Emergence of fentanyl-related deaths in Travis County,Texas and surrounding areas: A retrospective review of postmortem fentanyl-related drug toxicities from 2020 to 2022

The opioid epidemic has affected the United States (US) for decades with fentanyl and its analogs accounting for a recent surge in morbidity and mortality. Currently, there is a relative lack of information characterizing fentanyl-related fatalities specifically in the Southern US. A retrospective study was conducted to examine all postmortem fentanyl-related drug toxicities in Travis County, Texas, encompassing Austin (one of the fastest-growing cities in the US), from 2020 to 2022. Fentanyl contributed to 2.6% and 12.2% of deaths submitted for toxicology between 2020 and 2022, respectively, representing a 375% increase in fentanyl-related deaths over this 3-year period (n = 517). Fentanyl-related fatalities primarily occurred in males in their mid-30s. Fentanyl and norfentanyl concentrations ranged from 0.58 to 320 ng/mL and 0.53 to 140 ng/mL with mean (median) concentrations of 17.2 ± 25.0 (11.0) and 5.6 ± 10.9 (2.9) ng/mL, respectively. Polydrug use was present in 88% of cases, with methamphetamine (or other amphetamines) (25%), benzodiazepines (21%), and cocaine (17%) representing the most frequently identified concurrent substances. Co-positivity rates of various drugs and drug classes widely varied over time. Scene investigations reported illicit powder(s) (n = 141) and/or illicit pill(s) (n = 154) in 48% (n = 247) of fentanyl-related deaths. Illicit oxycodone (44%, n = 67) and illicit “Xanax” (38%, n = 59) pills were frequently reported on scene; however, toxicology only identified oxycodone and alprazolam in 2 and 24 of these cases, respectively. The results of this study provide a better understanding of the fentanyl epidemic in this region creating an opportunity to promote increased awareness, shift focus to harm reduction, and aid in minimizing public health risks.     

GC‐MS and IR Studies on the Six Ring Regioisomeric Dimethoxyphenylpiperazines (DOMePPs)

A number of N‐substituted piperazines have been described as drugs of abuse in recent years. This new drug category includes several series of aromatic ring substituted phenylpiperazines. The wide variety of available precursors makes regioisomerism a significant issue in these totally synthetic compounds. In this study, a complete series of regioisomeric dimethoxyphenylpiperazines were synthesized and evaluated using GC‐MS and FT‐IR. The EI mass spectra show fragments characteristic of both the dimethoxyphenyl and the piperazine portions of the molecules including the dimethoxyphenylaziridinium cation (m/z 180) and dimethoxyphenyl cation (m/z 137). The ion at m/z 56 for the C₃H₆N⁺ fragment is characteristic of the piperazine ring and was observed in all the spectra. The perfluoroacyl derivatives were resolved by GC, and their mass spectra showed some differences in relative abundance of ions. FTIR provides direct confirmatory data for differentiation between the regioisomeric dimethoxyphenylpiperazines, and GC separation was accomplished on an Rtx‐200 phase.     

Medium‐Chain Acyl‐CoA Dehydrogenase Deficiency in Adulthood: A Potential Diagnosis in a Patient with Mental Status Changes Suspected of Drug Toxicity

Medium‐chain acyl‐CoA dehydrogenase (MCAD) deficiency is a rare but important component of the differential diagnosis for adults with a history of premortem mental status changes and the postmortem finding of hepatic steatosis. This case report describes a 30‐year‐old white man who, following a period of nausea and vomiting, was admitted to the hospital with sudden mental status deterioration followed rapidly by clinical deterioration and death. Treating physicians in this case suspected acute illicit drug toxicity with synthetic cathinones based on social history. Clinicians and medical examiners should be aware that the presentation, signs, and symptoms described may indicate an underlying inborn error of metabolism such as MCAD deficiency and take action accordingly.     

Women and the left in Western Europe: A continuing dilemma

Feminism in Europe: Liberal and Socialist Strategies 1789–1919. By Maria Mies and Kumari Jaywardena. The Hague: Institute of Social Studies, 1983. Pp.208.

