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Usman M, Baig Y, Nardiello D, Quinto M. How new nanotechnologies are changing the opioid analysis scenery? A comparison with classical analytical methods. Forensic Sci Res 2024; 9:owae001. [PMID: 38560581 PMCID: PMC10981550 DOI: 10.1093/fsr/owae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/02/2024] [Indexed: 04/04/2024] Open
Abstract
Opioids such as heroin, fentanyl, raw opium, and morphine have become a serious threat to the world population in the recent past, due to their increasing use and abuse. The detection of these drugs in biological samples is usually carried out by spectroscopic and/or chromatographic techniques, but the need for quick, sensitive, selective, and low-cost new analytical tools has pushed the development of new methods based on selective nanosensors, able to meet these requirements. Modern sensors, which utilize "next-generation" technologies like nanotechnology, have revolutionized drug detection methods, due to easiness of use, their low cost, and their high sensitivity and reliability, allowing the detection of opioids at trace levels in raw, pharmaceutical, and biological samples (e.g. blood, urine, saliva, and other biological fluids). The peculiar characteristics of these sensors not only have allowed on-site analyses (in the field, at the crime scene, etc.) but also they are nowadays replacing the gold standard analytical methods in the laboratory, even if a proper method validation is still required. This paper reviews advances in the field of nanotechnology and nanosensors for the detection of commonly abused opioids both prescribed (i.e. codeine and morphine) and illegal narcotics (i.e. heroin and fentanyl analogues).
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Affiliation(s)
- Muhammad Usman
- Narcotic Unit, Punjab Forensic Science Agency, Home Department, Government of The Punjab, Lahore-54000, Pakistan
- Department of Sciences of Agriculture, Food, Natural Resources and Engineering (DAFNE), University of Foggia, I-71122 Foggia, Italy
| | - Yawar Baig
- Narcotic Unit, Punjab Forensic Science Agency, Home Department, Government of The Punjab, Lahore-54000, Pakistan
| | - Donatella Nardiello
- Department of Sciences of Agriculture, Food, Natural Resources and Engineering (DAFNE), University of Foggia, I-71122 Foggia, Italy
| | - Maurizio Quinto
- Department of Sciences of Agriculture, Food, Natural Resources and Engineering (DAFNE), University of Foggia, I-71122 Foggia, Italy
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2
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Gosetti F, Consonni V, Ballabio D, Orlandi ME, Amodio A, Valeria Picci M, Visentin M, Termopoli V. From the Streets to the Judicial Evidence: Determination of Traditional Illicit Substances in Drug Seizures by a Rapid and Sensitive UHPLC-MS/MS-Based Platform. MOLECULES (BASEL, SWITZERLAND) 2022; 28:molecules28010164. [PMID: 36615358 PMCID: PMC9822244 DOI: 10.3390/molecules28010164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
According to the 2021 World Drug Report, around 275 million people use drugs of abuse, and 36 million people suffer from addiction, fostering a thriving market for illicit substances. In Italy, 30,083 people were reported to the Judicial Authority for offenses in violation of the Italian Law D.P.R. 309/1990. These offences are sentenced after a qualitative-quantitative analysis of seized materials. Given the large quantity of seized drugs and the need to perform accurate analytical determinations, Italian forensic laboratories struggle to complete analyses in a short time, delaying the entire reporting process needed to achieve sentencing. For this purpose, an UHPLC-MS/MS-based platform was developed at the University of Milano-Bicocca to support law-enforcement authorities. Software was designed to easily manage street seizure acquisition, documentation registration, and sampling. A sensitive UHPLC-MS/MS method was fully validated for the quantification of the traditional illicit substances (cocaine, heroin, 6-MAM, morphine, amphetamine, methamphetamine, MDMA, ketamine, GHB, GBL, LSD, trans-∆9-THC, and THCA) at the ppb level. The final report is relayed to the Prefecture in 3-4 days, even within 24 h for urgent requests. The platform allows for semi-automatic data handling to minimize erroneous results for an accurate report generation by standardized procedures.
