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.     

<Emphasis Type="Italic">Commentary</Emphasis>: A Critical Review of Published Competency-to-Confess Measures

The development of standardized assessments for competency-to-confess evaluations has remained largely neglected for the last several decades. Groundbreaking research was conducted on Miranda waivers during the late 1970s, but researchers have failed to sustain programmatic research. This critical review focuses on four published Miranda measures (Comprehension of Miranda Rights, Comprehension of Miranda Rights-Recognition, Comprehension of Miranda Vocabulary, and Function of Rights in Interrogation). When evaluated by contemporary standards, the validation of these measures is very limited. Major improvements are needed for interrater reliability, test–retest reliability, content validity, construct validity, and criterion-related validity.     

Believing is seeing III: perceptions of content in criminal psychological profiles

This study explored Kocsis and Heller's findings concerning the relationship between one's belief and the perceived accuracy of a profile. The influence of types of information was also considered. A sample of 353 participants was used in the present experiment that gauged the perception of information contained in a profile. The results supported Kocsis and Heller's earlier findings with a positive relationship found between belief and perceived accuracy. The more an individual believes in profiling, the more likely he or she is to perceive a profile to be accurate. This relationship was most pronounced in participants' perceptions of information contained in a profile concerning an unknown offender's crime behavior and past history. The more an individual believes in profiling, the more information relating to these two factors is likely to be perceived. This relationship was not observed where information in the same profile involved physical features of the offender.     

European Court of Human Rights accepts blood donor screening based on sexual orientation

In a series of three rulings released simultaneously on 15 October 2002, the European Court of Human Rights dismissed complaints that Italy's approach to screening blood donors infringed privacy rights and discriminated against lesbians and gay men.     

Canada: national summit on "Global health is a human right"!

Held in Ottawa on 21-22 May 2003, a national summit on "Global Health is a Human Right!" brought together 86 people representing over 60 Canadian civil society groups interested in joint advocacy on realizing the human right to health in developing countries. The summit focused particularly on addressing the global crises of communicable diseases such as HIV/AIDS, tuberculosis, and malaria.