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Hansen SL, Nielsen MKK, Linnet K, Rasmussen BS. Suitability of cardiac blood, brain tissue, and muscle tissue as alternative matrices for toxicological evaluation in postmortem cases. Drug Test Anal 2023; 15:529-538. [PMID: 36611280 DOI: 10.1002/dta.3439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
Drug concentrations in peripheral blood are often used to evaluate whether death was caused by drug intoxication. In some cases, peripheral blood is not available, and analytical results of alternative matrices should instead be used in the toxicological evaluation. However, reference concentrations of alternative matrices are few, which makes interpretation of results a challenge. In this study, concentrations of selected benzodiazepines, opioids, illicit drugs, and other commonly used drugs in postmortem femoral blood, cardiac blood, brain tissue, and muscle tissue are presented. Alternative matrix-to-femoral blood drug concentration ratios and correlations of blood and alternative matrix drug concentrations were calculated to examine which of the investigated alternative matrices were most suited to use for toxicological evaluation in cases where peripheral blood is not available. The results showed that concentrations in cardiac blood, brain tissue, and muscle tissue could be useful in the postmortem evaluation of most of the 19 selected analytes. In most cases, analytes were detected in all the alternative matrices. The median concentration ratios for the selected analytes in brain tissue, cardiac blood, and muscle tissue relative to femoral blood ranged from 0.57 to 3.42, 0.59 to 1.87, and 0.67 to 7.04, respectively. Overall, cardiac blood provided the concentrations most comparable with femoral blood concentrations, indicating that cardiac blood can be useful in cases where femoral blood is not available. However, the measured concentrations should be interpreted with caution.
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Affiliation(s)
- Stine Lund Hansen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie Katrine Klose Nielsen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Linnet
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brian Schou Rasmussen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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2
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Abstract
BACKGROUND The benzodiazepine drug alprazolam, a fast-acting tranquiliser, cannot be prescribed on the National Health Service in the United Kingdom. Illicit alprazolam supply and consumption have increased. Concern about increasing numbers of alprazolam-related fatalities started circulating in 2018. However, statistics on this issue are very limited. This study examined patterns in such mortality in Scotland. METHODS Statistics on deaths where alprazolam was mentioned in the 'cause of death' were obtained from official mortality registers. Anonymised Scottish case-level data were obtained. Data were examined in respect of the characteristics of decedents and deaths using descriptive statistics. RESULTS Scotland registered 370 deaths in 2004-2020; 366 of these occurred in 2015-2020: most involved males (77.1%); mean age 39.0 (SD 12.6) years. The principal underlying cause of death was accidental poisoning: opiates/opioids (77.9%); sedatives/hypnotics (15.0%). Two deaths involved alprazolam alone. Main drug groups implicated: opiates/opioids (94.8%), 'other benzodiazepines' (67.2%), gabapentinoids (42.9%), stimulants (30.1%), antidepressants (15.0%). Two-thirds (64.2%) involved combinations of central nervous system (CNS) depressants. DISCUSSION Alprazolam-related deaths are likely due to an increasing illicit supply. The fall in deaths in 2019-2020 is partially due to increased use of designer benzodiazepines. Treatment for alprazolam dependence is growing. Clinicians need to be aware of continuing recreational alprazolam use. When such consumption occurs with CNS depressants, overdose and death risks increase. CONCLUSIONS More awareness of alprazolam contributing to deaths, especially in conjunction with other CNS depressants, is needed by consumers and clinicians. Improved monitoring of illicit supplies could identify emerging issues of medicines' abuse.
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Affiliation(s)
- John Martin Corkery
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK,John Martin Corkery, Psychopharmacology,
Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and
Medical Sciences, University of Hertfordshire, Health Research Building, College
Lane Campus, Hertfordshire AL10 9AB, UK.
