Urine toxicology screens in drivers suspected of driving while impaired from drugs

What's in drugs freely used by Brazilian truck drivers - "Rebites"? Determination of target and nontarget compounds by high-resolution mass spectrometry and nuclear magnetic resonance

Highways, the lifeline of the Brazilian economy, transport approximately 75% of the country's economic activity, highlighting its importance. However, professional drivers, accustomed to long daily journeys, make use of tablets widely available in Gas Station, which are known as "Rebites," which could contain a mixture of legal and illegal compounds. Thus, this study aims at the chemical characterization of these through different analytical methods. Initially, we performed a comprehensive screening of compounds present in seven samples collected across the country using high-resolution mass spectrometry (HRMS). The findings revealed caffeine as the main compound, alongside theophylline, lidocaine, and clobenzorex, among others. In the next step, we employ quantitative nuclear magnetic resonance (qNMR) to quantify the caffeine content in the tablets. The results indicated a caffeine concentration ranging between 14% and 31% (m/m), which may imply a daily overdose of this compound from around four tablets. In summary, this investigation provides a chemical characterization of real samples of "Rebites" freely obtained along Brazilian highways. Caffeine emerged as the predominant active compound, with its concentration determined by qNMR analysis. The notable presence of caffeine, combined with other stimulants, depressants, and hallucinogens, underscores the need for strict quality control measures regarding "Rebites" to safeguard public health.

Comparison of Two Immunoassay Screening Methods and a LC-MS/MS in Detecting Traditional and Designer Benzodiazepines in Urine

Sensitive and specific immunoassay screening methods for the detection of benzodiazepines in urine represent an important prerequisite for routine analysis in clinical and forensic toxicology. Moreover, emerging designer benzodiazepines force labs to keep their methodologies updated, in order to evaluate the reliability of the immunochemical techniques. This study aimed at evaluating the sensitivity and specificity of two different immunoassay methods for the detection of benzodiazepines in urine, through a comparison with the results obtained by a newly developed liquid chromatographic tandem mass spectrometric (LC-MS/MS) procedure. A cohort of authentic urine samples (N = 501) were processed, before and after a hydrolysis procedure, through two immunoassays and an LC-MS/MS method. The LC-MS/MS target procedure was optimized for monitoring 25 different molecules, among traditional and designer benzodiazepines, including some metabolites. At least one of the monitored substances was detected in 100 out of the 501 samples. A good specificity was observed for the two immunoassays (>0.99), independently of the cut-offs and the sample hydrolysis. The new kit demonstrated a fairly higher sensitivity, always higher than 0.90; in particular, a high cross-reactivity of the new immunoassay was observed for samples that tested positive for lorazepam and 7-aminoclonazepam. The two immunoassays appeared adequate to monitor not only traditional benzodiazepines but also new designer ones.

Identifying risk factors for marijuana use among veterans affairs patients

OBJECTIVES

Cannabis is the most widely used drug in the United States, and its use carries negative health consequences; however, universal screening for cannabis use is cumbersome. If data commonly collected in the primary care setting (eg, use of alcohol, smoking status, and depression symptoms) could predict cannabis use, then providers can implement targeted marijuana screening in high-risk groups.

METHODS

We reviewed Behavioral Health Laboratory data collected between 2003 and 2006 from 5512 patients referred by Veterans Affairs primary care clinics for potential mental health needs. Logistic regression was used to determine the predictors of past year marijuana use.

RESULTS

A total of 11.5% of the sample reported using marijuana in the past year. Age, gender, other drug use, presence of alcohol use disorders, smoking status, depressive disorders, posttraumatic stress disorder, anxiety disorders, and psychotic symptoms, individually, were associated with the patients' use of marijuana during the past year. When controlling for age, race, and gender in a logistic regression analyses, only other drug use, alcohol use disorder, and smoking status were linked to past year marijuana use. Patients were 5.4 (95% confidence interval [CI] 4.3-6.7) times more likely to have used marijuana during the past year if they used another illicit drug during the past year. Those with alcohol use disorder diagnosis or current smokers were 2.3 (95% CI 1.9-2.8) and 1.5 times (95% CI 1.3-1.7), respectively, more likely to have used marijuana during the past year. Receiver operating characteristic curve (area under curve = 0.79) represents good sensitivity and specificity of the model, correctly classifying 88.4% of the past year marijuana users.

CONCLUSION

Identifying patients at high risk for cannabis use may facilitate targeted screening and provision of interventions in primary care. Patients who screen positive for cigarette use, alcohol abuse or dependence, or have evidence of other illicit drug use could be considered for cannabis screening.

Repeat DUI offenders who have had a drug diagnosis: are they more prone to traffic crashes and violations?

OBJECTIVE

Study objectives are to test for differences (1) in rates of negative traffic outcomes between DUI offenders who have lifetime drug use disorders (DUD) and those with no lifetime DUD; and (2) by drug class for those with a DUD.

