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Anzar N, Suleman S, Parvez S, Narang J. A review on Illicit drugs and biosensing advances for its rapid detection. Process Biochem 2022. [DOI: 10.1016/j.procbio.2021.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Favretto D, Visentin S, Jones AW. Prevalence and concentrations of sedative-hypnotic drugs in blood of drivers involved in road traffic crashes in the Padova region of Italy - not so easy to interpret. Forensic Sci Int 2021; 330:111097. [PMID: 34814082 DOI: 10.1016/j.forsciint.2021.111097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND & OBJECTIVES This study reports the prevalence and concentrations of sedative-hypnotic drugs as exemplified by benzodiazepines (BZD) and zolpidem (Z-hypnotic) in blood samples from drivers involved in road traffic accidents (RTA) in the Padova region of Italy. Another aim of the study was to estimate the prevalence of these drugs with concentrations in blood above the therapeutic intervals and above specific per se limits. METHODS A total of 4066 blood samples collected from drivers involved in RTA were analysed for the presence of alcohol, drugs of abuse and medicinal drugs with sedative-hypnotic properties. Prevalence of drivers positive for BZDs and zolpidem were reported according to the reporting limit of our laboratory (1 ng/mL) in a sort of zero tolerance approach and compared with the prevalence according to analytical cut-offs used in the "European Union's research project on Driving Under the Influence of Drugs, Alcohol and Medicines" (DRUID). The impairment-based, per se limits adopted in Norway and in England and Wales and the values used to define "therapeutic ranges" in blood and in plasma/serum were also applied to the case study. RESULTS 175 blood samples were positive for sedative-hypnotics above 1 ng/mL, with the following prevalence: diazepam 44%, nordazepam 41.8%, lorazepam 32.6%, zolpidem 28%, oxazepam 25.6%, alprazolam 16%, delorazepam 11,6%, lormetazepam 11,6%, temazepam 11.6%, clonazepam 11.6%, triazolam 6.9%, N-desalkylflurazepam 4.6%, bromazepam 2.3%. When applying DRUID analytical cut-offs, the prevalence of BZDs and zolpidem sharply decreases. Applying the impairing cut-offs used in Norway, 56% of positive samples were above the limits equivalent to a BAC of 0.2 g/L, 39% above the limits corresponding to 0.5 g/L, and 23% above the cut-off corresponding to 1.2 g/L. Only 1% of the drivers had drug concentrations above the per se concentration limits adopted in England and Wales [26]. When comparing blood levels with therapeutic ranges in plasma, bromazepam, lormetazepam and delorazepam were often found above the highest limits. The adjustment of the concentrations with the plasma-to-blood ratios causes a significant increase of cases above the therapeutic ranges in plasma. CONCLUSIONS Sedative-hypnotic drugs are medicinal substances frequently identified in drivers involved in RTA, commonly in concentrations associated with driving impairment. Besides the concentrations of drugs in blood, several factors have to be considered to conclude that a driver was impaired. The frequent association with alcohol, cocaine and other BZDs, confirms the abuse potential of these medications.
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Affiliation(s)
- Donata Favretto
- University Hospital of Padova, Legal Medicine and Toxicology, Via Falloppio 50, Padova, Italy.
| | | | - Alan W Jones
- Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden.
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Eikelenboom-Schieveld SJM, Fogleman JC. Psychoactive Medication, Violence, and Variant Alleles for Cytochrome P450 Genes. J Pers Med 2021; 11:jpm11050426. [PMID: 34069803 PMCID: PMC8157279 DOI: 10.3390/jpm11050426] [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: 04/20/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022] Open
Abstract
From the start of the use of psychoactive prescription medications in the 1950s, physicians reported paradoxical adverse reactions, ranging from newly developing depressions to an increase in existing mood disorders, and extremely violent and bizarre acts of suicide and homicide. It is hypothesized that interactions between the drugs and the enzymes that are primarily responsible for their metabolism (cytochrome P450s) could cause these reactions. In this research, we evaluate statistical associations between CYP450 variant alleles, psychoactive medication, and acts of violence. Fifty-five persons who showed violent behavior or an altered emotional state were investigated for prescribed medication. Fifty-eight volunteers with no history of violence served as the controls. Genetic testing was performed on CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6 and CYP3A4. Statistical analysis was applied to gender, age, number of variant alleles, number and kind of medications, and potential drug-drug, drug-gene, and drug-drug-gene interactions. Four risk factors for developing an altered emotional state and/or acts of violence were identified. There is an association between prescription drugs (most notably antidepressants and other psychoactive medication), having variant alleles for CYP450 genes, and altered emotional states or acts of violence.