| | - Amira Guirguis
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK,Swansea University Medical School,
Swansea University, Swansea, UK
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK
| | - Giovanni Martinotti
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK,Department of Neuroscience, Imaging and
Clinical Sciences, “G. D’Annunzio” University, Chieti, Italy
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK
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3
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Hansen SL, Dalsgaard PW, Linnet K, Rasmussen BS. Comparison of Comprehensive Screening Results in Postmortem Blood and Brain Tissue by UHPLC-QTOF-MS. J Anal Toxicol 2022; 46:1053-1058. [PMID: 35157763 PMCID: PMC9872219 DOI: 10.1093/jat/bkac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023] Open
Abstract
Alternative specimens collected during autopsies can be valuable in postmortem toxicology in cases where peripheral blood is not available. The applicability of brain tissue as an alternative matrix for drug screening by ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry was investigated in this study. Results of the 50 most frequently detected drugs and metabolites of toxicological interest in blood and brain tissue samples from 1,719 autopsy cases were compared. Examination of the results in paired blood and brain tissue samples revealed that the two matrices were in general comparable, as the majority of the 50 analytes were observed in a high number of the examined cases in both blood and brain tissue. This demonstrates the potential of brain tissue as an alternative matrix for drug screening in postmortem toxicology or as a secondary matrix for confirmation.
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Affiliation(s)
| | - Petur Weihe Dalsgaard
- Department of Forensic Medicine, Section of Forensic Chemistry, Faculty of Health and Medical Sciences, University of Copenhagen, Frederik V’s Vej 11, DK-2100 Copenhagen Ø, Denmark
| | - Kristian Linnet
- Department of Forensic Medicine, Section of Forensic Chemistry, Faculty of Health and Medical Sciences, University of Copenhagen, Frederik V’s Vej 11, DK-2100 Copenhagen Ø, Denmark
| | - Brian Schou Rasmussen
- Department of Forensic Medicine, Section of Forensic Chemistry, Faculty of Health and Medical Sciences, University of Copenhagen, Frederik V’s Vej 11, DK-2100 Copenhagen Ø, Denmark
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4
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Ha HH, Mata DC. Flualprazolam distribution in postmortem samples. J Forensic Sci 2021; 67:297-308. [PMID: 34585411 DOI: 10.1111/1556-4029.14893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/02/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
The constant emergence of novel psychoactive substances is troubling to both public health officials and legislators. Additionally, sufficient data collection for each new compound can take months up to years. Flualprazolam, a triazolobenzodiazepine, quickly garnered attention as a sedative drug that likely expresses adverse reactions similarly to alprazolam. This study focuses on the distribution of flualprazolam in multiple common postmortem matrices. Central blood, vitreous humor, liver homogenate, brain homogenate, gastric contents, and urine samples from death investigation cases were quantitated when available. Samples were screened with liquid chromatography quadrupole time-of-flight with limit of detection set at 4 ng/ml and quantitated on liquid chromatography tandem mass spectrometry, with concentration range from 4 to 256 ng/ml. From August 2018 to September 2020, 24 central blood samples were quantitated for flualprazolam. Central bloods of 22 cases had concentrations above the limit of quantitation. The average flualprazolam central blood concentration was 16.3 ng/ml with a median of 9.95 ng/ml (4.24-48.0). Additional analyses for unconjugated flualprazolam were performed on at a total of 15 urine samples ( x ¯ = 14.4, 4.07-36.1 ng/ml), 23 brain homogenates ( x ¯ = 23.2, 3.99-69.3 ng/g), 23 liver homogenates ( x ¯ = 50.7, 13.6-156 ng/g), five vitreous humor samples ( x ¯ = 7.70, 4.03-12 ng/ml), and 12 gastric contents samples ( x ¯ = 0.36, 0.02-2.51 mg). The cause of death for 13 of the 24 cases listed flualprazolam as a contributing factor of death.
