Laboratory Medicine, Section of Drug Abuse Research, Oslo University Hospital, 0424 Oslo, Norway
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Division of Laboratory Medicine, Section of Drug Abuse Research, Oslo University Hospital, 0424 Oslo, Norway; Faculty of Health Sciences, Department of Nursing and Health Promotion, Acute and Critical Illness, Oslo Metropolitan University, 0130 Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Hallvard Gjerde
- Department of Forensic Sciences, Division of Laboratory Medicine, Section of Drug Abuse Research, Oslo University Hospital, 0424 Oslo, Norway
| | - Leiv Arne Rosseland
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, 0424 Oslo, Norway
| | - Thomas Kristiansen
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; Department of Anaesthesiology, Division of Emergencies and Critical Care, Radiumhospitalet, Oslo University Hospital, 0424 Oslo, Norway
| |
Collapse
|
5
|
Integration of smart nanomaterials for highly selective disposable sensors and their forensic applications in amphetamine determination. Electrochim Acta 2023. [DOI: 10.1016/j.electacta.2023.142009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
6
|
McGrane IR, Ramsbacher NC, Rook WC, Omar FA. Effects of 3,4-methylenedioxymethamphetamine and methamphetamine on motor vehicle driving performance: A systematic review of experimental and observational studies. J Forensic Sci 2023; 68:22-34. [PMID: 36411495 DOI: 10.1111/1556-4029.15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/29/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
Methamphetamine (METH) and 3,4-methylenedioxymethamphetamine (MDMA) are common drugs of abuse and driving under their influence may occur in 1 million people yearly in the United States. This systematic review fills the currently unmet need in understanding the effects of METH and MDMA on motor vehicle driving performance (MVP) and provides insight into the forensic community. A PubMed search on September 24, 2020, for experimental and observational studies, which evaluated the impact of METH and MDMA on MVP was performed. After a review of 208 abstracts, 103 were considered potentially interesting and full texts were obtained. After the exclusion of non-English articles, review articles, single case reports, and articles which did not evaluate METH or MDMA on MVP, a total of nine experimental studies, 10 traditional observational studies, and 35 case series were included. The clinical rigor of experimental studies was evaluated using the Jadad scale. Experimental studies often demonstrated no significant MVP safety signals for METH or MDMA use, which was contrary to the overwhelming MVP safety risks found in observational studies. Common driving behaviors while using METH or MDMA include: errors in judgment, traveling at high speeds, failure to stop, merging inappropriately, lane weaving, and crashes. Limitations of experimental studies that led to dissimilar MVP outcomes from observational studies include: the common use of driving simulators, as opposed to actual driving examinations, and doses of METH or MDMA administered may not be representative of blood concentrations seen in observational studies. This systematic review has no funding source and was not registered.
Collapse
Affiliation(s)
- Ian R McGrane
- Skaggs School of Pharmacy, College of Health, University of Montana, Missoula, Montana, USA.,Department of Pharmacy, Providence St. Patrick Hospital, Missoula, Montana, USA
| | - Nathan C Ramsbacher
- Department of Pharmacy, Providence St. Patrick Hospital, Missoula, Montana, USA
| | - William C Rook
- Department of Pharmacy, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Faddy A Omar
- Department of Pharmacy, Holy Rosary Healthcare, Miles City, Montana, USA
| |
Collapse
|
7
|
Development and Validation of a Uplc-Qtof-Ms Method for Blood Analysis of Isomeric Amphetamine-Related Drugs. SEPARATIONS 2022. [DOI: 10.3390/separations9100285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
The identification of isomeric drugs is gaining increasing importance in forensics and doping control. Isomers vary in terms of safety, effectiveness, and regulation, particularly for amphetamine-related drugs (ARDs). This study developed and validated a pseudo-isocratic UPLC-qTOF-MS analytical method for the identification of isomeric Amphetamine-related drugs (ARDs) in blood following mixed-mode solid-phase extraction (MMSPE). The procedure requires 250 μL of blood to achieve a limit of quantification (LOQ) and detection (LOD) of 20 ng/mL for all analytes. In aged animal blood samples, extraction recoveries of 63–90% and matrix effects of 9–21% were observed. Precision and accuracy for all analytes were within 20% and 89–118%, respectively. The analytical method was developed and validated in accordance with the Scientific Working Group for Forensic Toxicology (SWGTOX) Standard. It has acceptable accuracy and precision for use in doping control and forensic toxicology.
Collapse
|
8
|
Drug consumption of suspected drug-influenced drivers in Hungary (2016-2018). Forensic Sci Int 2022; 336:111325. [DOI: 10.1016/j.forsciint.2022.111325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022]
|
9
|
Blandino A, Cotroneo R, Tambuzzi S, Di Candia D, Genovese U, Zoja R. Driving under the influence of drugs: Correlation between blood psychoactive drug concentrations and cognitive impairment. A narrative review taking into account forensic issues. Forensic Sci Int Synerg 2022; 4:100224. [PMID: 35330981 PMCID: PMC8938866 DOI: 10.1016/j.fsisyn.2022.100224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/05/2022]
Abstract
Driving under the influence of alcohol has been shown to increase the risk of involvement in road traffic collisions (RTCs) however, less is known about the effects of illicit drugs, and a clear correlation between drug concentrations and RTC risk is still debated. The goal of this narrative review is to assess the current literature regarding the most detected psychoactive drugs in RTC (ethanol, amphetamines, cannabis, opioids and cocaine), in relation to driving performance. Evidence on impaired driving due to psychoactive substances, forensic issues relating to the assessment of the impact of drugs, blood cut-off values proposed to date as well as scientific basis for proposed legislative limits are discussed. At present there is no unequivocal evidence demonstrating a clear dose/concentration dependent impairment in many substances. Per se and zero tolerance approaches seem to have negative effect on drugged driving fatalities. However, the weight of these approaches needs further investigation. Driving under the influence of psychotropic substances has become a widespread phenomenon. Only a few substances have been reported to have a clear dose/concentration dependent impairment. Statistically significant differences should not be considered as clinically significant per se There is wide variability in legislative cut-offs. Detection limits seems to be the most public safety-oriented legislative approach.
Collapse
|
10
|
Apóstol Del Rosal GD, Limón ID, Martínez I, Patricio-Martínez A. The Chronic Oral Administration of Clobenzorex or Amphetamine Decreases Motor Behavior and Induces Glial Activation in the Striatum Without Dopaminergic Degeneration. Neurotox Res 2021; 39:1405-1417. [PMID: 34279823 DOI: 10.1007/s12640-021-00395-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 01/12/2023]
Abstract
Described as amphetamine-like due to their structural and stimulant similarities, clobenzorex is one of the five most-commonly used drugs in Mexico for the treatment of obesity. Various studies have shown that amphetamines induce dopaminergic neurotoxicity and neuroinflammation in the striatum, symptoms which are associated with motor damage. For this reason, the present study aimed to evaluate the effect of chronic clobenzorex administration on motor behaviors, TH immunoreactivity, gliosis, and the neurodegenerative process in the striatum and substantia nigra pars compacta (SNpc). The present research was conducted on three experimental groups of male Wistar rats: the vehicle group, the amphetamine group (2 mg/kg), and the clobenzorex group (30 mg/kg). All groups were subject to oral administration every 24 h for 31 days. Motor activity and motor coordination were evaluated in the open field test and the beam walking test, respectively. The animals were euthanized after the last day of treatment to enable the extraction of their brains for the evaluation of tyrosine hydroxylase (TH) levels, the immunoreactivity of the glial cells, and the neurodegeneration of both the striatum and SNpc via amino-cupric-silver stain. The results obtained show that amphetamine and clobenzorex administration decrease motor activity and motor coordination in the beam walking test and cause increased gliosis in the striatum, while no significant changes were observed in terms of immunoreactivity to TH and neurodegeneration in both the striatum and SNpc. These results suggest that the chronic administration of clobenzorex may decrease motor function in a manner similar to amphetamine, via the neuroadaptive and non-neurotoxic changes caused to the striatum under this administration scheme.
Collapse
Affiliation(s)
- Grego David Apóstol Del Rosal
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Ilhuicamina Daniel Limón
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Isabel Martínez
- Laboratorio de Neuroquímica, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Aleidy Patricio-Martínez
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
- Facultad de Ciencias Biológicas, Benemérita Universidad Autónoma de Puebla, Blvd. Valsequillo y Av. San Claudio Edificio BIO-1 C.U. Col. Jardines de San Manuel A.P, 72570, Puebla, Mexico.
| |
Collapse
|
11
|
Le Daré B, Degremont A, Couty C, Baert A, Bouvet R, Morel I, Gicquel T. Alcohol and drug consumption among motor vehicle drivers in the Brittany region of France: A 9-year cross-sectional population study. Prev Med Rep 2021; 23:101454. [PMID: 34194961 PMCID: PMC8227838 DOI: 10.1016/j.pmedr.2021.101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
The primary objective of the present study was to evaluate the frequency of positive tests for alcohol and drugs during roadside testing or after road accidents among drivers in the Brittany region of France. The study’s secondary objective was to describe the blood concentrations of the substances found during these tests, in order to provide a scientific basis for the establishment or modification of legislative threshold values for road injuries prevention. We performed a cross-sectional study of a database compiled by Rennes University Hospital’s toxicology laboratory in the Brittany region of France between 2010 and 2018. Driver’s age, sex, and test status (positive or negative), and blood levels of ethanol, 9-tetrahydrocannabinol (THC), methylene dioxymethamphetamine (MDMA), amphetamine, benzoylecgonine and 6-monoacetylmorphine (6-MAM) were collected. Twelve thousand four hundred and ninety-seven drivers (males: 86.1%; median (range) age: 29 (15–94)) have provided roadside blood samples, giving a total of 25,998 test results. Among the 10,996 drivers with at least one positive test, the median blood concentrations of ethanol, THC, MDMA, amphetamine, benzoylecgonine, and 6-MAM were respectively 1.82 g/L, 2.41 ng/mL, 138.4 ng/mL, 67.7 ng/mL, 173.3 ng/mL, and 0.97 ng/mL. 1159 (10.54%) of the 10,996 drivers tested positive for two or more substances, and 151 (1.4%) tested positive for three or more substances. With the exception of heroin, the currently recommended threshold values appear to be appropriate for road injuries prevention with regard to the concentrations observed in offenders.