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Affiliation(s)
- Fabio Gosetti
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Piazza della Scienza 1, 20126 Milan, Italy
| | - Viviana Consonni
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Piazza della Scienza 1, 20126 Milan, Italy
| | - Davide Ballabio
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Piazza della Scienza 1, 20126 Milan, Italy
- Correspondence: (D.B.); (V.T.)
| | - Marco Emilio Orlandi
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Piazza della Scienza 1, 20126 Milan, Italy
| | - Angelo Amodio
- Legione Carabinieri Lombardia, Comando Provinciale di Milano Sezione, Investigazioni Scientifiche L.A.S.S., Via V. Monti 58, 20145 Milan, Italy
| | - Maria Valeria Picci
- Gabinetto Regionale di Polizia Scientifica per la Lombardia, Polizia di Stato, Via Fatebenefratelli 11, 20121 Milan, Italy
| | - Marco Visentin
- Gabinetto Regionale di Polizia Scientifica per la Lombardia, Polizia di Stato, Via Fatebenefratelli 11, 20121 Milan, Italy
| | - Veronica Termopoli
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Piazza della Scienza 1, 20126 Milan, Italy
- Correspondence: (D.B.); (V.T.)
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Carfora A, Petrella R, Ambrosio G, Fracassi I, Festinese S, Feola A, Campobasso CP. Toxicological Analysis of Illicit Drugs Seized in Naples (Italy) and First Detection of Synthetic Cannabinoids during COVID-19 Pandemic. Healthcare (Basel) 2022; 10:healthcare10081488. [PMID: 36011145 PMCID: PMC9408475 DOI: 10.3390/healthcare10081488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/31/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022] Open
Abstract
The COVID-19 pandemic has consistently raised the number of drug seizures, in United States as in Europe. The COVID-19 pandemic has also changed the typology of seizures from “more traditional” drugs to New Psychoactive Substances (NPSs), depending on geographical area. In Europe, the most frequent NPSs are synthetic cannabinoids (SCs) and cathinones, nonetheless synthetic opioids and phenethylamines are widely used. The aim of the study is the detection of NPS and other substances of abuse available in the black market, by quali/quantitative methods in LC-MS/MS and GC-MS. From 2018 to 2021, 268 seizures occurred in total and were analyzed by the Forensic Toxicology Laboratory (FTL) of Naples (Italy). The distribution of analyzed seizures over the years is the following: 53 in 2018, 61 in 2019, 89 in 2020 and 65 during the first semester of 2021. Cannabis was the most detected drug both in hashish and marijuana seizures, followed by cocaine > heroine > prescribed drugs > ketamine−amphetamine MDMA. No NPSs were seized until June 2021, when NPSs were found in two different seizures: Case #1 showed a bar of Cannabis resin containing a low level of Δ9THC = 0.57% associated to SC AB-FUBINACA in 4.5%; Case #2 showed a vegetal resinous substance (Δ9THC = 0.27%) with SC 5F-APINACA (4.1%) associated with methadone (1.0%). The detection of NPSs is alarming evidence that can lead to an increase in the risk of overdose or other negative and unpredictable consequences, such as violent or self-harming behavior in unaware users of cannabis derivatives considered of “natural” origin.
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Alawi AI, Dhabbah AM, Morrison C, Ben-Jaber S, AlAngari WA, Bin Jassas M, Badjah‑Hadj‑Ahmed Y. Indirect chiral separation of crystal methamphetamine seized in Saudi Arabia using GC-MS. AUST J FORENSIC SCI 2022. [DOI: 10.1080/00450618.2022.2079720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ali I. Alawi
- Forensic Science Department, King Fahd Security College, Riyadh, Kingdom of Saudi Arabia
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary Life Sciences, University of Glasgow, Glasgow, UK
| | - Abdulrhman M. Dhabbah
- Forensic Science Department, King Fahd Security College, Riyadh, Kingdom of Saudi Arabia
| | - Calum Morrison
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary Life Sciences, University of Glasgow, Glasgow, UK
- Department of Applied Science, School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Glasgow, UK
| | - Sultan Ben-Jaber
- Forensic Science Department, King Fahd Security College, Riyadh, Kingdom of Saudi Arabia
| | - Waleed A. AlAngari
- Poison Control and Forensic Medical Center, Riyadh, Kingdom of Saudi Arabia
| | - Meshal Bin Jassas
- Poison Control and Forensic Medical Center, Riyadh, Kingdom of Saudi Arabia
| | - Yacine Badjah‑Hadj‑Ahmed
- Department of Chemistry, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Varì MR, Ricci G, Cavallo M, Pichini S, Sirignano A, Graziano S. Ketamine: from prescription anaesthetic to New Psychoactive Substance. Curr Pharm Des 2022; 28:1213-1220. [PMID: 35538799 DOI: 10.2174/1381612828666220510115209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/03/2022] [Indexed: 11/22/2022]
Abstract
