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Takahashi F, Shimosaka Y, Mori S, Kaneko M, Harayama Y, Kobayashi K, Shoji T, Seto Y, Tatsumi H, Jin J. Development of a Potential-Modulated Electrochemiluminescence Measurement System for Selective and Sensitive Determination of the Controlled Drug Codeine. Chem Pharm Bull (Tokyo) 2024; 72:271-279. [PMID: 38432909 DOI: 10.1248/cpb.c23-00585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Codeine is a common analgesic drug that is a pro-drug of morphine. It also has a high risk of abuse as a recreational drug because of its extensive distribution as an OTC drug. Therefore, sensitive and selective screening methods for codeine are crucial in forensic analytical chemistry. To date, a commercial analytical kit has not been developed for dedicated codeine determination, and there is a need for an analytical method to quantify codeine in the field. In the present work, potential modulation was combined with electrochemiluminescence (ECL) for sensitive determination of codeine. The potential modulated technique involved applying a signal to electrodes by superimposing an AC potential on the DC potential. When tris(2,2'-bipyridine)ruthenium(II) ([Ru(bpy)3]2+) was used as an ECL emitter, ECL activity was confirmed for codeine. A detailed investigation of the electrochemical reaction mechanism suggested a characteristic ECL reaction mechanism involving electrochemical oxidation of the opioid framework. Besides the usual ECL reaction derived from the amine framework, selective detection of codeine was possible under the measurement conditions, with clear luminescence observed in an acidic solution. The sensitivity of codeine detection by potential modulated-ECL was one order of magnitude higher than that obtained with the conventional potential sweep method. The proposed method was applied to codeine determination in actual prescription medications and OTC drug samples. Codeine was selectively determined from other compounds in medications and showed good linearity with a low detection limit (150 ng mL-1).
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Affiliation(s)
| | - Yuki Shimosaka
- Department of Chemistry, Faculty of Science, Shinshu University
| | - Shuki Mori
- Department of Chemistry, Faculty of Science, Shinshu University
| | - Mayu Kaneko
- Department of Chemistry, Faculty of Science, Shinshu University
| | - Yuta Harayama
- Department of Legal Medicine, Shinshu University School of Medicine
| | - Kanya Kobayashi
- Department of Legal Medicine, Shinshu University School of Medicine
| | - Taku Shoji
- Department of Chemical Biology and Applied Chemistry, College of Engineering, Nihon University
| | | | | | - Jiye Jin
- Department of Chemistry, Faculty of Science, Shinshu University
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2
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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.
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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
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Edvardsen HME, Clausen T. Opioid related deaths in Norway in 2000-2019. Drug Alcohol Depend 2022; 232:109281. [PMID: 35042099 DOI: 10.1016/j.drugalcdep.2022.109281] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/03/2022]
Abstract
AIMS The aim of the study is to present autopsy-based findings of the most prevalent opioids in overdose deaths in Norway from 2000 to 2019, as such data are lacking in the current literature. METHODS Data on cause of death obtained from the Norwegian Cause of Death Registry (NCoDR) were linked with forensic toxicological results from forensic autopsies. RESULTS From year 2000 the annual numbers of overdose deaths decreased, specifically during 2000-2003, thereafter a relatively stable annual number was observed. Opioids were detected in 93% of the cases. Heroin related deaths have decreased, whereas medical opioids for pain treatment have increased with time. Men in their early 40's dominate the overall numbers of deaths, but significantly different sex patterns emerge when studying the specific drugs. During the past 20 years, the mean age at overdose death has increased by 10 years (from 33 to 43 years). Overdose deaths without any illicit drugs present at autopsy have increased in recent years. These deaths, where only potentially prescription medications were detected, were more common among women and with higher age. CONCLUSIONS In Norway during the past 20 years, we observe a dynamic shift in overdose deaths caused by heroin and illicit drugs, to include a gradually increasing trend of overdose deaths from pill based pain medications and also methadone and buprenorphine. This warrants a shift in preventive responses, as the target groups differ.
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Affiliation(s)
- Hilde Marie Erøy Edvardsen
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Yen YT, Chang YJ, Lai PJ, Chang CL, Chen TY, Chyueh SC. A Study of Opiate, Opiate Metabolites and Antihistamines in Urine after Consumption of Cold Syrups by LC-MS/MS. MOLECULES (BASEL, SWITZERLAND) 2020; 25:molecules25040972. [PMID: 32098143 PMCID: PMC7070706 DOI: 10.3390/molecules25040972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/16/2022]
Abstract
Studying the origin of opiate and/or opiate metabolites in individual urine specimens after consumption of cold syrups is vital for patients, doctors, and law enforcement. A rapid liquid chromatography-tandem mass spectrometry method using "dilute-and-shoot" analysis without the need for extraction, hydrolysis and/or derivatization has been developed and validated. The approach provides linear ranges of 2.5-1000 ng mL-1 for 6-acetylmorphine, codeine, chlorpheniramine, and carbinoxamine, 2.5-800 ng mL-1 for morphine and morphine-3-β-d-glucuronide, and 2.5-600 ng mL-1 for morphine-6-β-d-glucuronide and codeine-6-β-d-glucuronide, with excellent correlation coefficients (R2 > 0.995) and matrix effects (< 5%). Urine samples collected from the ten participants orally administered cold syrups were analyzed. The results concluded that participants consuming codeine-containing cold syrups did not routinely pass urine tests for opiates, and their morphine-codeine concentration ratios (M/C) were not always < 1. In addition, the distribution map of the clinical total concentration of the sum of morphine and codeine against the antihistamines (chlorpheniramine or carbinoxamine) were plotted for discrimination of people who used cold syrups. The 15 real cases have been studied by using M/C rule, cutoff value, and distribution map, further revealing a potential approach to determine opiate metabolite in urine originating from cold syrups.
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Affiliation(s)
- Yao-Te Yen
- Correspondence: ; Tel.: +886-2-2911-2241 (ext. 3714)
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5
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WITHDRAWN: Ratio of Morphine and Codeine over Antihistamines in Urine by LC-MS/MS for Determining Opiate Metabolites from Cold Syrups. Forensic Sci Int 2020. [DOI: 10.1016/j.forsciint.2020.110172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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6
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Giorgetti A, Mogler L, Halter S, Haschimi B, Alt A, Rentsch D, Schmidt B, Thoma V, Vogt S, Auwärter V. Four cases of death involving the novel synthetic cannabinoid 5F-Cumyl-PEGACLONE. Forensic Toxicol 2019. [DOI: 10.1007/s11419-019-00514-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstract
Purpose
Cumyl-PEGACLONE was the first synthetic cannabinoid (SC) with a γ-carbolinone core structure detected in forensic casework and, since then, it has dominated the German SC-market. Here the first four cases of death involving its fluorinated analog, 5F-Cumyl-PEGACLONE, a recently emerged γ-carbolinone derived SC, are reported.
