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Holman POS, Høiseth G, Bachs L, Thaulow CH, Vevelstad MS, Mørland J, Strand MC. A two-sample approach to retrograde extrapolation of blood THC concentrations - Is it feasible? Forensic Sci Int 2023; 352:111833. [PMID: 37793282 DOI: 10.1016/j.forsciint.2023.111833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Retrograde extrapolation of drug concentrations in blood can be relevant in cases of drug-impaired driving and is regularly used in forensic toxicology in Norway. Δ9-tetrahydrocannabinol (THC) has complex, multi-compartmental pharmacokinetics, which makes retrograde extrapolation of blood THC concentrations problematic. In the present study, we evaluated an approach to retrograde extrapolation in which momentary rates of decrease of THC were estimated from two consecutive blood samples in apprehended drivers. MATERIAL AND METHODS Data were collected from apprehended drivers in Norway 2000-2020. We included 548 cases in which THC was detected in two consecutive blood samples collected ≥ 20 min apart. THC concentrations were measured by GC-MS and UHPLC-MS/MS. In each case, THC concentrations and the time between the two sampling points (Δt) were used to estimate the rate constant k. The relationship between THC concentration and k was modelled by linear regression. RESULTS The median Δt was 31 min (interquartile range, IQR = 9). The median blood THC concentration was 2.4 μg/L (IQR = 3.4) at the first sampling point and 2.3 μg/L (IQR =3.1) at the second. The concentration decreased in 62% and increased in 38% of all cases. However, considering measurement uncertainty, the changes were not statistically significant in 87% of cases. The mean of k was 0.12 h-1, corresponding to an apparent t1/2 of 6.0 h. The t1/2 predicted from linear regression of k against THC concentration ranged from 0.93 to 13 h for the highest and lowest concentrations observed (36 and 0.63 μg/L, respectively). The time from driving to blood collection had a median of 1.7 h (IQR = 1.5), and did not correlate with k. CONCLUSIONS The apparent t1/2 of THC calculated from the mean of k was 6.0 h, which is shorter than the terminal elimination t1/2 suggested in previous population studies. This indicates that blood samples were often taken during the late distribution phase of THC. Because Δt was short relative to the rates of decrease expected in the late distribution and elimination phases, the underlying true concentration changes related to in vivo pharmacokinetics were small and masked by the relatively larger "false" changes introduced by random analytical and pre-analytical error. Therefore, individual values of k calculated from only two blood samples taken a short time apart are unreliable, and a two-sample approach to retrograde extrapolation of THC cannot be recommended.
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Affiliation(s)
- Peder Olai Skjeflo Holman
- Department of Forensic Sciences, Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway; Department of Pharmacology, Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway.
| | - Gudrun Høiseth
- Department of Forensic Sciences, Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - Liliana Bachs
- Department of Forensic Sciences, Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - Cecilie H Thaulow
- Department of Forensic Sciences, Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - Merete S Vevelstad
- Department of Forensic Sciences, Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Maren Cecilie Strand
- Department of Forensic Sciences, Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway
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Bogen IL, Boix F, Andersen JM, Steinsland S, Nerem E, Mørland J. Heroin metabolism in human blood and its impact for the design of an immunotherapeutic approach against heroin effects. Basic Clin Pharmacol Toxicol 2023; 133:418-427. [PMID: 37452619 DOI: 10.1111/bcpt.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
Immunotherapeutic interventions that block drug effects by binding drug molecules to specific antibodies in the bloodstream have shown promising effects in animal studies. For heroin, which effects are mainly mediated by the metabolites 6-acetylmorphine (6-AM; also known as 6-monoacetylmorphine or 6-MAM) and morphine, the optimal antibody specificity has been discussed. In rodents, 6-AM specific antibodies have been recommended based on the rapid metabolism of heroin to 6-AM in the bloodstream. Since the metabolic rate of heroin in blood is unsettled in humans, we examined heroin metabolism with state-of-the-art analytical methodology (UHPLC-MS/MS) in freshly drawn human whole blood incubated with a wide range of heroin concentrations (1-500 μM). The half-life of heroin was highly concentration dependent, ranging from 1.2-1.7 min for concentrations at or above 25 μM, and gradually increasing to approximately 20 min for 1 μM heroin. At concentrations that can be attained in the bloodstream shortly after an i.v. injection, approximately 70% was transformed into 6-AM within 3 min, similar to previous observations in vivo. Our results indicate that blood enzymes play a more important role for the rapid metabolism of heroin in humans than previously assumed. This points to 6-AM as an important target for an efficient immunotherapeutic approach to block heroin effects in humans.
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Affiliation(s)
- Inger Lise Bogen
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Fernando Boix
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Jannike Mørch Andersen
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Synne Steinsland
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Nerem
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Jørg Mørland
- Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Bramness JG, Skulberg KR, Skulberg A, Moe JS, Mørland J. The Self-Rated Effects of Alcohol Are Related to Presystemic Metabolism of Alcohol. Alcohol Alcohol 2023; 58:203-208. [PMID: 36715301 PMCID: PMC10008105 DOI: 10.1093/alcalc/agad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/31/2023] Open
Abstract
AIMS A high number of alcohol units required to feel a subjective effect of alcohol predicts future alcohol use disorders (AUDs). The subjective response to alcohol can be measured using the validated retrospective self-rated effects of alcohol (SRE) questionnaire. Few studies have investigated the specific relationship between SRE and blood alcohol concentration (BAC) in an experimental setting. METHODS Twenty healthy young adult male volunteers who had experience with binge drinking, but did not have AUD, filled out the SRE-questionnaire and were served with a fixed amount of alcohol per body weight. BACs were measured throughout a 12-hour period, reaching a maximum BAC of ~0.13%. Median split of SRE-scores was utilized to compare BACs among participants with relatively high effects (low SRE) and relatively low effects (high SRE) of alcohol. RESULTS Participants reporting a relatively low SRE-score had a statistically significant higher measured BAC at all time points until alcohol was eliminated. This was especially pronounced during the first 2 hours after alcohol (P = 0.015) without a significant difference in the alcohol elimination rate being detected. CONCLUSION The study indicates that a self-ated SRE-score is related to BACs after the ingestion of a standardized amount of alcohol per body weight. Reporting a higher number of alcohol units before feeling an effect was related to a lower BAC. As the differences in BAC between relatively high and low self-rated effects appeared rapidly after intake, this could be interpreted as an effect of presystemic metabolism of alcohol.
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Affiliation(s)
- Jørgen G Bramness
- Norwegian Institute of Public Health, Oslo 0213, Norway.,National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal 2381, Norway.,Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø 9037, Norway
| | - Knut R Skulberg
- Inland Norway University of Applied Sciences, Elverum 2406, Norway
| | | | - Jenny Skumsnes Moe
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal 2381, Norway.,Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø 9037, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, Oslo 0213, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo 0316, Norway
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Mørland J, Bretteville-Jensen AL, Bramness JG. On the duration of cannabis effects and the presence of THC in the body. Addiction 2023; 118:390-391. [PMID: 36331427 DOI: 10.1111/add.16080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Jørg Mørland
- Norwegian Institute of Public Health, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Jørgen G Bramness
- Norwegian Institute of Public Health, Oslo, Norway.,National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Institute of Clinical Medicine, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
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5
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Oshaug K, Kronstrand R, Kugelberg FC, Kristoffersen L, Mørland J, Høiseth G. Frequency of postmortem ethanol formation in blood, urine and vitreous humor - Improving diagnostic accuracy with the use of ethylsulphate and putrefactive alcohols. Forensic Sci Int 2021; 331:111152. [PMID: 34952291 DOI: 10.1016/j.forsciint.2021.111152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to compare the frequency of postmortem ethanol formation in blood, urine and vitreous humor according to negative ethylsulphate (EtS) in blood or positive putrefactive alcohols (PA's) in either medium. Furthermore, it aimed to evaluate the interpretational value of calculated ethanol ratios in relation to EtS and PA results. METHODS Blood ethanol positive forensic cases were included; one dataset consisting of 2504 cases with EtS analysed in blood and another dataset with 8001 cases where PA's were analysed. RESULTS PA's were found in 24.4% of cases. EtS was negative in 15.3%, 9.4% and 7.4% of cases that were positive for ethanol in blood, urine and vitreous humor, respectively. In EtS negative cases, the concentrations of ethanol in blood, urine and vitreous humor were lower than 0.20 g/kg in 51.3%, 67.4% and 77.8%, respectively. It was 1.0 g/kg or higher in blood in 4.2% of cases. More EtS negative and PA positive cases were seen in central compared to peripheral blood. Ethanol ratios between urine or vitreous humor and blood were significantly lower in both EtS negative and PA positive cases, but large variations were observed. CONCLUSION EtS and PA analysis improve the diagnostic accuracy of ethanol in postmortem cases. Postmortem ethanol formation in vitreous humor and urine were both more frequent than expected and we recommend the analysis of ethanol primarily in peripheral blood if available.
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Affiliation(s)
- Katja Oshaug
- Oslo University Hospital, Department of Forensic Sciences, Oslo, Norway
| | - Robert Kronstrand
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden; Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fredrik C Kugelberg
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden; Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Jørg Mørland
- Norwegian Institute of Public Health, Oslo, Norway
| | - Gudrun Høiseth
- Oslo University Hospital, Department of Forensic Sciences, Oslo, Norway; Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway; Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.