Discovered in the United States of America (USA) in the 1960s, ketamine was introduced as an anaesthetic drug to specifically replace phencyclidine. Briefly, the substance moved from the medical world to recreational users, since it was discovered that intense psychedelic experiences were obtained with dosages lower than those prescribed for anesthesia. At the end of the 90's, circulated in London nightclubs as a drug itself and as counterfeit 3,4-methylenedioxymethamphetamine tablets. In 1997, the Drug Enforcement Administration (DEA) alerted the United States (US) government to the increasing diffusion of ketamine in American 'clubs', and in 1999, the substance was added to Schedule III of drugs controlled by federal authorities. In 2002, ketamine epidemics moved to Europe, and the European Monitoring Centre for Drugs and Drug Addiction carried out a risk assessment monitoring of the phenomenon. An estimated ninety-nine percent of all global ketamine seizures occurred in Asia. Its growing popularity is due to the fact that this new psychoactive substance is cheaper than other stimulants such as MDMA that the amount used for recreational purposes does not cause respiratory depression and its legal use as a drug makes it widely available for a diversion towards illicit markets. Nevertheless, acute intoxication and several deaths have been related to exclusive ketamine use both in Europe and internationally. Since 2015, there has been and increasing rise of the illicit ketamine market and currently the drug is being used with unprecedented peaks and a consequent significant increase in seizures and clinical cases worldwide.
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Affiliation(s)
- Maria Rosaria Varì
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | | | - Marco Cavallo
- Central Directorate for Antidrug Services, Rome, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | | | - Silvia Graziano
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
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Cutting agents in cocaine: A temporal study of the period 2015-2017 in the Northern Region of Colombia. Forensic Sci Int 2021; 327:110911. [PMID: 34450541 DOI: 10.1016/j.forsciint.2021.110911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/19/2021] [Accepted: 07/13/2021] [Indexed: 11/22/2022]
Abstract
Cocaine is a naturally occurring psychostimulant drug available worldwide. Drug trafficking networks adulterate pure cocaine with cutting agents to increase their earnings. This study presents a descriptive statistical analysis of the cutting agents found in 2118 cocaine samples that were seized in the Northern Region of Colombia (in the period 2015-2017). The data used in this study was drawn from the GC-MS analytical reports of the National Institute of Legal Medicine and Forensic Sciences -Colombia, Northern Region. Results showed diverse cutting agents in seized cocaine samples, from which the most commonly used are caffeine, phenacetin, lidocaine, imidazole and levamisole. In addition, cocaine samples showed different mixtures of the above cutting agents, predominantly caffeine/phenacetin and caffeine/lidocaine/phenacetin mixtures.
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Silvestre A, Basilicata P, Coraggio L, Guadagni R, Simonelli A, Pieri M. Illicit drugs seizures in 2013-2018 and characteristics of the illicit market within the Neapolitan area. Forensic Sci Int 2021; 321:110738. [PMID: 33647570 DOI: 10.1016/j.forsciint.2021.110738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/23/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
The study presents results of toxicological analysis performed on seized material in Neapolitan area in the period from 2013 to 2018. A constancy in THC and heroin percentages is evidenced (%THC ~10% and ~11.5% for marijuana and hashish; heroine: 20-24%), with mean values exceeding the European data. Data on cocaine revealed a constant increment of active principle percentage over the studied period (from 40% in 2013 to ~65% in 2018), with peak of 70% in 2017; also, number of samples exceeding the mean value increased over years. Active principles contents resulted higher than the ones reported in other Italian area ever the same period; marijuana was prevalent on hashish, confirming an Italian trend different from other European countries. A map of the Campania region evidenced two main "storage" districts, one corresponding to the city center and the second located in the northern part. If compared with literature data on the presence of local mafia, these areas are perfectly superimposable to those with the highest risk of homicides, thus confirming the degree of radicalization of local organizations and the relative weight of proceeds from drugs sale. Moreover, such radicalization within the territory seems to be the main reason of the absence of new psychoactive substances among the seized material.