METHODS

The study sample of 379 male and 74 female repeat DUI offenders was interviewed using the Composite International Diagnostic Interview.

RESULTS

Compared to those with an alcohol use disorder (AUD) only, the relative risk of being involved in a vehicular crash was greater for those with a central nervous system (CNS) depressant use disorder. The risk of being convicted of a traffic offense was higher for those with any DUD and for those with a CNS stimulant use disorder. Differences by class of drug used, after adjusting for demographics, were a 47 percent (confidence interval: 6-103%) greater risk of being in a crash with a CNS depressant use disorder and 28 percent (confidence interval: 11-48%) greater risk of a traffic conviction with a stimulant use disorder.

CONCLUSIONS

Results underscore the increased risk of negative traffic outcomes among repeat DUI offenders diagnosed with DUD, particularly CNS depressant disorders, supporting the call to establish policies that include comprehensive evaluation and treatment for this population.

Adverse effects of cannabis on health: an update of the literature since 1996

Recent research has clarified a number of important questions concerning adverse effects of cannabis on health. A causal role of acute cannabis intoxication in motor vehicle and other accidents has now been shown by the presence of measurable levels of Delta(9)-tetrahydrocannabinol (THC) in the blood of injured drivers in the absence of alcohol or other drugs, by surveys of driving under the influence of cannabis, and by significantly higher accident culpability risk of drivers using cannabis. Chronic inflammatory and precancerous changes in the airways have been demonstrated in cannabis smokers, and the most recent case-control study shows an increased risk of airways cancer that is proportional to the amount of cannabis use. Several different studies indicate that the epidemiological link between cannabis use and schizophrenia probably represents a causal role of cannabis in precipitating the onset or relapse of schizophrenia. A weaker but significant link between cannabis and depression has been found in various cohort studies, but the nature of the link is not yet clear. A large body of evidence now demonstrates that cannabis dependence, both behavioral and physical, does occur in about 7-10% of regular users, and that early onset of use, and especially of weekly or daily use, is a strong predictor of future dependence. Cognitive impairments of various types are readily demonstrable during acute cannabis intoxication, but there is no suitable evidence yet available to permit a decision as to whether long-lasting or permanent functional losses can result from chronic heavy use in adults. However, a small but growing body of evidence indicates subtle but apparently permanent effects on memory, information processing, and executive functions, in the offspring of women who used cannabis during pregnancy. In total, the evidence indicates that regular heavy use of cannabis carries significant risks for the individual user and for the health care system.

Are drunk-driving offenders referred for screening accurately reporting their drug use?

Several studies report that a substantial percentage of offenders arrested for impaired driving test positive for drugs of abuse besides alcohol. Current guidelines recommend screening offenders for both alcohol and other drug use, yet little is known about the accuracy of self-reports of drug use in this population. We compared drug abuse and dependence DSM-III-R diagnoses from an initial, court-ordered screening evaluation of 583 female and 495 male convicted drunk-driving offenders with diagnoses obtained via a voluntary, non-coerced interview 5 years later. At initial screening, fewer than 6% of offenders were diagnosed with drug abuse or dependence. Among offenders who did not receive an initial drug diagnosis, 28% subsequently reported having experienced drug use problems consistent with a retrospective diagnosis of drug abuse or dependence by the age at which they were screened. Half of those with a retrospective diagnosis of drug dependence reported their initial screening responses were "very accurate". We conclude that, although many drunk-driving offenders undergoing screening have diagnosable drug problems, a high proportion under-report their drug use. We suggest that certain modifications to screening procedures, such as urine drug screening, reducing barriers to treatment, and training counselors in motivational interviewing techniques, may increase accurate identification of drug use problems in this population.

Drugs and driving: a retrospective study of the analyses of blood and urine specimens submitted to the Lothian and Borders Police Forensic Laboratory

A comprehensive review of 75 samples of both blood and urine from 72 different drivers suspected of being impaired by drugs in the Lothian and Borders Police Force, Scotland area of jurisdiction, between 1st January 1995 and 2nd May 1997, was undertaken. The police reports, analytical results and criminal conviction records relating to each of the drivers were examined. This provided useful information concerning differences in laboratory procedures and produced a profile of the average drugged driver. The average age of the drivers was 23 years. Only two females were within the sample. Drugs were found in 65 cases (86.7%). Polydrug use was found in seven cases (9.3%). The drugs found, in order of frequency, were benzodiazepines (40%), cannabinoids (24%), alcohol (16%), methadone (12%), dihydrocodeine (9.3%), ecstacy (5.3%), amphetamine (2.7%), volatiles (1.3%) and morphine (1.3%). 90.3% of the drivers had previous convictions for criminal offences and 47.2% had convictions for drugs-related offences. Recommendations concerning police and medical training are discussed with particular reference to the Drug Recognition Expert program.