Carisoprodol, meprobamate, and driving impairment

This paper considers the pharmacology of the centrally acting muscle relaxant carisoprodol, and its metabolite meprobamate, which is also administered as an anxiolytic in its own right. Literature implicating these drugs in impaired driving is also reviewed. A series of 104 incidents in which these drugs were detected in the blood of drivers involved in accidents or arrested for impaired driving was considered, with respect to the analytical toxicology results, patterns of drug use in these subjects, the driving behaviors exhibited, and the symptoms observed in the drivers. Symptomatology and driving impairment were consistent with other CNS depressants, most notably alcohol. Reported driving behaviors included erratic lane travel, weaving, driving slowly, swerving, stopping in traffic, and hitting parked cars and other stationary objects. Drivers on contact by the police displayed poor balance and coordination, horizontal gaze nystagmus, bloodshot eyes, unsteadiness, slurred speech, slow responses, tendency to doze off or fall asleep, difficulty standing, walking or exiting their vehicles, and disorientation. Many of these cases had alcohol or other centrally acting drugs present also, making difficult the attribution of the documented impairment specifically to carisoprodol and meprobamate. In 21 cases, however, no other drugs were detected, and similar symptoms were present. Impairment appeared to be possible at any concentration of these two drugs; however, the most severe driving impairment and most overt symptoms of intoxication were noted when the combined concentration exceeded 10 mg/L, a level still within the normal therapeutic range.     

Value orientation and psychosocial adjustment at various levels of marijuana use

Personality characteristics and values of 475 undergraduates were studied with respect to marijuana use and the usual demographic variables. Frequent Users and Adamant Nonusers (i.e., those persons who never have used marijuana and never will) each account for 23% of the sample. The demographic data were essentially similar between the four groups under study, but the group differences in reported marijuana use corresponded to large differences in personality and values. The latter was assessed with an instrument developed by the authors based on F. Kluckhohn's theory of variation in value orientations; personality characteristics were assessed with the California Psychological Inventory. The latter (CPI) portrays the Frequent User, in comparison to the other groups but especially relative to the Adamant Nonuser, as likely to be interpersonally and intellectually more effective, trusting in others, and confident and to possess a greater degree of ego strength. The Adamant Nonuser appears to be more submissive in general, lacking in self-insight, dependent on external structure, and judgmental. These differences are interpreted in terms of the value orientations that have primacy for the members of each of the groups. For example, the Adamant Nonuser feels that nature is more subjugating than do the other groups. His standards are extrinsic, and he has a desire for order, associated with an emphasis on authority supported by a belief that humankind is naturally evil or dangerous and that oneThis study was supported in part by a grant from the Illinois Law Enforcement Commission under grant A-70-52R, 2-09-25-04 10-02.Received B.A. from Columbia University and M.A. from the City University of New York. Currently completing dissertation in Educational Psychology at the University of Chicago. Interests lie in the areas of moral development, moral education, role-taking, statistics, methodology, and delinquency.Received B.A. from Cornell University and M.A. from the University of Illinois, where he is a doctoral student in the Psychology Department. Interests lie in the areas of role-taking, therapy, moral education, guided group interaction, and aggression.     

Religious fundamentalism,religiosity, and priming: effects on attitudes,perceptions, and mock jurors’ decisions in an insanity defense case

Jurors are asked to use their personal knowledge and experience to make verdict decisions; thus, it is no surprise that their religious beliefs might influence their decisions. During legal insanity trials, jurors might also be exposed to religious stimuli (e.g. crucifix, prayer, Bible, etc.), which could evoke (prime) religious beliefs and thus influence decisions. Two studies examined whether dimensions of religiosity and religious beliefs relate to attitudes and decisions concerning mental health defenses, testing social identity theory against Allport and Ross’s religiosity hypothesis. In Study 1 (attitudes survey) and Study 2 (mock juror decision-making paradigm), religious fundamentalist beliefs consistently predicted punitive attitudes and decisions related to mental health defenses and verdicts, and this was moderated by intrinsic religiosity, such that religious fundamentalist beliefs only predicted punitiveness for individuals low in intrinsic religiosity. Also, priming fundamentalist beliefs increased punitiveness in both verdict and sentencing decisions. Combined, these results suggest that religious beliefs play a role in jurors’ verdict decisions in an insanity case, and that priming fundamentalist beliefs increases jurors’ punitiveness. Allport and Ross’s religiosity hypothesis was supported, but social identity theory was not.     