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Affiliation(s)
- A Silvestre
- Department of Advanced Biomedical Science-Legal Medicine Section. University of Naples "Federico II", Naples, Italy
| | - P Basilicata
- Department of Advanced Biomedical Science-Legal Medicine Section. University of Naples "Federico II", Naples, Italy.
| | - L Coraggio
- Department of Economics and Statistics. University of Naples "Federico II", Naples, Italy
| | - R Guadagni
- Department of Advanced Biomedical Science-Legal Medicine Section. University of Naples "Federico II", Naples, Italy
| | - A Simonelli
- Department of Advanced Biomedical Science-Legal Medicine Section. University of Naples "Federico II", Naples, Italy
| | - M Pieri
- Department of Advanced Biomedical Science-Legal Medicine Section. University of Naples "Federico II", Naples, Italy
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8
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Sharif AF, Elsheikh E, Al-Asmari AZ, Gameel DE. Potential Role of Serum S-100β Protein as a Predictor of Cardiotoxicity and Clinical Poor Outcome in Acute Amphetamine Intoxication. Cardiovasc Toxicol 2021; 21:375-386. [PMID: 33423174 DOI: 10.1007/s12012-020-09630-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
Cardio- and neurotoxicity of amphetamines play an important role in worsening morbidity, making the initial evaluation of the patient's status a potentially lifesaving action. The current study hypothesized that the S-100β serum level could predict the severity of acute amphetamine toxicity and the in-hospital outcome. The current study is a prospective cohort study conducted on 77 patients diagnosed with acute amphetamine exposure and referred to Aseer Poison Control Center, Saudi Arabia. The patients admitted to ICU showed significantly higher serum levels of S-100β in comparison to those not admitted (p < 0.05). Moreover, the S-100β level was significantly elevated among patients with prolonged QTc intervals. Receiver-operating characteristic curve of S-100β serum level as an in-hospital outcome predictor showed that at a cutoff value > 0.430 ug/L, the sensitivity of S-100β serum level as severity predictor was 100%, and the specificity was 74.1%. In conclusion, the current study revealed that the S-100β serum level could be used as an outcome predictor in hospital admission cases due to toxic amphetamine exposure and offers an idea about the cardiac and neuronal involvement. This can help select patients who will benefit most from ICU admission and early management and assess the severity of cases in settings where GC-MS is not available.
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Affiliation(s)
- Asmaa F Sharif
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt. .,Clinical Sciences Departement, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia.
| | - Eman Elsheikh
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Internal Medicine Department, King Faisal University, Hofuf, Saudi Arabia
| | - Abdullah Z Al-Asmari
- Poison Control Centers and Medical Chemistry Legitimacy South, Aseer, Saudi Arabia.,Poison Control Center, Aseer, Saudi Arabia
| | - Dina El Gameel
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Poison Control Center, Aseer, Saudi Arabia
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9
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Duarte LO, Ferreira B, Silva GR, Ipólito AJ, de Oliveira MF. Validated green phenyl reversed-phase LC method using ethanol to determine MDMA in seized ecstasy tablets. J LIQ CHROMATOGR R T 2020. [DOI: 10.1080/10826076.2020.1811725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Leandro Oka Duarte
- Departamento de Química, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Bruno Ferreira
- Departamento de Química, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | - Antônio J. Ipólito
- Núcleo de Perícias Criminalísticas, Superintendência da Polícia Técnico Científica, Ribeirão Preto, Brazil
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Mehrpour O, Hoyte C, Amirabadizadeh A, Brent J. Clinical characteristics and time trends of hospitalized methadone exposures in the United States based on the Toxicology Investigators Consortium (ToxIC) case registry: 2010-2017. BMC Pharmacol Toxicol 2020; 21:53. [PMID: 32698849 PMCID: PMC7376634 DOI: 10.1186/s40360-020-00435-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 07/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background Methadone is well known for its long duration of action and propensity for mortality after an overdose. The present research was aimed at evaluating the clinical manifestations and time trends of methadone exposure in patients in US hospitals. Methods We queried the American College of Medical Toxicology’s Toxicology Investigators Consortium case registry for all cases of methadone exposure between January 1, 2010, and December 31, 2017. The collected information included demographic features, clinical presentations, therapeutic interventions, poisoning type (acute, chronic, or acute on chronic), and the reason(s) for exposure. Descriptive data and relative frequencies were used to investigate the participants’ characteristics. Our data analysis was performed using SPSS version 19 and Prism software. The trends and clinical manifestations of methadone poisoning over the time period of the study were specifically investigated. Results Nine hundred and seventy-three patients who met our inclusion criteria, with a mean age of 41.9 ± 16.6 years (range: 11 months-78 years) were analyzed. Five hundred eighty-two (60.2%) were male. The highest rate of methadone poisoning was observed in 2013. There was an increasing rate of methadone exposures in 2010–2013, followed by a decline in 2014–2017. The most common clinical manifestations in methadone-poisoned patients were coma (48.6%) and respiratory depression (33.6%). The in-hospital mortality rate of methadone poisoning was 1.4%. Conclusion ToxIC Registry data showed that inpatient methadone exposures enhanced from 2010 to 2013, after which a reduction occurred in the years 2014 to 2017.