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Andersen JM, Bogen IL, Karinen R, Brochmann GW, Mørland J, Vindenes V, Boix F. Does the preparation for intravenous administration affect the composition of heroin injections? A controlled laboratory study. Addiction 2021; 116:3104-3112. [PMID: 33739552 DOI: 10.1111/add.15492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/27/2020] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
AIMS To study whether the preparation procedure, and its acidic and heating conditions, used by heroin users to prepare heroin for intravenous administration affects the final composition of the fluid to be injected. METHODS Samples from different seizures of illegal heroin provided by the Norwegian police were prepared by adding water and ascorbic acid before heating under controlled conditions in the laboratory. Further, three seizures were prepared with different amounts of ascorbic or citric acid relative to their diacetylmorphine content. Pure diacetylmorphine base or salt was also submitted to the procedure applying two different heating intensities. The seizures and the final product after preparation were analysed for diacetylmorphine, 6-acetylmorphine and morphine using liquid chromatography with tandem mass spectrometry (LC-MS-MS). RESULTS After preparation, a decrease of 19.8% (25th and 75th percentiles = -29.2 and -15.3) in the initial diacetylmorphine content was observed. Both the 6-acetylmorphine and morphine content increased but, due to their low content in the initial product, diacetylmorphine still represented 83.9% (25th and 75th percentiles = 77.3 and 88.0) of the sum of these three opioids in the final solution. The loss of water during preparation caused an increase in the concentration of diacetylmorphine, 6-acetylmorphine and morphine, depending on the heating intensity applied. The content of these opioids was affected by the quantity and type of acid added in relation to the heroin purity and the level of diacetylmorphine dissolved being proportional to the amount of ascorbic acid, but not citric acid, in the sample with high heroin purity. CONCLUSIONS Preparation of heroin for intravenous injection appears to change the amount or concentration of diacetylmorphine and its active metabolites, 6-acetylmorphine and morphine in the final product, depending on heroin purity, amount and type of acid used or heating conditions. These circumstances can contribute to unintentional variations in the potency of the final injected solution, and therefore affect the outcome after injection.
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Affiliation(s)
- Jannike M Andersen
- Section for Drug Abuse Research, Dept. of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway.,Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Norway
| | - Inger Lise Bogen
- Section for Drug Abuse Research, Dept. of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Ritva Karinen
- Section for Drug Abuse Research, Dept. of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Gerd Wenche Brochmann
- Section for Drug Abuse Research, Dept. of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Jørg Mørland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.,Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Vigdis Vindenes
- Section for Drug Abuse Research, Dept. of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Fernando Boix
- Section for Drug Abuse Research, Dept. of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
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7
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Tverdal A, Høiseth G, Magnus P, Næss Ø, Selmer R, Knudsen GP, Mørland J. Alcohol Consumption, HDL-Cholesterol and Incidence of Colon and Rectal Cancer: A Prospective Cohort Study Including 250,010 Participants. Alcohol Alcohol 2021; 56:718-725. [PMID: 33604595 PMCID: PMC8557640 DOI: 10.1093/alcalc/agab007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/04/2021] [Accepted: 01/16/2021] [Indexed: 11/19/2022] Open
Abstract
Aims Alcohol consumption has been linked to colorectal cancer (CRC) and also to the high-density lipoprotein cholesterol level (HDL-C). HDL-C has been associated with the incidence of CRC. The aim of this study was to investigate the association between self-reported alcohol consumption, HDL-C and incidence of CRC, separately for the two sites. Methods Altogether, 250,010 participants in Norwegian surveys have been followed-up for an average of 18 years with respect to a first-time outcome of colon or rectal cancer. During follow-up, 3023 and 1439 colon and rectal cancers were registered. Results For men, the HR per 1 drink per day was 1.05 with 95% confidence interval (0.98–1.12) for colon and 1.08 (1.02–1.15) for rectal cancer. The corresponding figures for women were 1.03 (0.97–1.10) and 1.05 (1.00–1.10). There was a positive association between alcohol consumption and HDL-C. HDL-C was inversely associated with colon cancer in men (0.74 (0.62–0.89) per 1 mmol/l) and positively associated with rectal cancer, although not statistically significant (1.15 (0.92–1.44). A robust regression that assigned weights to each observation and exclusion of weights ≤ 0.1 increased the HRs per 1 drink per day and decreased the HR per 1 mmol/l for colon cancer. The associations with rectal cancer remained unchanged. Conclusion Our results support a positive association between alcohol consumption and colon and rectal cancer, most pronounced for rectal cancer. Considering the positive relation between alcohol consumption and HDL-C, the inverse association between HDL-C and colon cancer in men remains unsettled.
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Affiliation(s)
- Aage Tverdal
- Norwegian Institute of Public Health, Centre for Fertility and Health, Pb 222 Skøyen, 0213 Oslo, Norway
| | - Gudrun Høiseth
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Pb 1171 Blinderen, 0318 Oslo, Norway.,Department of Forensic Sciences, Oslo University Hospital, Pb 4950 Nydalen, 0424 Oslo.,Center for Psychopharmacology, Diakonhjemmet Hospital, Forskningsveien 13, 0373 Oslo, Norway
| | - Per Magnus
- Norwegian Institute of Public Health, Centre for Fertility and Health, Pb 222 Skøyen, 0213 Oslo, Norway
| | - Øyvind Næss
- Institute of Health and Society, University of Oslo, Pb 1171 Blinderen, 0318 Oslo, Norway
| | - Randi Selmer
- Norwegian Institute of Public Health, Division of Chronic Diseases and Aging, Pb 222 Skøyen, 0213 Oslo, Norway
| | - Gun Peggy Knudsen
- Norwegian Institute of Public Health, Division of health data and digitalization, Pb 222 Skøyen, 0213 Oslo, Norway
| | - Jørg Mørland
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Pb 1171 Blinderen, 0318 Oslo, Norway.,Norwegian Institute of Public Health, Division of health data and digitalization, Pb 222 Skøyen, 0213 Oslo, Norway
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8
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Degerud E, Høiseth G, Mørland J, Ariansen I, Graff-Iversen S, Ystrom E, Zuccolo L, Tell GS, Næss Ø. Associations of Binge Drinking With the Risks of Ischemic Heart Disease and Stroke: A Study of Pooled Norwegian Health Surveys. Am J Epidemiol 2021; 190:1592-1603. [PMID: 33720294 PMCID: PMC8489425 DOI: 10.1093/aje/kwab063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 11/14/2022] Open
Abstract
Norwegian health survey data (1987-2003) were analyzed to determine if binge drinking increases the risk of incident major events from ischemic heart disease (IHD) and stroke. Among current drinkers reporting average alcohol intakes of 2.00-59.99 g/day (n = 44,476), frequent binge drinking (≥5 units at least once per month) was not associated with a greater risk of IHD (adjusted hazard ratio (HR) = 0.91, 95% confidence interval (CI): 0.76, 1.09) or stroke (adjusted HR = 0.98, 95% CI: 0.81, 1.19), in comparison with participants who reported that they never or only infrequently (less than once per month) had episodes of binge drinking. Participants with an average alcohol intake of 2.00-59.99 g/day had a lower risk of IHD in comparison with participants with very low intakes (<2.00 g/day), both among frequent binge drinkers (adjusted HR = 0.67, 95% CI: 0.56, 0.80) and among never/infrequent binge drinkers (adjusted HR = 0.75, 95% CI: 0.67, 0.84). The findings suggest that frequent binge drinking, independent of average alcohol intake, does not increase the risk of incident IHD or stroke events. However, the findings should be interpreted in light of the limitations of the study design.
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Affiliation(s)
- Eirik Degerud
- Correspondence to Dr Eirik Degerud, Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213 Oslo, Norway (e-mail: )
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Høiseth G, Hjelmeland K, Mørland J. A comparison of driving related skills impaired by ethanol and zopiclone. Traffic Inj Prev 2020; 22:26-31. [PMID: 33320019 DOI: 10.1080/15389588.2020.1849643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
Objective: Ethanol and zopiclone are both sedating drugs that impair traffic relevant skills, but that show vast differences in epidemiological traffic risk. One explanation for this could be that they impair various kinds of skills differently, but this is less previously studied. The aim of this study was to compare effects of zopiclone and ethanol on a large battery of computerized psychomotor and cognitive tests according to different test classifications. Methods: Ethanol (50 grams), zopiclone 5 mg, zopiclone 10 mg or placebo was administered in a randomized trial with a cross-over design. Blood was sampled nine times after administration and analyzed for zopiclone and ethanol using fully validated methods. The computerized tests Connors Continuous Performance Test (CPT), Stockings of Cambridge (SOC) and choice reaction time (CRT) was performed at baseline and after administration. The three tests yielded fifteen different test components, which were categorized according to the three well-known behavior levels (automative behavior, control behavior and executive planning). Secondly, they were categorized into tests measuring "reaction time", "impulsivity" and "attention/cognition". Results: On all tests belonging to behavior level 1 and on all tests measuring "reaction time", more subjects were impaired by zopiclone than ethanol. On all tests measuring "impulsivity", more subjects were impaired by ethanol than zopiclone. Conclusion: Zopiclone and ethanol both lead to impairment, but have a different profile on what kind of tests and neurocognitive functions they mostly impair. This could be important in the understanding of the differences in traffic risk connected to these two drugs.
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Affiliation(s)
- Gudrun Høiseth
- Department of Forensic Toxicology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Hjelmeland
- Department of Forensic Toxicology, Oslo University Hospital, Oslo, Norway
| | - Jørg Mørland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
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10
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Fosen JT, Mørland J, Høiseth G. The Relationship Between Ingested Dose of Ethanol and Amount of Ethyl Glucuronide Formed in Blood. J Anal Toxicol 2020; 44:861-863. [PMID: 32743665 PMCID: PMC7733326 DOI: 10.1093/jat/bkaa090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/20/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022] Open
Abstract
A positive non-linear relation between the dose of ethanol ingested and the area under the curve (AUC) for ethyl glucuronide (EtG) in urine is previously observed. The relation between both doses and AUC of ethanol and the AUC for EtG in blood is not previously published, and this study aimed to investigate this relationship. After an overnight fast, 10 healthy volunteers ingested 0.5-g ethanol per kilo body weight (low dose) in one occasion and 1.0-g ethanol per kilo body weight (high dose) in the next occasion. Results showed that there was a significant higher median ratio between blood AUC for EtG and dose of ethanol in the high-dose (8.99; range 7.37–10.94) group compared to the low-dose (5.02; range 4.25–6.15) group (P = 0.005). The median ratio between the AUC for EtG and AUC for ethanol was actually significantly higher in the low-dose (1.77; range 1.51–2.24) group compared to the high-dose (1.67; range 1.30–2.02) group (P = 0.005), although values are quite similar. This study therefore showed that the ratio between the AUC for EtG in blood and dose of ethanol is higher after intake of 1.0 g/kg than 0.5 g/kg. This pattern is however not seen when AUC for EtG is compared to AUC for ethanol. Results therefore support that the percentage of ethanol converted to EtG is not increasing when the doses increase. An explanation for the positive non-linear relation previously observed between the dose of ethanol ingested and amount of EtG formed may be a relative higher first-pass metabolism of ethanol at lower doses.