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Affiliation(s)
| | - James C. Fogleman
- Department of Biological Sciences, University of Denver, Denver, CO 80208, USA;
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Murphy KD, Lambert S, McCarthy S, Sahm LJ, Byrne S. “You Don’t Feel”: The Experience of Youth Benzodiazepine Misuse in Ireland. J Psychoactive Drugs 2017; 50:121-128. [DOI: 10.1080/02791072.2017.1371365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kevin D. Murphy
- Post-Doctoral Researcher, School of Pharmacy, University College Cork, Cork, Ireland
| | - Sharon Lambert
- Lecturer, School of Applied Psychology, University College Cork, Cork, Ireland
| | - Suzanne McCarthy
- Lecturer in Clinical Pharmacy, School of Pharmacy, University College Cork, Cork, Ireland
| | - Laura J. Sahm
- Senior Lecturer in Clinical Pharmacy, School of Pharmacy, University College Cork, Cork, Ireland
- Consultant Pharmacist, Mercy University Hospital, Cork, Ireland
| | - Stephen Byrne
- Chair in Clinical Pharmacy, School of Pharmacy, University College Cork, Cork, Ireland
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Bixo M, Ekberg K, Poromaa IS, Hirschberg AL, Jonasson AF, Andréen L, Timby E, Wulff M, Ehrenborg A, Bäckström T. Treatment of premenstrual dysphoric disorder with the GABA A receptor modulating steroid antagonist Sepranolone (UC1010)-A randomized controlled trial. Psychoneuroendocrinology 2017; 80:46-55. [PMID: 28319848 DOI: 10.1016/j.psyneuen.2017.02.031] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/07/2017] [Accepted: 02/27/2017] [Indexed: 01/04/2023]
Abstract
CONTEXT Allopregnanolone is a metabolite from progesterone and a positive modulator of the GABAA receptor. This endogenous steroid may induce negative mood in sensitive women when present in serum levels comparable to the premenstrual phase. Its endogenous isomer, isoallopregnanolone, has been shown to antagonize allopregnanolone effects in experimental animal and human models. OBJECTIVE The objective was to test whether inhibition of allopregnanolone by treatment with the GABAA modulating steroid antagonist (GAMSA) Sepranolone (UC1010) during the premenstrual phase could reduce symptoms of the premenstrual dysphoric disorder (PMDD). The pharmacokinetic parameters of UC1010 when given as a subcutaneous injection were measured in healthy women prior to the study in women with PMDD. DESIGN This was an explorative randomized, double-blind, placebo-controlled study. SETTING Swedish multicentre study with 10 centers. PARTICIPANTS Participants were 26 healthy women in a pharmacokinetic phase I study part, and 126 women with PMDD in a phase II study part. Diagnosis followed the criteria for PMDD in DSM-5 using Daily Record of Severity of Problems (DRSP) and Endicott's algorithm. INTERVENTION Subjects were randomized to treatment with UC1010 (10 or 16mg) subcutaneously every second day during the luteal phase or placebo during one menstrual cycle. OUTCOME MEASURES The primary outcome measure was the sum of all 21 items in DRSP (Total DRSP score). Secondary outcomes were Negative mood score i.e. the ratings of the 4 key symptoms in PMDD (anger/irritability, depression, anxiety and lability) and impairment (impact on daily life). RESULTS 26 healthy women completed the pharmacokinetic phase I study and the dosing in the following trial was adjusted according to the results. 106 of the 126 women completed the phase II study. Within this group, a significant treatment effect with UC1010 compared to placebo was obtained for the Total DRSP score (p=0.041) and borderline significance (p=0.051) for the sum of Negative mood score. Nineteen participants however showed symptoms during the follicular phase that might be signs of an underlying other conditions, and 27 participants had not received the medication as intended during the symptomatic phase. Hence, to secure that the significant result described above was not due to chance, a post hoc sub-group analysis was performed, including only women with pure PMDD who completed the trial as intended (n=60). In this group UC1010 reduced Total DRSP scores by 75% compared with 47% following placebo; the effect size 0.7 (p=0.006), and for sum of Negative mood score (p=0.003) and impairment (p=0.010) with the effect size 0.6. No severe adverse events were reported during the treatment and safety parameters (vital signs and blood chemistry) remained normal during the study. CONCLUSIONS This explorative study indicates promising results for UC1010 as a potential treatment for PMDD. The effect size was comparable to that of SSRIs and drospirenone containing oral contraceptives. UC1010 was well tolerated and deemed safe.
