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Castle JW, Syrjanen R, Di Rago M, Schumann JL, Greene SL, Glowacki LL, Gerostamoulos D. Identification of clobromazolam in Australian emergency department intoxications using data-independent high-resolution mass spectrometry and the HighResNPS.com database. J Anal Toxicol 2024; 48:273-280. [PMID: 38459915 DOI: 10.1093/jat/bkae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/26/2023] [Accepted: 02/13/2024] [Indexed: 03/11/2024] Open
Abstract
The proliferation of novel psychoactive substances (NPSs) continues to challenge toxicology laboratories. In particular, the United Nations Office on Drugs and Crime considers designer benzodiazepines to be a current primary threat among all NPSs. Herein, we report detection of a new emerging designer benzodiazepine, clobromazolam, using high-resolution mass spectrometry and untargeted data acquisition in combination with a "suspect screening" method built from the crowd-sourced HighResNPS.com database. Our laboratory first detected clobromazolam in emergency department presenting intoxications included within the Emerging Drugs Network of Australia-Victoria project in the state of Victoria, Australia, from April 2022 to March 2023. Clobromazolam was the most frequent designer benzodiazepine detected in this cohort (100/993 cases, 10%). No patients reported intentional administration of clobromazolam, although over half reported exposure to alprazolam, which was detected in only 7% of cases. Polydrug use was prevalent (98%), with phenazepam (45%), methylamphetamine (71%) and other benzodiazepines (60%) most frequently co-detected. This is the first case series published in the literature concerning clobromazolam in clinical patients. The identification of clobromazolam in patients presenting to emergency departments in Victoria demonstrates how high-resolution mass spectrometry coupled with the HighResNPS.com database can be a valuable tool to assist toxicology laboratories in keeping abreast of emerging psychoactive drug use.
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Affiliation(s)
- Jared W Castle
- Department of Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Rebekka Syrjanen
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia
| | - Matthew Di Rago
- Department of Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Jennifer L Schumann
- Department of Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Monash Addiction Research Centre, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia
| | - Shaun L Greene
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Austin Health, Emergency Department, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia
- Department of Critical Care, The University of Melbourne, Melbourne Medical School, Grattan Street, Parkville, VIC 3010, Australia
| | - Linda L Glowacki
- Department of Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Dimitri Gerostamoulos
- Department of Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
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Akimova VD, Barsegyan SS, Pleteneva TV. [Personalized character of toxic effects through mass nonlethal poisoning by phenazepam and other psychoactive substances]. Sud Med Ekspert 2024; 67:47-55. [PMID: 38353015 DOI: 10.17116/sudmed20246701147] [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: 02/16/2024]
Abstract
Over several months, 14 people were admitted in 6 hospitals with severe symptoms of intoxication with psychoactive substances as a result of mass poisoning. All symptoms occurred after taking a drink that contained crushed phenazepam tablets. Samples of blood (n=10) and urine (n=6) taken from 14 sufferers for forensic, chemical and toxicological examination were analyzed using the HPLC-MS/MS method. Phenazepam was detected in the biomaterial of all 14 patients. Other psychoactive substances (baclofen, pregabalin, chlorprothixene, chlorpromazine, phenibut, tramadol, diazepam), narcotic substances and ethanol were also found in the sufferers. The phenazepam concentration in the blood was in the range of 109.75-786.50 ng/ml, in the urine - 8.97-101.28 ng/ml. The pharmacokinetic and toxicokinetic characteristics of toxicants as well as additional factors characterizing the phenotype of the sufferer in addition to drug's content in the biological material must be taken into account to determine the toxicity level of phenazepam against the background of combined action with other psychoactive substances.
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Affiliation(s)
- V D Akimova
- Russian Center of Forensic Medical Expertise, Moscow, Russia
| | - S S Barsegyan
- Russian Center of Forensic Medical Expertise, Moscow, Russia
- Peoples' Friendship University of Russia, Moscow, Russia
| | - T V Pleteneva
- Serbsky Federal Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
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Wu D, Fu L. Recent findings and advancements in the detection of designer benzodiazepines: a brief review. Arh Hig Rada Toksikol 2023; 74:224-231. [PMID: 38146763 PMCID: PMC10750316 DOI: 10.2478/aiht-2023-74-3771] [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] [Received: 08/01/2023] [Revised: 08/01/2023] [Accepted: 11/01/2023] [Indexed: 12/27/2023] Open
Abstract
This review article takes a closer look at a new class of psychoactive substances called designer benzodiazepines (DBZs) and the challenges of their detection. These are adinazolam, clonazolam, deschloroetizolam, diclazepam, etizolam, flualprazolam, flubromazepam, flubromazolam, phenazepam, and pyrazolam. They are central nervous system depressants and sedatives that can cause psychomotor impairment and increase the overdose risk when combined with other sedatives. DBZs undergo phase I and II metabolism similar to traditional benzodiazepines, but their specific metabolic pathways and the influence of genetic polymorphisms are yet to be clarified. Advances in liquid chromatography-tandem mass spectrometry (LC-MS/MS) have enhanced the method's sensitivity for DBZs and their metabolites in biological samples and coupled with improved blood sampling methods require less blood for drug monitoring. Further research should focus on elucidating their pharmacokinetic properties and metabolism in humans, especially in view of genetic polymorphisms and drug interactions that could inform clinical treatment choices. Even though we have witnessed important advances in DBZ detection and measurement, further refinements are needed to expand the scope of detectable DBZs and their metabolites. All this should help toxicological research to better identify and characterise the risks of chronic and polydrug abuse and facilitate clinical, forensic, and regulatory responses to this growing issue.