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Affiliation(s)
- Jan Toralf Fosen
- Department of Forensic Sciences, Oslo University Hospital, Pb 4950 Nydalen, 0424 Oslo, Norway
| | - Jørg Mørland
- Institute of Clinical Medicine, University of Oslo, Pb 1171 Blinderen, 0318 Oslo, Norway.,Norwegian Institute of Public Health, Pb 222 Skøyen, 0213 Oslo, Norway
| | - Gudrun Høiseth
- Department of Forensic Sciences, Oslo University Hospital, Pb 4950 Nydalen, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Pb 1171 Blinderen, 0318 Oslo, Norway.,Center for Psychopharmacology, Diakonhjemmet Hospital, Forskningsveien 13, 0373 Oslo, Norway
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Christophersen AS, Karinen R, Mørland J, Gjerde H. The implementation of per-se limits for driving under the influence of benzodiazepines and related drugs: No increased risk for arrest during therapeutic use in Norway. Traffic Inj Prev 2020; 21:122-126. [PMID: 32119573 DOI: 10.1080/15389588.2020.1724977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 06/10/2023]
Abstract
Objective: To investigate whether the use of recommended therapeutic doses of medicinal drugs has led to suspicion of driving under the influence of drugs (DUID) after implementation of legislative limits for illicit and medicinal drugs in 2012.Methods: Data from suspected drug-impaired drivers apprehended by the police from 2013 to 2015 were selected from the Norwegian Forensic Toxicology Database. The blood samples had been analyzed for benzodiazepines (BZDs), z-hypnotics, opioids, stimulants, certain hallucinogens, and alcohol. Drivers who tested positive for one BZD or a z-hypnotic only, were included in the study. Drug concentrations measured in their blood samples were compared to the maximal obtainable steady state concentrations if the drug had been used in accordance with the recommendations set by the Norwegian Directorate of Health.Results: BZDs or z-hypnotics were found in 10 248 samples, representing 59.6% of the total number of drivers arrested for suspected DUID (n = 17 201). Only one BZD or z-hypnotic with a blood drug concentration above the legislative limit was detected in 390 (2.3%) of the total number of samples. Clonazepam was the most frequently detected BZD (n = 4656), while as a single drug above the legislative limit, it was detected in only 3.6% (n = 168) of the clonazepam-positive blood samples. For drivers testing positive for only one z-hypnotic, drug concentrations above the legislative limit were found in 27% (n = 55) of the blood samples that tested positive for zolpidem and 12.4% (n = 53) of the samples that tested positive for zopiclone. In total, 155 subjects out of 10 248 testing positive for BZDs or z-hypnotics displayed concentrations above the legislative limit but within the concentration ranges that are expected when taking recommended therapeutic drug doses, and 77 below the legislativel limit.Conclusions: The results show that the implementation of legislative limits for BZDs and z-hypnotics may have contributed to DUID suspicion for a small group of patients using therapeutic drug doses; only 1.3% of the suspected DUID offenders had concentrations of only one of those drugs in-line with recommended therapeutic dosing.
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Affiliation(s)
| | - Ritva Karinen
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Jørg Mørland
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
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Kvello AMS, Andersen JM, Boix F, Mørland J, Bogen IL. The role of 6-acetylmorphine in heroin-induced reward and locomotor sensitization in mice. Addict Biol 2020; 25:e12727. [PMID: 30788879 DOI: 10.1111/adb.12727] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 01/11/2023]
Abstract
We have previously demonstrated that heroin's first metabolite, 6-acetylmorphine (6-AM), is an important mediator of heroin's acute effects. However, the significance of 6-AM to the rewarding properties of heroin still remains unknown. The present study therefore aimed to examine the contribution of 6-AM to heroin-induced reward and locomotor sensitization. Mice were tested for conditioned place preference (CPP) induced by equimolar doses of heroin or 6-AM (1.25-5 μmol/kg). Psychomotor activity was recorded during the CPP conditioning sessions for assessment of drug-induced locomotor sensitization. The contribution of 6-AM to heroin reward and locomotor sensitization was further examined by pretreating mice with a 6-AM specific antibody (anti-6-AM mAb) 24 hours prior to the CPP procedure. Both heroin and 6-AM induced CPP in mice, but heroin generated twice as high CPP scores compared with 6-AM. Locomotor sensitization was expressed after repeated exposure to 2.5 and 5 μmol/kg heroin or 6-AM, but not after 1.25 μmol/kg, and we found no correlation between the expression of CPP and the magnitude of locomotor sensitization for either opioid. Pretreatment with anti-6-AM mAb suppressed both heroin-induced and 6-AM-induced CPP and locomotor sensitization. These findings provide evidence that 6-AM is essential for the rewarding and sensitizing properties of heroin; however, heroin caused stronger reward compared with 6-AM. This may be explained by the higher lipophilicity of heroin, providing more efficient drug transfer to the brain, ensuring rapid increase in the brain 6-AM concentration.
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Affiliation(s)
- Anne Marte Sjursen Kvello
- Section for Drug Abuse Research, Department of Forensic SciencesOslo University Hospital Oslo Norway
- School of Pharmacy, Faculty of Mathematics and Natural SciencesUniversity of Oslo Oslo Norway
| | - Jannike Mørch Andersen
- Section for Drug Abuse Research, Department of Forensic SciencesOslo University Hospital Oslo Norway
- School of Pharmacy, Faculty of Mathematics and Natural SciencesUniversity of Oslo Oslo Norway
| | - Fernando Boix
- Section for Drug Abuse Research, Department of Forensic SciencesOslo University Hospital Oslo Norway
| | - Jørg Mørland
- Division of Health Data and DigitalisationNorwegian Institute of Public Health Oslo Norway
| | - Inger Lise Bogen
- Section for Drug Abuse Research, Department of Forensic SciencesOslo University Hospital Oslo Norway
- Institute of Basic Medical Sciences, Faculty of MedicineUniversity of Oslo Oslo Norway
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Mørland J, Bramness JG. Δ9-tetrahydrocannabinol (THC) is present in the body between smoking sessions in occasional non-daily cannabis users. Forensic Sci Int 2020; 309:110188. [PMID: 32120192 DOI: 10.1016/j.forsciint.2020.110188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/04/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND THC can be measured in blood up to a month after last intake in heavy cannabis users. The cognitive deficits during abstinence have been hypothesized to be at least in part due to residual THC in brain. To which extent THC accumulation will occur after occasional cannabis use has gained limited attention. We aimed to predict THC-levels between smoking sessions in non-daily as well as daily cannabis users and to compare these predictions with published THC levels. METHODS Predictions were based on pharmacokinetic principles on drug accumulation after repeated dosing, applied to different cannabis smoking patterns, using data from a three-compartment model for THC pharmacokinetics and results on the terminal elimination half-life of THC in humans. We searched the literature for THC measurements which could be compared with these predictions. We found no such results from controlled studies of long-term repeated cannabis consumption of known THC amounts. Thirteen published studies contained, however, enough information on cannabis use and results from THC-measurements to make tentative comparisons with the predictions. RESULTS The predictions of THC-plasma levels present after different cannabis smoking patterns assuming terminal elimination half-lives of THC of 21.5 h or longer, had some support in published THC levels measured in individuals self-reporting their cannabis consumption. We found no consistent discrepancies between the predictions and reported THC plasma levels after non-daily or daily cannabis use. The predictions indicate that THC might be present in plasma between smoking sessions above usual analytical limits when smoking every third and second day, and at lower levels after once weekly smoking. CONCLUSIONS The study indicates that THC might be present continuously even in non-daily smokers at low levels, even if the smoking occasions are separated by a week. This is different from alcohol, where ethanol has disappeared after a day. From a toxicological point of view the persistance of THC in the brain, raises questions whether this should be given more attention as with other toxicological thinking where long-term presence of bioactive substances gives rise to concern. There are some uncertainties in this analysis, and controlled studies on THC-accumulation accompanying different use patterns seem warranted.
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Affiliation(s)
- J Mørland
- Norwegian Institute of Public Health, PO Box 222 Skøyen 0213, N-0403 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, PO Box 1072, Blindern, N-0316 Oslo, Norway.
| | - J G Bramness
- Norwegian Institute of Public Health, PO Box 222 Skøyen 0213, N-0403 Oslo, Norway; Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
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Mørland J, Waal H. «Hele Felleskatalogen» i behandling av rusmiddellidelser. Tidsskriftet 2019; 139:18-0678. [DOI: 10.4045/tidsskr.18.0678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Mørland J, Waal H. Er rus medisin for noen? Tidsskriftet 2019; 139:19-0521. [DOI: 10.4045/tidsskr.19.0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Levy FO, Osnes JB, Skomedal T, Reikvam Å, Gladhaug IP, Thoresen H, Mørland J. Thoralf Christoffersen. Tidsskriftet 2019. [DOI: 10.4045/tidsskr.18.0900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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17
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Kvello AMS, Andersen JM, Øiestad EL, Steinsland S, Aase A, Mørland J, Bogen IL. A Monoclonal Antibody against 6-Acetylmorphine Protects Female Mice Offspring from Adverse Behavioral Effects Induced by Prenatal Heroin Exposure. J Pharmacol Exp Ther 2018; 368:106-115. [PMID: 30361238 DOI: 10.1124/jpet.118.251504] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/22/2018] [Indexed: 01/04/2023] Open
Abstract
Escalating opioid use among fertile women has increased the number of children being exposed to opioids during fetal life. Furthermore, accumulating evidence links prenatal opioid exposure, including opioid maintenance treatment, to long-term negative effects on cognition and behavior, and presses the need to explore novel treatment strategies for pregnant opioid users. The present study examined the potential of a monoclonal antibody (mAb) targeting heroin's first metabolite, 6-acetylmorphine (6-AM), in providing fetal protection against harmful effects of prenatal heroin exposure in mice. First, we examined anti-6-AM mAb's ability to block materno-fetal transfer of active metabolites after maternal heroin administration. Next, we studied whether maternal mAb pretreatment could prevent adverse effects in neonatal and adolescent offspring exposed to intrauterine heroin (3 × 1.05 mg/kg). Anti-6-AM mAb pretreatment of pregnant dams profoundly reduced the distribution of active heroin metabolites to the fetal brain. Furthermore, maternal mAb administration prevented hyperactivity and drug sensitization in adolescent female offspring prenatally exposed to heroin. Our findings demonstrate that passive immunization with a 6-AM-specific antibody during pregnancy provides fetal neuroprotection against heroin metabolites, and thereby prevents persistent adverse behavioral effects in the offspring. An immunotherapeutic approach to protect the fetus against long-term effects of prenatal drug exposure has not been reported previously, and should be further explored as prophylactic treatment of pregnant heroin users susceptible to relapse.