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Affiliation(s)
- Marie Bixo
- Department of Clinical Science, Umeå University, SE-901 85 Umeå, Sweden.
| | - Karin Ekberg
- Asarina Pharma AB, Fogdevreten 2, SE-171 65 Solna, Sweden
| | | | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet and Department of Obstetrics and Gynecology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Aino Fianu Jonasson
- Kvinnoforskningsenheten, Karolinska University Hospital, SE-141 46 Huddinge, Sweden
| | - Lotta Andréen
- Department of Obstetrics and Gynecology, Sundsvall Hospital, SE-851 86 Sundsvall, Sweden
| | - Erika Timby
- Department of Clinical Science, Umeå University, SE-901 85 Umeå, Sweden
| | - Marianne Wulff
- Slottsstadens Läkarhus Malmö, Fågelbacksgatan 11, SE-217 44 Malmö, Sweden
| | - Agneta Ehrenborg
- Specialistläkarna Kungsbacka (Qvinnolivet), Södra Torggatan 18, SE-434 30 Kungsbacka, Sweden
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Hori S, Kinoshita K. Clinical characteristics of patients who overdose on multiple psychotropic drugs in Tokyo. J Toxicol Sci 2017; 41:765-773. [PMID: 27853105 DOI: 10.2131/jts.41.765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the clinical aspects leading to overdose of multiple psychotropic drugs, in order to determine areas which need attention in the proper treatment of overdose patients. METHODS Patients who were treated for overdose of psychotropic drugs at our emergency and critical center over two years were targeted. The clinical data was gathered from the medical records and database of all patients, including age, gender, vital signs, and laboratory data, drugs, and medical complications during hospital stay. In addition primary patient care at the emergency department was examined. RESULTS Among the 277 patients treated during this study period, 255 (74.0%) used two or more types of psychotropic drugs. Risk factors associated with endotracheal intubation and aspiration pneumonitis included the use of antipsychotics and/or barbiturates as types of overdose drugs. The mean number of days in the ICU was 3.4 days. Seventy-four patients (26.7%) stayed 4 days or more in the ICU of which 16 patients (5.8%) still had suicidal thoughts. A significantly higher incidence of extended ICU stay or endotracheal intubation and aspiration pneumonitis was observed in the group who overdosed on more than 50 or 60 tablets of psychotropic drugs, respectively. CONCLUSIONS Patients who ingested an overdose of more than 60 tablets of psychotropic drugs should be considered a high-risk group requiring intensive care with extended ICU stay. In case of including antipsychotics and/or barbiturates, the patient should be observed carefully due to a higher risk of medical complications.