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Affiliation(s)
- Dihua Wu
- Hangzhou Dianzi University College of Materials and Environmental Engineering, Hangzhou, China
| | - Li Fu
- Hangzhou Dianzi University College of Materials and Environmental Engineering, Hangzhou, China
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Ritvo AD, Foster DE, Huff C, Finlayson AJR, Silvernail B, Martin PR. Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLoS One 2023; 18:e0285584. [PMID: 37384788 PMCID: PMC10309976 DOI: 10.1371/journal.pone.0285584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/27/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Acute benzodiazepine withdrawal has been described, but literature regarding the benzodiazepine-induced neurological injury that may result in enduring symptoms and life consequences is scant. OBJECTIVE We conducted an internet survey of current and former benzodiazepine users and asked about their symptoms and adverse life events attributed to benzodiazepine use. METHODS This is a secondary analysis of the largest survey ever conducted with 1,207 benzodiazepine users from benzodiazepine support groups and health/wellness sites who completed the survey. Respondents included those still taking benzodiazepines (n = 136), tapering (n = 294), or fully discontinued (n = 763). RESULTS The survey asked about 23 specific symptoms and more than half of the respondents who experienced low energy, distractedness, memory loss, nervousness, anxiety, and other symptoms stated that these symptoms lasted a year or longer. These symptoms were often reported as de novo and distinct from the symptoms for which the benzodiazepines were originally prescribed. A subset of respondents stated that symptoms persisted even after benzodiazepines had been discontinued for a year or more. Adverse life consequences were reported by many respondents as well. LIMITATIONS This was a self-selected internet survey with no control group. No independent psychiatric diagnoses could be made in participants. CONCLUSIONS Many prolonged symptoms subsequent to benzodiazepine use and discontinuation (benzodiazepine-induced neurological dysfunction) have been shown in a large survey of benzodiazepine users. Benzodiazepine-induced neurological dysfunction (BIND) has been proposed as a term to describe symptoms and associated adverse life consequences that may emerge during benzodiazepine use, tapering, and continue after benzodiazepine discontinuation. Not all people who take benzodiazepines will develop BIND and risk factors for BIND remain to be elucidated. Further pathogenic and clinical study of BIND is needed.
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Affiliation(s)
- Alexis D. Ritvo
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - D. E. Foster
- Benzodiazepine Action Work Group, Colorado Consortium for Prescription Drug Abuse Prevention, Aurora, Colorado, United States of America
| | - Christy Huff
- Benzodiazepine Information Coalition, Midvale, Utah, United States of America
| | - A. J. Reid Finlayson
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Bernard Silvernail
- Alliance for Benzodiazepine Best Practices, Portland, Oregon, United States of America
| | - Peter R. Martin
- Department of Psychiatry and Behavioral Sciences and Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Degreef M, Berry EM, Covaci A, Maudens KE, van Nuijs AL. Qualitative and semi-quantitative screening of selected psychoactive substances in blood: Usefulness of liquid chromatography – triple quadrupole and quadrupole time-of-flight mass spectrometry in routine toxicological analyses. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1206:123279. [DOI: 10.1016/j.jchromb.2022.123279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/15/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
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Characteristics of fatal 'novel' benzodiazepine toxicity in Australia. Forensic Sci Int 2021; 331:111140. [PMID: 34894611 DOI: 10.1016/j.forsciint.2021.111140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The study aimed to determine: 1. The characteristics of all recorded cases of fatal drug poisoning involving 'novel' benzodiazepines (NBZDs) in Australia; 2. The toxicology of cases; and 3. The major autopsy findings. METHODS Retrospective study of all deaths due to drug toxicity in Australia in which NBZDs were present in blood toxicology, retrieved from the National Coronial Information System (2000-2021). Information was collected on case characteristics, toxicology and major organ pathology. RESULTS A total of 40 cases were identified, the first occurring in 2015, with a median age of 26.5 years and 87.5% being male. Death was due to accidental toxicity in 92.5% of cases. There were extensive histories of substance use problems (80.0%) and mental health problems (32.5%). Etizolam was the most common NBZD (87.5%), followed by flubromazolam (15.0%), with other NBZDs detected in 20.0% (delorazepam, diclazepam, flualprazolam, flubromazepam, lormetazepam). Multiple NBZDs were present in 27.5%. Other drugs were present in 97.5%, most commonly opioids (70.0%), registered benzodiazepines (62.5%), psychostimulants (45.0%) and gabapentinoids (32.5%). A CNS depressant other than a NBZD was detected in 95.0% (n = 38). Autopsies were conducted and available for 30 cases, with pulmonary oedema (76.7%, n = 23), aspiration of vomitus (46.7%, n = 14) and acute bronchopneumonia (36.7%, n = 11) the most common diagnoses. CONCLUSIONS The 'typical' NBZD-related death was a young male who died due to accidental toxicity. Deaths most frequently involved etizolam and multiple substances, particularly depressants.
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Designer Benzodiazepines: A Review of Toxicology and Public Health Risks. Pharmaceuticals (Basel) 2021; 14:ph14060560. [PMID: 34208284 PMCID: PMC8230725 DOI: 10.3390/ph14060560] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022] Open
Abstract
The rising use of designer benzodiazepines (DBZD) is a cat-and-mouse game between organized crime and law enforcement. Non-prohibited benzodiazepines are introduced onto the global drug market and scheduled as rapidly as possible by international authorities. In response, DBZD are continuously modified to avoid legal sanctions and drug seizures and generally to increase the abuse potential of the DBZD. This results in an unpredictable fluctuation between the appearance and disappearance of DBZD in the illicit market. Thirty-one DBZD were considered for review after consulting the international early warning database, but only 3-hydroxyphenazepam, adinazolam, clonazolam, etizolam, deschloroetizolam, diclazepam, flualprazolam, flubromazepam, flubromazolam, meclonazepam, phenazepam and pyrazolam had sufficient data to contribute to this scoping review. A total of 49 reports describing 1 drug offense, 2 self-administration studies, 3 outpatient department admissions, 44 emergency department (ED) admissions, 63 driving under the influence of drugs (DUID) and 141 deaths reported between 2008 and 2021 are included in this study. Etizolam, flualprazolam flubromazolam and phenazepam were implicated in the majority of adverse-events, drug offenses and deaths. However, due to a general lack of knowledge of DBZD pharmacokinetics and toxicity, and due to a lack of validated analytical methods, total cases are much likely higher. Between 2019 and April 2020, DBZD were identified in 48% and 83% of postmortem and DUID cases reported to the UNODC, respectively, with flualprazolam, flubromazolam and etizolam as the most frequently detected substances. DBZD toxicology, public health risks and adverse events are reported.