Collapse
Affiliation(s)
- Brendan Le Daré
- Rennes University Hospital, Forensic Toxicology Laboratory, F-35000 Rennes, France
- Univ. Rennes, INSERM, INRA, CHU Rennes, Institut NuMeCan (Nutrition, Metabolism and Cancer), F-35000 Rennes, France
- Corresponding author at: 2 Rue Henri Le Guilloux, Rennes University Hospital, Forensic Toxicology Laboratory, F-35000 Rennes, France.
| | - Adeline Degremont
- Rennes University Hospital, Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, F-35033 Rennes, France
- Univ Rennes, EA 7449 REPERES ‘Pharmacoepidemiology and Health Services Research’, F-35000 Rennes, France
| | - Clémence Couty
- Rennes University Hospital, Forensic Toxicology Laboratory, F-35000 Rennes, France
| | - Alain Baert
- Rennes University Hospital, Department of Forensic Medicine, F-35000 Rennes, France
| | - Renaud Bouvet
- Rennes University Hospital, Department of Forensic Medicine, F-35000 Rennes, France
- Univ. Rennes, EA IDPSP – UR1_RS438, F-35000 Rennes, France
| | - Isabelle Morel
- Rennes University Hospital, Forensic Toxicology Laboratory, F-35000 Rennes, France
- Univ. Rennes, INSERM, INRA, CHU Rennes, Institut NuMeCan (Nutrition, Metabolism and Cancer), F-35000 Rennes, France
| | - Thomas Gicquel
- Rennes University Hospital, Forensic Toxicology Laboratory, F-35000 Rennes, France
- Univ. Rennes, INSERM, INRA, CHU Rennes, Institut NuMeCan (Nutrition, Metabolism and Cancer), F-35000 Rennes, France
| |
Collapse
|
12
|
Roadside Drug Testing Approaches. Molecules 2021; 26:molecules26113291. [PMID: 34072538 PMCID: PMC8199318 DOI: 10.3390/molecules26113291] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/01/2023] Open
Abstract
The purpose of this review is to present an overview of roadside drug testing, driving enforcement, and drunk/drug driving detection around the world. Drunk and drug driving is a severe problem, not only in the UAE, but also around the world. This has important implications for road safety as drunk or drug driving may increase the chances of a driver’s involvement in a road crash when compared to a drug-free driver. Recently, due to increases in drug-impaired drivers’ crash involvement, many mobile roadside drug testing devices have been introduced to the market. These devices use oral fluid, urine or blood matrices. These are on-the-spot tests, which are easy to use and are applied by law enforcement agencies and the public. Law enforcement agencies most commonly use oral fluid to detect the presence of illicit drugs in drivers. This review discusses all the available devices in the market used by the authorities. It also describes the type of drugs widely abused by drivers along with behavioral testing methods. The different types of matrices used for roadside drug testing are also evaluated. Sample collection, storage, and pre-treatment methods are discussed, followed by the confirmatory analysis of positive samples. This article will significantly help law enforcement agencies compare and evaluate all the reliable roadside testing devices and new emerging confirmatory devices available to them in the market. This will help them make an informed decision on which device to adapt to their individual needs.
Collapse
|
13
|
Jørgenrud B, Skadberg E, de Carvalho Ponce J, Furuhaugen H, Berg T. Determination of the alcohol biomarker phosphatidylethanol 16:0/18:1 and 33 compounds from eight different drug classes in whole blood by LC-MS/MS. J Pharmacol Toxicol Methods 2020; 107:106939. [PMID: 33257303 DOI: 10.1016/j.vascn.2020.106939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Most bioanalytical LC-MS/MS methods are developed for determination of single drugs or classes of drugs, but a multi-compound LC-MS/MS method that can replace several methods could reduce both analysis time and costs. The aim of this study was to develop a high-throughput LC-MS/MS method for determination of the alcohol biomarker phosphatidylethanol 16:0/18:1 (PEth 16:0/18:1) and 33 other compounds from eight different drug classes in whole blood. METHODS Whole-blood samples were prepared by 96-well supported liquid extraction (SLE). Chromatographic separations were performed on a biphenyl core shell column with a mobile phase consisting of 10 mM ammonium formate, pH 3.1 and methanol. Each extract was analyzed twice by LC-MS/MS, injecting 0.4 μL and 2 μL, in order to obtain narrow and symmetrical peaks and good sensitivity for all compounds. Stable isotope-labeled internal standards were used for 31 of the 34 compounds. RESULTS A 96-well SLE reversed phase LC-MS/MS method for determination of PEth 16:0/18:1 and 33 other compounds from eight different drug classes was developed and validated. By using an organic solvent mixture of isopropanol/ methyl tert-butyl ether (1:5, v:v), all compounds, including the polar and ampholytic compounds pregabalin, gabapentin and benzoylecgonine, was extracted by 96-well SLE. DISCUSSION/CONCLUSION For the first time an LC-MS/MS method for the determination of alcohol biomarker PEth 16:0/18:1 and drugs and metabolites from several different drug classes was developed and validated. The developed LC-MS/MS method can be used for high-throughput analyses and sensitive determinations of the 34 compounds in whole blood.
Collapse
Affiliation(s)
- Benedicte Jørgenrud
- Section of Drug Abuse Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Eline Skadberg
- Section of Drug Abuse Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Julio de Carvalho Ponce
- Department of Preventive Medicine, School of Medicine, University of Sao Paulo, Av Dr. Arnaldo, 455, Brazil
| | - Håvard Furuhaugen
- Section of Drug Abuse Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Thomas Berg
- Section of Drug Abuse Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway.
| |
Collapse
|
14
|
Reynolds LM, Yetnikoff L, Pokinko M, Wodzinski M, Epelbaum JG, Lambert LC, Cossette MP, Arvanitogiannis A, Flores C. Early Adolescence is a Critical Period for the Maturation of Inhibitory Behavior. Cereb Cortex 2020; 29:3676-3686. [PMID: 30295713 DOI: 10.1093/cercor/bhy247] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/28/2018] [Accepted: 09/05/2018] [Indexed: 12/29/2022] Open
Abstract
Psychiatric conditions marked by impairments in cognitive control often emerge during adolescence, when the prefrontal cortex (PFC) and its inputs undergo structural and functional maturation and are vulnerable to disruption by external events. It is not known, however, whether there exists a specific temporal window within the broad range of adolescence when the development of PFC circuitry and its related behaviors are sensitive to disruption. Here we show, in male mice, that repeated exposure to amphetamine during early adolescence leads to impaired behavioral inhibition, aberrant PFC dopamine connectivity, and reduced PFC dopamine function in adulthood. Remarkably, these deficits are not observed following exposure to the exact same amphetamine regimen at later times. These findings demonstrate that there is a critical period for the disruption of the adolescent maturation of cognitive control and PFC dopamine function and suggest that early adolescence is particularly relevant to the emergence of psychopathology in humans.
Collapse
Affiliation(s)
- Lauren M Reynolds
- Integrated Program in Neuroscience, McGill University, Montréal, QC, Canada.,Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Leora Yetnikoff
- Department of Psychology, College of Staten Island, City University of New York, Staten Island, NY, USA.,CUNY Neuroscience Collaborative, The Graduate Center, City University of New York, New York, NY, USA
| | - Matthew Pokinko
- Integrated Program in Neuroscience, McGill University, Montréal, QC, Canada.,Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Michael Wodzinski
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Julia G Epelbaum
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Laura C Lambert
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Marie-Pierre Cossette
- Department of Psychology, Center for Studies in Behavioural Neurobiology, Concordia University, Montréal, QC, Canada
| | - Andreas Arvanitogiannis
- Department of Psychology, Center for Studies in Behavioural Neurobiology, Concordia University, Montréal, QC, Canada
| | - Cecilia Flores
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montréal, QC, Canada
| |
Collapse
|
15
|
Dutt M, Dharavath RN, Kaur T, Chopra K, Sharma S. Differential effects of alprazolam against methylphenidate-induced neurobehavioral alterations. Physiol Behav 2020; 222:112935. [DOI: 10.1016/j.physbeh.2020.112935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/03/2023]
|
16
|
Cuesta S, Restrepo-Lozano JM, Popescu C, He S, Reynolds LM, Israel S, Hernandez G, Rais R, Slusher BS, Flores C. DCC-related developmental effects of abused- versus therapeutic-like amphetamine doses in adolescence. Addict Biol 2020; 25:e12791. [PMID: 31192517 PMCID: PMC8301742 DOI: 10.1111/adb.12791] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/11/2019] [Accepted: 05/15/2019] [Indexed: 12/24/2022]
Abstract
The guidance cue receptor DCC controls mesocortical dopamine development in adolescence. Repeated exposure to an amphetamine regimen of 4 mg/kg during early adolescence induces, in male mice, downregulation of DCC expression in dopamine neurons by recruiting the Dcc microRNA repressor, microRNA-218 (miR-218). This adolescent amphetamine regimen also disrupts mesocortical dopamine connectivity and behavioral control in adulthood. Whether low doses of amphetamine in adolescence induce similar molecular and developmental effects needs to be established. Here, we quantified plasma amphetamine concentrations in early adolescent mice following a 4 or 0.5 mg/kg dose and found peak levels corresponding to those seen in humans following recreational and therapeutic settings, respectively. In contrast to the high doses, the low amphetamine regimen does not alter Dcc mRNA or miR-218 expression; instead, it upregulates DCC protein levels. Furthermore, high, but not low, drug doses downregulate the expression of the DCC receptor ligand, Netrin-1, in the nucleus accumbens and prefrontal cortex. Exposure to the low-dose regimen did not alter the expanse of mesocortical dopamine axons or their number/density of presynaptic sites in adulthood. Strikingly, adolescent exposure to the low-dose drug regimen does not impair behavioral inhibition in adulthood; instead, it induces an overall increase in performance in a go/no-go task. These results show that developmental consequences of exposure to therapeutic- versus abused-like doses of amphetamine in adolescence have dissimilar molecular signatures and opposite behavioral effects. These findings have important clinical relevance since amphetamines are widely used for therapeutic purposes in youth.