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Affiliation(s)
- Satoshi Hori
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine
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Niedrig DF, Hoppe L, Mächler S, Russmann H, Russmann S. Benzodiazepine Use During Hospitalization: Automated Identification of Potential Medication Errors and Systematic Assessment of Preventable Adverse Events. PLoS One 2016; 11:e0163224. [PMID: 27711224 PMCID: PMC5053537 DOI: 10.1371/journal.pone.0163224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 09/06/2016] [Indexed: 12/22/2022] Open
Abstract
Objective Benzodiazepines and “Z-drug” GABA-receptor modulators (BDZ) are among the most frequently used drugs in hospitals. Adverse drug events (ADE) associated with BDZ can be the result of preventable medication errors (ME) related to dosing, drug interactions and comorbidities. The present study evaluated inpatient use of BDZ and related ME and ADE. Methods We conducted an observational study within a pharmacoepidemiological database derived from the clinical information system of a tertiary care hospital. We developed algorithms that identified dosing errors and interacting comedication for all administered BDZ. Associated ADE and risk factors were validated in medical records. Results Among 53,081 patients contributing 495,813 patient-days BDZ were administered to 25,626 patients (48.3%) on 115,150 patient-days (23.2%). We identified 3,372 patient-days (2.9%) with comedication that inhibits BDZ metabolism, and 1,197 (1.0%) with lorazepam administration in severe renal impairment. After validation we classified 134, 56, 12, and 3 cases involving lorazepam, zolpidem, midazolam and triazolam, respectively, as clinically relevant ME. Among those there were 23 cases with associated adverse drug events, including severe CNS-depression, falls with subsequent injuries and severe dyspnea. Causality for BDZ was formally assessed as ‘possible’ or ‘probable’ in 20 of those cases. Four cases with ME and associated severe ADE required administration of the BDZ antagonist flumazenil. Conclusions BDZ use was remarkably high in the studied setting, frequently involved potential ME related to dosing, co-medication and comorbidities, and rarely cases with associated ADE. We propose the implementation of automated ME screening and validation for the prevention of BDZ-related ADE.
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Affiliation(s)
- David Franklin Niedrig
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich ZH, Switzerland
- Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, ZH Switzerland
| | - Liesa Hoppe
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich ZH, Switzerland
| | | | | | - Stefan Russmann
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich ZH, Switzerland
- Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, ZH Switzerland
- drugsafety.ch, Küsnacht ZH, Switzerland
- * E-mail:
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Katselou M, Papoutsis I, Nikolaou P, Spiliopoulou C, Athanaselis S. Metabolites replace the parent drug in the drug arena. The cases of fonazepam and nifoxipam. Forensic Toxicol 2016; 35:1-10. [PMID: 28127407 PMCID: PMC5214877 DOI: 10.1007/s11419-016-0338-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/27/2016] [Indexed: 11/27/2022]
Abstract
Fonazepam (desmethylflunitrazepam) and nifoxipam (3-hydroxy-desmethylflunitrazepam) are benzodiazepine derivatives and active metabolites of flunitrazepam. They recently invaded the drug arena as substances of abuse and alerted the forensic community after being seized in powder and tablet forms in Europe between 2014 and 2016. A review of all the existing knowledge of fonazepam and nifoxipam is reported, concerning their chemistry, synthesis, pharmacology and toxicology, prevalence/use, biotransformation and their analysis in biological samples. To our knowledge, fonazepam and nifoxipam-related intoxications, lethal or not, have not been reported in the scientific literature. All the available information was gathered through a detailed search of PubMed and the World Wide Web.