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9
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Degreef M, Vits L, Berry EM, Maudens KEK, van Nuijs ALN. Quantification of 54 Benzodiazepines and Z-Drugs, Including 20 Designer Ones, in Plasma. J Anal Toxicol 2021; 45:141-153. [PMID: 32507898 DOI: 10.1093/jat/bkaa059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 02/07/2023] Open
Abstract
Benzodiazepines are widely used in the treatment of sleep and anxiety disorders, as well as epileptic seizures and alcohol withdrawal because of their broad therapeutic index and low cost. Due to their central nervous system depressant effects they are also often implicated in traffic accidents and drug-related intoxications. With an increasing number of designer benzodiazepines used in a recreational setting, there is a need for analytical methods to be able to quantify both the prescribed and designer benzodiazepines. A liquid chromatography-triple quadrupole mass spectrometry method was developed for the quantification of 34 prescribed and 20 designer benzodiazepines in plasma. Different sample preparation strategies, including protein precipitation, liquid-liquid extraction, solid-phase extraction and mini-QuEChERS, were tested. The best recoveries for all compounds of interest were obtained with a liquid-liquid extraction using methyl-tertiary-butyl-ether and 500 μL plasma. The method was fully validated according to the European Medicines Agency guidelines for all compounds, except pivoxazepam, which is included for qualitative purposes only. In-sample stability issues were observed for cloxazolam, both at ambient temperature and during long-term storage at -20°C. Due to the large number of compounds included, the simple and time-efficient sample preparation and the relatively inexpensive instrumentation used, the presented method can be readily implemented in both therapeutic drug monitoring and forensic analyses.
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Affiliation(s)
- Maarten Degreef
- Toxicological Centre, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
| | - Lore Vits
- Toxicological Centre, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
| | - Eleanor M Berry
- Toxicological Centre, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
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Heide G, Høiseth G, Middelkoop G, Øiestad ÅML. Blood Concentrations of Designer Benzodiazepines: Relation to Impairment and Findings in Forensic Cases. J Anal Toxicol 2020; 44:905-914. [PMID: 32369173 PMCID: PMC7733327 DOI: 10.1093/jat/bkaa043] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The use of designer benzodiazepines appears to be increasing in many countries, but data concerning blood concentrations are scarce, making interpretation of concentrations difficult. The aim of this study was to report blood concentrations of clonazolam, diclazepam, etizolam, flualprazolam, flubromazepam, flubromazolam and phenazepam and to investigate the relationship between blood concentrations and impairment. The concentration data are from blood samples collected from living cases (apprehended drivers and other drug offences) and medico-legal autopsies. The blood samples were analysed for the seven designer benzodiazepines mentioned above by ultra high performance liquid chromatography–tandem mass spectrometry. Positive cases from between 1 June 2016 and 30 September 2019 were included. Blood concentrations and the conclusion from a clinical test of impairment (when available) are reported. The presented seven benzodiazepines were detected in a total of 575 cases, where 554 of these cases concerned apprehended drivers or other criminal offenders. The number of findings and the median (range) concentrations were as follows: clonazolam, n = 22, 0.0041 mg/L (0.0017–0.053 mg/L); diclazepam, n = 334, 0.0096 mg/L (0.0016–0.25 mg/L); etizolam, n = 40, 0.054 mg/L (0.015–0.30 mg/L); flualprazolam, n = 10, 0.0080 mg/L (0.0033–0.056 mg/L); flubromazepam, n = 5, 0.037 mg/L (0.0070–0.70 mg/L); flubromazolam, n = 20, 0.0056 mg/L (0.0004–0.036 mg/L); and phenazepam, n = 138, 0.022 mg/L (0.0018–0.85 mg/L). A designer benzodiazepine was the only drug detected with relevance for impairment in 25 of the 554 living cases. The physician concluded with impairment in 19 of the 25 cases. Most of the concentrations in these cases were relatively similar to or higher than the median reported concentrations. The most frequent other drugs detected were amphetamine, tetrahydrocannabinol, clonazepam and methamphetamine. The presented blood concentrations can be helpful with the interpretation of cases involving one or more of these seven benzodiazepines. The results indicate that concentrations commonly observed in forensic cases are associated with impairment.