Methods
Complete postmortem examinations were performed. Postmortem samples were screened by immunoassay, gas chromatography mass spectrometry (GC–MS) or liquid chromatography tandem mass spectrometry. For quantification of SCs, the standard addition method was employed. Herbal blends were analyzed by GC–MS. In each case of death, the Toxicological Significance Score (TSS) was assigned to the compound.
Results
5F-Cumyl-PEGACLONE was identified at concentrations ranging 0.09–0.45 ng/mL in postmortem femoral blood. In case 1, signs of hypothermia and kidney bleedings were noted. Despite a possible tolerance due to long term SC use, a TSS of 3 was assigned. In case 2, an acute heroin intoxication occurred and a contributory role (TSS = 1) of 5F-Cumyl-PEGACLONE was suggested. In case 3, a prisoner was found dead. GC–MS analysis of herbal blends, retrieved in his cell together with paraphernalia, confirmed the presence of 5F-Cumyl-PEGACLONE and a causative role was deemed probable (TSS = 2). In case 4, the aspiration of gastric content due to a SC-induced coma was observed (TSS = 3).
Conclusions
5F-Cumyl-PEGACLONE is an emerging and extremely potent SC which raises serious public health concerns. A comprehensive analysis of circumstantial, clinical, and postmortem findings, as well as an in-depth toxicological analysis is necessary for a valid interpretation and for the assessment of the toxicological significance.
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Reisinger A, Rabensteiner J, Hackl G. Diagnosis of acute intoxications in critically ill patients: focus on biomarkers - part 1: epidemiology, methodology and general overview. Biomarkers 2019; 25:9-19. [PMID: 31735069 DOI: 10.1080/1354750x.2019.1694994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Acute intoxications account for a significant proportion of the patient population in intensive care units and sedative medications, ethanol, illicit drugs, inhalable poisons and mixed intoxications are the most common causes. The aim of this article is to describe biomarkers for screening and diagnosis of acute intoxications in critically ill patients. For this purpose, a survey of the relevant literature was conducted, and guidelines, case reports, expert assessments, and scientific publications were reviewed. In critical care, it should always be attempted to identify and quantify the poison or toxin with the assistance of enzyme immunoassay (EIA), chromatography, and mass spectrometry techniques and this section is critically appraised in this publication. The principles for anion gap, osmol gap and lactate gap and their usage in intoxications is shown. Basic rules in test methodology and pre-analytics are reviewed. Biomarkers in general are presented in part one and biomarkers for specific intoxications including ethanol, paracetamol, cardiovascular drugs and many others are presented in part two of these publications.
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Affiliation(s)
- Alexander Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Gerald Hackl
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Wester N, Mynttinen E, Etula J, Lilius T, Kalso E, Kauppinen EI, Laurila T, Koskinen J. Simultaneous Detection of Morphine and Codeine in the Presence of Ascorbic Acid and Uric Acid and in Human Plasma at Nafion Single-Walled Carbon Nanotube Thin-Film Electrode. ACS OMEGA 2019; 4:17726-17734. [PMID: 31681878 PMCID: PMC6822113 DOI: 10.1021/acsomega.9b02147] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/02/2019] [Indexed: 05/21/2023]
Abstract
In clinical settings, the dosing and differential diagnosis of the poisoning of morphine (MO) and codeine (CO) is challenging due to interindividual variations in metabolism. However, direct electrochemical detection of these analytes from biological matrices is inherently challenging due to interference from large concentrations of anions, such as ascorbic acid (AA) and uric acid (UA), as well as fouling of the electrode by proteins. In this work, a disposable Nafion-coated single-walled carbon nanotube network (SWCNT) electrode was developed. We show facile electron transfer and efficient charge separation between the interfering anions and positively charged MO and CO, as well as significantly reduced matrix effect in human plasma. The Nafion coating alters the voltammetric response of MO and CO, enabling simultaneous detection. With this SWCNT/Nafion electrode, two linear ranges of 0.05-1 and 1-10 μM were found for MO and one linear range of 0.1-50 μM for CO. Moreover, the selective and simultaneous detection of MO and CO was achieved in large excess of AA and UA, as well as, for the first time, in unprocessed human plasma. The favorable properties of this electrode enabled measurements in plasma with only mild dilution and without the precipitation of proteins.
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Affiliation(s)
- Niklas Wester
- Department
of Chemistry and Materials Science, Aalto
University, Kemistintie 1, 02150 Espoo, Finland
- E-mail:
| | - Elsi Mynttinen
- Department
of Electrical Engineering and Automation, Aalto University, Tietotie 3, 02150 Espoo, Finland
| | - Jarkko Etula
- Department
of Chemistry and Materials Science, Aalto
University, Kemistintie 1, 02150 Espoo, Finland
| | - Tuomas Lilius
- Department
of Pharmacology, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department
of Clinical Pharmacology, University of
Helsinki and Helsinki University Hospital, Tukholmankatu 8C, 00290 Helsinki, Finland
| | - Eija Kalso
- Department
of Pharmacology, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
- Pain
Clinic, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2A, 00290 Helsinki, Finland
| | - Esko I. Kauppinen
- Department
of Applied Physics, Aalto University School
of Science, P.O. Box 15100, FI-00076 Aalto, Finland
| | - Tomi Laurila
- Department
of Electrical Engineering and Automation, Aalto University, Tietotie 3, 02150 Espoo, Finland
| | - Jari Koskinen
- Department
of Chemistry and Materials Science, Aalto
University, Kemistintie 1, 02150 Espoo, Finland
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Prata M, Ribeiro A, Figueirinha D, Rosado T, Oppolzer D, Restolho J, Araújo AR, Costa S, Barroso M, Gallardo E. Determination of opiates in whole blood using microextraction by packed sorbent and gas chromatography-tandem mass spectrometry. J Chromatogr A 2019; 1602:1-10. [DOI: 10.1016/j.chroma.2019.05.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/07/2019] [Accepted: 05/12/2019] [Indexed: 11/25/2022]
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10
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Hamnett HJ, Jack RE. The use of contextual information in forensic toxicology: An international survey of toxicologists' experiences. Sci Justice 2019; 59:380-389. [DOI: 10.1016/j.scijus.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/02/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022]
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11
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Slavova S, Delcher C, Buchanich JM, Bunn TL, Goldberger BA, Costich JF. Methodological Complexities in Quantifying Rates of Fatal Opioid-Related Overdose. CURR EPIDEMIOL REP 2019; 6:263-274. [PMID: 31259141 PMCID: PMC6559129 DOI: 10.1007/s40471-019-00201-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Effective responses to the US opioid overdose epidemic rely on accurate and timely drug overdose mortality data, which are generated from medicolegal death investigations (MDI) and certifications of overdose deaths. We identify nuances of MDI and certification of overdose deaths that can influence drug overdose mortality surveillance, as well as recent research, recommendations, and epidemiological tools for improved identification and quantification of specific drug involvement in overdose mortality. RECENT FINDINGS Death certificates are the foundation of drug overdose mortality surveillance. Accordingly, counts and rates of specific drug involvement in overdose deaths are only as accurate as the drug listed on death certificates. Variation in systematic approaches or jurisdictional office policy in drug overdose death certification can lead to bias in mortality rate calculations. Recent research has examined statistical adjustments to improve underreported opioid involvement in overdose deaths. New cause-of-death natural language text analysis tools improve quantification of specific opioid overdose mortality rates. Enhanced opioid overdose surveillance, which combines death certificate data with other MDI-generated data, has the potential to improve understanding of factors and circumstances of opioid overdose mortality. SUMMARY The opioid overdose crisis has brought into focus some of the limitations of US MDI systems for drug overdose surveillance and has given rise to a sense of urgency regarding the pressing need for improvements in our MDI data for public health action and research. Epidemiologists can stimulate positive changes in MDI data quality by demonstrating the critical role of data in guiding public health and safety decisions and addressing the challenges of accurate and timely overdose mortality measures with stakeholders. Education, training, and resources specific to drug overdose surveillance and analysis will be essential as the nation's overdose crisis continues to evolve.