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Affiliation(s)
- Anne Marte Sjursen Kvello
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Jannike Mørch Andersen
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Elisabeth Leere Øiestad
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Synne Steinsland
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Audun Aase
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Jørg Mørland
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Inger Lise Bogen
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
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18
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Gjerde H, Romeo G, Mørland J. Challenges and common weaknesses in case-control studies on drug use and road traffic injury based on drug testing of biological samples. Ann Epidemiol 2018; 28:812-820. [PMID: 30217677 DOI: 10.1016/j.annepidem.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/01/2018] [Accepted: 08/19/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine and discuss common weaknesses and errors in case-control studies on the association between drug use and road traffic crash injury among drivers and recommend improvements for future studies. METHODS A search for case-control studies published between 2000 and 2016 was performed using PubMed and other databases in addition to manual search. The used methodologies were compared with requirements and recommendations for case-control studies as well as current knowledge on the interpretation of drug concentrations in biological samples. RESULTS Seventeen studies were identified. The major difficulties in the studies were related to likely selection bias, information bias, and confounding. In some studies, the definition of drug exposure was different for controls than for cases, generating potentially serious errors in the odds ratio estimations. Other weaknesses include lacking explanation of the assessment of drug exposure, missing covariates, lacking description of statistical methods, and lack of discussion of bias and confounding. CONCLUSIONS Many of the observed challenges and weaknesses can be overcome or reduced. Recommendations for future studies are presented.
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Affiliation(s)
- Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.
| | - Giovanni Romeo
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jørg Mørland
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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19
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Fosen JT, Høiseth G, Sempio C, Giarratana N, Enger A, Mørland J, Morini L. Hair EtG: Alterations in segment levels accompanying hair growth. Drug Test Anal 2018; 11:112-118. [DOI: 10.1002/dta.2474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Jan Toralf Fosen
- Department of Forensic Sciences; Oslo University Hospital; Oslo Norway
| | - Gudrun Høiseth
- Department of Forensic Sciences; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine, University of Oslo; Oslo Norway
- Center for Psychopharmacology; Diakonhjemmet Hospital; Oslo Norway
| | - Cristina Sempio
- Department of Public Health, Experimental and Forensic Medicine; University of Pavia; Pavia Italy
| | - Nefele Giarratana
- Department of Public Health, Experimental and Forensic Medicine; University of Pavia; Pavia Italy
| | - Asle Enger
- Trasoppklinikken; Oslo Norway
- Department of Addiction Treatment; Oslo University Hospital; Oslo Norway
| | - Jørg Mørland
- Institute of Clinical Medicine, University of Oslo; Oslo Norway
- Norwegian Institute of Public Health; Oslo Norway
| | - Luca Morini
- Department of Public Health, Experimental and Forensic Medicine; University of Pavia; Pavia Italy
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20
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Degerud E, Ystrom E, Tambs K, Ariansen I, Mørland J, Magnus P, Davey Smith G, Næss Ø. The interplay between cognitive ability, alcohol consumption, and health characteristics. Psychol Med 2018; 48:2011-2022. [PMID: 29239293 DOI: 10.1017/s0033291717003543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Higher cognitive ability is associated with favourable health characteristics. The relation between ability and alcohol consumption, and their interplay with other health characteristics, is unclear. We aimed to assess the relationship between cognitive ability and alcohol consumption and to assess whether alcohol consumption relates differently to health characteristics across strata of ability. METHODS For 63 120 Norwegian males, data on cognitive ability in early adulthood were linked to midlife data on alcohol consumption frequency (times per month, 0-30) and other health characteristics, including cardiovascular risk factors and mental distress. Relations were assessed using linear regression and reported as unstandardised beta coefficients [95% confidence interval (CI)]. RESULTS The mean ± s.d. frequency of total alcohol consumption in the sample was 4.0 ± 3.8 times per month. In the low, medium, and high group of ability, the frequencies were 3.0 ± 3.3, 3.7 ± 3.5, and 4.7 ± 4.1, respectively. In the full sample, alcohol consumption was associated with physical activity, heart rate, fat mass, smoking, and mental distress. Most notably, each additional day of consumption was associated with a 0.54% (0.44-0.64) and 0.14% (0.09-0.18) increase in the probability of current smoking and mental distress, respectively. In each strata of ability (low, medium, high), estimates were 0.87% (0.57-1.17), 0.48% (0.31-0.66) and 0.49% (0.36-0.62) for current smoking, and 0.44% (0.28-0.60), 0.10% (0.02-0.18), and 0.09% (0.03-0.15) for mental distress, respectively. CONCLUSIONS Participants with low cognitive ability drink less frequently, but in this group, more frequent alcohol consumption is more strongly associated with adverse health characteristics.
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Affiliation(s)
- E Degerud
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - E Ystrom
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - K Tambs
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - I Ariansen
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - J Mørland
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - P Magnus
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - G Davey Smith
- MRC Integrative Epidemiology Unit,School of Social and Community Medicine,University of Bristol,Senate House,Tyndall Avenue,Bristol BS8 1TH,UK
| | - Ø Næss
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
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Thaulow CH, Øiestad ÅML, Rogde S, Andersen JM, Høiseth G, Handal M, Mørland J, Vindenes V. Can measurements of heroin metabolites in post-mortem matrices other than peripheral blood indicate if death was rapid or delayed? Forensic Sci Int 2018; 290:121-128. [DOI: 10.1016/j.forsciint.2018.06.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
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Abstract
SummaryThe effect of chronic administration of ethanol to rats in a controlled regimen upon the activities of the coagulation factors II, VII, VIII, IX and X has been studied.No significant differences were found for factor II, IX and X between the ethanol-treated rats and the control group given an isocaloric diet with carbohydrate replacing ethanol. Factor VII activity was somewhat higher and factor VIII activity decreased significantly in the experimental group when ethanol treatment was combined with an approximately two-fold increase in dietary polyunsaturated fatty acid.
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Thaulow CH, Øiestad ÅML, Rogde S, Karinen R, Brochmann GW, Andersen JM, Høiseth G, Handal M, Mørland J, Arnestad M, Øiestad EL, Strand DH, Vindenes V. Metabolites of Heroin in Several Different Post-mortem Matrices. J Anal Toxicol 2018; 42:311-320. [DOI: 10.1093/jat/bky002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cecilie Hasselø Thaulow
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Åse Marit Leere Øiestad
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Sidsel Rogde
- Department of Forensic Sciences, Section of Forensic Pathology and Clinical Forensic Medicine, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, N-0318 OSLO, Norway
| | - Ritva Karinen
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Gerd Wenche Brochmann
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Jannike Mørch Andersen
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Gudrun Høiseth
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Marte Handal
- Department of Mental Disorders, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 OSLO, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 OSLO, Norway
- Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, N-0318 OSLO, Norway
| | - Marianne Arnestad
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Elisabeth Leere Øiestad
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
- School of Pharmacy, University of Oslo, PO Box 1068 Blindern, N-0316 Oslo, Norway
| | - Dag Helge Strand
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Vigdis Vindenes
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, N-0318 OSLO, Norway
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Mørland J, Bramness JG. J. Mørland & J.G. Bramness svarer. Tidsskriftet 2018; 138:18-0014. [DOI: 10.4045/tidsskr.18.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Degerud E, Ariansen I, Ystrom E, Graff-Iversen S, Høiseth G, Mørland J, Davey Smith G, Næss Ø. Life course socioeconomic position, alcohol drinking patterns in midlife, and cardiovascular mortality: Analysis of Norwegian population-based health surveys. PLoS Med 2018; 15:e1002476. [PMID: 29293492 PMCID: PMC5749685 DOI: 10.1371/journal.pmed.1002476] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/21/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Socioeconomically disadvantaged groups tend to experience more harm from the same level of exposure to alcohol as advantaged groups. Alcohol has multiple biological effects on the cardiovascular system, both potentially harmful and protective. We investigated whether the diverging relationships between alcohol drinking patterns and cardiovascular disease (CVD) mortality differed by life course socioeconomic position (SEP). METHODS AND FINDINGS From 3 cohorts (the Counties Studies, the Cohort of Norway, and the Age 40 Program, 1987-2003) containing data from population-based cardiovascular health surveys in Norway, we included participants with self-reported information on alcohol consumption frequency (n = 207,394) and binge drinking episodes (≥5 units per occasion, n = 32,616). We also used data from national registries obtained by linkage. Hazard ratio (HR) with 95% confidence intervals (CIs) for CVD mortality was estimated using Cox models, including alcohol, life course SEP, age, gender, smoking, physical activity, body mass index (BMI), systolic blood pressure, heart rate, triglycerides, diabetes, history of CVD, and family history of coronary heart disease (CHD). Analyses were performed in the overall sample and stratified by high, middle, and low strata of life course SEP. A total of 8,435 CVD deaths occurred during the mean 17 years of follow-up. Compared to infrequent consumption ( CONCLUSIONS Moderately frequent consumers had a lower risk of CVD mortality compared with infrequent consumers, and we observed that this association was more pronounced among participants with higher SEP throughout their life course. Frequent binge drinking was associated with a higher risk of CVD mortality, but it was more uncertain whether the risk differed by life course SEP. It is unclear if these findings reflect differential confounding of alcohol consumption with health-protective or damaging exposures, or differing effects of alcohol on health across socioeconomic groups.