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Affiliation(s)
- Gunhild Heide
- Department of Forensic Sciences, Oslo University Hospital, 0424 Oslo, Norway
| | - Gudrun Høiseth
- Department of Forensic Sciences, Oslo University Hospital, 0424 Oslo, Norway.,Center for Psychopharmacology, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Gerrit Middelkoop
- Department of Forensic Sciences, Oslo University Hospital, 0424 Oslo, Norway
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Demin KA, Lakstygal AM, Chernysh MV, Krotova NA, Taranov AS, Ilyin NP, Seredinskaya MV, Tagawa N, Savva AK, Mor MS, Vasyutina ML, Efimova EV, Kolesnikova TO, Gainetdinov RR, Strekalova T, Amstislavskaya TG, de Abreu MS, Kalueff AV. The zebrafish tail immobilization (ZTI) test as a new tool to assess stress-related behavior and a potential screen for drugs affecting despair-like states. J Neurosci Methods 2020; 337:108637. [PMID: 32081675 DOI: 10.1016/j.jneumeth.2020.108637] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Affective disorders, especially depression and anxiety, are highly prevalent, debilitating mental illnesses. Animal experimental models are a valuable tool in translational affective neuroscience research. A hallmark phenotype of clinical and experimental depression, the learned helplessness, has become a key target for 'behavioral despair'-based animal models of depression. The zebrafish (Danio rerio) has recently emerged as a promising novel organism for affective disease modeling and CNS drug screening. Despite being widely used to assess stress and anxiety-like behaviors, there are presently no clear-cut despair-like models in zebrafish. NEW METHOD Here, we introduce a novel behavioral paradigm, the zebrafish tail immobilization (ZTI) test, as a potential tool to assess zebrafish despair-like behavior. Conceptually similar to rodent 'despair' models, the ZTI protocol involves immobilizing the caudal half of the fish body for 5 min, leaving the cranial part to move freely, suspended vertically in a small beaker with water. RESULTS To validate this model, we used exposure to low-voltage electric shock, alarm pheromone, selected antidepressants (sertraline and amitriptyline) and an anxiolytic drug benzodiazepine (phenazepam), assessing the number of mobility episodes, time spent 'moving', total distance moved and other activity measures of the cranial part of the body, using video-tracking. Both electric shock and alarm pheromone decreased zebrafish activity in this test, antidepressants increased it, and phenazepam was inactive. Furthermore, a 5-min ZTI exposure increased serotonin turnover, elevating the 5-hydroxyindoleacetic acid/serotonin ratio in zebrafish brain, while electric shock prior to ZTI elevated both this and the 3,4-dihydroxyphenylacetic acid/dopamine ratios. In contrast, preexposure to antidepressants sertraline and amitriptyline lowered both ratios, compared to the ZTI test-exposed fish. COMPARISON WITH EXISTINGMETHOD(S) The ZTI test is the first despair-like experimental model in zebrafish. CONCLUSIONS Collectively, this study suggests the ZTI test as a potentially useful protocol to assess stress-/despair-related behaviors, potentially relevant to CNS drug screening and behavioral phenotyping of zebrafish.
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Affiliation(s)
- Konstantin A Demin
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia.
| | - Anton M Lakstygal
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia; Laboratory of Preclinical Bioscreening, Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of Russian Federation, Pesochny, Russia
| | - Maria V Chernysh
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Natalia A Krotova
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Aleksandr S Taranov
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Nikita P Ilyin
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Maria V Seredinskaya
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Natsuki Tagawa
- Department of Biophysics and Biochemistry, Graduate School of Science, University of Tokyo, Tokyo, Japan
| | - Anna K Savva
- Laboratory of Insect Biopharmacology and Immunology, Faculty of Biology, St. Petersburg State University, St. Petersburg, Russia
| | - Mikael S Mor
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Marina L Vasyutina
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | - Evgeniya V Efimova
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Tatyana O Kolesnikova
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Raul R Gainetdinov
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Tatyana Strekalova
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Maastricht University, Maastricht, The Netherlands; Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | | | - Murilo S de Abreu
- Bioscience Institute, University of Passo Fundo, Passo Fundo, Brazil
| | - Allan V Kalueff
- School of Pharmacy, Southwest University, Chongqing, China; Ural Federal University, Ekaterinburg, Russia.
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Abstract
Background: Studies on prevalence or the therapy of dementia are rare or non-existent in Russia. Objective: The purpose of this study was to analyze the prescription patterns of antidementia therapy in Russia in 2018. Methods: This retrospective cross-sectional study was based on the IQVIA Russia LRx database, which covers approximately 11% of all patients enrolled in federal or regional reimbursement state healthcare programs. We descriptively analyzed the proportions of patients treated with antidementia drugs, antipsychotics, antidepressants, and benzodiazepines. Results: A total of 12,051 dementia patients were available for analysis. Of those, 6,394 patients had a vascular dementia (VaD) diagnosis, while 3,413 were diagnosed with dementia in other diseases (DOD), 1,128 with Alzheimer’s disease (AD), and 1,116 with unspecified dementia (UD). The therapy with the highest patient proportion was antipsychotics, with 74% of VaD patients, 73% of UD patients, and 47% of DOD patients receiving these drugs. The proportion of patients treated with antidementia drugs was 68% in AZ, 56% in VaD, 45% in UD, and only 9% in DOD. Antidepressants were a relatively rare therapy in dementia patients (between 4% and 12%), and 30% of DOD patients received benzodiazepines, while the proportions of patients receiving this therapy class in other dementias was low (7–10%). Most patients were treated with old-generation drugs. Conclusion: The proportion of older drugs prescribed in Russia is higher than in Western Europe, which may likely be due to their low prices, resulting in a higher chance for successful health insurance reimbursement claims.