Collapse
Affiliation(s)
- Santiago Cuesta
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - José Maria Restrepo-Lozano
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Christina Popescu
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Susan He
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Lauren M. Reynolds
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Sonia Israel
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Giovanni Hernandez
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Rana Rais
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Barbara S. Slusher
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cecilia Flores
- Department of Psychiatry and Department of Neurology and Neurosurgery, McGill University, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| |
Collapse
|
17
|
Davey JD, Armstrong KA, Freeman JE, Parkes A. Alcohol and illicit substances associated with fatal crashes in Queensland: An examination of the 2011 to 2015 Coroner's findings. Forensic Sci Int 2020; 312:110190. [PMID: 32413687 DOI: 10.1016/j.forsciint.2020.110190] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/31/2019] [Accepted: 02/07/2020] [Indexed: 11/15/2022]
Abstract
PROBLEM The problem of impaired driving is well documented in the literature but is heavily dependent upon self-report studies and/or databases that do not include in-depth information about the contributing origins of fatalities. AIM This study aimed to conduct an in-depth analysis of Coroner's findings for all fatally injured drivers in the state of Queensland in order to explore the prevalence of alcohol and different types of illicit substances (including drug combinations) in fatal crash reports. METHOD A total of 701 Coroner's reports related to drivers or controllers of vehicles involved in traffic related fatalities for the period of 2011-2015 were analysed, revealing 306 controllers (43.6%) were detected with either alcohol or illegal drugs (e.g., methylamphetamine, Δ9-tetrahydrocannabinol, cocaine or MDMA) RESULTS: Alcohol was the most commonly detected substance identified with 223 cases (72.9% of the drug and alcohol sample). Illicit drug detections totalled 147 cases (48% of the drug and alcohol sample) with Δ9-tetrahydrocannabinol the most commonly detected illicit substance (109 cases; 35.6% of the drug and alcohol sample) followed by methylamphetamine (total of 63 cases; 20.6% of the drug and alcohol sample). An important theme to emerge was the prevalence of polysubstance use among fatally injured drivers, not just for alcohol and one drug type, but also multiple drug combinations. Fatality trends revealed a decrease in both non-substance and alcohol-related fatalities across the study period. However, road fatalities where an illicit substance was detected increased by approximately 57%. Males were overrepresented as a proportion of total fatalities (82.4%) and there were no significant sex or age differences regarding illicit substance related deaths. Drivers of passenger vehicles were most commonly identified in the data (66.2%), but motorcycle operators were disproportionately represented (28.1% of the total controller sample compared to 4% of vehicle registrations in Queensland) CONCLUSION: This case study analysis of fatal crashes not only confirms the ongoing problem of alcohol and driving, but also illuminates the emerging (and escalating) issue of illicit substances detected in fatally injured drivers.
Collapse
Affiliation(s)
- Jeremy D Davey
- Road Safety Research Collaboration, University of the Sunshine Coast, Sippy Downs, Queensland, 4556 QLD, Australia.
| | - Kerry A Armstrong
- Road Safety Research Collaboration, University of the Sunshine Coast, Sippy Downs, Queensland, 4556 QLD, Australia
| | - James E Freeman
- Road Safety Research Collaboration, University of the Sunshine Coast, Sippy Downs, Queensland, 4556 QLD, Australia
| | - Alexander Parkes
- Road Safety Research Collaboration, University of the Sunshine Coast, Sippy Downs, Queensland, 4556 QLD, Australia
| |
Collapse
|
18
|
DINI G, BRAGAZZI N, MONTECUCCO A, RAHMANI A, DURANDO P. Psychoactive drug consumption among truck-drivers: a systematic review of the literature with meta-analysis and meta-regression. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E124-E139. [PMID: 31312742 PMCID: PMC6614564 DOI: 10.15167/2421-4248/jpmh2019.60.2.1245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022]
Abstract
Few studies have assessed the extent of psychoactive drug consumption in the occupational setting. The trucking sector, in particular, is an important cause for concern, since psychoactive substance use has a relevant impact on the drivers' health and safety, increasing the risk of injuries and traffic accidents, potentially affecting the general public health as well. A systematic review of the literature and meta-analysis was performed in order to provide Occupational Health Professionals and policy-makers with an updated epidemiological perspective regarding this important issue. The results showed a prevalence of overall drug consumption of 27.6% [95%CI 17.8-40.1], particularly high considering illicit CNS-stimulants (amphetamine consumption of 21.3% [95%CI 15.7-28.1], and cocaine consumption of 2.2% [95%CI 1.2-4.1]). It appears that truck-drivers choose stimulant substances as a form of performance enhancing drug, in order to increase productivity. However, chronic and high dose consumption has been shown to decrease driving skills, placing these professional drivers at risk for health and road safety. Further research is required, particularly in Europe, in order to fill the knowledge gap and improve the strength of evidence.
Collapse
Affiliation(s)
- G. DINI
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - N.L. BRAGAZZI
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Correspondence: Nicola Luigi Bragazzi, Dipartimento di Scienze della Salute (DISSAL), Università degli Studi di Genova, l.go R. Benzi 10 (Padiglione 3), 16132 Genova, Italy - E-mail:
| | - A. MONTECUCCO
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - A. RAHMANI
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - P. DURANDO
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| |
Collapse
|
19
|
Garton DR, Ross SG, Maldonado-Hernández R, Quick M, Lasalde-Dominicci JA, Lizardi-Ortiz JE. Amphetamine enantiomers inhibit homomeric α7 nicotinic receptor through a competitive mechanism and within the intoxication levels in humans. Neuropharmacology 2018; 144:172-183. [PMID: 30359640 DOI: 10.1016/j.neuropharm.2018.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/10/2018] [Accepted: 10/21/2018] [Indexed: 11/28/2022]
Abstract
Amphetamine-type stimulants (ATS) are the second most consumed illicit drug worldwide and lack good treatments for associated substance use disorders, lagging behind other addictive drugs. For this reason, a deeper understanding of the pharmacodynamics of ATS is required. The present study seeks to determine amphetamine (AMPH) enantiomers' effects on the homomeric α7 nicotinic acetylcholine receptor (α7 nAChR). Here we have shown that AMPH enantiomers bind to the α7 nAChR and competitively inhibit acetylcholine responses. Our in silico docking analysis suggests that AMPH binds close to the β7 strand of the B-loop of a chimera comprising of the human α7 nAChR and the acetylcholine binding protein from Lymnaea stagnalis. This may inhibit the required movement of the C-loop for channel opening, due to steric hindrance, providing a structural mechanism for its antagonist effect. Finally, we have shown that, in α7 nAChR full knockout mice, the behavioral response to D-AMPH is attenuated, providing direct evidence for the role of α7 nAChRs on the physiological response to D-AMPH. Importantly, D-AMPH exerts these effects at concentrations predicted to be pharmacologically relevant for chronic methamphetamine users and during binges. In conclusion, our data present new findings that implicate the α7 nAChR on the pharmacodynamics of ATS, which may be important for behavioral responses to these drugs, indicating a potential role for α7 nAChRs in ATS substance-use disorders.
Collapse
Affiliation(s)
- Daniel R Garton
- Columbia College of Columbia University, New York, NY, 10027, USA
| | - Sharmaine G Ross
- Department of Biobehavioral Sciences, Teachers College Columbia University, New York, NY, 10027, USA
| | | | - Matthias Quick
- Department of Psychiatry, Molecular Therapeutics Division, Columbia University Medical Center, New York, NY, 10032, USA
| | - José A Lasalde-Dominicci
- Departments of Biology and Chemistry, University of Puerto Rico, Río Piedras Campus, San Juan, PR, 00931, USA; Molecular Sciences Research Center, University of Puerto Rico, San Juan, PR, 00927, USA
| | - José E Lizardi-Ortiz
- Molecular Sciences Research Center, University of Puerto Rico, San Juan, PR, 00927, USA; Departments of Neurology and Psychiatry, Columbia University Medical Center, New York, NY, 10032, USA.
| |
Collapse
|
20
|
Åhman A, Jerkeman A, Blomé MA, Björkman P, Håkansson A. Mortality and causes of death among people who inject amphetamine: A long-term follow-up cohort study from a needle exchange program in Sweden. Drug Alcohol Depend 2018; 188:274-280. [PMID: 29803034 DOI: 10.1016/j.drugalcdep.2018.03.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abuse of amphetamines is a worldwide problem with around 34 million users, and amphetamine is commonly used by people who inject drugs (PWID). Despite this, there is relatively little research on mortality and cause of death among people who use amphetamines primarily. The present study aimed to examine mortality and causes of death among people who inject amphetamine, and compare these results to the general population. METHODS This retrospective cohort study was based on data from The Malmö Needle Exchange Program in Sweden (MNEP) and on data from The Swedish National Cause of Death Register. Participants in the MNEP, between 1987 and 2011, with registered national identity number and amphetamine as their primary drug of injection use, were included in the study. Standardized mortality ratios (SMR) was calculated for overall mortality and categories of causes of death. RESULTS 2019 individuals were included (mean follow-up-time 13.7 years [range 0.02-24.2 years], a total of 27,698 person-years). Of the 448 deceased, 428 had a registered cause of death. The most common causes of death were external causes (n = 162, 38%), followed by diseases of the circulatory system (n = 67, 16%). SMR were significantly elevated (8.3, 95% CI [7.5-9.1]) for the entire study population, and for every category of causes of death respectively. CONCLUSIONS People injecting amphetamine as a primary drug were found to have significantly elevated mortality compared with the general population, with high rates of both external and somatic causes of death.