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Affiliation(s)
- Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY USA
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave, Suite 242, Lexington, KY 40504 USA
| | - Chris Delcher
- Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, KY USA
| | - Jeannine M. Buchanich
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Terry L. Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave, Suite 242, Lexington, KY 40504 USA
- Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY USA
| | - Bruce A. Goldberger
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Julia F. Costich
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave, Suite 242, Lexington, KY 40504 USA
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY USA
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Stam NC, Gerostamoulos D, Pilgrim JL, Smith K, Moran L, Parsons S, Drummer OH. An analysis of issues in the classification and reporting of heroin-related deaths. Addiction 2019; 114:504-512. [PMID: 30397976 DOI: 10.1111/add.14486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/02/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the extent of variability in the reporting of heroin-related deaths in Victoria, Australia. Additionally, to identify opportunities to improve the accuracy and consistency of heroin-related death reporting by examining variability in the attribution, death certification, classification and coding of heroin-related death cases. METHODS Heroin-related deaths in Victoria, Australia during a 2-year period (2012-13) were identified using the National Coronial Information System (NCIS) and used as the 'gold standard' measure in this study. Heroin-related death data from the Australian Institute of Health and Welfare (AIHW) and Australian Bureau of Statistics (ABS) were then compared. Differences in the number of deaths reported as well as the classification and coding assigned to the identified heroin-related death cases were investigated by cross-referencing these data sets and examining the assigned ICD-10 codes. RESULTS A total of 243 heroin-related deaths were identified through the NCIS compared with 165 heroin-related deaths reported by the AIHW and assigned the heroin-specific ICD-10 code of T40.1. Forty per cent of all the missed heroin-related death cases resulted from either the attribution of the death to morphine toxicity or with non-specific drug toxicity certification; 30% occurred where the cases had been attributed to heroin but there were irregularities in death certification. Additional missed heroin-related death cases occurred as a result of late initial registration of these deaths to the Registry of Births, Deaths and Marriages, and where these cases were then not assessed by the ABS for classification and coding purposes. CONCLUSIONS In Victoria, Australia, in 2012 and 2013, the overall number of heroin-related deaths was under-reported by 32% compared with the number of deaths currently identified by the Australian Bureau of Statistics and reported by the Australian Institute of Health and Welfare.
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Affiliation(s)
- Nathan C Stam
- Department of Forensic Medicine, Monash University, Melbourne, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Monash University, Melbourne, Australia.,Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Jennifer L Pilgrim
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Karen Smith
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lauren Moran
- Mortality Data Centre, Health and Vital Statistics Section, Australian Bureau of Statistics, Brisbane, Australia
| | - Sarah Parsons
- Department of Forensic Medicine, Monash University, Melbourne, Australia.,Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, Melbourne, Australia
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13
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Lowder EM, Ray BR, Huynh P, Ballew A, Watson DP. Identifying Unreported Opioid Deaths Through Toxicology Data and Vital Records Linkage: Case Study in Marion County, Indiana, 2011-2016. Am J Public Health 2018; 108:1682-1687. [PMID: 30359109 PMCID: PMC6236744 DOI: 10.2105/ajph.2018.304683] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To demonstrate the severity of undercounting opioid-involved deaths in a local jurisdiction with a high proportion of unspecified accidental poisoning deaths. METHODS We matched toxicology data to vital records for all accidental poisoning deaths (n = 1238) in Marion County, Indiana, from January 2011 to December 2016. From vital records, we coded cases as opioid involved, specified other substance, or unspecified. We extracted toxicology data on opioid substances for unspecified cases, and we have reported corrected estimates of opioid-involved deaths after accounting for toxicology findings. RESULTS Over a 6-year period, 57.7% of accidental overdose deaths were unspecified and 34.2% involved opioids. Toxicology data showed that 86.8% of unspecified cases tested positive for an opioid. Inclusion of toxicology results more than doubled the proportion of opioid-involved deaths, from 34.2% to 86.0%. CONCLUSIONS Local jurisdictions may be undercounting opioid-involved overdose deaths to a considerable degree. Toxicology data can improve accuracy in identifying opioid-involved overdose deaths. Public Health Implications. Mandatory toxicology testing and enhanced training for local coroners on standards for death certificate reporting are needed to improve the accuracy of local monitoring of opioid-involved accidental overdose deaths.