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Orsolini L, Corkery JM, Chiappini S, Guirguis A, Vento A, De Berardis D, Papanti D, Schifano F. 'New/Designer Benzodiazepines': An Analysis of the Literature and Psychonauts' Trip Reports. Curr Neuropharmacol 2020; 18:809-837. [PMID: 31933443 PMCID: PMC7569319 DOI: 10.2174/1570159x18666200110121333] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/08/2019] [Accepted: 01/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND NPS belonging to the benzodiazepine (BZD) class, e.g., 'legal/designer BZDs'/'research chemicals', have recently emerged in the drug (mainly online/virtual) market. OBJECTIVE While certain NPS belonging to the BZD class possess pharmacological profiles similar to controlled pharmaceutical BZDs, clinical and pharmacological profiles of current emerging BZDs are still not well-described. Therefore, there is a need to increase clinicians'/public health knowledge/awareness, to incentive harm reduction strategies. METHOD A comprehensive overview was carried out by using the EMCDDA/EDND database regularly monitored by our research team, by specifically looking at the 'new BZDs' so far notified. Furthermore, given the limitation of peer-reviewed data published so far, a nonparticipant multilingual qualitative netnographic study was conducted to obtain further clinical/pharmacological/ toxicological data, including psychonauts' online trip reports. RESULTS First designer BZDs appeared as NPS around 2007. So far, 29 designer BZDs have been notified to the EMCDDA, being some of them extremely powerful, also at lower dosages. They are sold as tablets/powder/pellets/capsules/blotters/liquids, at very affordable prices, and variably administered. Some are also sold on the illicit drugmarket as counterfeit forms of traditional BZDs or as either adulterants or diluents in heroin or other synthetic opioids/cannabinoids. Nowadays, there is no guarantee of the quality of designer BZDs composition/purification and, hence, most NPS consumers may be inadvertently exposed to unsafe and harmful compounds. CONCLUSION Given the limited information on their pharmacology/toxicity, variations in dosage, onset of effects, combination of substances, potency, and general patient or individual variability, the concomitant use of these substances with other drugs entails several and unpredictable risks.
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Affiliation(s)
- Laura Orsolini
- Address correspondence to this author at the Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, Herts, UK; Villa Jolanda Hospital, Neomesia Mental Health, Villa Jolanda, Italy; Polyedra, Teramo, Italy; Tel: (+39) 392 3244643; E-mail:
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Zawilska JB, Wojcieszak J. An expanding world of new psychoactive substances—designer benzodiazepines. Neurotoxicology 2019; 73:8-16. [DOI: 10.1016/j.neuro.2019.02.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 01/06/2023]
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15
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Greenblatt HK, Greenblatt DJ. Designer Benzodiazepines: A Review of Published Data and Public Health Significance. Clin Pharmacol Drug Dev 2019; 8:266-269. [PMID: 30730611 DOI: 10.1002/cpdd.667] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Kostev K, Osina G, Konrad M. Treatment patterns of patients with schizophrenia based on the data from 44,836 outpatients in Russia. HEART AND MIND 2019. [DOI: 10.4103/hm.hm_73_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Švidrnoch M, Boráňová B, Tomková J, Ondra P, Maier V. Simultaneous determination of designer benzodiazepines in human serum using non-aqueous capillary electrophoresis – Tandem mass spectrometry with successive multiple ionic – Polymer layer coated capillary. Talanta 2018; 176:69-76. [DOI: 10.1016/j.talanta.2017.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/30/2017] [Accepted: 08/02/2017] [Indexed: 01/07/2023]
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18
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Waters L, Manchester KR, Maskell PD, Haegeman C, Haider S. The use of a quantitative structure-activity relationship (QSAR) model to predict GABA-A receptor binding of newly emerging benzodiazepines. Sci Justice 2017; 58:219-225. [PMID: 29685303 DOI: 10.1016/j.scijus.2017.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/13/2017] [Accepted: 12/16/2017] [Indexed: 02/06/2023]
Abstract
The illicit market for new psychoactive substances is forever expanding. Benzodiazepines and their derivatives are one of a number of groups of these substances and thus far their number has grown year upon year. For both forensic and clinical purposes it is important to be able to rapidly understand these emerging substances. However as a consequence of the illicit nature of these compounds, there is a deficiency in the pharmacological data available for these 'new' benzodiazepines. In order to further understand the pharmacology of 'new' benzodiazepines we utilised a quantitative structure-activity relationship (QSAR) approach. A set of 69 benzodiazepine-based compounds was analysed to develop a QSAR training set with respect to published binding values to GABAA receptors. The QSAR model returned an R2 value of 0.90. The most influential factors were found to be the positioning of two H-bond acceptors, two aromatic rings and a hydrophobic group. A test set of nine random compounds was then selected for internal validation to determine the predictive ability of the model and gave an R2 value of 0.86 when comparing the binding values with their experimental data. The QSAR model was then used to predict the binding for 22 benzodiazepines that are classed as new psychoactive substances. This model will allow rapid prediction of the binding activity of emerging benzodiazepines in a rapid and economic way, compared with lengthy and expensive in vitro/in vivo analysis. This will enable forensic chemists and toxicologists to better understand both recently developed compounds and prediction of substances likely to emerge in the future.
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Affiliation(s)
- Laura Waters
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK.