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Affiliation(s)
- Omid Mehrpour
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 1391 Speer Blvd, 777 Bannock St. MC 0180, Denver, CO, 80204, USA. .,Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of of Medical Sciences, Birjand, Iran.
| | - Christopher Hoyte
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 1391 Speer Blvd, 777 Bannock St. MC 0180, Denver, CO, 80204, USA.,Department of Emergency Medicine and Medical Toxicology, University of Colorado Anschutz Medical Campus, University Hospital, Aurora, CO, USA
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of of Medical Sciences, Birjand, Iran.,Cardiovascular Diseases Research Center Birjand University of Medical Sciences, Birjand, Iran
| | - Jeffrey Brent
- School of medicine, University of Colorado, Aurora, CO, USA
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11
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Jones NS, Comparin JH. Interpol review of controlled substances 2016-2019. Forensic Sci Int Synerg 2020; 2:608-669. [PMID: 33385148 PMCID: PMC7770462 DOI: 10.1016/j.fsisyn.2020.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/23/2020] [Indexed: 12/14/2022]
Abstract
This review paper covers the forensic-relevant literature in controlled substances from 2016 to 2019 as a part of the 19th Interpol International Forensic Science Managers Symposium. The review papers are also available at the Interpol website at: https://www.interpol.int/content/download/14458/file/Interpol%20Review%20Papers%202019.pdf.
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Affiliation(s)
- Nicole S. Jones
- RTI International, Applied Justice Research Division, Center for Forensic Sciences, 3040 E. Cornwallis Road, Research Triangle Park, NC, 22709-2194, USA
| | - Jeffrey H. Comparin
- United States Drug Enforcement Administration, Special Testing and Research Laboratory, USA
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12
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Manetti F, Scopetti M, Santurro A, Consoloni L, D'Errico S. Widespread septic embolization in injection drug use mitro-aortic infective endocarditis as a remote cause of death. Int J Legal Med 2020; 134:1345-1351. [PMID: 32367331 DOI: 10.1007/s00414-020-02309-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/22/2020] [Indexed: 01/09/2023]
Abstract
Injection drug use-related infective endocarditis (IDU-IE) assumes peculiar epidemiological, pathogenetic, and prognostic characteristics that allow to consider it a distinct nosological entity, as well as a current problem of considerable social weight. Incidence is reasonably underestimated because diagnosis is often accidental in postmortem examination when drug-related death is suspected. In many cases, postmortem toxicological examinations are negative for acute drug abuse, and findings of infective endocarditis became relevant in the explanation of the mechanism of death. Extracardiac involvement of infective endocarditis is rarely reported as fatal. Fragmentation and embolization of bacterial vegetations can be associated with parenchymal infarcts, systemic spread of the infectious process by formation of an abscess. A case of septic shock as a consequence of the constant bacteremia determined by the continuous proliferation and release of bacteria into the circulation is presented in an injection drug user with left-sided endocarditis and widespread septic embolization. Authors reviewed forensic and medical literature and promote epidemiological value of medical and forensic autopsy. Extracardiac involvement of infective endocarditis may represent a remote and alternative cause of death in injection drug users, and an early diagnosis can be relevant for prognosis. Postmortem examination still represents a valuable opportunity of learning for clinicians and improving diagnostic accuracy with injection drug users. A call for changing of attitudes and practice toward autopsy is finally demanded.