Collapse
Affiliation(s)
- Ada Åhman
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden, Malmö Addiction Center, Södra Förstadsgatan 35, plan 4, 205 02 Malmö, Sweden.
| | - Anna Jerkeman
- Lund University, Faculty of Medicine, Department of Translational Medicine, Clinical Infection Medicine, Malmö, Sweden, Jan Waldenströms gata 35, 205 02 Malmö, Sweden.
| | - Marianne Alanko Blomé
- Lund University, Faculty of Medicine, Department of Translational Medicine, Clinical Infection Medicine, Malmö, Sweden, Jan Waldenströms gata 35, 205 02 Malmö, Sweden.
| | - Per Björkman
- Lund University, Faculty of Medicine, Department of Translational Medicine, Clinical Infection Medicine, Malmö, Sweden, Jan Waldenströms gata 35, 205 02 Malmö, Sweden.
| | - Anders Håkansson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden, Malmö Addiction Center, Södra Förstadsgatan 35, plan 4, 205 02 Malmö, Sweden.
| |
Collapse
|
21
|
Riva MM, Cantamessa F, Borleri D, Mosconi G. Occupational health and safety of road haulage company employees. LA MEDICINA DEL LAVORO 2018; 109:180-9. [PMID: 29943749 PMCID: PMC7689798 DOI: 10.23749/mdl.v109i3.6827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
Background: This paper follows up on a project that was launched in 2008 and contributed to the development of the new Italian Society of Occupational Medicine (SIML) guidelines for the road haulage industry. Objective: To reach a better understanding of occupational illness amongst truck drivers, in order to define appropriate health monitoring protocols and promote a healthy life-style. Methods: We assessed 673 male drivers (mean age 43.85 years, SD 9.56; mean working seniority 27.28 years, SD 10.59), employed by 46 different companies. The drivers, who were gradually recruited in the study over the years, had a maximum of 8 re-assessments each, for a total of 2608 examinations. We applied a survey protocol consisting in a medical examination, questionnaires for the most common risks and instrumental and laboratory tests in compliance with SIML guidelines. Results: We identified a total of 44 work-related diseases: 22 cases of noise-induced hearing loss (NIHL) and 22 cases of lumbar degenerative disc disease. As regards metabolic disorders, we observed 28 cases of diabetes mellitus, in most cases (71.4%) as a first diagnosis or under poor therapeutic control. We observed poorly-controlled hypertension in 103 drivers, the majority of whom (54%) were diagnosed for the first time. Over 30% of the workers in our study were obese and approximately 40% were tobacco smokers. We identified just 9 individuals (1.3%) with a positive toxicological screening for use of recreational drugs. Our data confirm a high prevalence of occupational illness amongst truck drivers. Cardiovascular and metabolic conditions require close monitoring.
Collapse
Affiliation(s)
- Matteo Marco Riva
- UOC Medicina del Lavoro Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII.
| | - Francesco Cantamessa
- UOC Medicina del Lavoro Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII.
| | - Daniela Borleri
- UOC Medicina del Lavoro Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII.
| | - Giovanni Mosconi
- UOC Medicina del Lavoro Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII.
| |
Collapse
|
22
|
Dopamine Development in the Mouse Orbital Prefrontal Cortex Is Protracted and Sensitive to Amphetamine in Adolescence. eNeuro 2018; 5:eN-NWR-0372-17. [PMID: 29333488 PMCID: PMC5762649 DOI: 10.1523/eneuro.0372-17.2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 02/04/2023] Open
Abstract
The prefrontal cortex (PFC) is divided into subregions, including the medial and orbital prefrontal cortices. Dopamine connectivity in the medial PFC (mPFC) continues to be established throughout adolescence as the result of the continuous growth of axons that innervated the nucleus accumbens (NAcc) prior to adolescence. During this period, dopamine axons remain vulnerable to environmental influences, such as drugs used recreationally by humans. The developmental trajectory of the orbital prefrontal dopamine innervation remains almost completely unstudied. Nonetheless, the orbital PFC (oPFC) is critical for some of the most complex functions of the PFC and is disrupted by drugs of abuse, both in adolescent humans and rodents. Here, we use quantitative neuroanatomy, axon-initiated viral-vector recombination, and pharmacology in mice to determine the spatiotemporal development of the dopamine innervation to the oPFC and its vulnerability to amphetamine in adolescence. We find that dopamine innervation to the oPFC also continues to increase during adolescence and that this increase is due to the growth of new dopamine axons to this region. Furthermore, amphetamine in adolescence dramatically reduces the number of presynaptic sites on oPFC dopamine axons. In contrast, dopamine innervation to the piriform cortex is not protracted across adolescence and is not impacted by amphetamine exposure during adolescence, indicating that dopamine development during adolescence is a uniquely prefrontal phenomenon. This renders these fibers, and the PFC in general, particularly vulnerable to environmental risk factors during adolescence, such as recreational drug use.
Collapse
|
23
|
Busardò FP, Pichini S, Pellegrini M, Montana A, Lo Faro AF, Zaami S, Graziano S. Correlation between Blood and Oral Fluid Psychoactive Drug Concentrations and Cognitive Impairment in Driving under the Influence of Drugs. Curr Neuropharmacol 2018; 16:84-96. [PMID: 28847293 PMCID: PMC5771389 DOI: 10.2174/1570159x15666170828162057] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/09/2017] [Accepted: 08/24/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The effects of drugs on driving performance should be checked with drug concentration in the brain and at the same time with the evaluation of both the behavioural and neurophysiological effects. The best accessible indicator of this information is the concentration of the drug and/or metabolites in blood and, to a certain extent, oral fluid. We sought to review international studies on correlation between blood and oral fluid drug concentrations, neurological correlates and cognitive impairment in driving under the influence of drugs. METHODS Relevant scientific articles were identified from PubMed, Cochrane Central, Scopus, Web of Science, Science Direct, EMBASE up to April 2017. RESULTS Up to 2010, no epidemiological studies were available on this matter and International scientists suggested that even minimal amounts of parent drugs in blood and oral fluid could affect driving impairment. More recently, epidemiological data, systematic reviews and meta-analysis on drugged drivers allowed the suggestion of impairment concentration limits for the most common illicit drugs. These values were obtained comparing driving disability induced by psychotropic drugs with that of established blood alcohol limits. Differently from ethyl alcohol where both detection methods and concentration limits have been well established even with inhomogeneity of ranges within different countries, in case of drugs of abuse no official cut-offs have yet been established, nor any standardized analytical protocols. CONCLUSION Multiple aspects of driving performance can be differently affected by illicit drugs, and even if for few of them some dose/concentration dependent impairment has been reported, a wider knowledge on concentration/impairment relationship is still missing.
Collapse
Affiliation(s)
- Francesco Paolo Busardò
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Manuela Pellegrini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Angelo Montana
- Department “G.F. Ingrassia” – University of Catania, Catania, Italy
| | | | - Simona Zaami
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy
| | - Silvia Graziano
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
24
|
McKetin R. Why methamphetamine-related deaths need more attention. Addiction 2017; 112:2203-2204. [PMID: 29105919 DOI: 10.1111/add.14021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Rebecca McKetin
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| |
Collapse
|
25
|
Strand MC, Mørland J, Slørdal L, Riedel B, Innerdal C, Aamo T, Mathisrud G, Vindenes V. Conversion factors for assessment of driving impairment after exposure to multiple benzodiazepines/z-hypnotics or opioids. Forensic Sci Int 2017; 281:29-36. [PMID: 29101905 DOI: 10.1016/j.forsciint.2017.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/06/2017] [Accepted: 10/11/2017] [Indexed: 11/18/2022]
Abstract
AIMS Norway has introduced legal concentration limits in blood for 28 non-alcohol drugs in driving under the influence cases. As of 2016 this legislation also regulates the assessment of combined effects of multiple benzodiazepines and opioids. We herein describe the employed methodology for the equivalence tables for concentrations of benzodiazepines/z-hypnotics and opioids implemented in the Norwegian Road Traffic Act. METHODS Legislative limits corresponding to impairment at blood alcohol concentrations (BAC) of 0.02%, 0.05% and 0.12% were established for 15 different benzodiazepines and opioids. This was based on a concept of a linear relationship between blood drug concentration and impairment in drug naïve users. Concentration ratios between these drugs were used to establish conversion factors and calculate net impairment using diazepam and morphine equivalents. RESULTS Conversion factors were established for 14 benzodiazepines/z-hypnotics (alprazolam, bromazepam, clobazam, clonazepam, etizolam, flunitrazepam, lorazepam, nitrazepam, nordiazepam, oxazepam, phenazepam, temazepam, zolpidem and zopiclone) and two opioids (methadone and oxycodone). CONCLUSIONS Conversion factors to calculate diazepam and morphine equivalents for benzodiazepines/z-hypnotics and selected opioids, respectively, have been operative in the Norwegian Road Traffic Act as of February 2016. Calculated equivalents can be applied by the courts to meter out sanctions.