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Affiliation(s)
- Evan M Lowder
- Evan M. Lowder and Bradley R. Ray are with the School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis. At the time of this study, Philip Huynh and Dennis P. Watson were with the Center for Health Engagement and Equity Research, Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University. Alfarena Ballew is with the Marion County Coroner's Office, Indianapolis
| | - Bradley R Ray
- Evan M. Lowder and Bradley R. Ray are with the School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis. At the time of this study, Philip Huynh and Dennis P. Watson were with the Center for Health Engagement and Equity Research, Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University. Alfarena Ballew is with the Marion County Coroner's Office, Indianapolis
| | - Philip Huynh
- Evan M. Lowder and Bradley R. Ray are with the School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis. At the time of this study, Philip Huynh and Dennis P. Watson were with the Center for Health Engagement and Equity Research, Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University. Alfarena Ballew is with the Marion County Coroner's Office, Indianapolis
| | - Alfarena Ballew
- Evan M. Lowder and Bradley R. Ray are with the School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis. At the time of this study, Philip Huynh and Dennis P. Watson were with the Center for Health Engagement and Equity Research, Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University. Alfarena Ballew is with the Marion County Coroner's Office, Indianapolis
| | - Dennis P Watson
- Evan M. Lowder and Bradley R. Ray are with the School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis. At the time of this study, Philip Huynh and Dennis P. Watson were with the Center for Health Engagement and Equity Research, Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University. Alfarena Ballew is with the Marion County Coroner's Office, Indianapolis
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Stam NC, Gerostamoulos D, Gerstner-Stevens J, Scott N, Smith K, Drummer OH, Pilgrim JL. Determining the effective dose of street-level heroin: A new way to consider fluctuations in heroin purity, mass and potential contribution to overdose. Forensic Sci Int 2018; 290:219-226. [DOI: 10.1016/j.forsciint.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 01/04/2023]
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15
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Thaulow CH, Øiestad ÅML, Rogde S, Andersen JM, Høiseth G, Handal M, Mørland J, Vindenes V. Can measurements of heroin metabolites in post-mortem matrices other than peripheral blood indicate if death was rapid or delayed? Forensic Sci Int 2018; 290:121-128. [DOI: 10.1016/j.forsciint.2018.06.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
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16
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Stam NC, Pilgrim JL, Drummer OH, Smith K, Gerostamoulos D. Catch and release: evaluating the safety of non-fatal heroin overdose management in the out-of-hospital environment. Clin Toxicol (Phila) 2018; 56:1135-1142. [DOI: 10.1080/15563650.2018.1478093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Nathan C. Stam
- Department of Forensic Medicine, Monash University, Melbourne, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
| | | | - Olaf H. Drummer
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Karen Smith
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Monash University, Melbourne, Australia
- Victorian Institute of Forensic Medicine, Melbourne, Australia
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17
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Liu J, Hu X, Cao F, Zhang Y, Lu J, Zeng L. A lateral flow strip based on gold nanoparticles to detect 6-monoacetylmorphine in oral fluid. ROYAL SOCIETY OPEN SCIENCE 2018; 5:180288. [PMID: 30110425 PMCID: PMC6030262 DOI: 10.1098/rsos.180288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/14/2018] [Indexed: 05/25/2023]
Abstract
We used lateral flow strips based on gold nanoparticles to detect 6-monoacetylmorphine (6-MAM; heroin's unique metabolite) in oral fluid samples. In this competitive lateral chromatographic immunoassay, the 6-MAM was chemically synthesized and conjugated to bovine serum albumin. The results were qualitatively detected via the colour change of the test line. By using a proper sample pad, a suitable nitrocellulose membrane and a customized sponge device adsorbed the oral fluid directly from the mouth; the total test time was 3 min. The sensitivity of the assay was 4.0 ng ml-1 without any cross-reactivity with 10 normal drugs, which are widely subject to abuse, including morphine and codeine. This test could be easily used on site to detect heroin in oral fluid, and it could be a promising product in the future including for driving under the influence.
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Affiliation(s)
- Jia Liu
- School of Pharmacy, Fudan University, Shanghai 200433, People's Republic of China
- Shanghai Institute of Pharmaceutical Industry, Shanghai 200437, People's Republic of China
| | - Xiaolong Hu
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Institute of Forensic Science, Shanghai 200083, People's Republic of China
| | - Fangqi Cao
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Research Institute of Criminal Science and Technology, Shanghai, People's Republic of China
| | - Yurong Zhang
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Institute of Forensic Science, Shanghai 200083, People's Republic of China
| | - Jianzhong Lu
- School of Pharmacy, Fudan University, Shanghai 200433, People's Republic of China
| | - Libo Zeng
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Institute of Forensic Science, Shanghai 200083, People's Republic of China
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Roxburgh A, Pilgrim JL, Hall WD, Burns L, Degenhardt L. Accurate identification of opioid overdose deaths using coronial data. Forensic Sci Int 2018; 287:40-46. [PMID: 29627712 DOI: 10.1016/j.forsciint.2018.03.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/15/2018] [Accepted: 03/17/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Defining drug-related mortality is complex as these deaths can include a wide range of diseases and circumstances. This paper outlines a method to identify deaths that are directly due to fatal opioid toxicity (i.e. overdose), utilising coronial data. MATERIALS AND METHODS The National Coronial Information System (NCIS), an online coronial database containing information on all deaths that are reported to a coroner in Australia, is used to develop methods to more accurately identify opioid overdose deaths. The NCIS contains demographic information, Medical Cause of Death, and associated documentation on toxicology, clinical and police investigations. RESULTS Identifying overdose deaths using the coroner determined Medical Cause of Death provided greater capture, and specificity, of opioid overdose deaths. Distinguishing morphine from heroin-related deaths presented challenges, requiring analysis of clinical and investigative information in addition to toxicology results. One-quarter of the deaths attributed to morphine were recorded to heroin as a result of further investigation. There was also some underestimation of codeine-related deaths. Access to clinical and investigative information also yields important information in relation to comorbid conditions among these decedents, such as history of chronic pain, substance use issues and mental health problems. CONCLUSIONS Reliance on toxicology results alone leads to an underestimate of heroin-related deaths. Differentiating between heroin and pharmaceutical opioid (e.g. morphine) overdose deaths has important public health and policy implications, particularly in relation to prescribing practices and development of a strategic response. Understanding comorbidities among these decedents is also important in efforts to reduce preventable causes of death such as opioid overdose.