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Affiliation(s)
- Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Lara Consoloni
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy
| | - Stefano D'Errico
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy.
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Verri P, Rustichelli C, Ferrari A, Marchesi F, Baraldi C, Licata M, Vandelli D, Palazzoli F, Potì F, Silingardi E. Seizures of illicit substances for personal use in two Italian provinces: analysis of trends by type and purity from 2008 to 2017. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:41. [PMID: 31533834 PMCID: PMC6751801 DOI: 10.1186/s13011-019-0229-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The use of illicit substances represents one of the most difficult problems to confront in the health system. Drug use is a global problem but is not uniform throughout the world, within the same country and changes over time. Therefore, knowing the illicit substances that are used in a territory is essential to better organize health services in that specific geographical area. To this aim, we analysed 4200 samples confiscated from individuals who held them for personal use by police forces in the Italian provinces of Modena and Reggio Emilia from 2008 to 2017. METHODS The suspected samples were screened by gas-chromatography-mass spectrometry (GC-MS) and by liquid chromatography-tandem mass spectrometry (LC-MS/MS); all samples were subsequently analysed by gas chromatography-flame ionization detector (GC-FID) for quantitative analyses. RESULTS Cannabis was the most seized illicit substance (70.7%). Over the study period, the number of seizures of herb with a high content of Δ9-THC increased. The number of cocaine seizures remained stable (total 16.1%), but the median purity of seized cocaine increased to 75% in 2017. Heroin seizures decreased over time, but the median purity of seized heroin reached 16.8% in 2017. In almost all the years, heroin samples with a purity exceeding the 97.5 percentile were found. Especially from 2014, the range of seized substances increased and started to include synthetic cathinones, phenylethylamines, UR-144, LSD, psilocybe, prescription opioid and hypnotics. In two cases, tramadol together with tropicamide was seized. Most of the seizures involved male subjects and 82% of the seizures were from individuals younger than 35 years of age. CONCLUSIONS The persistence of old illicit drugs and the rapid emergence of new psychoactive substances represented a serious challenge for public health in the studied Italian area. Some useful interventions might be: informing mainly young people about the possible complications of cannabis use; implementing standardized procedures to diagnose and treat cocaine-related emergencies in hospitals; increasing the distribution of naloxone to antagonize possible heroin overdoses; equipping laboratories to be able to identify the new psychoactive substances.
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Affiliation(s)
- Patrizia Verri
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Cecilia Rustichelli
- Department of Life Sciences, University of Modena and Reggio Emilia, via G. Campi, 103, 41125, Modena, Italy.
| | - Anna Ferrari
- Unit of Medical Toxicology, Headache Centre and Drug Abuse; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Filippo Marchesi
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Carlo Baraldi
- School of Medical Toxicology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Manuela Licata
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Daniele Vandelli
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Federica Palazzoli
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Francesco Potì
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Via Volturno, 39F, 43125, Parma, Italy
| | - Enrico Silingardi
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
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Vaiano F, Pascali JP, Bertol E. New psychoactive substances: An actual problem or an overestimated phenomenon? Forensic Sci Int 2019; 304:109941. [PMID: 31574421 DOI: 10.1016/j.forsciint.2019.109941] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/21/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
In last years, international and national Institutions have been completely focused on the new psychoactive substances (NPS) phenomenon. Many contrast policies have been planned in order to control their spread. Even scientific entities, such as our Forensic Toxicology Division, have spent time and resources for NPS identification in biological (from clinical and forensic caseworks) and non-biological (seized material) samples. Last reports show a low prevalence of NPS across the Europe and Italy, while the classical drugs are still the main cause of drug-related deaths. In particular, a worrisome datum is represented by the increasing number of deaths due to heroin. Seen these statistics, is the NPS phenomenon overestimated? Is the interest in classical drugs decreased? Were we diverted by NPS?
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Affiliation(s)
- Fabio Vaiano
- Forensic Toxicology Division, Department of Health Science, University of Florence, Florence, Italy; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Jennifer P Pascali
- Forensic Toxicology Division, Department of Health Science, University of Florence, Florence, Italy
| | - Elisabetta Bertol
- Forensic Toxicology Division, Department of Health Science, University of Florence, Florence, Italy.
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