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Affiliation(s)
| | | | - Eivind Ystrom
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- School of Pharmacy, University of Oslo, Oslo, Norway
| | | | - Gudrun Høiseth
- Norwegian Institute of Public Health, Oslo, Norway
- Diakonhjemmet Hospital, Center for Psychopharmacology, Oslo, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Øyvind Næss
- Norwegian Institute of Public Health, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
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Strand MC, Arnestad M, Fjeld B, Mørland J. Acute impairing effects of morphine related to driving: A systematic review of experimental studies to define blood morphine concentrations related to impairment in opioid-naïve subjects. Traffic Inj Prev 2017; 18:788-794. [PMID: 28481682 DOI: 10.1080/15389588.2017.1326595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this study was to look for dose- and concentration-effect relationships in experimental studies on single-dose administration of morphine on traffic-relevant behavioral tests by a systematic literature review and possibly to see whether a dose/concentration could be defined below which few or no tests would be affected. METHODS Searches for corresponding literature were conducted using MEDLINE, EMBASE, and PsycINFO, throughout March of 2016. The search strategy consisted of words colligated to cognitive and psychomotor functions of relevance to driving, in relation to morphine administration. The tests were arranged in main groups, and tests showing impairment were categorized by doses as well as calculated plasma concentrations. RESULTS Fifteen studies were included in the review. Impairment after the administration of a single intravenously dose of morphine was found in some of the tests on reaction time, attention, and visual functions. No impairment was observed in tests on psychomotor skills and en-/decoding. Tests on reaction time appeared to be less sensitive to the morphine administration, whereas tests on visual functions and attention appeared to be the most sensitive to the morphine administration. Single-dose administration of morphine with dosages up to 5 mg appeared to cause very few effects on traffic-relevant performance tasks. At higher dosages, impairment was found on various tasks but with no clear dose-effect relationship. Plasma morphine concentrations less than 50 nmol/L are most probably accompanied by few effects on traffic-relevant performance tasks. CONCLUSIONS A plasma morphine concentration of 50 nmol/L (approximately 14.3 ng/mL) could represent an upper level, under which there is little accompanying road traffic risk. A single dose of 5 mg morphine IV and analgetic equivalence doses of fentanyl, hydromorphone, oxycodone, and oxymorphone are presented with the suggestion that few traffic-relevant effects will appear after such doses.
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Affiliation(s)
- Maren Cecilie Strand
- a Department of Forensic Sciences , Oslo University Hospital , Nydalen, Oslo , Norway
| | - Marianne Arnestad
- a Department of Forensic Sciences , Oslo University Hospital , Nydalen, Oslo , Norway
| | - Bente Fjeld
- b Department of Medical Biochemistry , Oslo University Hospital , Nydalen, Oslo , Norway
| | - Jørg Mørland
- c Division of Health Data and Digitalization , Norwegian Institute of Public Health , Nydalen, Oslo , Norway
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Strand MC, Mørland J, Slørdal L, Riedel B, Innerdal C, Aamo T, Mathisrud G, Vindenes V. Conversion factors for assessment of driving impairment after exposure to multiple benzodiazepines/z-hypnotics or opioids. Forensic Sci Int 2017; 281:29-36. [PMID: 29101905 DOI: 10.1016/j.forsciint.2017.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/06/2017] [Accepted: 10/11/2017] [Indexed: 11/18/2022]
Abstract
AIMS Norway has introduced legal concentration limits in blood for 28 non-alcohol drugs in driving under the influence cases. As of 2016 this legislation also regulates the assessment of combined effects of multiple benzodiazepines and opioids. We herein describe the employed methodology for the equivalence tables for concentrations of benzodiazepines/z-hypnotics and opioids implemented in the Norwegian Road Traffic Act. METHODS Legislative limits corresponding to impairment at blood alcohol concentrations (BAC) of 0.02%, 0.05% and 0.12% were established for 15 different benzodiazepines and opioids. This was based on a concept of a linear relationship between blood drug concentration and impairment in drug naïve users. Concentration ratios between these drugs were used to establish conversion factors and calculate net impairment using diazepam and morphine equivalents. RESULTS Conversion factors were established for 14 benzodiazepines/z-hypnotics (alprazolam, bromazepam, clobazam, clonazepam, etizolam, flunitrazepam, lorazepam, nitrazepam, nordiazepam, oxazepam, phenazepam, temazepam, zolpidem and zopiclone) and two opioids (methadone and oxycodone). CONCLUSIONS Conversion factors to calculate diazepam and morphine equivalents for benzodiazepines/z-hypnotics and selected opioids, respectively, have been operative in the Norwegian Road Traffic Act as of February 2016. Calculated equivalents can be applied by the courts to meter out sanctions.
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Affiliation(s)
| | - Jørg Mørland
- Norwegian Institute of Public Health, Division of Health Data and Digitalization, Oslo, Norway.
| | - Lars Slørdal
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.
| | - Bettina Riedel
- University of Bergen, Faculty of Medicine and Dentistry, Department of Clinical Science, Bergen, Norway; Haukeland University Hospital, Laboratory of Clinical Biochemistry, Bergen, Norway.
| | | | - Trond Aamo
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.
| | - Grete Mathisrud
- Norwegian Ministry of Transport and Communications, Department of Public Roads and Traffic Safety, Oslo, Norway.
| | - Vigdis Vindenes
- Oslo University Hospital, Department of Forensic Medicine, Oslo, Norway; Center of Drug and Addiction Research, Faculty of Medicine, University of Oslo, Norway.
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Hjelmeland K, Gustavsen I, Øiestad EL, Øiestad ÅML, Høiseth G, Mørland J. Zopiclone concentrations in oral fluid and blood after, administration of therapeutic doses of zopiclone. Forensic Sci Int 2017; 278:177-183. [PMID: 28735217 DOI: 10.1016/j.forsciint.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/16/2017] [Accepted: 07/05/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Little is known about the relationship between concentrations in oral fluid (OF) and blood for the widely prescribed hypnotic drug zopiclone. The purpose of this study was to investigate the usefulness of OF zopiclone concentrations to predict blood zopiclone concentrations in order to introduce OF testing as an alternative to more cumbersome blood testing. METHODS 16 healthy young male volunteers received capsules of either 5 or 10mg zopiclone on two different study days separated by at least one week. Blood and OF were collected simultaneously at baseline and 9 times after intake of zopiclone on each study day. In addition an OF sample was collected 24-81h after intake. Lunch was served between samples taken 2.5 and 3.5h after intake. All samples were analysed for zopiclone, and the cut-off was 10ng/ml in blood and 0.2ng/ml in OF-buffer mixture. RESULTS Zopiclone was detected in all OF samples during the study day. After 24-81h, all subjects were also positive for zopiclone in OF, except from three subjects ingesting the 5mg dose. In a single case zopiclone was detected in a baseline OF sample 14days after intake on an earlier study day. Zopiclone was detected in both OF and blood in 231 OF/blood pairs, and a significant but weak correlation between OF and blood concentration was seen (R2 of 0.30). The median (range) zopiclone OF/blood concentration ratio (ZOBCR) for all samples were 3.3 (0.8-18). The ZOBCR decreased when the OF volume increased. After 30 of 31 given doses of zopiclone, the ZOBCR was higher in samples collected before lunch than samples collected after lunch. DISCUSSION Vast intra- and interindividual differences in ZOBCR were found, and the correlation between OF and blood concentration was less pronounced than reported in former studies. In accordance with earlier studies we found a negative correlation between ZOBCR and OF volume. The ZOBCR decreases in relation to recent intake of a meal, probably because stimulated saliva production causes "dilution" of saliva. OF zopiclone concentration appeared unsuitable for estimation of blood zopiclone concentration. Due to long detection time, analysis of zopiclone in OF might be useful to detect non-recent, previous intake.
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Affiliation(s)
- Knut Hjelmeland
- Department of Forensic Sciences, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway.
| | - Ingebjørg Gustavsen
- Department of Pharmacology, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway
| | - Elisabeth Leere Øiestad
- Department of Forensic Sciences, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway; School of Pharmacy, University of Oslo, P.O. Box 1068, Blindern, N-0316 Oslo, Norway
| | - Åse Marit Leere Øiestad
- Department of Forensic Sciences, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway
| | - Gudrun Høiseth
- Department of Forensic Sciences, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway; Norwegian Centre of Addiction Research (SERAF), University of Oslo, P.O. Box 1039, Blindern, N-0315 Oslo, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, PO Box 1072, Blindern, N-0316 Oslo, Norway
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Fosen JT, Morini L, Sempio C, Giarratana N, Enger A, Mørland J, Høiseth G. Ethyl Glucuronide Elimination Kinetics in Fingernails and Comparison to Levels in Hair. Alcohol Alcohol 2017; 52:580-586. [DOI: 10.1093/alcalc/agx035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/18/2017] [Indexed: 11/14/2022] Open
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Høiseth G, Berg-Hansen GO, Øiestad ÅML, Bachs L, Mørland J. Impairment due to alcohol, tetrahydrocannabinol, and benzodiazepines in impaired drivers compared to experimental studies. Traffic Inj Prev 2017; 18:244-250. [PMID: 27327554 DOI: 10.1080/15389588.2016.1201205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In some countries, per se laws for other drugs than alcohol are used to judge drunk and drugged drivers. These blood concentration limits are often derived from experimental studies on traffic relevant behavior of healthy volunteers. Knowledge about how results from experimental studies could be transferred to a real-life setting is missing. The aim of this study was to compare impairment seen in experimental studies to the impairment seen at equivalent concentrations in apprehended drunk and drugged drivers. METHODS Results from previously performed meta-analyses of experimental studies regarding impairment from alcohol, tetrahydrocannabinol (THC), and benzodiazepines were compared to impairment in apprehended drunk and drugged drivers as judged by a clinical test of impairment. Both experimental studies and real-life cases were divided into 4 groups according to increasing blood drug concentration intervals. The percentage of impaired test results in experimental studies was compared to the percentage of impaired subjects among drivers within the same blood drug concentration window. RESULTS For ethanol, the percentage of impaired drivers (n = 1,223) increased from 59% in the lowest drug concentration group to 95% in the highest drug concentration group, compared to 7 and 72% in the respective groups in experimental studies. For THC, the percentage of impaired drivers (n = 950) increased from 42 to 58%, the corresponding numbers being 11 and 42% for experimental studies. For benzodiazepines, the percentage of impaired drivers (n = 245) increased from 46 to 76%, the corresponding numbers being 16 and 60% for experimental studies. The increased odds ratio for impairment between 2 concentration groups was comparable for experimental studies and impaired drivers. CONCLUSIONS Fewer test results indicated impairment in experimental studies compared to impaired drivers in real life when influenced by similar blood concentrations of either ethanol, THC, or benzodiazepines. In addition, a comparable relationship between drug concentration and impairment was seen for both experimental studies and real-life cases. We believe that the present study strengthens the background for using experimental studies to establish fixed concentration limits for drunk and drugged drivers, but experimental studies in an impaired driver population could further expand our knowledge.