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Affiliation(s)
- Amanda Roxburgh
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, NSW 2052, Australia.
| | | | - Wayne D Hall
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, NSW 2052, Australia; University of Queensland Clinical Centre for Research, University of Queensland, Brisbane, QLD 4072, Australia; University of Queensland Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD 4006, Australia; National Addiction Centre, Kings College London, WC2R 2LS, United Kingdom
| | - Lucinda Burns
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, NSW 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, NSW 2052, Australia; School of Population and Global Health, University of Melbourne, VIC 3010, Australia
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Hurstak E, Rowe C, Turner C, Behar E, Cabugao R, Lemos NP, Burke C, Coffin P. Using medical examiner case narratives to improve opioid overdose surveillance. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:35-42. [PMID: 29353022 DOI: 10.1016/j.drugpo.2017.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/14/2017] [Accepted: 12/22/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Current opioid overdose mortality surveillance methods do not capture the complexity of the overdose epidemic. Most rely on death certificates, which may underestimate both opioid analgesic and heroin deaths. Categorizing deaths using other characteristics from the death record including route of drug administration may provide useful information to design and evaluate overdose prevention interventions. METHODS We reviewed California Electronic Death Reporting System records and San Francisco Office of the Chief Medical Examiner (OCME) toxicology reports and investigative case narratives for all unintentional opioid overdose deaths in San Francisco County from 2006 to 2012. We chose this time period because it encompassed a period of evolution in local opioid use patterns and expansion of overdose prevention efforts. We created a classification system for heroin-related and injection-related opioid overdose deaths and compared demographic, death scene, and toxicology characteristics among these groups. RESULTS We identified 816 unintentional opioid overdose deaths. One hundred fifty-two (19%) were standard heroin deaths, as designated by the OCME or by the presence of 6-monoacetylmorphine. An "expanded" classification for heroin deaths incorporating information from toxicology reports and case narratives added 20 additional heroin deaths (13% increase), accounting for 21% of all opioid deaths. Two hundred five deaths (25%) were injection-related, 60% of which were attributed to heroin. A combined classification of expanded heroin and injection-related deaths accounted for 31% of opioid overdose deaths during this period. CONCLUSIONS Using additional sources of information to classify opioid overdose cases resulted in a modest increase in the count of heroin overdose deaths but identified a substantial number of non-heroin injection-related opioid analgesic deaths. Including the route of administration in the characterization of opioid overdose deaths can identify meaningful subgroups of opioid users to enhance surveillance efforts and inform targeted public health programming including overdose prevention programs.
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Affiliation(s)
- Emily Hurstak
- Division of General Internal Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
| | - Christopher Rowe
- Substance Use Research Unit, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Caitlin Turner
- Substance Use Research Unit, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Emily Behar
- Substance Use Research Unit, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Rachel Cabugao
- Substance Use Research Unit, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Nikolas P Lemos
- Department of Laboratory Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Catherine Burke
- Division of Internal Medicine, University of California School of Medicine, San Francisco, CA, USA
| | - Phillip Coffin
- Substance Use Research Unit, San Francisco Department of Public Health, San Francisco, CA, USA.
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20
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Stam NC, Gerostamoulos D, Dietze PM, Parsons S, Smith K, Lloyd B, Pilgrim JL. The attribution of a death to heroin: A model to help improve the consistent and transparent classification and reporting of heroin-related deaths. Forensic Sci Int 2017; 281:18-28. [DOI: 10.1016/j.forsciint.2017.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/11/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
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21
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Singh S, Mishra P, Banga I, S Parmar A, Prakash Tripathi P, Gandhi S. Chemiluminescence based immunoassay for the detection of heroin and its metabolites. BIOIMPACTS : BI 2017; 8:53-58. [PMID: 29713602 PMCID: PMC5915709 DOI: 10.15171/bi.2018.07] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/10/2017] [Accepted: 10/22/2017] [Indexed: 12/27/2022]
Abstract
Introduction: Continuous use of opiates causes drug-related illnesses, which poses an alarming situation to develop sensitive detection platform. In this study, a highly sensitive and reliable chemiluminescence immunoassay (CI) has been developed for the detection of heroin and its major metabolites in spiked urine samples. Methods: To develop robust immunoassay, monoacetyl morphine-bovine serum albumin (MAM-BSA) conjugate was synthesized and characterized thoroughly by physicochemical techniques. The anti-MAM antibodies were developed, labeled with horseradish peroxidase (HRP) and immunoassay was developed to detect the presence of target drug in spiked urine samples. Results: A competitive CI was developed, where heroin, MAM, morphine, and codeine concentration were ranged from 0-1000 ng/ mL in spiked urine samples and limit of detection were 80, 95, 90, 75 pg/ mL. Conclusion: The developed CI is highly sensitive, specific, point of care, cost-effective and can be used as a routine technique for quantitative analysis for screening of narcotic drugs.
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Affiliation(s)
- Smritee Singh
- Amity Institute of Biotechnology, Amity University, Sector-125, Noida-201313, India
| | - Priya Mishra
- Amity Institute of Biotechnology, Amity University, Sector-125, Noida-201313, India
- Amity Institute of Neurophyscology and Neurosciences, Amity University, Sector-125, Noida-201313, India
| | - Ivneet Banga
- Amity Institute of Biotechnology, Amity University, Sector-125, Noida-201313, India
| | - Avanish S Parmar
- Department of Physics, Indian Institute of Technology-BHU, Varanasi-221005, India
| | - Prem Prakash Tripathi
- CSIR-Indian Institute of Chemical Biology, Jadavpur, Kolkata, West Bengal-700032, India
| | - Sonu Gandhi
- Amity Institute of Biotechnology, Amity University, Sector-125, Noida-201313, India
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22
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Maas A, Madea B, Hess C. Confirmation of recent heroin abuse: Accepting the challenge. Drug Test Anal 2017; 10:54-71. [DOI: 10.1002/dta.2244] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Alexandra Maas
- Department of Forensic Toxicology; University Bonn, Institute of Forensic Medicine; Bonn Germany
| | - Burkhard Madea
- Department of Forensic Toxicology; University Bonn, Institute of Forensic Medicine; Bonn Germany
| | - Cornelius Hess
- Department of Forensic Toxicology; University Bonn, Institute of Forensic Medicine; Bonn Germany
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23
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Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:120-129. [DOI: 10.1016/j.drugpo.2017.05.051] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/19/2017] [Accepted: 05/28/2017] [Indexed: 01/05/2023]
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24
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Slavova S, Bunn TL, Hargrove SL, Corey T, Ingram V. Linking Death Certificates, Postmortem Toxicology, and Prescription History Data for Better Identification of Populations at Increased Risk for Drug Intoxication Deaths. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0185-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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25
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Abstract
In recent years, there has been a substantial increase in opioid use and abuse, and in opioid-related fatal overdoses. The increase in opioid use has resulted at least in part from individuals transitioning from prescribed opioids to heroin and fentanyl, which can cause significant respiratory depression that can progress to apnea and death. Heroin and fentanyl may be used individually, together, or in combination with other substances such as ethanol, benzodiazepines, or other drugs that can have additional deleterious effects on respiration. Suspicion that a death is drug-related begins with the decedent's medical and social history, and scene investigation, where drugs and drug paraphernalia may be encountered, and examination of the decedent, which may reveal needle punctures and needle track marks. At autopsy, the most significant internal finding that is reflective of opioid toxicity is pulmonary edema and congestion, and frothy watery fluid is often present in the airways. Various medical ailments such as heart and lung disease and obesity may limit an individual's physiologic reserve, rendering them more susceptible to the toxic effects of opioids and other drugs. Although many opioids will be detected on routine toxicology testing, more specialized testing may be warranted for opioid analogs, or other uncommon, synthetic, or semisynthetic drugs.
