Tramadol (Ultram) concentrations in death investigation and impaired driving cases and their significance

We reviewed a series of 66 deaths in Washington State between 1995-2000 in which tramadol (Ultram and Ultracet, Ortho-McNeil) was detected in the decedent's blood, in order to assess the role tramadol was determined to have played. Additionally, we reviewed a series of 83 impaired driving cases in which tramadol was detected in order to establish a non-lethal blood tramadol concentration reference range. In both populations, tramadol was consistently found together with other analgesic, muscle relaxant, and CNS depressant drugs. Death was rarely attributable to tramadol alone. However, tramadol may be a significant contributor to lethal intoxication when taken in excess with other drugs, via the potential interaction with serotonergic antidepressant medications, as well as the potential for increased CNS depression. Although the incidence of tramadol detection has increased consistently over the last eight years, there is no evidence of a corresponding increase in the number of cases in which death was attributed solely to tramadol. Blood drug concentrations in many deaths exceeded the therapeutic serum range of 0.28-0.61 mg/L; however, the concentrations overlapped almost completely with the range identified in living subjects arrested for impaired driving. These findings suggest caution in the interpretation of blood tramadol concentrations outside of the recognized therapeutic range. It also suggests that the drug, even when used in moderate excess, is not a principle cause of death in suicidal or accidental deaths.     

AN EVALUATION OF SUPERVISED ACCESS III

Although supervised access has become a more frequently used option within the custody and access domain over the last 10 years, no empirical literature has examined supervised access from the standpoint of its effect on the legal system. As part of a large-scale evaluation of Ontorio's Supervised Access Pilot Project, the present study sought the perceptions of the legal community and the courts regarding supervised access centers. A total of 14 lawyers and 13 judges participated in semistructured telephone interviews concerning supervised access cases in general, the function and impact of the supervised access program in their community, and their satisfaction with and recommendations regarding the center. Both lawyers and judges expressed high levels of satisfaction with the centers and believed that their availability resulted in savings to the legal system and reductions in hostility and conflict between parents. Implications and limitations of the study are discussed.     

Home and away

Conclusion Overall the thrust of the Children’s Bill is welcomed, however the opportunity to revise legislation, in operation for nearly a century, is unique and will set the tone for the first thirty years of the new millennium. Given this unique opportunity and the growing strength of the Irish culture and economy it is a pity that the radical stance adopted at the diversion stage is not carried throughout the Bill to present a more progressive future for the children of Ireland.     

The Impact of Victim Demographics on Case Outcomes in Delinquency Proceedings: An Empirical Test

While the impact of the defendant's sex and race on processing decisions is well researched, less is known about the impact of the victim's sex and race on juvenile court decision making. Using data from the juvenile court in St. Louis, Missouri, this study explores direct and interactive effects of the victim's sex and race on outcome decisions for juvenile offenders. Findings suggest that legal differences account for most of the observed differences in detention, commitment and adjudication among the sample studied.