Sisters or Citizens? Woman and Socialism in France Since 1876. By Charles Sowerwine. Cambridge: Cambridge University Press, 1982. Pp.248. £16.40.

Enquête sur les femmes et la politique en France. By Janine Mossuz‐Lavau and Mariette Sineau. Paris: Presses Universitaires de France, 1983. Pp.280. Fr. 90.

German Feminism: Readings in Politics and Literature. Edited by Edith Hoshimo Altbach, Jeanette Clausen, Dagmar Schultz and Naomi Stephan. New York: State University of New York Press, 1984. Pp.389. $12.95 (paperback); $39.50 (hardback).

Unfinished Democracy: Woman in Nordic Politics. Edited by Elina Haavio‐Mannila, Drude Dahlerup, Maud Eduards, Esther Gudmundsdottir, Beatrice Halsaa, Helga Maria Hernes, Eva Hänninen‐Salmeljri, Bergthora Sigmundsdóttir, Sirka Sinkonnen and Torild Skard. Translated by Christine Badcock, Oxford: Pergamon Press, 1985. Pp.206. £14.50 (hardback).

The Situation of Women in the Political Process in Europe. Preliminary report submitted to the Council of Europe, Strasbourg: Directorate of Human Rights, Council of Europe. 1984. Pp.74 (Part 1); pp.185 (Part 2); pp.43 (Part 3).

Women and European Politics: Contemporary Feminism and Public Policy. By Joni Lovenduski. Brighton: Wheatsheaf, 1985. Pp.313. £18.95 (hardback); £7.95 (paperback).     

Just,in time: cultivating the long arc of justice

Justice is an overused concept that is in danger of losing its meaning altogether. Our generational task is to reclaim its essential teachings of empathy and equality as we strive to find the hidden opportunities within the myriad crises presently before us. By placing our intentions and actions within the ambit of ‘the arc of the moral universe,’ we can recapture a sense of wonder that will serve to guide our choices as we navigate the lesson-filled road ahead.     

Restoring (dis)order: Sanctions,resolutions, and "social control" in anarchist communities

This essay explores the restorative implications of anarchist communities through an analysis of processes such as norm formation, sanctioning, conflict resolution, and economic exchange. The study explores ways in which anarchist communities employ various restorative measures to maintain group cohesion and achieve a modicum of social control through the application of natural phenomena such as diffuse power, fluid authority, community consensus and mutual aid. Drawing upon studies of communities manifesting anarchist tendencies--Aincluding utopian experiments, indigenous cultures, and the unique case of the Rainbow Family of Living Light--a picture begins to emerge wherein conceptions of property and the social dynamics that inhere within a community are inextricably linked, suggesting the propensity of anarchist communities to promote an organic synthesis of self, society, and nature. In the end, by exploring tenets associated with the nascent restorative justice paradigm, it is observed that anarchist communities manifest principles that challenge the dominant conceptions of criminality and legality, providing a framework for envisioning models of justice-in-practice that appear on the horizon of possibility and potentiality.     

Constellations of Interpersonal Trauma and Symptoms in Child Welfare: Implications for a Developmental Trauma Framework

Patterns of trauma exposure and symptoms were examined in a sample of 16,212 children in Illinois child welfare. Data were collected on trauma histories, child and caregiver needs and strengths, and analyzed in light of the proposed Developmental Trauma Disorder diagnostic criteria. Youth exposed to both interpersonal violence and attachment-based (“non-violent”) traumas within the caregiving system had significantly higher levels of affective/physiological, attentional/behavioral, and self/relational dysregulation in addition to posttraumatic stress symptoms compared to youth with either type of trauma alone or in relation to other trauma experiences. These complexly traumatized children exhibited higher levels of functional impairment and were more likely to have placement disruptions and psychiatric hospitalizations. Findings suggest a developmental trauma framework can more adequately capture the spectrum of needs of these multiply traumatized youth than existing diagnostic formulations. Utilizing this framework for assessment, treatment planning, and intervention can lead to more targeted and effective services for these children.