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26
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Ellis AD, McGwin G, Davis GG, Dye DW. Identifying cases of heroin toxicity where 6-acetylmorphine (6-AM) is not detected by toxicological analyses. Forensic Sci Med Pathol 2016; 12:243-7. [PMID: 27114260 PMCID: PMC4967084 DOI: 10.1007/s12024-016-9780-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Heroin has a half-life of 2-6 min and is metabolized too quickly to be detected in autopsy samples. The presence of 6-acetylmophine (6-AM) in urine, blood, or other samples is convincing evidence of heroin use by a decedent, but 6-AM itself has a half-life of 6-25 min before it is hydrolyzed to morphine, so 6-AM may not be present in sufficient concentration to detect in postmortem samples. Codeine is often present in heroin preparations as an impurity and is not a metabolite of heroin. Studies report that a ratio of morphine to codeine greater than one indicates heroin use. We hypothesize that the ratio of morphine to codeine in our decedents abusing drugs intravenously will be no different in individuals with 6-AM present than in individuals where no 6-AM is detected, and we report our study of this hypothesis. METHODS All accidental deaths investigated by the Jefferson County Coroner/Medical Examiner Office from 2010 to 2013 with morphine detected in blood samples collected at autopsy were reviewed. Five deaths where trauma caused or contributed to death were excluded from the review. The presence or absence of 6-AM and the concentrations of morphine and codeine were recorded for each case. The ratio of morphine to codeine was calculated for all decedents. Any individual in whom no morphine or codeine was detected in a postmortem sample was excluded from further study. Absence or presence of drug paraphernalia or evidence of intravascular (IV) drug use was documented in each case to identify IV drug users. The proportion of the IV drug users with and without 6-AM present in a postmortem sample was compared to the M/C ratio for the individuals. RESULTS Of the 230 deaths included in the analysis, 103 IV drug users with quantifiable morphine and codeine in a postmortem sample were identified allowing for calculation of an M/C ratio. In these IV drug users, the M/C ratio was greater than 1 in 98 % of decedents. When controlling for the absence or presence of 6-AM there was no statistically significant difference in the proportion of IV drug users when compared to non IV drug users with an M/C ratio of greater than 1 (p = 1.000). CONCLUSION The M/C ratio in IV drug users, if greater than 1, is seen in deaths due to heroin toxicity where 6-AM is detected in a postmortem sample. This study provides evidence that a M/C ratio greater than one in an IV drug user is evidence of a death due to heroin toxicity even if 6-AM is not detected in the blood. Using the M/C ratio, in addition to scene and autopsy findings, provides sufficient evidence to show heroin is the source of the morphine and codeine. Listing heroin as a cause or contributing factor in deaths with evidence of IV drug abuse and where the M/C ratio exceeds 1 will improve identification of heroin fatalities, which will allow better allocation of resources for public health initiatives.
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Affiliation(s)
- Ashley D Ellis
- Virginia Commonwealth University School of Medicine, 1101 E. Marshall Street, PO Box 980662, Richmond, VA, 23298, USA
| | - Gerald McGwin
- University of Alabama at Birmingham, 1515 6th Ave. S, Birmingham, AL, 35233, USA
| | - Gregory G Davis
- University of Alabama at Birmingham, 1515 6th Ave. S, Birmingham, AL, 35233, USA
| | - Daniel W Dye
- University of Alabama at Birmingham, 1515 6th Ave. S, Birmingham, AL, 35233, USA.
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27
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Liang B, Jiang J, Pan P, Chen R, Zhuang D, Zhao F, Chen H, Huang J, Su Q, Cao C, Li J, Liang H, Ye L. Morphine Increases Lamivudine- and Nevirapine-Induced Human Immunodeficiency Virus-1 Drug-Resistant Mutations In Vitro. Microb Drug Resist 2016; 23:285-293. [PMID: 27420739 DOI: 10.1089/mdr.2015.0347] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Epidemiological studies have demonstrated that the human immunodeficiency virus (HIV)-1 drug-resistant rate among injecting drug users is higher than that in other HIV-1-positive populations, which is generally believed to be largely due to clinical nonadherence. Little is known, however, about whether heroin abuse has a direct impact on the generation of HIV-1 drug-resistant mutations. In this study, we investigated the impacts of morphine, the active metabolite of heroin, on HIV-1 infection/replication and HIV-1 drug-resistant mutations through an in vitro HIV-1-CD4+ T cell system under selective pressure from two typical antiviral drugs, Lamivudine and Nevirapine. We found that morphine treatment of MT4 cells (a CD4+ T cell line) significantly increased HIV-1 III B (a T-tropic viral strain) infection and replication in MT4 cells, and the effect of morphine on HIV-1 was mediated through an opioid receptor. More importantly, our results showed that morphine treatment not only induced more drug-resistant mutations under selective pressure from antiretroviral drugs but also shortened the mutations' generation time, compared with the control groups that were treated with antiretroviral drugs alone. Although the in vivo relevance remains to be determined, these findings provide direct in vitro evidence to support the possibility that heroin abuse itself can act as an independent factor contributing to the generation of HIV-1 drug resistance during clinical antiretroviral therapy. Therapeutic guidelines should consider this issue for heroin users with HIV infection.