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Affiliation(s)
- Gudrun Høiseth
- a Norwegian Institute of Public Health , Division of Forensic Sciences , Oslo , Norway
- b Center for Psychopharmacology, Diakonhjemmet Hospital , Oslo , Norway
| | - Grim Otto Berg-Hansen
- a Norwegian Institute of Public Health , Division of Forensic Sciences , Oslo , Norway
| | - Åse Marit L Øiestad
- a Norwegian Institute of Public Health , Division of Forensic Sciences , Oslo , Norway
| | - Liliana Bachs
- a Norwegian Institute of Public Health , Division of Forensic Sciences , Oslo , Norway
| | - Jørg Mørland
- a Norwegian Institute of Public Health , Division of Forensic Sciences , Oslo , Norway
- c Institute of Clinical Medicine , University of Oslo , Oslo , Norway
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Høiseth G, Austdal LE, Wiik E, Bogstrand ST, Mørland J. Prevalence and concentrations of drugs in older suspected drugged drivers. Traffic Inj Prev 2017; 18:231-236. [PMID: 27740861 DOI: 10.1080/15389588.2016.1247209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Older drivers are somewhat more likely to be involved in car crashes than middle-aged drivers but less likely to be involved than younger drivers. This study aimed to assess the extent of drug use in older suspected drunk and drugged drivers, with respect to which drugs were detected and at which concentrations. METHODS Blood samples from older suspected drunk and drugged drivers taken between February 1, 2012, and May 22, 2013, were identified from the database at the Norwegian Institute of Public Health and were retrospectively analyzed for a broad repertoire of drugs relevant for impairment. The prevalence of different drugs among the suspected drunk and drugged drivers was studied. Regarding drug concentrations, the findings in older drivers (>65 years) were compared to a reference group of apprehended drivers aged 20-40 years. RESULTS Four hundred and ten older suspected drunk and drugged drivers were included. Any drug (including ethanol) was detected in 92% of blood samples, and ethanol was detected in 81%. Benzodiazepines were found in 15% of the older drivers and z-hypnotics (zopiclone or zolpidem) were detected in 13%. The most frequent single legal drugs found in blood samples taken from older impaired drivers were zopiclone (9.8%) and diazepam (9.3%). Regarding drug combinations, older drivers used a mean number of 1.4 drugs, and 20% of ethanol-positive cases showed at least one other drug. High drug concentrations of clonazepam and diazepam were more frequently seen in the younger group. CONCLUSIONS This study showed that drugs were detected in the vast majority of older drivers suspected for drunk or drugged driving. Ethanol was the most frequent drug detected, followed by zopiclone and diazepam. Older drivers combine drugs to a lesser degree than younger drivers, but their combination of ethanol and other drugs represents a considerable traffic risk. Lower concentrations of benzodiazepines are seen in older compared to younger drivers.
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Affiliation(s)
- Gudrun Høiseth
- a Norwegian Institute of Public Health, Division of Forensic Sciences , Oslo , Norway
- b Diakonhjemmet Hospital , Center for Psychopharmacology , Oslo , Norway
| | - Linn Engeset Austdal
- a Norwegian Institute of Public Health, Division of Forensic Sciences , Oslo , Norway
| | - Elisabeth Wiik
- a Norwegian Institute of Public Health, Division of Forensic Sciences , Oslo , Norway
| | - Stig Tore Bogstrand
- a Norwegian Institute of Public Health, Division of Forensic Sciences , Oslo , Norway
- c Lovisenberg University College , Oslo , Norway
| | - Jørg Mørland
- a Norwegian Institute of Public Health, Division of Forensic Sciences , Oslo , Norway
- d Institute of Clinical Medicine, University of Oslo , Oslo , Norway
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Mørland J, Bramness JG. Effekter av cannabis varer lenger enn antatt. Tidsskriftet 2017; 137:17-0429. [DOI: 10.4045/tidsskr.17.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Gladhaug IP, Skomedal T, Mørland J, Christoffersen T, Osnes JB. Minneord: Johannes Setekleiv. Tidsskriftet 2017; 137:17-0518. [DOI: 10.4045/tidsskr.17.0518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Waal H, Mørland J. H. Waal og J. Mørland svarer:. Tidsskriftet 2017; 137:857. [DOI: 10.4045/tidsskr.17.0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Sakshaug S, Handal M, Hjellvik V, Berg C, Ripel Å, Gustavsen I, Mørland J, Skurtveit S. Long‐term Use of Z‐Hypnotics and Co‐medication with Benzodiazepines and Opioids. Basic Clin Pharmacol Toxicol 2016; 120:292-298. [DOI: 10.1111/bcpt.12684] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Marte Handal
- Norwegian Institute of Public Health Oslo Norway
| | | | | | - Åse Ripel
- Norwegian Institute of Public Health Oslo Norway
| | | | - Jørg Mørland
- Norwegian Institute of Public Health Oslo Norway
| | - Svetlana Skurtveit
- Norwegian Institute of Public Health Oslo Norway
- Norwegian Centre for Addiction Research University of Oslo Oslo Norway
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Helland A, Lydersen S, Lervåg LE, Jenssen GD, Mørland J, Slørdal L. Driving simulator sickness: Impact on driving performance, influence of blood alcohol concentration, and effect of repeated simulator exposures. Accid Anal Prev 2016; 94:180-187. [PMID: 27322638 DOI: 10.1016/j.aap.2016.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 04/25/2016] [Accepted: 05/08/2016] [Indexed: 06/06/2023]
Abstract
Simulator sickness is a major obstacle to the use of driving simulators for research, training and driver assessment purposes. The purpose of the present study was to investigate the possible influence of simulator sickness on driving performance measures such as standard deviation of lateral position (SDLP), and the effect of alcohol or repeated simulator exposure on the degree of simulator sickness. Twenty healthy male volunteers underwent three simulated driving trials of 1h's duration with a curvy rural road scenario, and rated their degree of simulator sickness after each trial. Subjects drove sober and with blood alcohol concentrations (BAC) of approx. 0.5g/L and 0.9g/L in a randomized order. Simulator sickness score (SSS) did not influence the primary outcome measure SDLP. Higher SSS significantly predicted lower average speed and frequency of steering wheel reversals. These effects seemed to be mitigated by alcohol. Higher BAC significantly predicted lower SSS, suggesting that alcohol inebriation alleviates simulator sickness. The negative relation between the number of previous exposures to the simulator and SSS was not statistically significant, but is consistent with habituation to the sickness-inducing effects, as shown in other studies. Overall, the results suggest no influence of simulator sickness on SDLP or several other driving performance measures. However, simulator sickness seems to cause test subjects to drive more carefully, with lower average speed and fewer steering wheel reversals, hampering the interpretation of these outcomes as measures of driving impairment and safety. BAC and repeated simulator exposures may act as confounding variables by influencing the degree of simulator sickness in experimental studies.
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Affiliation(s)
- Arne Helland
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare-Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lone-Eirin Lervåg
- SINTEF Technology and Society, Department of Transport Research, Trondheim, Norway
| | - Gunnar D Jenssen
- SINTEF Technology and Society, Department of Transport Research, Trondheim, Norway
| | - Jørg Mørland
- National Institute of Public Health, Oslo, Norway and Institute of Clinical Medicine, University of Oslo, Norway
| | - Lars Slørdal
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
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Affiliation(s)
- Hallvard Gjerde
- Norwegian Institute of Public Health, Nydalen, Oslo, Norway.
| | - Jørg Mørland
- Norwegian Institute of Public Health, Nydalen, Oslo, Norway
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Strand MC, Gjerde H, Mørland J. Driving under the influence of non-alcohol drugs--An update. Part II: Experimental studies. Forensic Sci Rev 2016; 28:79-101. [PMID: 27257716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Experimental studies on the impairing effects of drugs of relevance to driving-related performance published between 1998 and 2015 were reviewed. Studies with on-the-road driving, driving simulators, and performance tests were included for benzodiazepines and related drugs, cannabis, opioids, stimulants, GHB, ketamine, antihistamines, and antidepressants. The findings in these experimental studies were briefly discussed in relation to a review of epidemiological studies published recently. The studies mainly concluded that there may be a significant psychomotor impairment after using benzodiazepines or related drugs, cannabis, opioids, GHB, or ketamine. Low doses of central stimulants did not seem to cause impairment of driving behavior.
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Affiliation(s)
- M C Strand
- Domain for Forensic Science, Norwegian Institute of Public Health, Oslo, Norway
| | - H Gjerde
- Domain for Forensic Science, Norwegian Institute of Public Health, Oslo, Norway
| | - J Mørland
- Domain for Forensic Science, Norwegian Institute of Public Health, Oslo, Norway
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Eriksen GS, Andersen JM, Boix F, Bergh MSS, Vindenes V, Rice KC, Huestis MA, Mørland J. Comparison of (+)- and (-)-Naloxone on the Acute Psychomotor-Stimulating Effects of Heroin, 6-Acetylmorphine, and Morphine in Mice. J Pharmacol Exp Ther 2016; 358:209-15. [PMID: 27278234 DOI: 10.1124/jpet.116.233544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/07/2016] [Indexed: 11/22/2022] Open
Abstract
Toll-like receptor 4 (TLR4) signaling is implied in opioid reinforcement, reward, and withdrawal. Here, we explored whether TLR4 signaling is involved in the acute psychomotor-stimulating effects of heroin, 6-acetylmorphine (6-AM), and morphine as well as whether there are differences between the three opioids regarding TLR4 signaling. To address this, we examined how pretreatment with (+)-naloxone, a TLR4 active but opioid receptor (OR) inactive antagonist, affected the acute increase in locomotor activity induced by heroin, 6-AM, or morphine in mice. We also assessed the effect of pretreatment with (-)-naloxone, a TLR4 and OR active antagonist, as well as the pharmacokinetic profiles of (+) and (-)-naloxone in the blood and brain. We found that (-)-naloxone reduced acute opioid-induced locomotor activity in a dose-dependent manner. By contrast, (+)-naloxone, administered in doses assumed to antagonize TLR4 but not ORs, did not affect acute locomotor activity induced by heroin, 6-AM, or morphine. Both naloxone isomers exhibited similar concentration versus time profiles in the blood and brain, but the brain concentrations of (-)-naloxone reached higher levels than those of (+)-naloxone. However, the discrepancies in their pharmacokinetic properties did not explain the marked difference between the two isomers' ability to affect opioid-induced locomotor activity. Our results underpin the importance of OR activation and do not indicate an apparent role of TLR4 signaling in acute opioid-induced psychomotor stimulation in mice. Furthermore, there were no marked differences between heroin, 6-AM, and morphine regarding involvement of OR or TLR4 signaling.