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Affiliation(s)
- Helen H Ha
- Toxicology Section, Orange County Crime Laboratory, Santa Ana, California, USA
| | - Dani C Mata
- Toxicology Section, Orange County Crime Laboratory, Santa Ana, California, USA
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5
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Regen F, Cosma NC, Otto LR, Clemens V, Saksone L, Gellrich J, Uesekes B, Ta TMT, Hahn E, Dettling M, Heuser I, Hellmann-Regen J. Clozapine modulates retinoid homeostasis in human brain and normalizes serum retinoic acid deficit in patients with schizophrenia. Mol Psychiatry 2021; 26:5417-5428. [PMID: 32488128 PMCID: PMC8589649 DOI: 10.1038/s41380-020-0791-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/24/2022]
Abstract
The atypical antipsychotic clozapine is one of the most potent drugs of its class, yet its precise mechanisms of action remain insufficiently understood. Recent evidence points toward the involvement of endogenous retinoic acid (RA) signaling in the pathophysiology of schizophrenia. Here we investigated whether clozapine may modulate RA-signaling. Effects of clozapine on the catabolism of all-trans RA (at-RA), the biologically most active metabolite of Vitamin A, were assessed in murine and human brain tissue and peripheral blood-derived mononuclear cells (PBMC). In patients with schizophrenia with and without clozapine treatment and matched healthy controls, at-RA serum levels and blood mRNA expression of retinoid-related genes in PBMCs were quantified. Clozapine and its metabolites potently inhibited RA catabolism at clinically relevant concentrations. In PBMC-derived microsomes, we found a large interindividual variability of the sensitivity toward the effects of clozapine. Furthermore, at-RA and retinol serum levels were significantly lower in patients with schizophrenia compared with matched healthy controls. Patients treated with clozapine exhibited significantly higher at-RA serum levels compared with patients treated with other antipsychotics, while retinol levels did not differ between treatment groups. Similarly, in patients without clozapine treatment, mRNA expression of RA-inducible targets CYP26A and STRA6, as well as at-RA/retinol ratio, were significantly reduced. In contrast, clozapine-treated patients did not differ from healthy controls in this regard. Our findings provide the first evidence for altered peripheral retinoid homeostasis in schizophrenia and suggest modulation of RA catabolism as a novel mechanism of action of clozapine, which may be useful in future antipsychotic drug development.
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Affiliation(s)
- Francesca Regen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Nicoleta-Carmen Cosma
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Lisa R Otto
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Vera Clemens
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Lana Saksone
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Janine Gellrich
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Berk Uesekes
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Thi Minh Tam Ta
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Eric Hahn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Isabella Heuser
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Julian Hellmann-Regen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany.
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6
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Moustafa RE, Tarbah F, Saeed HS, Sharif SI. Designer benzodiazepines versus prescription benzodiazepines: can structural relation predict the next step? Crit Rev Toxicol 2021; 51:249-263. [PMID: 34038656 DOI: 10.1080/10408444.2021.1907303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Designer benzodiazepines are a part of the recently discovered abuse synthetic drugs called Novel Psychoactive Substances (NPS) which need to be controlled due to their constantly growing market. Most of them are derived from the medically approved benzodiazepines used nowadays yet, may possess stronger effects, more toxicity, and longer durations of action. Some differences have also been observed in their detection and characteristics, in addition to the variations discovered in postmortem redistribution and drug stability. All these major alterations in features can result from only minor structural modifications. For example, a classic benzodiazepine (BZD) like diazepam only lacks one fluorine atom which exists in its derivatized designer drug, diclazepam, making substantial differences in activity. For this reason, it is essential to study the designer drugs in order to identify their dangers and distinguish them thus rule out their abuse and control the spread of such drugs. This review would highlight the distinct characteristics of some of the most commonly abused designer benzodiazepine analogies in relation to their original prescription BZD compounds.
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Affiliation(s)
- Raneem E Moustafa
- Department of Pharmacy Practice & Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Fuad Tarbah
- Department of Pharmacy Practice & Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Huda Sulaiman Saeed
- General Department of Forensic Science and Criminology, Toxicology Section, Dubai Police Head Quarter, Dubai, United Arab Emirates
| | - Suleiman I Sharif
- Department of Pharmacy Practice & Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
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7
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Integration of evidence to evaluate the potential for neurobehavioral effects following exposure to USFDA-approved food colors. Food Chem Toxicol 2021; 151:112097. [DOI: 10.1016/j.fct.2021.112097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 01/02/2023]
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8
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Zhao T, Du L, Zhang Z, Li N, Wang M, Ren Q. A poly(N,N-dimethylaminoethyl methacrylate-co-ethylene glycol dimethacrylate) monolith for direct solid-phase extraction of benzodiazepines from undiluted human urine. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2020; 12:3924-3932. [PMID: 32720657 DOI: 10.1039/d0ay01025a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A novel polymeric monolith using N,N-dimethylaminoethyl methacrylate as the monomer and ethylene glycol dimethacrylate as the crosslinker was successfully synthesized in a syringe and applied for direct solid-phase extraction of four benzodiazepines (bromazepam, triazolam, midazolam and diazepam) from undiluted urine samples prior to high performance liquid chromatography. The monolith was characterized by scanning electron microscopy, Fourier transform infrared spectroscopy and nitrogen adsorption-desorption experiments. Moreover, extraction parameters, including loading, washing and eluting conditions were optimized. Under the optimized conditions, the proposed method obtained linear ranges of 2.0-500 ng mL-1 with correlation coefficients (r) higher than 0.9997. The limits of detection (S/N = 3) and limits of quantification (S/N = 10) were 0.4-0.6 ng mL-1 and 1.4-2.0 ng mL-1, respectively. The recoveries at three spiked levels ranged from 83.7% to 103% with the intra- and inter-day precisions from 0.6-7.6% to 2.7-9.8%. The present monolith allowed direct loading of crude urine samples without any filtration or dilution step. Besides, the sorbent offered an enhancement factor of 16.7-20.6 and was stable enough for ten replicate cycles of extraction/desorption of urine samples. The developed method presented an alternative strategy for the accurate and convenient determination of benzodiazepines in urine samples.