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Affiliation(s)
- Bingyu Liang
- 1 Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University , Nanning, China .,2 Life Sciences Institute, Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University , Nanning, China
| | - Junjun Jiang
- 1 Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University , Nanning, China .,2 Life Sciences Institute, Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University , Nanning, China
| | - Peijiang Pan
- 1 Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University , Nanning, China .,3 Institute of Acute Communicable Diseases Prevention and Control , Guangxi Center for Diseases Prevention and Control, Nanning, China
| | - Rongfeng Chen
- 1 Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University , Nanning, China
| | - Daomin Zhuang
- 4 State Key Laboratory of Pathogen and Biosecurity, Department of AIDS Research, Beijing Institute of Microbiology and Epidemiology , Beijing, China
| | - Fangning Zhao
- 1 Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University , Nanning, China
| | - Hui Chen
- 5 Geriatrics Digestion Department of Internal Medicine, The First Affiliated Hospital of Guangxi Medical University , Nanning, China
| | - Jiegang Huang
- 1 Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University , Nanning, China .,2 Life Sciences Institute, Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University , Nanning, China
| | - Qijian Su
- 6 Center for AIDS Research, The Affiliated Ruikang Hospital of Guangxi Traditional Chinese Medical University , Nanning, China
| | - Cunwei Cao
- 1 Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University , Nanning, China
| | - Jingyun Li
- 4 State Key Laboratory of Pathogen and Biosecurity, Department of AIDS Research, Beijing Institute of Microbiology and Epidemiology , Beijing, China
| | - Hao Liang
- 1 Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University , Nanning, China .,2 Life Sciences Institute, Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University , Nanning, China
| | - Li Ye
- 1 Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University , Nanning, China .,2 Life Sciences Institute, Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University , Nanning, China
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28
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Ahlner J, Holmgren A, Jones AW. Demographics and post-mortem toxicology findings in deaths among people arrested multiple times for use of illicit drugs and/or impaired driving. Forensic Sci Int 2016; 265:138-43. [PMID: 26901639 DOI: 10.1016/j.forsciint.2016.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem. METHODS This retrospective study (1993-2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma. RESULTS Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p<0.001). The repeat offenders were predominantly male (90% vs 10%) and mean age of drug poisoning deaths was 5 y younger (mean 35 y) than other causes of death (mean 40 y). Significantly more repeat offenders (46%) died from drug overdose compared with all other forensic autopsies (14%) (p<0.001). Four or more drugs were identified in femoral blood in 44% of deaths from poisoning (drug overdose) compared with 18% of deaths by other causes (p<0.001). The manner of death was considered accidental in 54% of deaths among repeat offenders compared with 28% for other suspicious deaths (p<0.001). The psychoactive substances most commonly identified in autopsy blood from repeat offenders were ethanol, morphine (from heroin), diazepam, amphetamines, cannabis, and various opioids. CONCLUSIONS This study shows that people arrested multiple times for use of illicit drugs and/or impaired driving are more likely to die by accidentally overdosing with drugs. Lives might be saved if repeat offenders were sentenced to treatment and rehabilitation for their drug abuse problem instead of conventional penalties for drug-related crimes.
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Affiliation(s)
- Johan Ahlner
- Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Anita Holmgren
- Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden
| | - Alan Wayne Jones
- Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden.
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29
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Bagheri H, Khoshsafar H, Afkhami A, Amidi S. Sensitive and simple simultaneous determination of morphine and codeine using a Zn2SnO4nanoparticle/graphene composite modified electrochemical sensor. NEW J CHEM 2016. [DOI: 10.1039/c6nj00505e] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Simultaneous determination of morphine and codeine using a nanocomposite modified electrochemical sensor.
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Affiliation(s)
- Hasan Bagheri
- Chemical Injuries Research Center
- Baqiyatallah University of Medical Sciences
- Tehran
- Iran
| | - Hosein Khoshsafar
- Chemical Injuries Research Center
- Baqiyatallah University of Medical Sciences
- Tehran
- Iran
| | - Abbas Afkhami
- Faculty of Chemistry
- Bu-Ali Sina University
- Hamedan
- Iran
| | - Salimeh Amidi
- Department of Medicinal Chemistry
- School of Pharmacy
- Shahid Beheshti University of Medical Sciences
- Tehran
- Iran
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30
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Bévalot F, Cartiser N, Bottinelli C, Fanton L, Guitton J. Vitreous humor analysis for the detection of xenobiotics in forensic toxicology: a review. Forensic Toxicol 2015; 34:12-40. [PMID: 26793276 PMCID: PMC4705140 DOI: 10.1007/s11419-015-0294-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/21/2015] [Indexed: 01/10/2023]
Abstract
Vitreous humor (VH) is a gelatinous substance contained in the posterior chamber of the eye, playing a mechanical role in the eyeball. It has been the subject of numerous studies in various forensic applications, primarily for the assessment of postmortem interval and for postmortem chemical analysis. Since most of the xenobiotics present in the bloodstream are detected in VH after crossing the selective blood-retinal barrier, VH is an alternative matrix useful for forensic toxicology. VH analysis offers particular advantages over other biological matrices: it is less prone to postmortem redistribution, is easy to collect, has relatively few interfering compounds for the analytical process, and shows sample stability over time after death. The present study is an overview of VH physiology, drug transport and elimination. Collection, storage, analytical techniques and interpretation of results from qualitative and quantitative points of view are dealt with. The distribution of xenobiotics in VH samples is thus discussed and illustrated by a table reporting the concentrations of 106 drugs from more than 300 case reports. For this purpose, a survey was conducted of publications found in the MEDLINE database from 1969 through April 30, 2015.
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Affiliation(s)
- Fabien Bévalot
- Laboratoire LAT LUMTOX, 71 Avenue Rockefeller, 69003 Lyon, France.,Institut de Médecine Légale, Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 Avenue Rockefeller, 69373 Lyon Cedex 08, France
| | - Nathalie Cartiser
- Laboratoire de Toxicologie, ISPB-Faculté de Pharmacie, Université de Lyon, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69373 Lyon Cedex 08, France
| | | | - Laurent Fanton
- Département de Médecine Légale, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Place D'Arsonval, 69437 Lyon Cedex 03, France.,CREATIS CNRS UMR 5220, INSERM U1044, Université de Lyon, Université Claude Bernard Lyon 1, INSA Lyon, 7 Avenue Jean Capelle, 69621 Villeurbanne Cedex, France
| | - Jérôme Guitton
- Laboratoire de Toxicologie, ISPB-Faculté de Pharmacie, Université de Lyon, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69373 Lyon Cedex 08, France.,Laboratoire de Pharmacologie-Toxicologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165 Chemin Grand Revoyet, 69495 Pierre Bénite Cedex, France
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31
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Bernard JP, Khiabani HZ, Hilberg T, Karinen R, Slørdal L, Waal H, Mørland J. Characteristics of methadone-related fatalities in Norway. J Forensic Leg Med 2015; 36:114-20. [PMID: 26439870 DOI: 10.1016/j.jflm.2015.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/15/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
There are currently over 7000 patients enrolled in opioid maintenance treatment (OMT) programs in Norway. A rise in methadone-related deaths proportional to increasing methadone sales over the period 2000-2006 has been observed, but the causative factors for these fatalities have been elusive. In the present study, individual characteristics, methadone concentrations and additional toxicological findings were analyzed. Methadone intoxication deaths (n = 264) were divided into 3 groups according to toxicological findings in whole blood: group 1 - methadone detected alone, or together with one additional drug at low or therapeutic levels, or a low concentration of ethanol (<1 g/L) (n = 21); group 2 - multiple additional drugs/substances detected below lethal levels (n = 175); group 3 - one or more additional drugs/substances detected at lethal levels, or ethanol >3 g/L (n = 55). Methadone blood concentrations in decedents who had been enrolled in OMT were higher than for decedents not in treatment, in all groups. Blood methadone concentrations around 1 mg/L were present in fatal multi-drug intoxications in OMT patients. Results suggest that some patients may be at risk of dying when combining therapeutic concentrations of methadone with other psychoactive substances. Somatic disease was a common finding among deceased OMT patients. Concentrations in methadone users not enrolled in OMT were predominantly between 0.3 and 0.4 mg/L and were not related to the presence of other drugs. However, methadone concentrations below 0.1 mg/L may be associated with intoxication following methadone use, both alone and in combination with other drugs. Younger male users (mean age 34 years) seemed to have a higher susceptibility to methadone intoxication.
