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.     

Effects of cocaine and heroin,and their combination,on the development rate of Calliphora vomitoria (Diptera: Calliphoridae)

Insects present on or near decomposing bodies are collected by forensic entomologists and used to estimate the post-mortem interval. Drugs metabolized by a person before death may affect the rate of development of insects feeding on the corpse. This study aimed to determine the effects of cocaine and heroin main metabolites on the development rate of the Calliphora vomitoria (Diptera: Calliphoridae) and their implications on minimum post-mortem interval determination. Groups of 250 eggs each were placed into four separate pots of 150 g of minced pork meat being either un-spiked, or spiked with benzoylecgonine, morphine, or a combination of both. Larval length (mm) and weight (mg) measurements were taken twice daily and the rate of development of the insects’ life cycle was monitored until eclosion. Results show that cocaine-fed larvae developed less in length and weight than the control group. Heroin-fed larvae showed a more fluctuating pattern, being smaller and lighter than the control group for most of their larval cycle, but overtaking them in both parameters towards pupation. Combination-fed larvae seemed to favour the effects of cocaine. The three conditions also had a significant impact on the length of the insects’ life cycle. Cocaine and drug combination treatments increased the length of the second and third instar stages, but led to the shortening of pupation and accelerated eclosion. Conversely, heroin treatment led to lengthier pupation. Interestingly, the effects of the drug combination seemed to mirror more precisely those of cocaine.These findings indicate that both cocaine and heroin, singularly and in combination, have sizable effects on blowflies’ development rates, potentially biasing post-mortem interval estimations.     

Is it possible to have cheaper drugs and preserve the incentive to innovate? The benefits of privatizing the drug approval process

In this paper, we argue that lower prices for pharmaceuticals can be achieved by fostering a new type of competition in the pharmaceutical industry. Lower drug development costs, and hence prices, can be brought about by abolishing national drug administrations and replacing them with private certification boards that compete on the basis of safety, efficiency and cost of their drug approval process. A major benefit of this type of privatization is that it would not necessitate limits on data exclusivity in order to achieve lower prices. Drug approval privatization could achieve the same positive results as generic competition, in terms of lower costs and prices, without the negative effects of intellectual property rights violation and the consequent discouragement of innovative activities.

Improving the quality of drug court clinical screening: a call for performance measurement policy reform

Despite the widespread use of the drug court model, standardized performance measures for drug courts are not uniformly utilized, and rarely include process measures. To ensure that drug courts are being implemented in the most effective manner, the use of performance measurement tools should be considered for wide scale adoption. Drug court effectiveness is moderated by participant characteristics, and is most effective for individuals with the highest substance use needs. Therefore, having quality clinical screening processes is crucial to ensuring that drug courts are serving the population for which they are effective. This paper examines clinical screening in drug courts, to answer the following 1) what is the current state of screening, 2) what works, and 3) why measurement matters. It also proposes a clinical screening performance measure to improve fidelity and ensure appropriate participant enrollment. The creation of a performance measure would create opportunities to improve drug court outcomes, and leverage pay-for-performance models.     

Preventing construction deaths: The role of public policies

Are stronger direct financial incentives or regulatory enforcement effective in reducing fatalities in the construction industry? We examine two important policies—state workers' compensation (WC) programs and federal and state Occupational Safety and Health Administration (OSHA) activities—which embody those strategies. We examine their impact by looking at state-level fatality rates in the construction industry from 1992 to 2016. Setting aside highway crashes and violence, the majority of employee deaths occur in construction. We find that states which exempt small firms from the requirement to buy WC insurance have higher fatality rates. When eligibility for compensation is restricted by longer waiting periods, fatality rates are substantially higher. More frequent federal or state OSHA inspections and, especially, consultation visits are associated with lower fatality rates, but higher average penalties are not. Limited variation in these policies over our sample period, especially for WC, makes these results suggestive rather than definitively causal.     

有偿采供血或吸毒致艾滋病毒携带和艾滋病人群的舌象特点

目的 通过临床调查研究因有偿采供血、吸毒致艾滋病毒(human immunodeficiency virus, HIV)携带和(或)艾滋病(acquired immunodeficiency syndrome, AIDS)人群的舌象特点. 方法 运用舌象拍摄和专家分析相结合的方法,对有偿采供血或吸毒致HIV携带和(或)AIDS人群的舌象特点进行比较和分析. 结果 有偿采供血或吸毒致HIV携带和(或)AIDS人群中出现率较高的舌象有:热象舌色出现率分别为63.64%和65.71%,瘀象舌色出现率分别为33.64%和41.14%,胖大和(或)齿痕舌分别为40.45%和45.14%,裂纹舌分别为35%和26.86%;两类人群均以白苔居多,黄苔出现率分别是23.18%、28.00%,厚苔的出现率分别是40.45%和31.43%,腻苔出现率分别是65.91%和82.29%. 结论 两组人群的舌象表现较为一致,HIV携带者和(或)AIDS患者常见舌象特点是:舌质红;苔厚腻,以白腻居多;舌体胖大或有齿痕;有瘀象.