Collapse
Affiliation(s)
| | - Jørg Mørland
- Norwegian Institute of Public Health, Division of Health Data and Digitalization, Oslo, Norway.
| | - Lars Slørdal
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.
| | - Bettina Riedel
- University of Bergen, Faculty of Medicine and Dentistry, Department of Clinical Science, Bergen, Norway; Haukeland University Hospital, Laboratory of Clinical Biochemistry, Bergen, Norway.
| | | | - Trond Aamo
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.
| | - Grete Mathisrud
- Norwegian Ministry of Transport and Communications, Department of Public Roads and Traffic Safety, Oslo, Norway.
| | - Vigdis Vindenes
- Oslo University Hospital, Department of Forensic Medicine, Oslo, Norway; Center of Drug and Addiction Research, Faculty of Medicine, University of Oslo, Norway.
| |
Collapse
|
26
|
Hondebrink L, Zwartsen A, Westerink RHS. Effect fingerprinting of new psychoactive substances (NPS): What can we learn from in vitro data? Pharmacol Ther 2017; 182:193-224. [PMID: 29097307 DOI: 10.1016/j.pharmthera.2017.10.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The use of new psychoactive substances (NPS) is increasing and currently >600 NPS have been reported. However, limited information on neuropharmacological and toxicological effects of NPS is available, hampering risk characterization. We reviewed the literature on the in vitro neuronal modes of action to obtain effect fingerprints of different classes of illicit drugs and NPS. The most frequently reported NPS were selected for review: cathinones (MDPV, α-PVP, mephedrone, 4-MEC, pentedrone, methylone), cannabinoids (JWH-018), (hallucinogenic) phenethylamines (4-fluoroamphetamine, benzofurans (5-APB, 6-APB), 2C-B, NBOMes (25B-NBOMe, 25C-NBOMe, 25I-NBOMe)), arylcyclohexylamines (methoxetamine) and piperazine derivatives (mCPP, TFMPP, BZP). Our effect fingerprints highlight the main modes of action for the different NPS studied, including inhibition and/or reversal of monoamine reuptake transporters (cathinones and non-hallucinogenic phenethylamines), activation of 5-HT2receptors (hallucinogenic phenethylamines and piperazines), activation of cannabinoid receptors (cannabinoids) and inhibition of NDMA receptors (arylcyclohexylamines). Importantly, we identified additional targets by relating reported effect concentrations to the estimated human brain concentrations during recreational use. These additional targets include dopamine receptors, α- and β-adrenergic receptors, GABAAreceptors and acetylcholine receptors, which may all contribute to the observed clinical symptoms following exposure. Additional data is needed as the number of NPS continues to increase. Also, the effect fingerprints we have obtained are still incomplete and suffer from a large variation in the reported effects and effect sizes. Dedicated in vitro screening batteries will aid in complementing specific effect fingerprints of NPS. These fingerprints can be implemented in the risk assessments of NPS that are necessary for eventual control measures to reduce Public Health risks.
Collapse
Affiliation(s)
- Laura Hondebrink
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Anne Zwartsen
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht University, The Netherlands; Neurotoxicology Research Group, Division Toxicology, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80.177, NL-3508 TD, Utrecht, The Netherlands
| | - Remco H S Westerink
- Neurotoxicology Research Group, Division Toxicology, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80.177, NL-3508 TD, Utrecht, The Netherlands.
| |
Collapse
|
27
|
Making Dopamine Connections in Adolescence. Trends Neurosci 2017; 40:709-719. [PMID: 29032842 DOI: 10.1016/j.tins.2017.09.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 12/13/2022]
Abstract
A dramatic maturational process ongoing in adolescence is prefrontal cortex development, including its dopamine innervation. Dopamine axons grow from the striatum to the prefrontal cortex, the only known case of long-distance axon growth during adolescence. This is coordinated by the Netrin-1 guidance cue receptor DCC (deleted in colorectal cancer), which in turn controls the intrinsic development of the prefrontal cortex itself. Stimulant drugs in adolescence alter DCC in dopamine neurons and, in turn prefrontal cortex maturation, impacting cognitive abilities. Variations in DCC expression are linked to psychiatric conditions of prefrontal cortex dysfunction, and microRNA regulation of DCC may be key to determining adolescent vulnerability or resilience. Since early interventions are proving to effectively ameliorate disease outcome, the Netrin-1 system is a promising therapeutic target.
Collapse
|
28
|
Pelição FS, Peres MD, Pissinate JF, de Paula DML, de Faria MDGC, Nakamura-Palacios EM, De Martinis BS. Predominance of alcohol and illicit drugs among traffic accidents fatalities in an urban area of Brazil. TRAFFIC INJURY PREVENTION 2016; 17:663-667. [PMID: 26891425 DOI: 10.1080/15389588.2016.1146824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence of alcohol and illicit drug use among victims of fatal traffic accidents in the Metropolitan Region of Vitória, Brazil, during the period 2011-2012. METHODS Blood samples were collected and analyzed for the presence of drugs from 391 deceased victims of traffic crashes that occurred in the Metropolitan Region of Vitória, Brazil. The victims included drivers, passengers, and pedestrians. Sociodemographic variables such as age, gender, day of the week, and period of the year in which the accidents occurred were recorded. The analyses were performed by a gas chromatography-flame ionization method for alcohol and by a gas chromatography-mass spectrometry for amphetamines, cocaine, and cannabis. RESULTS The results showed that 44.8% (n = 175) of all cases were positive for alcohol and/or illicit drugs. The detection of alcohol and/or drugs was more frequent in young males, aged 17 to 34, whose samples were positive in 46.8% of cases. Small differences among drivers, passengers, and pedestrians were observed (drivers = 45.9%, passengers = 46.4%, and pedestrians = 45.6%). In general, the most prevalent drug was alcohol, with 141 positive cases (36.1%), followed by cocaine, with 47 positive cases (12%). Amphetamines and cannabis had positivity rates of 4.1 and 4.3%, with 16 and 17 positive cases, respectively. The combined use of alcohol and other drugs was found in 36 cases (9.2%). Crack cocaine use was observed in 27.7% of the positive cases for cocaine. CONCLUSIONS For the effective reduction of traffic accidents related to driving under influence of drugs (DUID), we suggest the intensification of enforcement actions against the use of alcohol by drivers, the definition of which illicit drugs should be surveyed, as well the cutoff values, the promotion of changing legislation to oblige drivers to provide samples for toxicological testing, and the establishment of public information programs and specific actions aimed at young drivers to promote behavioral changes.
Collapse
Affiliation(s)
- Fabrício Souza Pelição
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
- b Departamento de Análises Clínicas , Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
| | - Mariana Dadalto Peres
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
- b Departamento de Análises Clínicas , Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
| | - Jauber Fornaciari Pissinate
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
| | | | | | - Ester Miyuki Nakamura-Palacios
- c Departamento de Ciências Fisiológicas , Centro de Ciências da Saúde, Universidade Federal do Espírito Santo , Vitória , Brazil
| | - Bruno Spinosa De Martinis
- d Departamento de Química , Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
| |
Collapse
|
29
|
Bakke E, Bogstrand ST, Normann PT, Ekeberg Ø, Bachs L. Influence of alcohol and other substances of abuse at the time of injury among patients in a Norwegian emergency department. BMC Emerg Med 2016; 16:20. [PMID: 27277762 PMCID: PMC4898304 DOI: 10.1186/s12873-016-0085-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The presence of alcohol or other substances of abuse in blood or urine from injured patients is often used as a proxy for substance influence at the time of injury. The aim of this study was to obtain an estimate of substance influence at the time of injury based on blood concentrations of alcohol and other substances of abuse, and to explore the relationship between the substance prevalence at the time of admittance to the hospital and the actual influence at the time of the injury. METHODS The study included all adult patients admitted to the emergency department of a university hospital during 1 year (n = 996). Quantification in blood was done by an enzymatic method for alcohol, and by liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry for 28 other substances of abuse. Concentrations of alcohol and other substances in blood at the time of injury were calculated. The degree of influence was assessed on the basis of the calculated blood concentrations, with a threshold of influence set at a blood alcohol concentration (BAC) of 0.05 %, or a substance concentration leading to an influence similar to that of a BAC of 0.05 %. RESULTS A total of 324 patients (32.5 %) were determined to be under the influence at the time of injury. In comparison, 394 patients (39.6 %) had one or more substances above the cut-off limit in blood at the time of admittance to the hospital. Alcohol was the most prevalent substance causing influence at 25.9 %. Among patients with violence-related injuries, almost 75 % were under the influence of alcohol and/or substances. Patients under the influence were younger, and men were more often under the influence than women. More patients were under the influence at nighttime and during weekends than at daytime and on weekdays. CONCLUSIONS About one third of the injured patients were determined to be under the influence at the time of injury, with alcohol being the most prevalent substance causing influence. Approximately 98 % of the patients with alcohol detected in blood at the time of admittance to the hospital were under the influence of alcohol at the time of injury.