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Affiliation(s)
- Maria Katselou
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 115 27 Athens, Greece
| | - Ioannis Papoutsis
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 115 27 Athens, Greece
| | - Panagiota Nikolaou
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 115 27 Athens, Greece
| | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 115 27 Athens, Greece
| | - Sotiris Athanaselis
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 115 27 Athens, Greece
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Bruining H, Passtoors L, Goriounova N, Jansen F, Hakvoort B, de Jonge M, Poil SS. Paradoxical Benzodiazepine Response: A Rationale for Bumetanide in Neurodevelopmental Disorders? Pediatrics 2015. [PMID: 26216321 DOI: 10.1542/peds.2014-4133] [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] [Indexed: 11/24/2022] Open
Abstract
The diuretic agent bumetanide has recently been put forward as a novel, promising treatment of behavioral symptoms in autism spectrum disorder (ASD) and related conditions. Bumetanide can decrease neuronal chloride concentrations and may thereby reinstate γ-aminobutyric acid (GABA)-ergic inhibition in patients with neurodevelopmental disorders. However, strategies to select appropriate candidates for bumetanide treatment are lacking. We hypothesized that a paradoxical response to GABA-enforcing agents such as benzodiazepines may predict the efficacy of bumetanide treatment in neurodevelopmental disorders. We describe a case of a 10-year-old girl with ASD, epilepsy, cortical dysplasia, and a 15q11.2 duplication who had exhibited marked behavioral arousal after previous treatment with clobazam, a benzodiazepine. We hypothesized that this response indicated the presence of depolarizing excitatory GABA and started bumetanide treatment with monitoring of behavior, cognition, and EEG. The treatment resulted in a marked clinical improvement in sensory behaviors, rigidity, and memory performance, which was substantiated by questionnaires and cognitive assessments. At baseline, the girl's EEG showed a depression in absolute α power, an electrographic sign previously related to ASD, which was normalized with bumetanide treatment. The effects of bumetanide on cognition and EEG seemed to mirror the "nonparadoxical" responses to benzodiazepines in healthy subjects. In addition, temporal lobe epilepsy and cortical dysplasia have both been linked to disturbed chloride homeostasis and seem to support our assumption that the observed paradoxical response was due to GABA-mediated excitation. This case highlights that a paradoxical behavioral response to GABA-enforcing drugs may constitute a framework for targeted treatment with bumetanide.
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Affiliation(s)
- Hilgo Bruining
- Departments of Translational Neuroscience, Psychiatry, and
| | | | - Natalia Goriounova
- Mediterranean Institute of Neurobiology (INMED), INSERM, Marseille, France
| | - Floor Jansen
- Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center, Utrecht, Netherlands
| | - Britt Hakvoort
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands; and
| | | | - Simon-Shlomo Poil
- Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University Amsterdam, Netherlands
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Albrecht B, Staiger PK, Hall K, Miller P, Best D, Lubman DI. Benzodiazepine use and aggressive behaviour: a systematic review. Aust N Z J Psychiatry 2014; 48:1096-114. [PMID: 25183003 DOI: 10.1177/0004867414548902] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
CONTEXT The relationship between benzodiazepine consumption and subsequent increases in aggressive behaviour in humans is not well understood. OBJECTIVES The current study aimed to identify, via a systematic review, whether there is an association between benzodiazepine consumption and aggressive responding in adults. METHOD A systematic review was conducted and reported in line with the PRISMA statement. English articles within MEDLINE, PsycARTICLES, PsycINFO, Academic Search Complete, and Psychology and Behavioural Sciences Collection databases were searched. Additional studies were identified by searching reference lists of reviewed articles. Only articles that explicitly investigated the relationship between benzodiazepine consumption and subsequent aggressive behaviour, or a lack thereof, in human adults were included. RESULTS Forty-six studies met the inclusion criteria. It was not possible to conduct a meta-analysis due to the heterogeneity of study design and benzodiazepine type and dose. An association between benzodiazepine use and subsequent aggressive behaviour was found in the majority of the more rigorous studies, although there is a paucity of high-quality research with clinical or forensic populations. Diazepam and alprazolam have received the most attention. Dose-related findings are inconsistent: therapeutic doses may be more likely to be associated with aggressive responding when administered as a once-off, whereas higher doses may be more risky following repeated administration. Trait levels of anxiety and hostility may indicate a vulnerability to the experience of benzodiazepine-related aggression. CONCLUSIONS There appears to be a moderate association between some benzodiazepines and subsequent aggressive behaviour in humans. The circumstances under which aggressive responding may be more likely to follow benzodiazepine use remain unclear, although some evidence suggests dose and/or personality factors may influence this effect.