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Affiliation(s)
- Tengwen Zhao
- School of Public Health, North China University of Science and Technology, No. 21 Bohai Road, Caofeidian, Tangshan 063210, Hebei, China.
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Chan WS, Wong GF, Hung CW, Wong YN, Fung KM, Lee WK, Dao KL, Leung CW, Lo KM, Lee WM, Cheung BKK. Interpol review of toxicology 2016-2019. Forensic Sci Int Synerg 2020; 2:563-607. [PMID: 33385147 PMCID: PMC7770452 DOI: 10.1016/j.fsisyn.2020.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/13/2022]
Abstract
This review paper covers the forensic-relevant literature in toxicology 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%20.Papers%202019.pdf.
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10
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Femoral blood concentrations of flualprazolam in 33 postmortem cases. Forensic Sci Int 2020; 307:110101. [DOI: 10.1016/j.forsciint.2019.110101] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 01/27/2023]
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11
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Ketola RA, Kriikku P. Drug concentrations in post‐mortem specimens. Drug Test Anal 2019; 11:1338-1357. [DOI: 10.1002/dta.2662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Raimo A. Ketola
- Forensic Toxicology UnitNational Institute for Health and Welfare (THL) Mannerheimintie 166 FI‐00270 Helsinki Finland
| | - Pirkko Kriikku
- Forensic Toxicology UnitNational Institute for Health and Welfare (THL) Mannerheimintie 166 FI‐00270 Helsinki Finland
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12
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Nedahl M, Johansen SS, Linnet K. Reference Brain/Blood Concentrations of Citalopram, Duloxetine, Mirtazapine and Sertraline. J Anal Toxicol 2018; 42:149-156. [PMID: 29244076 DOI: 10.1093/jat/bkx098] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/22/2017] [Indexed: 11/14/2022] Open
Abstract
Postmortem blood samples may not accurately reflect antemortem drug concentrations, as the levels of some drugs increase due to postmortem redistribution (PMR). The brain has been suggested as an alternative sampling site. The anatomically secluded site of the brain limits redistribution and prolongs the detection window, thereby enabling sampling from deceased individuals where blood is no longer suitable for analysis. We report concentrations in brain tissue and blood from 91 cases for the four antidepressants citalopram, duloxetine, mirtazapine and sertraline. The cases were classified according to their role in the cause of death, as follows: (A) concentrations where the drug was the sole cause of fatal intoxication; (B) concentrations where the drug contributed to a fatal outcome; and (C) concentrations where the drug was not related to the cause of death. The analytical method was successfully validated in brain tissue in terms of linearity, process efficiency, precision and accuracy. Quantification of analytes was performed by ultra-performance liquid chromatography with tandem mass spectrometry. Correlations between blood and brain concentrations were achieved with R2-values between 0.67 and 0.91. The following median brain-blood ratios were obtained: 3.71 for citalopram (range: 1.4-5.9), 11.0 for duloxetine (range: 5.0-21.6), 1.53 for mirtazapine (range: 1.02-4.71) and 7.38 for sertraline (range: 3.2-14.2). The S/R ratio of racemic citalopram was the same in brain (0.80) and blood (0.85), whereas the median citalopram/N-desmethylcitalopram ratio was higher in brain (9.1) than blood (4.1). The results of this study may serve as reference concentrations in brain for forensic cases.
