Impairment in drivers due to cannabis in combination with other drugs.

Blood samples from 425 suspected drugged drivers who were clinically impaired and negative for alcohol were analysed. Fifty-six percent of the samples were positive for tetrahydrocannabinol (THC). Tetrahydrocannabinol-positive blood samples were analysed for amphetamines, barbiturates, benzodiazepines, cocaine metabolites and opiates. Eighty-two percent of the samples were found to be positive for one or more drugs in addition to THC, and the concentrations of these drugs were often high. Thus, THC in combination with other drugs seems to be a much more frequent reason for impairment than THC alone among Norwegian drugged drivers.     

The detection of sedatives in hair and nail samples using tandem LC-MS-MS

Drug screening methods were developed to detect alprazolam, clobazam, clonazepam, diazepam, midazolam, oxazepam, temazepam, triazolam, zopiclone, and selected metabolites in human hair and nail samples employing liquid-liquid extraction and tandem liquid chromatography-mass spectrometry (LC-MS-MS). Hair and nail samples were obtained from patients who had recently discontinued or were currently prescribed one or more of the targeted drugs. Prazepam was used as the internal standard for all compounds. Some components in the hair matrix gave the same transitions as some of the analytes but did not compromise the analyses because their retention times differed from those for the target compounds. The analytical run time was 8-10min. Results of the hair analysis of a DFSA victim are also presented.     

The distribution of controlled drugs on banknotes via counting machines

Bundles of paper, similar to sterling banknotes, were counted in banks in England and Wales. Subsequent analysis showed that the counting process, both by machine and by hand, transferred nanogram amounts of cocaine to the paper. Crystalline material, similar to cocaine hydrochloride, could be observed on the surface of the paper following counting. The geographical distribution of contamination broadly followed Government statistics for cocaine usage within the UK. Diacetylmorphine, Delta(9)-tetrahydrocannabinol (THC) and 3,4-methylenedioxymethylamphetamine (MDMA) were not detected during this study.     

The determination of drugs and their substitutes in human hairs

In recent years it has become possible to detect organic pharmaceuticals and drugs in a few milligrams of a person's hair, using modern analytical methods (RIA, GC/MS, GC), whether this person has taken narcotics and other drugs in past times. With the aid of hair analysis it is possible to examine the drug career of a drug addict for up to 1 year, and sometimes for a longer time. This is mostly of great importance in criminalistics and forensic medicine, in the criminal retrospective examination of addicts.     

The use of drugs in torture and human rights abuses

The forced administration of drugs, usually by injection, may accompany physical torture. In the extrajudicial environment in which torture occurs, documentation of the types of drugs used is difficult. In violation of all codes of professional ethics, physician participation appears to be ubiquitous. In the Soviet Union, human rights abuses have become institutionalized within the mental health care system. Therapeutic drugs are used, often at toxic levels, to punish political and/or religious dissidents.     

Lethal combination of tramadol and multiple drugs affecting serotonin

The death of a 36-year-old alcoholic man who died after developing seizure activity while being treated with tramadol, as well as with venlafaxine, trazodone, and quetiapine, all of which interact with the neurotransmitter serotonin, is reported. The decedent, who had a history of chronic back pain, alcoholism, depression, mild hypertensive cardiovascular disease, and gastritis, had just been discharged from the hospital after 4 days of alcohol detoxification treatment. During the admission, no withdrawal seizures were noted. The morning after discharge, a witness observed the decedent exhibiting seizure activity and then collapsing. An autopsy was performed approximately 6 hours after death, and the anatomic findings were consistent with seizure activity and collapse, which included biting injuries of the tongue and soft-tissue injuries of the face. Toxicologic analysis identified tramadol, venlafaxine, promethazine, and acetaminophen in the urine; tramadol (0.70 mg/L) and venlafaxine (0.30 mg/L) in the heart blood, and 0.10 mg of tramadol in 40 ml of submitted stomach contents. No metabolites, such as acetate, acetone, lactate, and pyruvate, were found in the specimens that would be characteristically found in a person with alcohol withdrawal syndrome. The threshold for seizures is lowered by tramadol. In addition, the risk for seizure is enhanced by the concomitant use of tramadol with selective serotonin reuptake inhibitors or neuroleptics, and its use in patients with a recognized risk for seizures, i.e., alcohol withdrawal. The cause of death in this individual was seizure activity complicating therapy for back pain, depression, and alcohol withdrawal syndrome. The data in Adverse Event Reporting System of the Food and Drug Administration from November 1, 1997 to September 8, 1999 was reviewed along with a MEDLINE search from 1966 to the present. This case appears to be the first reported death caused by seizure activity in a patient taking tramadol in combination with drugs that affect serotonin.     