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Affiliation(s)
- Bonnie Albrecht
- School of Psychology, Deakin University, Melbourne, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Melbourne, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Melbourne, Australia Turning Point, Eastern Health, Fitzroy, Australia
| | - Peter Miller
- School of Psychology, Deakin University, Melbourne, Australia
| | - David Best
- Turning Point, Eastern Health, Fitzroy, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Fitzroy, Australia Eastern Health Clinical School, Monash University, Clayton, Australia
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Hedlund J, Ahlner J, Kristiansson M, Sturup J. A population-based study on toxicological findings in Swedish homicide victims and offenders from 2007 to 2009. Forensic Sci Int 2014; 244:25-9. [DOI: 10.1016/j.forsciint.2014.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 07/17/2014] [Indexed: 11/29/2022]
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Havnes IA, Clausen T, Brux C, Middelthon AL. The role of substance use and morality in violent crime - a qualitative study among imprisoned individuals in opioid maintenance treatment. Harm Reduct J 2014; 11:24. [PMID: 25142321 PMCID: PMC4142255 DOI: 10.1186/1477-7517-11-24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/14/2014] [Indexed: 01/23/2023] Open
Abstract
Background Opioid maintenance treatment (OMT) is regarded as a crime control measure. Yet, some individuals are charged with violent criminal offenses while enrolled in OMT. This article aims to generate nuanced knowledge about violent crime among a group of imprisoned, OMT-enrolled individuals by exploring their understandings of the role of substances in violent crime prior to and during OMT, moral values related to violent crime, and post-crime processing of their moral transgressions. Methods Twenty-eight semi-structured interviews were undertaken among 12 OMT-enrolled prisoners. The interviews were audio recorded and transcribed verbatim. An exploratory, thematic analysis was carried out with a reflexive and interactive approach. Findings Prior to OMT, substances and, in particular, high-dose benzodiazepines were deliberately used to induce ‘antisocial selves’ capable of transgressing individual moral codes and performing non-violent and violent criminal acts, mainly to support costly heroin use. During OMT, impulsive and uncontrolled substance use just prior to the violent acts that the participants were imprisoned for was reported. Yet, to conduct a (violent) criminal act does not necessarily imply that one is without moral principles. The study participants maintain moral standards, engage in complex moral negotiations, and struggle to reconcile their moral transgressions. Benzodiazepines were also used to reduce memories of and alleviate the guilt associated with having committed violent crimes. Conclusions Substances are used to transgress moral codes prior to committing and to neutralize the shame and guilt experienced after having committed violent crimes. Being simultaneously enrolled in OMT and imprisoned for a (violent) crime might evoke feelings of ‘double’ shame and guilt for both the criminal behavior prior to treatment and the actual case(s) one is imprisoned for while in OMT. Treatment providers should identify individuals with histories of violent behavior and, together with them, explore concrete episodes of violence and their emotional reactions. Particular attention should be given to potential relationships between substance use and violence and treatment approaches tailored accordingly. What appears as severe antisocial personality disorder may be partly explained by substance use.
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Affiliation(s)
- Ingrid Amalia Havnes
- Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4956, Oslo, Nydalen 0424, Norway.
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Talarek S, Orzelska J, Listos J, Mazur A, Fidecka S. Effects of chronic flunitrazepam treatment schedule on therapy-induced sedation and motor impairment in mice. Pharmacol Rep 2013; 65:50-8. [PMID: 23563023 DOI: 10.1016/s1734-1140(13)70963-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 10/08/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the present study was to examine whether different treatment schedules could be associated with tolerance development to the ataxic and sedative effects of flunitrazepam in mice. METHODS Effects of repeated flunitrazepam administration were studied in the rotarod and the chimney test for motor coordination and in a photocell apparatus for locomotor activity in mice. Flunitrazepam doses varied in particular types of injections or in different experiment duration periods. RESULTS Repeated flunitrazepam administration (1 mg/kg, sc and 2 mg/kg, ip) for 8 consecutive days induced tolerance to the motor impairing effects of flunitrazepam in mice, both in the rotarod and the chimney test. In turn, no tolerance developed to sedative flunitrazepam effects, regarding either dose level, injection type or treatment duration. CONCLUSIONS Those findings confirmed the previous observations that tolerance to benzodiazepines was not simultaneous for each pharmacological property of the drugs. Interestingly enough, an acute dose of flunitrazepam (1 mg/kg, sc) in our study enhanced locomotor activity of mice.