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Affiliation(s)
- Michael Nedahl
- Department of Forensic Medicine, University of Copenhagen, Frederik V's vej 11, 3. Floor, 2100 Copenhagen Ø, Denmark
| | - Sys Stybe Johansen
- Department of Forensic Medicine, University of Copenhagen, Frederik V's vej 11, 3. Floor, 2100 Copenhagen Ø, Denmark
| | - Kristian Linnet
- Department of Forensic Medicine, University of Copenhagen, Frederik V's vej 11, 3. Floor, 2100 Copenhagen Ø, Denmark
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13
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Nedahl M, Johansen S, Linnet K. Reference Brain and Blood Concentrations of Olanzapine in Postmortem Cases. J Anal Toxicol 2018; 42:650-654. [DOI: 10.1093/jat/bky036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Michael Nedahl
- Department of Forensic Medicine, University of Copenhagen, Frederik V’s vej 11, 3. Floor, 2100 Copenhagen Ø, Denmark
| | - Sys Johansen
- Department of Forensic Medicine, University of Copenhagen, Frederik V’s vej 11, 3. Floor, 2100 Copenhagen Ø, Denmark
| | - Kristian Linnet
- Department of Forensic Medicine, University of Copenhagen, Frederik V’s vej 11, 3. Floor, 2100 Copenhagen Ø, Denmark
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Peterson BL, Schreiber S, Fumo N, Brooke Lerner E. Opioid Deaths in Milwaukee County, Wisconsin 2013-2017: The Primacy of Heroin and Fentanyl. J Forensic Sci 2018; 64:144-148. [PMID: 29684941 DOI: 10.1111/1556-4029.13808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/24/2018] [Accepted: 04/02/2018] [Indexed: 12/30/2022]
Abstract
Heroin and fentanyl are the overwhelming and increasing cause of opioid deaths in Milwaukee County, Wisconsin. We reviewed all drug and opioid deaths from 2013 to 2017 to delineate the specific opioid drugs involved and changes in their incidence. From 2013 to 2017, 980 deaths were due to opioids, rising from 184 in 2013 to 337 in 2017. In 2017, opioid deaths exceeded combined non-natural deaths from homicide and suicide. Illicit heroin and fentanyl/analogs caused 84% of opioid deaths and 80% of drug deaths, with no increase in deaths due to oral prescription drugs such as oxycodone and hydrocodone. Any approach to decreasing this dramatic increase in opioid deaths should first focus on interdicting the supply and cheap availability of these illicit opioids. Fentanyl and its analogs represent the most deadly opioids and the greatest threat to human life in our population.
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Affiliation(s)
- Brian L Peterson
- Milwaukee County Medical Examiner's Office, 933 West Highland Avenue, Milwaukee, WI, 53233.,Department of Pathology, Medical College of Wisconsin, Froedert/Medical College Lab Building FMCLB 239, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226
| | - Sara Schreiber
- Milwaukee County Medical Examiner's Office, 933 West Highland Avenue, Milwaukee, WI, 53233
| | - Nicole Fumo
- Comprehensive Injury Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226
| | - E Brooke Lerner
- Department of Emergency Medicine, Medical College of Wisconsin, Froedert Hospital, Pavilion 1P, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226
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Abstract
Cause of Death: 'Intoxication' - a Matter of the Concentration? Abstract. Elucidation of the cause of death is one of the main reasons for medico-legal investigations. In clinical toxicology, the severity of a given poisoning is typically assessed with the blood concentration of a pharmacologically or toxicologically active compound. Such an interpretation proves to be difficult or even impossible in postmortem toxicology. Numerous biochemical and biological processes beginning immediately after death may render the calculated drug concentration unreliable. Concentrations obtained from postmortem samples do not necessarily reflect the blood concentration at the time of death. A prediction if and to what extent such postmortem changes might have occurred is still impossible for individual cases. Interpretation therefore needs to be done with care, considering case circumstances and all available information.
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Affiliation(s)
- Andrea E Steuer
- 1 Abteilung für Forensische Pharmakologie und Toxikologie, Institut für Rechtsmedizin, Universität Zürich
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Advantages of analyzing postmortem brain samples in routine forensic drug screening—Case series of three non-natural deaths tested positive for lysergic acid diethylamide (LSD). Forensic Sci Int 2017; 278:e14-e18. [DOI: 10.1016/j.forsciint.2017.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/06/2017] [Accepted: 07/23/2017] [Indexed: 11/21/2022]
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17
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Skov L, Holm KMD, Linnet K. Nitrobenzodiazepines: Postmortem brain and blood reference concentrations. Forensic Sci Int 2016; 268:39-45. [DOI: 10.1016/j.forsciint.2016.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/20/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
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