Detection of antidepressant and antipsychotic drugs in human hair

The presence of therapeutic drugs and their metabolites in the hair of psychiatric patients was investigated using gas chromatography (GC)-mass spectroscopy (MS)-electron ionization (EI) and GC-MS-chemical ionization (CI). In hair samples tested from 35 subjects, carbamazepine, amitriptyline, doxepin, trihexyphenidyl, chlorpromazine, chlorprothixene, trifluoperazine, clozapine and haloperidol were detected, with maximal concentrations of 22.5, 57.7, 183.3, 15.6, 68.2, 30.0, 36.8, 59.2 and 20.1 ng/mg of hair sample, respectively. Chlorpromazine and clozapine concentrations in the hair were found to be dependent on the dosage used and their correlation coefficients were 0.8047 (P<0.001, n=16) and 0.7097 (P<0.001, n=16), respectively. Segmental analysis demonstrated that there was a correlation between the history of subject's drug exposure and the distribution of drug along the hair shaft. Our results also show that drug analysis in hair may provide useful information about drug treatment and the history of usage, and that drugs can be detected in normally kept hair for at least 16 months after intake.     

Extraction procedures for some common drugs in clinical and forensic toxicology.

The results of four extraction systems for 86 drugs are reported. These systems were investigated with the view to obtaining a rapid, reliable, and efficient extraction technique in clinical and forensic toxicology.     

The spatial distribution of zinc and cobalt in single human head hairs.

The concentration patterns of indigenous zinc and of zinc and cobalt absorbed from radiotracer solutions have been measured via flameless AA and radioactivity assay, respectively, in individual human head hairs. Patterns for indigenous zinc were found to be relatively flat and featureless. Patterns for absorbed zinc (like those for indigenous and absorbed copper in the same subjects) showed increasing concentrations with increasing distance from the root, plus zones of locally increased concentrations at positions different from those for zones of increased copper concentrations. In bleached hair, indigenous zinc concentrations were decreased, and absorbed zinc and cobalt concentrations were increased compared to values in normal hair. The data for absorbed zinc and cobalt were interpreted in terms of a variable concentration of metal-binding sites in the hair structure, coupled with an increased porosity induced by hair bleaching. The flat patterns for the indigenous zinc content were interpreted as indicating the importance of dietary zinc and incorporation via the follicle, and the unimportance of external contamination as the source of this zinc. The forensic implications of the data have been discussed.     

血中精神药物的气相色谱-质谱分析

目的建立人血中精神药物的GC-MS测定方法。方法样品在pH12条件下用乙醚萃取,SKF_525A为内标。以DB-5MS石英毛细管柱、EI源、不分流进样测定人血中四种精神药物。结果人血中四种精神药物与内标物分离良好,血药浓度在0.2-1.0μg,／ml范围内呈线性关系,R2≥0.9728,最低检出限为0.01μg(S／N≥3),血中精神药物的最低检出浓度为0.05μg／ml(S／N≥3),提取率72.5％～89.3％,RSD≤5.17％。四种精神药物日内差RSD≤3.7％(n=5)。结论本法可用于精神药物的血药浓度监测。     

The GC/MS analysis of some commonly used non-steriodal anti-inflammatory drugs (NSAIDs) in pharmaceutical dosage forms and in urine

All the commonly used non-steriodal anti-inflammatory drugs (NSAIDs), except mefenamic acid, when extracted from the pharmaceutical dosage forms or the urines of users, and derivatized by silylation and then analysed by GC/MS, gave the mono- or the di-trimethylsilyl derivatives (depending on the number of derivatized groups in the drug) as the sole products. Mefenamic acid gave a mixture of products. When extracted from pharmaceutical dosage froms or from the urines of users, and analysed by GC/MS without derivatization, some of the NSAIDs were separated and detected as the unchanged molecules as the sole products, while others were separated and detected in altered forms as sole products or mixtures, depending on: (a) the solvent in which the extract was dissolved for injection into GC/MS, (b) the chemical structure of the drug, and (c) specifically for diflunisal, the presence or absence of potential methylating and/or acetylating agents on the GC column and/or septum. The main thermally-induced reactions of the underivatized NSAIDs included (i) methyl ester formation at the COOH group when the extract was dissolved in methanol, (ii) decarboxylation (i.e., loss of CO2), (iii) dehydration (i.e., loss of H2O) when the chemical structure permitted, such as for diclofenac, and (iv) cleavage at a carbon-heterocyclic nitrogen bond when one is present in an NSAID. Heating the urine in approximately 2 M HCl at 100 degrees C for 30 min, has been found to be a satisfactory means for effecting hydrolysis of the NSAIDs glucuronide conjugates. No metabolites, resulting from aromatic-ring hydroxylation, have been detected in urine for any of the NSAIDs studied.     

From alcohol to liquid ecstasy (GHB)--a survey of old and modern knockout agents. Part 2: benzodiazepines and other sedatives/hypnotic drugs

Owing to the rapid progress in the development of synthetic pharmaceuticals, the classical knockout drugs such as chloroform and diethyl ether have been superseded by highly effective sedative and hypnotic drugs (e. g. methyprylone, clozapine and especially benzodiazepines). These are frequently given to the victim unnoticed by adding them to an alcoholic drink. In this way, alcohol still plays an important role as an interaction partner. The article presents relevant case examples together with their criminalistic background.