| | | | - Peter D Maskell
- School of Science, Engineering and Technology, Abertay University, Dundee, UK
| | | | - Shozeb Haider
- School of Pharmacy, University College London, London, UK
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Tomková J, Švidrnoch M, Maier V, Ondra P. Analysis of selected designer benzodiazepines by ultra high performance liquid chromatography with high-resolution time-of-flight mass spectrometry and the estimation of their partition coefficients by micellar electrokinetic chromatography. J Sep Sci 2017; 40:2037-2044. [DOI: 10.1002/jssc.201700069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Jana Tomková
- Department of Forensic Medicine and Medical Law; Faculty Hospital; Olomouc Czech Republic
| | - Martin Švidrnoch
- Department of Analytical Chemistry; Regional Centre of Advanced Technologies and Materials, Faculty of Science; Palacky University in Olomouc; Olomouc Czech Republic
| | - Vítězslav Maier
- Department of Analytical Chemistry; Regional Centre of Advanced Technologies and Materials, Faculty of Science; Palacky University in Olomouc; Olomouc Czech Republic
| | - Peter Ondra
- Department of Forensic Medicine and Medical Law; Faculty Hospital; Olomouc Czech Republic
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Kintz P, Jamey C, Ameline A, Richeval C, Raul JS. Characterization of metizolam, a designer benzodiazepine, in alternative biological specimens. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2016.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Pettersson Bergstrand M, Helander A, Beck O. Development and application of a multi-component LC–MS/MS method for determination of designer benzodiazepines in urine. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1035:104-110. [DOI: 10.1016/j.jchromb.2016.08.047] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/22/2016] [Accepted: 08/27/2016] [Indexed: 11/24/2022]
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22
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Kintz P, Richeval C, Jamey C, Ameline A, Allorge D, Gaulier JM, Raul JS. Detection of the designer benzodiazepine metizolam in urine and preliminary data on its metabolism. Drug Test Anal 2016; 9:1026-1033. [PMID: 27671107 DOI: 10.1002/dta.2099] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/24/2016] [Accepted: 09/24/2016] [Indexed: 12/27/2022]
Abstract
Designer benzodiazepines provide an attractive alternative to prescribed benzodiazepines for abuse purposes as they are readily available via the Internet without control. Metizolam was ordered via the Internet and a 2 mg blue tablet was orally administered to a 54-year-old man. Urine samples were collected over 6 days in polypropylene tubes. After liquid/liquid extraction at pH 9.5, metizolam was analyzed by ultra-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (UPLC-ESI-MS/MS) using a standard method devoted to benzodiazepines, and ions transitions, at m/z 328.9 > 275.0 and 328.9 > 300.0. Metizolam was detectable in hydrolyzed urine during the 46-h period, with concentrations always lower than 11 ng/mL. About 0.3% of the initial dose was excreted in urines as total unchanged metizolam during the first 24 h. The most relevant potential CYP- and UGT-dependent metabolites of metizolam were investigated in vitro using human liver microsome incubation and, subsequently, liquid chromatography coupled with quadrupole-time of flight mass spectrometry (UHPLC-Q-TOF-MS) analysis. Three mono-hydroxylated metabolites were produced including a hydroxylation compound at the 2-ethyl moiety of metizolam (M1) as quantitatively main metabolite, and a N-hydroxymetiazolam (M2). The structure of the third metabolite (M3) could not be elucidated because of a too low experimental production rate. Two authentic urine samples were analyzed using the same analytical method to search for metabolites of metizolam. M1, together with its glucuronide (M1-Glu), and M2 were observed in urine at the 8 h mark, whereas only M1 and M1-Glu were still detected in urine at 30 h post administration. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Pascal Kintz
- X-Pertise Consulting, Oberhausbergen, France.,Institut de medicine légale, Strasbourg, France
| | - Camille Richeval
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France.,Univ. Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | | | | | - Delphine Allorge
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France.,Univ. Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | - Jean-Michel Gaulier
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France.,Univ. Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
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Lim WJL, Yap ATW, Mangudi M, Koh HB, Tang ASY, Chan KB. Detection of phenazepam in illicitly manufactured Erimin 5 tablets. Drug Test Anal 2016; 9:293-305. [PMID: 27390251 DOI: 10.1002/dta.1981] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 03/22/2016] [Accepted: 03/25/2016] [Indexed: 11/12/2022]
Abstract
A validated ultra-high-performance liquid chromatographic (UHPLC) method was used to determine the phenazepam dosage in clandestinely produced Erimin 5 tablets. Tablets from five different seizures submitted to the laboratory in 2013 were found to have a dosage of about 2.4 milligrams. The measurement uncertainty of the assay was estimated to be 3.2 % (relative) at a coverage factor of k=2. As an adjunct study the dyes in the tablets from several seizures were determined by thin-layer chromatography (TLC) for future comparative studies.
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Affiliation(s)
- Wendy J L Lim
- Illicit Drugs Laboratory, Illicit Drugs Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Angeline T W Yap
- Illicit Drugs Laboratory, Illicit Drugs Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Merula Mangudi
- Illicit Drugs Laboratory, Illicit Drugs Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - H B Koh
- Illicit Drugs Laboratory, Illicit Drugs Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Angeline S Y Tang
- Illicit Drugs Laboratory, Illicit Drugs Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - K B Chan
- Illicit Drugs Laboratory, Illicit Drugs Division, Applied Sciences Group, Health Sciences Authority, Singapore
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Sedative-hypnotics are widely abused by drivers apprehended for driving under the influence of drugs. Ther Drug Monit 2016; 37:339-46. [PMID: 25254415 DOI: 10.1097/ftd.0000000000000138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sedative-hypnotics are commonly encountered in drivers apprehended for driving under the influence of drugs (DUID). Previous research has mainly concentrated on the residual effects of the drugs. METHODS In this study, the extent of sleep medication use and abuse among drivers apprehended on suspicion of DUID was assessed. Additionally, the prevalence and concentrations of the drugs, concomitant use of other drugs of abuse, and the age and sex of the drivers positive for the most commonly prescribed sedative-hypnotics (temazepam, midazolam, nitrazepam, zopiclone, and zolpidem) in DUID cases in Finland in 2009 to 2011 were examined. RESULTS Sedative-hypnotics were found in 3155 samples of the 13,248 that were analyzed. Temazepam was present in over half of the cases (57.9%), along with other benzodiazepines such as midazolam (13.1%) and nitrazepam (7.0%) and the non-benzodiazepine hypnotics zopiclone (12.2%) and zolpidem (9.8%). The mean age of the drivers using the studied sedative-hypnotics was 33.5 years. Many of the drivers were polydrug users; concomitant stimulant use was found in nearly half of the cases. Cannabis and alcohol were also very common co-findings. In nearly 20% of the cases, the driver had taken more than 1 of the studied sedative-hypnotics; only 2.5% had no findings other than a single sedative-hypnotic in their blood. The drug use pattern of those positive for zopiclone and zolpidem was somewhat different from that of users of benzodiazepine sedative-hypnotics; their age was higher and the concomitant use of illegal stimulants was markedly less prevalent than among the users of temazepam, midazolam, and nitrazepam. CONCLUSIONS There were very few cases in our study population where the positive sedative-hypnotic finding could have been due to appropriate medical use. The extremely prevalent concomitant use of other psychoactive drugs and the high median serum concentrations of the studied sedative-hypnotics suggest their widespread abuse among apprehended drivers.