Collapse
Affiliation(s)
- Eirin Bakke
- Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
| | - Stig Tore Bogstrand
- Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
| | - Per Trygve Normann
- Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
| | - Øivind Ekeberg
- Department of Acute Medicine, Oslo University Hospital, 0407, Oslo, Norway
| | - Liliana Bachs
- Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
| |
Collapse
|
30
|
Vearrier D, Vearrier L, McKeever R, Okaneku J, LaSala G, Goldberger D, McCloskey K. Issues in driving impairment. Dis Mon 2016; 62:72-116. [DOI: 10.1016/j.disamonth.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
31
|
Jones AW, Holmgren A, Ahlner J. High prevalence of previous arrests for illicit drug use and/or impaired driving among drivers killed in motor vehicle crashes in Sweden with amphetamine in blood at autopsy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:790-3. [DOI: 10.1016/j.drugpo.2015.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 01/23/2015] [Accepted: 04/16/2015] [Indexed: 11/29/2022]
|
32
|
Amphetamine in adolescence disrupts the development of medial prefrontal cortex dopamine connectivity in a DCC-dependent manner. Neuropsychopharmacology 2015; 40:1101-12. [PMID: 25336209 PMCID: PMC4367452 DOI: 10.1038/npp.2014.287] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/04/2014] [Accepted: 10/15/2014] [Indexed: 01/25/2023]
Abstract
Initiation of drug use during adolescence is a strong predictor of both the incidence and severity of addiction throughout the lifetime. Intriguingly, adolescence is a period of dynamic refinement in the organization of neuronal connectivity, in particular medial prefrontal cortex (mPFC) dopamine circuitry. The guidance cue receptor, DCC (deleted in colorectal cancer), is highly expressed by dopamine neurons and orchestrates their innervation to the mPFC during adolescence. Furthermore, we have shown that amphetamine in adolescence regulates DCC expression in dopamine neurons. Drugs in adolescence may therefore induce their enduring behavioral effects via DCC-mediated disruption in mPFC dopamine development. In this study, we investigated the impact of repeated exposure to amphetamine during adolescence on both the development of mPFC dopamine connectivity and on salience attribution to drug context in adulthood. We compare these effects to those induced by adult exposure to an identical amphetamine regimen. Finally, we determine whether DCC signaling within dopamine neurons is necessary for these events. Exposure to amphetamine in adolescence, but not in adulthood, leads to an increase in the span of dopamine innervation to the mPFC, but a reduction of presynaptic sites present on these axons. Amphetamine treatment in adolescence, but not in adulthood, also produces an increase in salience attribution to a previously drug-paired context in adulthood. Remarkably, DCC signaling within dopamine neurons is required for both of these effects. Drugs of abuse in adolescence may therefore induce their detrimental behavioral consequences by disrupting mesocortical dopamine development through alterations in the DCC signaling cascade.
Collapse
|
33
|
Wilson FA, Stimpson JP, Pagán JA. Fatal crashes from drivers testing positive for drugs in the U.S., 1993-2010. Public Health Rep 2014; 129:342-50. [PMID: 24982537 DOI: 10.1177/003335491412900409] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Illegal drug use is a persistent problem, prescription drug abuse is on the rise, and there is clinical evidence that drug use reduces driving performance. This study describes trends in characteristics of drivers involved in fatal motor vehicle crashes who test positive for drugs. METHODS We used the Fatality Analysis Reporting System-a census of motor vehicle crashes resulting in at least one fatality on U.S. public roads-to investigate suspected drug use for the period 1993-2010. RESULTS Drugged drivers who were tested for drug use accounted for 11.4% of all drivers involved in fatal motor vehicle crashes in 2010. Drugged drivers are increasingly likely to be older drivers, and the percentage using multiple drugs increased from 32.6% in 1993 to 45.8% in 2010. About half (52.4%) of all drugged drivers used alcohol, but nearly three-quarters of drivers testing positive for cocaine also used alcohol. Prescription drugs accounted for the highest fraction of drugs used by drugged drivers in fatal crashes in 2010 (46.5%), with much of the increase in prevalence occurring since the mid-2000s. CONCLUSIONS The profile of a drugged driver has changed substantially over time. An increasing share of these drivers is now testing positive for prescription drugs, cannabis, and multiple drugs. These findings have implications for developing interventions to address the changing nature of drug use among drivers in the U.S.
Collapse
Affiliation(s)
- Fernando A Wilson
- University of Nebraska Medical Center, Department of Health Services Research and Administration, Omaha, NE
| | - Jim P Stimpson
- University of Nebraska Medical Center, Department of Health Services Research and Administration, Omaha, NE
| | - José A Pagán
- New York Academy of Medicine, Center for Health Innovation, New York, NY
| |
Collapse
|
34
|
Poulsen H, Moar R, Pirie R. The culpability of drivers killed in New Zealand road crashes and their use of alcohol and other drugs. ACCIDENT; ANALYSIS AND PREVENTION 2014; 67:119-128. [PMID: 24636874 DOI: 10.1016/j.aap.2014.02.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/23/2014] [Accepted: 02/24/2014] [Indexed: 06/03/2023]
Abstract
Over a period of five years, blood samples were taken from 1046 drivers killed as a result of a motor vehicle crash on New Zealand roads. These were analysed for the presence of alcohol and a range of both illicit drugs and psychoactive medicinal drugs. Driver culpability was determined for all crashes. The control group of drug- and alcohol-free drivers comprised 52.2% of the study population. Drivers positive for psychoactive drugs were more likely to be culpable (odds ratio (OR) 3.5, confidence interval (CI) 95% 2.4-5.2) than the control group. Driver culpability exhibited the expected positive association with alcohol use (OR 13.7, 95% CI 4.3-44) and with combined alcohol and cannabis use (OR 6.9, 95% CI 3.0-16). There was only a weak positive association between cannabis use (with no other drug) and culpability (OR 1.3, CI 95% 0.8-2.3). Furthermore, the OR for drivers with blood tetrahydrocannabinol (THC) concentrations greater than 5 ng/mL was lower (OR 1.0, CI 95% 0.4-2.4) than drivers with blood THC concentrations less than 2 ng/mL (OR 3.1, CI 95% 0.9-10). This is inconsistent with results reported by other studies where a significant increase in crash risk was found with blood THC levels greater than 5 ng/mL. In this study, there were very few drivers who had used a single drug, other than cannabis or alcohol. Therefore, from this study, it is not possible to comment on any relationship between opioid, stimulant or sedative drug use and an increased risk of being killed in a crash for the drivers using these drugs. The results from a multivariate analysis indicate that driver gender, age group and licence status, (P=0.022, P=0.016, P=0.026, respectively), the type of vehicle being driven (P=0.013), the number of vehicles in the crash (P<0.001), the blood alcohol concentration of the driver (P<0.001) and the use of any drug other than alcohol and cannabis (P=0.044), are all independently associated with culpability.
Collapse
Affiliation(s)
- Helen Poulsen
- Environmental Science and Research, Porirua, New Zealand.
| | - Rosemary Moar
- Environmental Science and Research, Porirua, New Zealand
| | - Ruth Pirie
- Environmental Science and Research, Porirua, New Zealand
| |
Collapse
|
35
|
Ericsson E, Bradvik L, Hakansson A. Mortality, causes of death and risk factors for death among primary amphetamine users in the Swedish criminal justice system. Subst Use Misuse 2014; 49:262-9. [PMID: 23965040 DOI: 10.3109/10826084.2013.825921] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined mortality and predictors of death in 1,396 primary amphetamine users (85% males) who were interviewed with the Addiction Severity Index in the Swedish criminal justice system during 2000-2006 and followed through 2008. Forty-nine clients deceased (standardized mortality ratio 4.1 [3.0-5.4]), at least 84% of deaths were violent or drug-related (12% suicides), and Cox regression analysis indicated that death was associated with frequent use of sedatives and less frequent use of amphetamine. No female deaths were observed; death and male gender were associated in binary analysis. Implications for diagnostics and treatment are discussed.
Collapse
Affiliation(s)
- Emmy Ericsson
- 1Department of Medicine, Danderyd Hospital , Stockholm , Sweden
| | | | | |
Collapse
|
36
|
Tuv SS, Krabseth H, Karinen R, Olsen KM, Øiestad EL, Vindenes V. Prevalence of synthetic cannabinoids in blood samples from Norwegian drivers suspected of impaired driving during a seven weeks period. ACCIDENT; ANALYSIS AND PREVENTION 2014; 62:26-31. [PMID: 24129318 DOI: 10.1016/j.aap.2013.09.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 09/05/2013] [Accepted: 09/15/2013] [Indexed: 06/02/2023]
Abstract
From early year 2000 different herbal products containing synthetic cannabinoids (SC) have appeared on the drug market all over the world, and new substances are frequently introduced. The prevalence of SC use in different populations is however still mainly unknown, also in Norway. This information is difficult to obtain, but studies of drivers suspected of driving under the influence of drugs (DUID), might provide important information. The aim of this study was to assess the prevalence of SC in drivers suspected of being under the influence of drugs in Norway, and investigate if SCs impair driving performance. For two periods of three and four weeks all blood samples from drivers suspected of DUID in Norway were analyzed for the presence of 12 and 18 different SCs, respectively. A new ultra performance liquid chromatography tandem mass spectrometry method was developed. A total of 726 cases were analyzed during our study period, and SCs were detected in 16 cases (2.2%) in total. The mean age of these drivers was 29.6 years. High concentrations of other psychoactive drugs were detected in all the blood samples where a SC was found. AM-2201 and JWH-018 were the most frequently detected SCs, each found in five cases. In addition RSC-4, JWH-122, JWH-081 and JWH-250 were detected. None of the drivers had reported using SCs prior to driving. Despite the limited number of SCs investigated in this 7 week study period, a considerable percent of the cases were positive. Other psychoactive drugs of abuse were always found concomitant with the SCs, and the age of these drivers indicates that experienced drug users also ingest SCs. Since other drugs were found in all the samples, the psychomotor impairment caused by the SCs is difficult to estimate. Our study shows the importance of screening analyses of biological samples from different populations to assess the prevalence of drug use, since self-reporting might be encumbered with significant under-reporting.