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Affiliation(s)
- Jean-Paul Bernard
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Centre for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.
| | - Hassan Z Khiabani
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Oslo University Hospital, Rikshospitalet, Department of Pharmacology, Oslo, Norway
| | - Thor Hilberg
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Fürst Medical Laboratory, Oslo, Norway
| | - Ritva Karinen
- Norwegian Institute of Public Health, Division of Forensic Sciences, 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's Hospital, Trondheim, Norway
| | - Helge Waal
- SERAF-Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway; Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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32
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Abstract
This paper is the thirty-sixth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2013 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Mathias PC, Hayden JA, Laha TJ, Hoofnagle AN. Evaluation of matrix effects using a spike recovery approach in a dilute-and-inject liquid chromatography–tandem mass spectrometry opioid monitoring assay. Clin Chim Acta 2014; 437:38-42. [DOI: 10.1016/j.cca.2014.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/09/2014] [Accepted: 06/23/2014] [Indexed: 11/15/2022]
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34
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Høiseth G, Fjeld B, Burns ML, Strand DH, Vindenes V. Long-term stability of morphine, codeine, and 6-acetylmorphine in real-life whole blood samples, stored at −20°C. Forensic Sci Int 2014; 239:6-10. [DOI: 10.1016/j.forsciint.2014.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/27/2014] [Accepted: 03/07/2014] [Indexed: 11/27/2022]
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35
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Winklhofer S, Surer E, Ampanozi G, Ruder T, Stolzmann P, Elliott M, Oestreich A, Kraemer T, Thali M, Alkadhi H, Schweitzer W. Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy. Eur Radiol 2014; 24:1276-82. [DOI: 10.1007/s00330-014-3128-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 02/07/2014] [Accepted: 02/12/2014] [Indexed: 11/30/2022]
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36
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Berg-Pedersen RM, Ripel A, Karinen R, Vevelstad M, Bachs L, Vindenes V. Codeine to Morphine Concentration Ratios in Samples from Living Subjects and Autopsy Cases after Incubation. J Anal Toxicol 2013; 38:99-105. [DOI: 10.1093/jat/bkt099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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38
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Abstract
Opioid analgesic misuse has risen significantly over the past two decades, and these drugs now represent the most commonly abused class of prescription medications. They are a major cause of poisoning deaths in the USA exceeding heroin and cocaine. Laboratory testing plays a role in the detection of opioid misuse and the evaluation of patients with opioid intoxication. Laboratories use both immunoassay and chromatographic methods (e.g., liquid chromatography with mass spectrometry detection), often in combination, to yield high detection sensitivity and drug specificity. Testing methods for opioids originated in the workplace-testing arena and focused on detection of illicit heroin use. Analysis for a wide range of opioids is now required in the context of the prescription opioid epidemic. Testing methods have also been primarily based upon urine screening; however, methods for analyzing alternative samples such as saliva, sweat, and hair are available. Application of testing to monitor prescription opioid drug therapy is an increasingly important use of drug testing, and this area of testing introduces new interpretative challenges. In particular, drug metabolism may transform one clinically available opioid into another. The sensitivity of testing methods also varies considerably across the spectrum of opioid drugs. An understanding of opioid metabolism and method sensitivity towards different opioid drugs is therefore essential to effective use of these tests. Improved testing algorithms and more research into the effective use of drug testing in the clinical setting, particularly in pain medicine and substance abuse, are needed.
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Distribution of opiates in femoral blood and vitreous humour in heroin/morphine-related deaths. Forensic Sci Int 2013; 226:152-9. [DOI: 10.1016/j.forsciint.2013.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 11/28/2012] [Accepted: 01/04/2013] [Indexed: 11/30/2022]
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40
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Jones AW, Holmgren A. Concentrations of alprazolam in blood from impaired drivers and forensic autopsies were not much different but showed a high prevalence of co-ingested illicit drugs. J Psychopharmacol 2013; 27:276-81. [PMID: 23257168 DOI: 10.1177/0269881112471155] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alprazolam is a benzodiazepine anxiolytic widely prescribed for treatment of panic-disorder and social phobias, although this medication is also subject to abuse. In this paper, the concentrations of alprazolam in venous blood samples from impaired drivers were compared with femoral blood samples from forensic autopsies classified as intoxication or other causes of death (e.g. natural, trauma). After liquid-liquid extraction (n-butyl acetate) alprazolam was determined in blood by capillary gas chromatography with a nitrogen-phosphorous detector. The mean (median) and range of alprazolam concentrations in blood from impaired drivers (n = 773) were 0.08 mg/L (0.05 mg/L) and 0.02-3.9 mg/L, respectively. Many traffic offenders had co-ingested ethanol (13%), amphetamine (46%), cannabis (32%), or heroin (14%), as well as other drugs. In deaths attributed to drug intoxication, the mean (median) and range of alprazolam concentrations in blood (n = 438) were 0.10 mg/L (0.06 mg/L) and 0.02-1.6 mg/L, respectively, which were not much different from other causes of death (n = 278); 0.08 mg/L (0.05 mg/L) and 0.02-0.9 mg/L. Median concentrations of alprazolam in blood from living and deceased persons did not seem to depend on the number of co-ingested substances. The result of this pharmacoepidemiological study suggests that alprazolam is a fairly innocent drug when used as monotherapy, but toxicity problems arise when co-ingested with illicit drugs and/or psychoactive medication.
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Affiliation(s)
- Alan Wayne Jones
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
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41
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Bu J, Zhan C, Huang Y, Shen B, Zhuo X. Distinguishing Heroin Abuse from Codeine Administration in the Urine of Chinese People by UPLC-MS-MS. J Anal Toxicol 2013; 37:166-74. [DOI: 10.1093/jat/bks093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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