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25
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Phenazepam: More information coming in from the cold. J Forensic Leg Med 2015; 36:61-2. [PMID: 26408390 DOI: 10.1016/j.jflm.2015.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 08/20/2015] [Accepted: 08/31/2015] [Indexed: 11/23/2022]
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26
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Crichton ML, Shenton CF, Drummond G, Beer LJ, Seetohul LN, Maskell PD. Analysis of phenazepam and 3-hydroxyphenazepam in post-mortem fluids and tissues. Drug Test Anal 2015; 7:926-36. [PMID: 25847502 DOI: 10.1002/dta.1790] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 11/08/2022]
Abstract
Phenazepam is a benzodiazepine that is predominantly used clinically in the former Soviet states but is being abused throughout the wider world. This study reports the tissue distribution and concentration of both phenazepam and 3-hydroxyphenazepam in 29 cases quantitated by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in a variety of post-mortem fluids (subclavian blood, femoral blood, cardiac blood, urine, vitreous humour) and tissues (thalamus, liver and psoas muscle). In 27 cases, the cause of death was not directly related to phenazepam (preserved (fluoride/oxalate) femoral blood phenazepam concentrations 0.007 mg/L to 0.360 mg/L (median 0.097 mg/L). In two cases, phenazepam was either a contributing factor to, or the certified cause of death (preserved (fluoride/oxalate) femoral blood 0.97 mg/L and 1.64 mg/L). The analysis of phenazepam and 3-hydroxyphenazepam in this study suggests that they are unlikely to be subject to large post-mortem redistribution and that there is no direct correlation between tissues/fluid and femoral blood concentrations. Preliminary investigations of phenazepam stability comparing femoral blood phenazepam concentrations in paired preserved (2.5% fluoride/oxalate) and unpreserved blood show that unpreserved samples show on average a 14% lower concentration of phenazepam and we recommend that phenazepam quantitation is carried out using preserved samples wherever possible.
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Affiliation(s)
- Megan L Crichton
- Centre for Forensic and Legal Medicine, University of Dundee, Dundee, DD1 4HN, Scotland, UK
| | - Catriona F Shenton
- Centre for Forensic and Legal Medicine, University of Dundee, Dundee, DD1 4HN, Scotland, UK
| | - Gail Drummond
- Centre for Forensic and Legal Medicine, University of Dundee, Dundee, DD1 4HN, Scotland, UK
| | - Lewis J Beer
- Centre for Forensic and Legal Medicine, University of Dundee, Dundee, DD1 4HN, Scotland, UK
| | - L Nitin Seetohul
- Centre for Forensic and Legal Medicine, University of Dundee, Dundee, DD1 4HN, Scotland, UK.,Department of Chemical and Forensic Sciences, University of Huddersfield, Huddersfield, UK
| | - Peter D Maskell
- Centre for Forensic and Legal Medicine, University of Dundee, Dundee, DD1 4HN, Scotland, UK.,School of Science and Technology, Nottingham Trent University, Nottingham, UK
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Karinen R, Tuv SS, Rogde S, Peres MD, Johansen U, Frost J, Vindenes V, Øiestad ÅML. Lethal poisonings with AH-7921 in combination with other substances. Forensic Sci Int 2014; 244:e21-4. [DOI: 10.1016/j.forsciint.2014.08.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/14/2014] [Accepted: 08/17/2014] [Indexed: 10/24/2022]
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Delirium induced by a new synthetic legal intoxicating drug: phenazepam. PSYCHOSOMATICS 2014; 56:414-8. [PMID: 25555294 DOI: 10.1016/j.psym.2014.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/17/2014] [Accepted: 05/19/2014] [Indexed: 11/22/2022]
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Moták L, Bayssac L, Taillard J, Sagaspe P, Huet N, Terrier P, Philip P, Daurat A. Naturalistic conversation improves daytime motorway driving performance under a benzodiazepine: a randomised, crossover, double-blind, placebo-controlled study. ACCIDENT; ANALYSIS AND PREVENTION 2014; 67:61-66. [PMID: 24631977 DOI: 10.1016/j.aap.2014.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 02/01/2014] [Accepted: 02/12/2014] [Indexed: 06/03/2023]
Abstract
The adverse effects of benzodiazepines on driving are widely recognised. The aims of this study were both to determine the impact of naturalistic conversation on the driving ability of drivers under a benzodiazepine, and to measure the accuracy of drivers' assessments of the joint effects of the benzodiazepine and conversation. Sixteen healthy male participants (29.69 ± 3.30 years) underwent a randomised, crossover, double-blind, placebo-controlled study with the benzodiazepine lorazepam (2mg). They drove 200 km (125 miles) on a motorway in the morning. We measured two driving ability-related variables (i.e., lane-keeping performance), and collected a set of self-assessed variables (i.e., self-assessment of driving performance) during two 10-min sequences of interest (no conversation vs. conversation). An analysis of variance revealed an interaction whereby lane-keeping performance under lorazepam was worse in the no-conversation condition than in the conversation condition. No such difference was detected under placebo. Pearson's correlation coefficients revealed that self-assessments were (i) not at all predictive of lane-keeping when performed before the drive, but (ii) moderately predictive of lane-keeping performance when performed during or after the drive. We conclude that conversation with a passenger may contribute to safer lane-keeping when driving under a benzodiazepine. Moreover, a degree of awareness may be attained after some experience of driving under the influence of this type of medication.