Collapse
Affiliation(s)
- Silja Skogstad Tuv
- Norwegian Institute of Public Health, Division of Forensic Medicine and Drug Abuse Research, P.O. 4404, Nydalen, N-0403 Oslo, Norway.
| | | | | | | | | | | |
Collapse
|
37
|
Girotto E, Mesas AE, de Andrade SM, Birolim MM. Psychoactive substance use by truck drivers: a systematic review. Occup Environ Med 2013; 71:71-6. [PMID: 24145953 PMCID: PMC3888602 DOI: 10.1136/oemed-2013-101452] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The aim of this study was to summarise the scientific evidence on the prevalence of psychoactive substance use and on the factors associated with their intake among truck drivers. A systematic review was performed in the databases PubMed, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences, and Cochrane and 36 cross-sectional studies were identified with quantitative results about the use of psychoactive substances by truck drivers. Out of these, 28 were carried out in countries with large land areas and 23 obtained their information through self-reporting. The most frequently studied substances were alcohol (n=25), amphetamines (n=17), marijuana (n=16) and cocaine (n=13). The prevalence of the use of these substances greatly varied: alcohol (0.1-91.0%); amphetamines (0.2-82.5%), marijuana (0.2-29.9%), cocaine (0.1-8.3%). The frequency of substance use was lower in studies that investigated the presence of these substances in biological samples than in those based on self-reported use. In 12 studies that evaluated factors associated with the intake of psychoactive substances, the following stood out: younger age, higher income, longer trips, alcohol consumption, driving in the night shift, travelling interstate routes, long or short sleep, fewer hours of rest, little experience of the driver, connection with small and medium sized companies, income below levels determined by labour agreements, productivity-based earnings and prior involvement in accidents. The frequency of psychoactive substance use by truck drivers seems to be high, although that greatly varies according to the type of substance and the method of collecting the information. The use of these substances was mainly associated with indicators of poor working conditions.
Collapse
Affiliation(s)
- Edmarlon Girotto
- Department of Pharmaceutical Sciences, Universidade Estadual de Londrina (UEL), Londrina, Paraná, Brazil
| | | | | | | |
Collapse
|
38
|
van der Beek AJ. Psychoactive substance use in truck drivers: occupational health and public health. Occup Environ Med 2013; 71:1. [PMID: 24145952 DOI: 10.1136/oemed-2013-101791] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A J van der Beek
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
39
|
Hels T, Lyckegaard A, Simonsen KW, Steentoft A, Bernhoft IM. Risk of severe driver injury by driving with psychoactive substances. ACCIDENT; ANALYSIS AND PREVENTION 2013; 59:346-356. [PMID: 23867258 DOI: 10.1016/j.aap.2013.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 05/29/2013] [Accepted: 06/01/2013] [Indexed: 06/02/2023]
Abstract
Driving with alcohol and other psychoactive substances imposes an increased risk of severe injury accidents. In a population-based case-control design, the relative risks of severe driver injury (MAIS≥2) by driving with ten substance groups were approximated by odds ratios (alcohol, amphetamines, benzoylecgonine, cocaine, cannabis, illicit opiates, benzodiazepines and Z-drugs, i.e. zolpidem and zopiclone, medicinal opioids, alcohol-drug combinations and drug-drug combinations). Data from six countries were included in the study: Belgium, Denmark, Finland, Italy, Lithuania and the Netherlands. Case samples (N=2490) were collected from severely injured drivers of passenger cars or vans in selected hospitals in various regions of the countries. Control samples (N=15,832) were sampled in a uniform sampling scheme stratified according to country, time, road type and season. Relative risks were approximated by odds ratios and calculated by logistic regression. The estimates were adjusted for age, gender and country. The highest risk of the driver being severely injured was associated with driving positive for high concentrations of alcohol (≥0.8 g/L), alone or in combination with other psychoactive substances. For alcohol, risk increased exponentially with blood alcohol concentration (BAC). The second most risky category contained various drug-drug combinations, amphetamines and medicinal opioids. Medium increased risk was associated with medium sized BACs (at or above 0.5 g/L, below 0.8 g/L) and benzoylecgonine. The least risky drug seemed to be cannabis and benzodiazepines and Z-drugs. For male drivers, the risk of being severely injured by driving with any of the psychoactive substances was about 65% of that of female drivers. For each of the substance groups there was a decrease in the risk of severe driver injury with increasing age. It is concluded that among psychoactive substances alcohol still poses the largest problem in terms of driver risk of getting injured.
Collapse
Affiliation(s)
- Tove Hels
- Technical University of Denmark, Department of Transport, Bygningstorvet 116B, DK-2800 Lyngby, Denmark.
| | | | | | | | | |
Collapse
|
40
|
Acar F, Asirdizer M, Aker RG, Kucukibrahimoglu EE, Ates I, Erol Y, Sahin A. A review of suspected cases of driving under the influence of drugs (DUID) involved in traffic accidents in Istanbul (Turkey). J Forensic Leg Med 2013; 20:626-31. [DOI: 10.1016/j.jflm.2013.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/09/2013] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
|
41
|
Influence of drugs of abuse and alcohol upon patients admitted to acute psychiatric wards: physician's assessment compared to blood drug concentrations. J Clin Psychopharmacol 2013; 33:415-9. [PMID: 23609387 DOI: 10.1097/jcp.0b013e31828ec934] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In acute psychiatric services, rapid and accurate detection of psychoactive substance intake may be required for appropriate diagnosis and intervention. The aim of this study was to investigate the relationship between (a) drug influence as assessed by physicians and (b) blood drug concentrations among patients admitted to acute psychiatric wards. We also explored the possible effects of age, sex, and psychotic symptoms on physician's assessment of drug influence. In a cross-sectional study, the sample comprised 271 consecutive admissions from 2 acute psychiatric wards. At admission, the physician on call performed an overall judgment of drug influence. Psychotic symptoms were assessed with the positive subscale of the Positive and Negative Syndrome Scale. Blood samples were screened for a wide range of psychoactive substances, and quantitative results were used to calculate blood drug concentration scores. Patients were judged as being under the influence of drugs and/or alcohol in 28% of the 271 admissions. Psychoactive substances were detected in 56% of the blood samples. Altogether, 15 different substances were found; up to 8 substances were found in samples from 1 patient. Markedly elevated blood drug concentration scores were estimated for 15% of the patients. Physician's assessment was positively related to the blood drug concentration scores (r = 0.52; P < 0.001), to symptoms of excitement, and to the detection of alcohol, cannabis, and amphetamines. The study demonstrates the major impact of alcohol and drugs in acute psychiatric settings and illustrates the challenging nature of the initial clinical assessment.
Collapse
|
42
|
Laćan G, Hadamitzky M, Kuczenski R, Melega WP. Alterations in the striatal dopamine system during intravenous methamphetamine exposure: effects of contingent and noncontingent administration. Synapse 2013; 67:476-88. [PMID: 23417852 DOI: 10.1002/syn.21654] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 02/12/2013] [Indexed: 11/09/2022]
Abstract
The continuing spread of methamphetamine (METH) abuse has stimulated research aimed at understanding consequences of its prolonged exposure. Alterations in nigrostriatal dopamine (DA) system parameters have been characterized in experimental studies after discontinuation of long-term METH but fewer studies have included similar assessments during METH exposure. Here, we report METH plasma pharmacokinetics and striatal DA system alterations in rat after noncontingent and contingent METH administration for 7.5 weeks. Escalating METH exposure was delivered by dynamic infusion (DI) that incorporated a "humanized" plasma METH half life or by intravenous self-administration (IVSA) that included binge intakes. Kinetic modeling of DI and IVSA for 24 h periods during the final week of METH exposure showed that plasma METH levels remained between 0.7 and 1.5 µM. Animals were sacrificed during their last METH administration for autoradiography assessment using [³H]ligands and D2 agonist-induced [³⁵S]GTPγS binding. DA transporter binding was decreased (DI, 34%; IVSA, 15%) while vesicular monoamine transporter binding and substantia nigra DA cell numbers were unchanged. Decreases were measured for D2 receptor (DI and IVSA, 15-20%) and [³⁵S]GTPγS binding (DI, 35%; IVSA, 18%). These similar patterns of DI and IVSA associated decreases in striatal DA markers reflect consequences of cumulative METH exposure and not the drug delivery method. For METH IVSA, individual differences were observed, yet each animal's total intake was similar within and across three 24-h binges. IVSA rodent models may be useful for identifying molecular mechanisms that are associated with METH binges in humans.
Collapse
Affiliation(s)
- Goran Laćan
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | | | | |
Collapse
|
43
|
The influence of stimulants on truck driver crash responsibility in fatal crashes. Forensic Sci Int 2013; 228:15-20. [PMID: 23597733 DOI: 10.1016/j.forsciint.2013.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/30/2013] [Accepted: 02/01/2013] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Given the monotony and extended driving periods inherent in transport truck driving, drivers might rely on stimulants to sustain attention and combat fatigue. Research indicates that stimulant use improves some cognitive functions but impairs driving ability and is linked to crashes. The research on crash responsibility among stimulant-positive truck drivers is inconclusive due to small sample sizes and a lack of control over confounding variables. The present study investigated the influence of stimulants on unsafe driving actions (UDAs) in fatal crashes contained in the Fatality Analysis Reporting System (FARS) database. METHODS Logistic regression was used to calculate the odds ratio of an UDA (cases committed an UDA; controls did not) by stimulant status (present; absent) while accounting for the influence of confounding variables (age, previous driving record, and other drug use). RESULTS For all truck drivers, we found that 372 truck drivers tested stimulant-positive representing 0.57% of the entire truck driver sample and 3.7% of truck drivers who were actually tested for drug use. Stimulant-positive truck drivers had a greater proportion of driving record infractions and narcotic drug use compared to stimulant-negative truck drivers. The adjusted odds of committing an UDA were 78% greater for truck drivers who were stimulant-positive (OR: 1.78, 95% CI: 1.41-2.26) compared to truck drivers stimulant-negative. CONCLUSION The results suggest stimulants are associated with crash responsibility and warrant further study into their impact on truck drivers.