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Affiliation(s)
- Guro Søe Eriksen
- Department of Drug Abuse Research, Division for Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway (G.S.E., J.M.A., F.B., M.S.-S.B., V.V., J.M.); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (V.V., J.M.); University of Maryland School of Medicine, Baltimore, Maryland (M.A.H.); and Section on Drug Design and Synthesis, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland (K.C.R)
| | - Jannike Mørch Andersen
- Department of Drug Abuse Research, Division for Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway (G.S.E., J.M.A., F.B., M.S.-S.B., V.V., J.M.); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (V.V., J.M.); University of Maryland School of Medicine, Baltimore, Maryland (M.A.H.); and Section on Drug Design and Synthesis, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland (K.C.R)
| | - Fernando Boix
- Department of Drug Abuse Research, Division for Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway (G.S.E., J.M.A., F.B., M.S.-S.B., V.V., J.M.); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (V.V., J.M.); University of Maryland School of Medicine, Baltimore, Maryland (M.A.H.); and Section on Drug Design and Synthesis, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland (K.C.R)
| | - Marianne Skov-Skov Bergh
- Department of Drug Abuse Research, Division for Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway (G.S.E., J.M.A., F.B., M.S.-S.B., V.V., J.M.); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (V.V., J.M.); University of Maryland School of Medicine, Baltimore, Maryland (M.A.H.); and Section on Drug Design and Synthesis, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland (K.C.R)
| | - Vigdis Vindenes
- Department of Drug Abuse Research, Division for Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway (G.S.E., J.M.A., F.B., M.S.-S.B., V.V., J.M.); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (V.V., J.M.); University of Maryland School of Medicine, Baltimore, Maryland (M.A.H.); and Section on Drug Design and Synthesis, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland (K.C.R)
| | - Kenner C Rice
- Department of Drug Abuse Research, Division for Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway (G.S.E., J.M.A., F.B., M.S.-S.B., V.V., J.M.); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (V.V., J.M.); University of Maryland School of Medicine, Baltimore, Maryland (M.A.H.); and Section on Drug Design and Synthesis, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland (K.C.R)
| | - Marilyn A Huestis
- Department of Drug Abuse Research, Division for Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway (G.S.E., J.M.A., F.B., M.S.-S.B., V.V., J.M.); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (V.V., J.M.); University of Maryland School of Medicine, Baltimore, Maryland (M.A.H.); and Section on Drug Design and Synthesis, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland (K.C.R)
| | - Jørg Mørland
- Department of Drug Abuse Research, Division for Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway (G.S.E., J.M.A., F.B., M.S.-S.B., V.V., J.M.); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (V.V., J.M.); University of Maryland School of Medicine, Baltimore, Maryland (M.A.H.); and Section on Drug Design and Synthesis, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland (K.C.R)
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Kvello AMS, Andersen JM, Øiestad EL, Mørland J, Bogen IL. Pharmacological Effects of a Monoclonal Antibody against 6-Monoacetylmorphine upon Heroin-Induced Locomotor Activity and Pharmacokinetics in Mice. J Pharmacol Exp Ther 2016; 358:181-9. [PMID: 27217591 DOI: 10.1124/jpet.116.233510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/19/2016] [Indexed: 12/21/2022] Open
Abstract
Immunotherapy can provide a supplemental treatment strategy against heroin use on the principle of sequestering the active drug in the bloodstream, thereby reducing its distribution to the brain. Previous studies have shown that heroin's first metabolite, 6-monoacetylmorphine (6-MAM), is the main mediator of acute heroin effects. The objective of the present study was to characterize the pharmacological potential of a monoclonal antibody against 6-MAM (anti-6-MAM mAb) to counteract the heroin response. The individual contributions from heroin and 6-MAM to heroin effects were also examined by pretreating mice with anti-6-MAM mAb (10-100 mg/kg) prior to either heroin or 6-MAM injection (1.25-2.5 μmol/kg). The opioid-induced behavioral response was assessed in a locomotor activity test, followed by opioid and antibody quantification in blood and brain tissue. Pretreatment with mAb caused a profound reduction of heroin- and 6-MAM-induced behavior, accompanied by correspondingly decreased levels of 6-MAM in brain tissue. mAb pretreatment was more efficient against 6-MAM injection than against heroin, leading to an almost complete blockade of 6-MAM-induced effects. mAb pretreatment was unable to block the immediate (5-minute) transport of active metabolites across the blood-brain barrier after heroin injection, indicating that heroin itself appears to enhance the immediate delivery of 6-MAM to the brain. The current study provides additional evidence that 6-MAM sequestration is crucial for counteracting the acute heroin response, and demonstrates the pharmacological potential of immunotherapy against heroin use.
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Affiliation(s)
- Anne Marte Sjursen Kvello
- Department of Drug Abuse Research, Domain for Forensic Sciences, Norwegian Institute of Public Health (A.M.S.K., J.M.A., E.L.Ø., J.M. and I.L.B.) and School of Pharmacy, University of Oslo (E.L.Ø.) Oslo, Norway
| | - Jannike Mørch Andersen
- Department of Drug Abuse Research, Domain for Forensic Sciences, Norwegian Institute of Public Health (A.M.S.K., J.M.A., E.L.Ø., J.M. and I.L.B.) and School of Pharmacy, University of Oslo (E.L.Ø.) Oslo, Norway
| | - Elisabeth Leere Øiestad
- Department of Drug Abuse Research, Domain for Forensic Sciences, Norwegian Institute of Public Health (A.M.S.K., J.M.A., E.L.Ø., J.M. and I.L.B.) and School of Pharmacy, University of Oslo (E.L.Ø.) Oslo, Norway
| | - Jørg Mørland
- Department of Drug Abuse Research, Domain for Forensic Sciences, Norwegian Institute of Public Health (A.M.S.K., J.M.A., E.L.Ø., J.M. and I.L.B.) and School of Pharmacy, University of Oslo (E.L.Ø.) Oslo, Norway
| | - Inger Lise Bogen
- Department of Drug Abuse Research, Domain for Forensic Sciences, Norwegian Institute of Public Health (A.M.S.K., J.M.A., E.L.Ø., J.M. and I.L.B.) and School of Pharmacy, University of Oslo (E.L.Ø.) Oslo, Norway
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Affiliation(s)
- J Mørland
- Department of Drug Abuse Research and Method Development, Division of Forensic Sciences, Norwegian Institute of Public Health, and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Fosen JT, Morini L, Sempio C, Ganss R, Mørland J, Høiseth G. Levels of Hair Ethyl Glucuronide in Patients with Decreased Kidney Function: Possibility of Misclassification of Social Drinkers. Alcohol Clin Exp Res 2016; 40:451-6. [DOI: 10.1111/acer.12970] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/23/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Jan Toralf Fosen
- Division of Forensic Sciences; Norwegian Institute of Public Health; Oslo Norway
| | - Luca Morini
- Department of Public Health, Experimental and Forensic Medicine; University of Pavia; Pavia Italy
| | - Cristina Sempio
- Department of Public Health, Experimental and Forensic Medicine; University of Pavia; Pavia Italy
| | - Rudiger Ganss
- Division of Internal Medicine; Department of Nephrology; Akershus University Hospital; Lørenskog Norway
| | - Jørg Mørland
- Division of Forensic Sciences; Norwegian Institute of Public Health; Oslo Norway
| | - Gudrun Høiseth
- Division of Forensic Sciences; Norwegian Institute of Public Health; Oslo Norway
- Center for psychopharmacology; Diakonhjemmet Hospital; Oslo Norway
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Vindenes V, Bramness JG, Bretteville-Jensen AL, Mørland J, Bachs L. Gir sterkere cannabis flere helseproblemer? Tidsskriftet 2016; 136:1736-1738. [DOI: 10.4045/tidsskr.15.1297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Strand MC, Innerdal C, Mathisrud G, Mørland J, Riedel B, Slørdal L, Aamo TO, Vindenes V. Revisjon av faste grenser for rusmidler i trafikken. Tidsskriftet 2016; 136:1619-1620. [DOI: 10.4045/tidsskr.16.0730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Christophersen AS, Mørland J, Stewart K, Gjerde H. International trends in alcohol and drug use among vehicle drivers. Forensic Sci Rev 2016; 28:37-66. [PMID: 26841722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Trends in the use of alcohol and drugs among motor vehicle drivers in Australia, Brazil, Norway, Spain, and the United States have been reviewed. Laws, regulations, enforcement, and studies on alcohol and drugs in biological samples from motor vehicle drivers in general road traffic and fatal road traffic crashes (RTCs) are discussed. Roadside surveys showed a reduction of drunk driving over time in the studied countries; however, the pattern varied within and between different countries. The reduction of alcohol use may be related to changes in road traffic laws, public information campaigns, and enforcement, including implementation of random breath testing or sobriety checkpoints. For non-alcohol drugs, the trend in general road traffic is an increase in use. However, drugs were not included in older studies; it is therefore impossible to assess the trends over longer time periods. Data from the studied countries, except Brazil, have shown a significant decrease in fatal RTCs per 100,000 inhabitants over the last decades; from 18.6 to 4.9 in Australia, 14.5 to 2.9 in Norway, 11.1 to 3.6 in Spain, and 19.3 to 10.3 in the United States. The number of alcohol-related fatal RTCs also decreased during the same time period. The proportion of fatal RTCs related to non-alcohol drugs increased, particularly for cannabis and stimulants. A general challenge when comparing alcohol and drug findings in biological samples from several countries is connected to differences in study design, particularly the time period for performing roadside surveys, biological matrix types, drugs included in the analytical program, and the cutoff limits used for evaluation of results. For RTC fatalities, the cases included are based on the police requests for legal autopsy or drug testing, which may introduce a significant selection bias. General comparisons between high-income countries and low- and middle-income countries as well as a discussion of possible future trends are included.