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Affiliation(s)
- Ladislav Moták
- Laboratoire Cognition, Langues, Langage, Ergonomie (CLLE-LTC), UMR 5263, CNRS, Université de Toulouse Le Mirail, Toulouse, France
| | - Laëtitia Bayssac
- Laboratoire Cognition, Langues, Langage, Ergonomie (CLLE-LTC), UMR 5263, CNRS, Université de Toulouse Le Mirail, Toulouse, France
| | - Jacques Taillard
- Université de Bordeaux, CNRS, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France
| | - Patricia Sagaspe
- Université de Bordeaux, CNRS, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France
| | - Nathalie Huet
- Laboratoire Cognition, Langues, Langage, Ergonomie (CLLE-LTC), UMR 5263, CNRS, Université de Toulouse Le Mirail, Toulouse, France
| | - Patrice Terrier
- Laboratoire Cognition, Langues, Langage, Ergonomie (CLLE-LTC), UMR 5263, CNRS, Université de Toulouse Le Mirail, Toulouse, France
| | - Pierre Philip
- Université de Bordeaux, CNRS, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France
| | - Agnès Daurat
- Laboratoire Cognition, Langues, Langage, Ergonomie (CLLE-LTC), UMR 5263, CNRS, Université de Toulouse Le Mirail, Toulouse, France.
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Daurat A, Sagaspe P, Moták L, Taillard J, Bayssac L, Huet N, Authié C, Mestre D, Philip P. Lorazepam impairs highway driving performance more than heavy alcohol consumption. ACCIDENT; ANALYSIS AND PREVENTION 2013; 60:31-34. [PMID: 24007754 DOI: 10.1016/j.aap.2013.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/26/2013] [Accepted: 08/10/2013] [Indexed: 06/02/2023]
Abstract
While research indicates that benzodiazepine (BZD)-like drugs impair driving performance, it remains unclear (i) how far BZDs affect lane-keeping performance, compared with alcohol and (ii) to what extent this impact can realistically be measured in a simulated environment. To clarify these issues, 16 healthy male drivers who had never previously taken BZDs underwent a randomized, crossover, double-blind, placebo-controlled driving paradigm (with the BZD lorazepam) in both real-world and simulated settings. Two lane-keeping variables, namely inappropriate line crossings (ILCs) and standard deviation of lateral position (SDLP), were recorded during the driving sessions. Analyses revealed that (i) a single lorazepam dose (2 mg given by mouth) caused higher SDLP increases than a blood alcohol concentration of above 0.05%, and that (ii) this BZD effect was amplified in the simulated driving setting, mainly for ILCs. As a consequence, we recommend that physicians be made more aware of BZD-related risks and that researchers make a clear distinction between the effects of BZD intake per se and the impact of simulated driving settings.
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Affiliation(s)
- Agnès Daurat
- UMR 5263 CNRS - EPHE - Toulouse II University, "CLLE-LTC" Laboratory, Toulouse, France.
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Kerrigan S, Mellon MB, Hinners P. Detection of phenazepam in impaired driving. J Anal Toxicol 2013; 37:605-10. [PMID: 24022117 DOI: 10.1093/jat/bkt075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Phenazepam is a potent 1,4-benzodiazepine that has gained notoriety among recreational drug users. First synthesized in Ukraine in the 1970s, it is one of the most commonly prescribed benzodiazepines in Russia and other commonwealth of independent state nations, where it is used therapeutically as a prescription drug. Reports of abuse are widespread and several European countries have taken steps to control its use. However, in the USA, phenazepam is not approved for use by the Food and Drug Administration, nor scheduled under the Federal Controlled Substances Act. Phenazepam is widely available on the Internet, and recreational drug users report a potency 10-fold greater than that of nordiazepam. We report a case of a 24-year-old male driver who was apprehended for impaired driving following a two-vehicle crash. The subject exhibited slurred speech and profound psychomotor impairment. Toxicology testing revealed phenazepam at a concentration of 76 ng/mL in blood, with no other drugs detected. This case report not only demonstrates the potential for adverse traffic safety consequences following the misuse of phenazepam, but also highlights the importance of analytical factors such as immunoassay cutoff concentration, cross-reactivity and comprehensive screening using chromatographic-based techniques for impaired driving investigations.
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Affiliation(s)
- Sarah Kerrigan
- 1 Sam Houston State University Regional Crime Laboratory, The Woodlands, TX 77381, USA
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Uddin MN, Samanidou VF, Papadoyannis IN. Bio-Sample Preparation and Gas Chromatographic Determination of Benzodiazepines--A Review. J Chromatogr Sci 2013; 51:587-98. [DOI: 10.1093/chromsci/bms263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Dargan PI, Davies S, Puchnarewicz M, Johnston A, Wood DM. First reported case in the UK of acute prolonged neuropsychiatric toxicity associated with analytically confirmed recreational use of phenazepam. Eur J Clin Pharmacol 2012; 69:361-3. [PMID: 22843017 DOI: 10.1007/s00228-012-1361-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE There is increasing evidence from around Europe of the availability and misuse of long-acting benzodiazepines such as phenazepam. There is little information on the acute toxicity of these compounds; we describe here a case of analytically confirmed phenazepam-related acute toxicity. CASE REPORT A 42-year-old man with no previous medical or psychiatric history was brought to the Emergency Department by his friends because he had developed prolonged ongoing confusion and disorientation following use of up to three different "legal high" powders. There was no obvious medical cause for this acute confusion and disorientation. His symptoms continued for approximately 60 h after suspected use. Subsequent toxicological analysis of a serum sample confirmed use of phenazepam (concentration 0.49 mg/L); no other drugs were detected during an extensive analytical screening. CONCLUSION This is the second case of analytically confirmed acute toxicity related to phenazepam in Europe. This adds to the scant published information on the acute toxicity of this drug, and will provide healthcare and legislative authorities with further information on which to base advice and consideration of the need for its control.
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Affiliation(s)
- Paul I Dargan
- Clinical Toxicology Service, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
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