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Affiliation(s)
- Sylwia Talarek
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, Chodźki 4A, PL 20-093, Lublin, Poland.
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Ramadan ASE, Wenanu O, Cock ADE, Maes V, Lheureux P, Mols P. Chemical submission to commit robbery: a series of involuntary intoxications with flunitrazepam in Asian travellers in Brussels. J Forensic Leg Med 2013; 20:918-21. [PMID: 24112346 DOI: 10.1016/j.jflm.2013.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 06/17/2013] [Accepted: 06/28/2013] [Indexed: 11/25/2022]
Abstract
Between January 17, 2003 and August 29, 2003, the Emergency Department admitted a patient who had been surreptitiously intoxicated and robbed of his valuables every Friday. The first cases were considered anecdotal, but criminal activity was rapidly suspected. The cohort includes 16 male Asian patients aged 28-50 years. All the victims had just arrived in Brussels through one of the main rail station of the town and were admitted via the emergency ambulance service from different locations in the centre of Brussels around the CHU Saint-Pierre Hospital. Haemodynamic parameters upon admission were within normal limits. The Glasgow Coma Scale was equal or higher than 9/15 in 14 of the 16 victims. Toxicology screening obtained in 12 patients revealed the presence of flunitrazepam, which was further quantified at levels ranging from 21 to 75 μg/l. One of the Japanese patients, who returned to Belgium afterwards for professional reasons, was approached by the police and accepted to press charges. This allowed the police to investigate and send undercover agents to the railway station on Friday afternoons and evenings. They found a person who was offering welcome cookies to Asian travellers. He arrived from Amsterdam and returned once his crime was committed. Flunitrazepam is well known as a rape drug. We report a series of victims in whom flunitrazepam was used to facilitate robbery.
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Affiliation(s)
- Ahmed S E Ramadan
- Department of Emergency Medicine, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium, Université Libre de Bruxelles (ULB).
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The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study. Drug Alcohol Depend 2013; 129:110-5. [PMID: 23102731 DOI: 10.1016/j.drugalcdep.2012.09.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/18/2012] [Accepted: 09/22/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND The association between substance abuse, particularly alcohol abuse, and violence has been well established. However, since substance abuse co-occurs with several other risk factors for violence, the causal link between substance abuse and violence and the extent to which the acute influence of alcohol, illicit drugs, benzodiazepines, and anabolic androgenic steroids have a triggering effect on violent behavior are more uncertain. METHODS Case-crossover design was used based on data from structured face to face interviews with remand prisoners (n=194; 172 men, 22 women) suspected of violent crimes. MAIN OUTCOME MEASURE odds ratio (OR 95% CI) for a violent crime, 24h after exposure to different substances, compared to periods of no exposure was calculated using conditional logistic regression and a Mantel-Haenszel estimator with confidence intervals for sparse data. RESULTS Intake of alcohol (OR 6.41 CI 4.24-9.67) and large doses of benzodiazepines (OR 36.32 CI 7.14-183.65) triggered interpersonal violence. Stratified analyses of possible effect modifiers were sex, conduct/behavioral problems, trauma experiences; psychiatric vulnerability did not reveal any substantial differences. CONCLUSION Influences of alcohol and unusually high doses of benzodiazepines are proximal risk factors for violent crime. Improved knowledge of short-term (and dose-related) risk factors may contribute to treatment planning and risk assessment of violence.