Looking into the Day-To-Day Process of Victim Safety Planning

Although safety planning is a widely recommended intervention for domestic violence and sexual assault victims, there has been limited research on the safety planning process, content, context or effectiveness. This study builds on prior research to increase the understanding of safety planning in every day practice through focus group discussions with domestic violence and sexual assault advocates from a variety of settings. Five focus groups with 37 participants from a variety of settings discussed typical safety planning strategies and addressing the complexity of safety in challenging situations. Six main themes emerged with regard to typical safety planning strategies. Additionally, discussions revealed there are no widely accepted protocols or evidence-based strategies regarding how to assess and handle common but risky situations. Lastly, results indicate that risks are multi-layered and impacted by resources available to victims as well as civil or criminal justice system procedures, policies and victim status. It is essential that evidence based best practices and protocols be developed for safety planning for a number of high risk situations along with ongoing training, supervision and support. Future research is needed to examine whether, and how, safety planning best practices and protocols should differ depending on agency setting or delivery mode (e.g., hotline, case management, counseling) and geographic context.     

A Multi-Drug Intoxication Fatality Involving Xyrem® (GHB)

Abstract:  Gamma-hydroxybutyrate (GHB) is best known as a recreational depressant drug, whose use has also been implicated in drug facilitated sexual assault cases. It is also available as a therapeutic agent (Xyrem^®) used for the treatment of daytime sleepiness or cataplexy associated with narcolepsy. This is a report of a case of a 53-year-old woman undergoing treatment with Xyrem^® for narcolepsy. The decedent was also prescribed tramadol, gabapentin, cetirizine, modafinil, carisoprodol, and Xyrem^®. Toxicological analysis of the blood revealed GHB 165.6 mg/L, and 90.7 mg/L in the urine. Blood GHB concentrations in the range 156–260 mg/L have been reported to induce moderately sound sleep. The combined use of central nervous system depressant drugs, together with her problematic sleep apnea, and snoring (both contraindications for GHB use) were determined to have caused this subject's death. The manner of death was determined to be accidental.     

Toluene-Impaired Drivers: Behavioral Observations, Impairment Assessment, and Toxicological Findings

Abstract:  Toluene is an aromatic hydrocarbon solvent frequently abused for its euphoric and intoxicating properties. This report describes a series of six cases involving drivers arrested for driving under the influence who subsequently tested positive for toluene. Case data including driving behavior, physiological signs and symptoms, evidence of impairment, and toxicology findings were reviewed. Blood toluene concentrations in the drivers ranged from 12 to 45 mg/L (median 23 mg/L, mean 25 mg/L, SD 12.1 mg/L). All drivers were determined to be intoxicated, and displayed symptoms including balance problems, confusion and disorientation, loss of coordination, and inability to follow instructions. They also displayed horizontal but not vertical nystagmus, elevated pulse and blood pressure, and lower body temperature. These findings are consistent with prior reports that subjects with blood toluene concentrations above 10 mg/L are invariably under the influence and their driving skills are affected.     

Factors Associated with Separation and Ongoing Violence among Women with Civil Protective Orders

This study examined a large sample of women recruited out of court at the time they received a civil protective order to better understand relationship status after obtaining a protective order (PO) and factors associated with protective order violations. Results are consistent with prior research suggesting that the protective order may be the impetus in separating from the abusive partner for some women, while for other women it is part of the separation process. Results also indicated that five out of ten women who did not continue a relationship experienced a violation while seven out of ten women who did continue a relationship with the PO partner experienced a violation. The majority of women felt safer and reported they believed the protective order was effective 13 months post-PO, regardless of relationship status. Furthermore, stalking played a significant role in separation from an abusive relationship and in protective order violations regardless of relationship status. Implications for practice and future research are discussed.