Collapse
|
44
|
Has the intake of THC by cannabis users changed over the last decade? Evidence of increased exposure by analysis of blood THC concentrations in impaired drivers. Forensic Sci Int 2013; 226:197-201. [DOI: 10.1016/j.forsciint.2013.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 01/12/2013] [Accepted: 01/16/2013] [Indexed: 11/19/2022]
|
45
|
Wong GTC, Irwin MG. Poisoning with illicit substances: toxicology for the anaesthetist. Anaesthesia 2013; 68 Suppl 1:117-24. [PMID: 23210561 DOI: 10.1111/anae.12053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The consumption of illicit substances represents a considerable threat to the health and wellbeing of particular sectors of our communities. Hospitalisation is sometimes required for the treatment of the direct toxic effects of the drugs as well as for injuries sustained while under their influence. Although poisoning with 'traditional' substances of abuse such as opioids, cocaine and cannabis still predominate in terms of numbers, the availability and use of new psychoactive substances are on the rise. These latter agents, some of which began life as failed pharmaceutical products, have enjoyed renewed status as recreational stimulants, entactogens or hallucinogens, properties that originally precluded them from legitimate use. These drugs may act by enhancing endogenous release of neurotransmitters, inhibiting their reuptake back into neurons or having direct effects on receptors, and may involve adrenergic, dopaminergic or serotonergic systems. The use of intravenous lipid emulsion for the symptomatic treatment of drug overdose has become a fertile ground for research and may hold promise as a non-specific treatment for poisoning with illicit substances. Dexmedetomidine, an α(2)-receptor agonist with a central sympatholytic effect, may be able to counteract the cardiovascular and central nervous system overstimulation that may accompany stimulant toxicity.
Collapse
Affiliation(s)
- G T C Wong
- Department of Anaesthesiology, University of Hong Kong, Hong Kong.
| | | |
Collapse
|
46
|
Poulsen H, Moar R, Troncoso C. The incidence of alcohol and other drugs in drivers killed in New Zealand road crashes 2004-2009. Forensic Sci Int 2012; 223:364-70. [PMID: 23131305 DOI: 10.1016/j.forsciint.2012.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/15/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
Alcohol is a drug known to impair the ability to drive safely and is acknowledged as a major factor in New Zealand road crashes. However, the use of other impairing drugs by New Zealand drivers is largely unknown. This paper reports the prevalence of drug use by drivers killed on New Zealand roads. As this is a biased population sample the results can only indicate possible drug use in the wider driving population. Blood samples taken from 1046 deceased drivers were analysed for the presence of alcohol and a range of both illicit drugs and psychoactive medicinal drugs. Five hundred and forty-six (52%) of these drivers had not used alcohol or other potentially impairing drugs. Five hundred (48%) had alcohol and/or other drugs in their blood that may have impaired their ability to drive safely. Of these 500 drivers, 135 had used alcohol alone, 96 had used cannabis alone and 142 had used a combination of alcohol and cannabis, but no other drug. Alcohol concentrations in 351 drivers who had drunk alcohol ranged from 5 to 354 mg per 100 mL (mean 152 mg/100 mL). Levels of tetrahydrocannabinol (THC) in the blood of the 314 drivers who had used cannabis ranged from approximately 0.1 ng/mL to 44 ng/mL (mean 5.6 ng/mL). There were 127 drivers who had used some other combination of drugs, many still including alcohol and/or cannabis. Only 29 of the 500 drivers who had used a drug, had not used either cannabis or alcohol and 240 (48%) of the 500 drivers had used more than one potentially impairing drug.
Collapse
Affiliation(s)
- Helen Poulsen
- Environmental Science and Research Ltd. (ESR), Porirua, New Zealand.
| | | | | |
Collapse
|
47
|
Jones AW, Holmgren A. Concentration ratios of methamphetamine to amphetamine in blood can help to distinguish use of methamphetamine from various mixtures of the two stimulants. J Anal Toxicol 2012; 36:634-7. [PMID: 23034928 DOI: 10.1093/jat/bks075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Using a forensic toxicology database, the authors investigated cases of driving under the influence of drugs (DUID) if methamphetamine (MA) was identified in the blood samples (N = 9,310). The concentrations of MA and amphetamine (AM) in blood were determined after liquid-liquid extraction by gas chromatography-mass spectrometry at limits of quantitation of 0.03 mg/L for both stimulants. In 814 cases, AM was negative in blood and MA was positive at mean (median) and highest concentrations of 0.19 mg/L (0.11 mg/L) and 3.4 mg/L, respectively. Both amines were present in blood in 8,496 cases at concentrations of 0.54 mg/L (0.35 mg/L) and 10.4 mg/L for AM and 0.41 mg/L (0.22 mg/L) and 5.6 mg/L for MA. However, the correlation between AM and MA was low and insignificant (r = -0.13) in the whole material. The coefficient of correlation increased to r = 0.41 (P < 0.001) when the MA/AM concentration ratio was >1. When MA/AM ratios were selected at intervals of 1.0 (e.g., >3.0 and <4.0 up to >9.0 and <10.0), the correlation between AM and MA was r = 0.99 (P < 0.001). Such cases represent the use of MA without contamination from AM, and the mean (median) and highest concentrations of this secondary amine in blood of DUID suspects were 0.72 mg/L (0.56 mg/L) and 4.2 mg/L, respectively.
Collapse
Affiliation(s)
- A W Jones
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
| | | |
Collapse
|
48
|
Fenproporex and Amphetamine Pharmacokinetics in Oral Fluid After Controlled Oral Administration of Fenproporex. Ther Drug Monit 2012; 34:545-53. [DOI: 10.1097/ftd.0b013e318263c6c5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
49
|
Legrand SA, Isalberti C, der Linden TV, Bernhoft IM, Hels T, Simonsen KW, Favretto D, Ferrara SD, Caplinskiene M, Minkuviene Z, Pauliukevicius A, Houwing S, Mathijssen R, Lillsunde P, Langel K, Blencowe T, Verstraete AG. Alcohol and drugs in seriously injured drivers in six European countries. Drug Test Anal 2012; 5:156-65. [DOI: 10.1002/dta.1393] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 06/29/2012] [Accepted: 07/08/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Sara-Ann Legrand
- Department of Clinical Chemistry, Microbiology and Immunology; Ghent University; De Pintelaan 185; 9000 Ghent; Belgium
| | - Cristina Isalberti
- Department of Clinical Chemistry, Microbiology and Immunology; Ghent University; De Pintelaan 185; 9000 Ghent; Belgium
| | - Trudy Van der Linden
- National Institute of Criminalistics and Criminology; Vilvoordsesteenweg 100; 1120 Brussels; Belgium
| | - Inger Marie Bernhoft
- Department of Transport; Technical University of Denmark; Bygningstorvet 116B; DK - 2800 Kgs. Lyngby; Denmark
| | - Tove Hels
- Department of Transport; Technical University of Denmark; Bygningstorvet 116B; DK - 2800 Kgs. Lyngby; Denmark
| | - Kirsten Wiese Simonsen
- Section of Forensic Chemistry, Department of Forensic Medicine; Copenhagen University; Frederik V's Vej 11; DK-2100 Copenhagen; Denmark
| | - Donata Favretto
- Department of Molecular Medicine, Forensic Toxicology and Antidoping; University of Padova; Italy
| | - Santo Davide Ferrara
- Department of Molecular Medicine, Forensic Toxicology and Antidoping; University of Padova; Italy
| | - Marija Caplinskiene
- VTMT State Forensic Medicine Service under the Ministry of Justice of the Republic of Lithuania; Didlaukio g. 86E; LT - 08303 Vilnius; Lithuania
| | - Zita Minkuviene
- VTMT State Forensic Medicine Service under the Ministry of Justice of the Republic of Lithuania; Didlaukio g. 86E; LT - 08303 Vilnius; Lithuania
| | - Alvydas Pauliukevicius
- VTMT State Forensic Medicine Service under the Ministry of Justice of the Republic of Lithuania; Didlaukio g. 86E; LT - 08303 Vilnius; Lithuania
| | - Sjoerd Houwing
- SWOV Institute for Road Safety Research; P.O. Box 1090, 2260 BB; Leidschendam; The Netherlands
| | - René Mathijssen
- SWOV Institute for Road Safety Research; P.O. Box 1090, 2260 BB; Leidschendam; The Netherlands
| | - Pirjo Lillsunde
- Alcohol and Drug Analytics Unit; National Institute for Health and Welfare; PO Box 30, FI-00271; Finland
| | - Kaarina Langel
- Alcohol and Drug Analytics Unit; National Institute for Health and Welfare; PO Box 30, FI-00271; Finland
| | - Tom Blencowe
- Alcohol and Drug Analytics Unit; National Institute for Health and Welfare; PO Box 30, FI-00271; Finland
| | - Alain G. Verstraete
- Department of Clinical Chemistry, Microbiology and Immunology; Ghent University; De Pintelaan 185; 9000 Ghent; Belgium
| |
Collapse
|
50
|
Impairment based legislative limits for driving under the influence of non-alcohol drugs in Norway. Forensic Sci Int 2012; 219:1-11. [DOI: 10.1016/j.forsciint.2011.11.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/28/2011] [Accepted: 11/01/2011] [Indexed: 11/18/2022]
|