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.     

Substance use,health, and mental health: problems and service utilization among incarcerated women

This article profiles self-reported substance use, health, and mental health problems among a sample of incarcerated women in Kentucky as well as lifetime service utilization. Findings indicate that a high percentage of women reported use of alcohol, cocaine, and multiple substances during the month before incarceration. In addition, participants reported common health problems such as dental, female reproductive, physical injuries, and mental health problems including depression and anxiety. Participants reported moderate use of emergency room and mental health treatment but limited substance abuse treatment utilization. Implications for criminal justice programs and linkages with community-based aftercare services for women are recommended based on findings that health and mental health problems are associated with service utilization before incarceration.     

Ontario: pressure from stakeholders leads to improved access to selected drugs

A campaign spearheaded by the Canadian Treatment Action Council, and involving other disease groups, has convinced the Ontario government to cover the costs of vaccines for HIV-positive children and to speed up access to other subsidized drugs.     

Zaleplon and driving impairment

Zaleplon, a sedative-hypnotic, was identified in the blood of a subject arrested for impaired driving. Symptoms reported were those of central nervous system (CNS) depression. The zaleplon concentration was determined to be 0.13 microg/mL. Symptoms included slow movements and reactions, poor coordination, and lack of balance. Although no quantitative relationship between blood concentrations and degree of driving impairment is currently possible, it is reasonable to conclude that because of its specific activity as a sedative-hypnotic, blood concentrations consistent with doses exceeding therapeutic concentrations of zaleplon have the potential to cause impairment of psychomotor function, and would impair a person's level of consciousness and driving ability.     

The Effect of Jury Deliberations on Jurors' Reasoning Skills

The effect of jury deliberation on jurors' reasoning skill in a murder trial was examined. Specifically, the effect of deliberating on reasoning competence (as defined by Kuhn, Weinstock and Flaton, 1994) was explored. One hundred and four participants viewed a videotaped murder trial and either deliberated in 12-person juries or ruminated on the case individually. Among those assigned to juries, half had their reasoning skill assessed prior to deliberations, while the others were tested after deliberating. Jurors in the individual rumination condition were assessed after they had the opportunity to reflect on the case alone. As hypothesized, post-group-deliberation jurors were more likely to discount both the selected verdict and alternative theories and incorporate judgmental supporting statements than were the other mock jurors. However, the mock jurors did not differ with regard to making statements that supported alternative verdicts or including judgmental statements that discounted their chosen verdict. In terms of Kuhn's reasoning continuum from satisficing (low level) to theory–evidence coordination (high level), there is some evidence that post-group-deliberation jurors may be closer to the high end than predeliberation jurors or post-individual-rumination jurors in some aspects of the task, but not in others.     

Is a Local Government’s Decision ‘In Writing?’:The U.S. Supreme Court to Rule

Abstract

An application to place a 108‐foot‐tall cell tower in a residential neighborhood. An outpouring of opposition. A public hearing. A denial—by unanimous vote on an oral motion. And a letter to the applicant stating that the application had been denied and referring to the hearing’s minutes, which reflect reasons why the board may have denied the application. These are the key facts of T‐Mobile South, LLC v. City of Roswell, No. 13‐ 975, a case that the U.S. Supreme Court will consider this fall. The case’s central legal question is also straightforward. The Telecommunications Act of 1996 states that “ [a]ny decision . . . to deny a request . . . shall be in writing. ” The Court will decide whether it is sufficient for a city to state in writing that it has denied the application and to refer to the record, or whether the written denial must also describe the reasons for the city’s decision. The case could have significant impacts on how local zoning boards function and on the form their decisions must take to survive legal challenge. It also could lead to effects on local governments well beyond the narrow issue presented here.