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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]
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17
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Effects of Ignatia amara in mouse behavioural models. HOMEOPATHY 2012; 101:57-67. [DOI: 10.1016/j.homp.2011.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 09/26/2011] [Accepted: 10/17/2011] [Indexed: 01/25/2023]
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Reilly D, Cham S, Golomb BA. First-degree relatives with behavioural adverse effects on statins. BMJ Case Rep 2011; 2011:bcr.09.2011.4758. [PMID: 22675104 DOI: 10.1136/bcr.09.2011.4758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Irritability, aggression and other adverse behavioural effects have been associated with the use of statins (3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors) and other drug classes. A number of studies have also linked low cholesterol with aggression and violence. This paper presents the cases of two first-degree male relative patients (father and son) identified by self-referral to the University of California in San Diego Statin Effects Study. Both patients experienced behavioural adverse effects on statins including irritability and aggression, however neither patient recognised a significant change in their behaviour. This may be the first report of behavioural adverse effects manifested on statins by first-degree male relatives, which may suggest possible familial/biological predisposition. These cases also highlight the issue of externalisation by patients of the origin of interpersonal discord, which may serve as an obstacle to adverse effects reporting and lead to negative outcomes for patients, and for those around them.
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Affiliation(s)
- David Reilly
- Department of Medicine, UCSD, San Diego, California, United States
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19
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Svensson AI. Chronic effects of flunitrazepam on shock-induced behavioral inhibition in adult male rats. Behav Brain Res 2009; 199:360-3. [DOI: 10.1016/j.bbr.2009.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Saïas T, Gallarda T. Réactions d’agressivité sous benzodiazépines : une revue de la littérature. Encephale 2008; 34:330-6. [PMID: 18922233 DOI: 10.1016/j.encep.2007.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 05/15/2007] [Indexed: 12/01/2022]
Affiliation(s)
- T Saïas
- Laboratoire de recherche, EPS Maison-Blanche, 3-6, rue Lespagnol, 75020 Paris, France.
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Jones AW, Holmgren A, Kugelberg FC. Concentrations of scheduled prescription drugs in blood of impaired drivers: considerations for interpreting the results. Ther Drug Monit 2007; 29:248-60. [PMID: 17417081 DOI: 10.1097/ftd.0b013e31803d3c04] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the concentrations of scheduled prescription drugs in blood samples from people arrested in Sweden for driving under the influence of drugs (DUID). The investigation covered a 2 year period 2004 (N = 7052 cases) and 2005 (N = 7759 cases) and was prompted by recent legislation stipulating zero-concentration limits in blood for controlled substances. However, prescription drugs are exempt from the zero-limit law provided that the medication was being used in accordance with a doctor's prescription. The blood concentrations of various psychoactive substances were compared with the limits of quantitation of the analytic method used and the so-called therapeutic concentration range according to various reference books and tabulations. Diazepam [N = 1950 (26%)] and nordazepam [N = 2168 (28%)] were the therapeutic agents most frequently identified in these forensic blood samples along with other benzodiazepines such as alprazolam [N = 430 (5.6%)], flunitrazepam [N = 308 (4.0%)], and nitrazepam [N = 222 (2.9%)]. The newer hypnotics, exemplified by zolpidem [N = 148 (1.9%)] and zopiclone [N = 111 (1.5%)], were also high on the list of psychoactive substances identified. Interpreting the concentration of a prescription drug in blood in relation to whether the person had taken an overdose or was abusing the substance in question is not always easy. The age, gender, degree of obesity, and ethnicity of the person concerned; the pharmacokinetic profile of the drug; polymorphism of drug-metabolizing enzymes as well as liver and kidney function and blood hematocrit need to be considered. Among preanalytic factors, stability of the drug in blood after sampling, the type of tubes and preservatives used, the dosage form and route of administration deserve consideration. When therapeutic drug monitoring concentrations are compared with forensic toxicology results, then the plasma-to-whole blood distribution ratio of the drug also needs to be considered. In blood samples from DUID suspects, the concentrations of many commonly used sedatives and hypnotics exceeded the accepted therapeutic limits, which gives an indication of the abuse potential of these types of medications.
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Affiliation(s)
- A W Jones
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Artillerigatan 12, Linköping, Sweden.
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Affiliation(s)
- T A Brettell
- Department of Chemical and Physical Sciences, Cedar Crest College, 100 College Drive, Allentown, Pennsylvania 18104-6196, USA
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