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Affiliation(s)
- A S Christophersen
- Division of Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - J Mørland
- Division of Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway
| | - K Stewart
- Prevention Research Center, Safety and Policy Analysis International, Oakland, CA, USA
| | - H Gjerde
- Division of Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway
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Høiseth G, Berg-Hansen GO, Mørland J. Evaluation of the hip-flask defence by determination of ethyl glucuronide and ethyl sulphate concentrations in blood. Forensic Sci Int 2015; 257:398-402. [PMID: 26555501 DOI: 10.1016/j.forsciint.2015.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/14/2015] [Accepted: 10/18/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The hip-flask defence (i.e. claiming ethanol intake after an incident) is difficult to refute by the use of ethanol analyses alone, as these may show decreasing concentrations shortly after intake of alcohol. The non-oxidative metabolites of ethanol, ethyl glucuronide (EtG) and ethyl sulphate (EtS) have a different pharmacokinetic profile, with peak concentrations in blood around 4h after intake. The aim of this study was to describe a method for using EtG-analysis for the purpose of estimating the time point of ethanol intake and to report cases in which this method is used. METHODS Previously published studies are summarised. Also, in expert witness cases where the hip-flask defence is claimed, EtG and EtS were analysed in selected cases. Twelve such cases are reported. RESULTS In previous studies, about 70 healthy volunteers have been included in different kinetic studies, demonstrating maximal individual concentrations of EtG always below 0.5 mg/L after 1 h, below 1 mg/L after 2 h and somewhat above 1 mg/L 4 h after a moderate alcohol intake (up to 80 grams of ethanol). Twelve cases are reported in the present study, where the suspect claimed no alcohol intake before driving, only intake after driving. In all 12 cases, ethanol concentration was lower in the second sample (taken approximately 30 min after the first). The median EtG concentration in the first sample was 4.13 mg/L (range 2.0-7.4) and 4.34 mg/L (range 2.1-7.2) in the second sample. One case showed an increase in EtG concentrations of 15% from first to second sample (the time difference between the samples was 32 min, with the first sample taken 41 min after driving). For the remainder of the cases, EtG concentrations were relatively stable. CONCLUSIONS In all the presented cases, the levels of EtG were substantially higher than what would be expected only about 1-2h after a very recent alcohol intake. The relatively stable concentrations between the first and second sample also indicated that the high EtG concentrations were not caused by a rapid formation after a recent intake, as this would have demonstrated increasing concentrations over a time period of 30 min. In conclusion, EtG and EtS in blood could be a helpful tool in assessment of the hip-flask defence, in cases where the detected ethanol is claimed to be caused solely by a single intake after driving.
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Affiliation(s)
- Gudrun Høiseth
- Norwegian Institute of Public Health, Division of Forensic Medicine, Oslo, Norway; Center for psychopharmacology, Diakonhjemmet hospital, Oslo, Norway.
| | | | - Jørg Mørland
- Norwegian Institute of Public Health, Division of Forensic Medicine, Oslo, Norway
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Bernard JP, Khiabani HZ, Hilberg T, Karinen R, Slørdal L, Waal H, Mørland J. Characteristics of methadone-related fatalities in Norway. J Forensic Leg Med 2015; 36:114-20. [PMID: 26439870 DOI: 10.1016/j.jflm.2015.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/15/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
There are currently over 7000 patients enrolled in opioid maintenance treatment (OMT) programs in Norway. A rise in methadone-related deaths proportional to increasing methadone sales over the period 2000-2006 has been observed, but the causative factors for these fatalities have been elusive. In the present study, individual characteristics, methadone concentrations and additional toxicological findings were analyzed. Methadone intoxication deaths (n = 264) were divided into 3 groups according to toxicological findings in whole blood: group 1 - methadone detected alone, or together with one additional drug at low or therapeutic levels, or a low concentration of ethanol (<1 g/L) (n = 21); group 2 - multiple additional drugs/substances detected below lethal levels (n = 175); group 3 - one or more additional drugs/substances detected at lethal levels, or ethanol >3 g/L (n = 55). Methadone blood concentrations in decedents who had been enrolled in OMT were higher than for decedents not in treatment, in all groups. Blood methadone concentrations around 1 mg/L were present in fatal multi-drug intoxications in OMT patients. Results suggest that some patients may be at risk of dying when combining therapeutic concentrations of methadone with other psychoactive substances. Somatic disease was a common finding among deceased OMT patients. Concentrations in methadone users not enrolled in OMT were predominantly between 0.3 and 0.4 mg/L and were not related to the presence of other drugs. However, methadone concentrations below 0.1 mg/L may be associated with intoxication following methadone use, both alone and in combination with other drugs. Younger male users (mean age 34 years) seemed to have a higher susceptibility to methadone intoxication.
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Affiliation(s)
- Jean-Paul Bernard
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Centre for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.
| | - Hassan Z Khiabani
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Oslo University Hospital, Rikshospitalet, Department of Pharmacology, Oslo, Norway
| | - Thor Hilberg
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Fürst Medical Laboratory, Oslo, Norway
| | - Ritva Karinen
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway
| | - Lars Slørdal
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Clinical Pharmacology, St. Olav's Hospital, Trondheim, Norway
| | - Helge Waal
- SERAF-Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway; Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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Medhus S, Rognli EB, Gossop M, Holm B, Mørland J, Bramness JG. Amphetamine-induced psychosis: Transition to schizophrenia and mortality in a small prospective sample. Am J Addict 2015; 24:586-9. [PMID: 26332037 DOI: 10.1111/ajad.12274] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/12/2015] [Accepted: 08/08/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We investigated transition from amphetamine-induced psychosis (AIP) to schizophrenia. METHODS A sample of 28 individuals was identified while hospitalized for AIP. We reviewed their hospital records after six years. RESULTS During follow-up, seven individuals (25%) died and nine (32%) had moved from the area. Of the remaining 12, four individuals (25%) were diagnosed with schizophrenia. These individuals were, at baseline, characterized by fewer hallucinatory symptoms and more homelessness. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Hospitalization for AIP was a relatively specific risk factor for schizophrenia and the mortality rate in AIP was high.
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Affiliation(s)
- Sigrid Medhus
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Norway.,Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Eline Borger Rognli
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Norway.,Oslo University Hospital, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Norway
| | - Michael Gossop
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Norway.,Kings College London, National Addiction Centre, London, UK
| | - Bjørn Holm
- Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, Oslo, Norway
| | - Jørgen G Bramness
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Norway
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Helland A, Jenssen GD, Lervåg LE, Moen T, Engen T, Lydersen S, Mørland J, Slørdal L. Evaluation of measures of impairment in real and simulated driving: Results from a randomized, placebo-controlled study. Traffic Inj Prev 2015; 17:245-250. [PMID: 26147898 DOI: 10.1080/15389588.2015.1065975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 06/21/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Standard deviation of lateral position (SDLP) is often the primary outcome in experimental studies on impaired driving. However, other measures may be easier and more practical to obtain and reflect a broader range of driving-related behaviors. We wanted to assess the validity and sensitivity of a range of measures in a driving simulator as well as during real driving and compare these to SDLP. METHODS Twenty healthy male volunteers undertook 6 driving trials each, 3 in a regular car on a closed track resembling rural road conditions and 3 in a simulator with an identical driving scenario. Ethanol was used as impairing substance due to its well-characterized effects on driving. The subjects were tested sober and at blood alcohol concentrations (BAC) of approximately 0.5 and 0.9 g/L. We explored dose-response relationships between BAC and a range of driving-related measures, as well as their BAC-dependent effect sizes. RESULTS In simulator driving, ethanol intake increased steering wheel reversal frequency, steering wheel movement measures, average speed, standard deviation of speed, and pedal use frequency. At the test track, only steering wheel movement and standard deviation of speed were significantly correlated to BAC. Likewise, reaction to unexpected incidents and observance of red traffic lights were adversely affected by ethanol in the simulator but not at the test track. Whereas SDLP showed a relatively large effect size that was similar in simulated and real driving, all other measures demonstrated smaller effect sizes, with less pronounced BAC effects on the test track than in the simulator. CONCLUSIONS The results suggest that the driving-related measures explored in this study are less sensitive to alcohol-mediated driving impairment than SDLP, especially during real (test track) driving. The discrepancy in effect sizes between simulated and real driving may imply low external validity of these measures in simulator studies.
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Affiliation(s)
- Arne Helland
- a Department of Clinical Pharmacology , St. Olav University Hospital , Trondheim , Norway
- b Department of Laboratory Medicine , Children's and Women's Health, Norwegian University of Science and Technology , Trondheim , Norway
| | - Gunnar D Jenssen
- c SINTEF Technology and Society , Department of Transport Research , Trondheim , Norway
| | - Lone-Eirin Lervåg
- c SINTEF Technology and Society , Department of Transport Research , Trondheim , Norway
| | - Terje Moen
- c SINTEF Technology and Society , Department of Transport Research , Trondheim , Norway
| | - Thomas Engen
- c SINTEF Technology and Society , Department of Transport Research , Trondheim , Norway
| | - Stian Lydersen
- d Regional Centre for Child and Youth Mental Health and Child Welfare-Central Norway, Norwegian University of Science and Technology , Trondheim , Norway
| | - Jørg Mørland
- e National Institute of Public Health, Oslo, Norway and Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Lars Slørdal
- a Department of Clinical Pharmacology , St. Olav University Hospital , Trondheim , Norway
- b Department of Laboratory Medicine , Children's and Women's Health, Norwegian University of Science and Technology , Trondheim , Norway
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