Evidence Of Drug Use Research Articles

Evaluation of in-house drug evidence testing by King County Medical Examiner's Office in "real-time" fatal overdose surveillance.

With the escalating overdose epidemic, many surveillance efforts have appeared. In 2018, King County Medical Examiner's Office (KCMEO) initiated a fatal overdose surveillance project aimed at expediting death certification and disseminating timely information. In this project, KCMEO investigators collected items of evidence of drug use from overdose death scenes, which were tested by five in-house methods, four using handheld devices: TruNarc Raman spectrometer, with and without the manufacture's H-Kit, Rigaku ResQ Raman spectrometer, and MX908 mass spectrometer. The fifth in-house method used fentanyl-specific urine test strips. Results from in-house testing were compared with results from Washington State Patrol (WSP) Materials Analysis Laboratory. From 2019 to 2022, there were 4244 evidence items of drugs and paraphernalia collected from 1777 deaths scenes. A total of 7526 in-house tests were performed on collected specimens, and 2153 tests were performed by the WSP laboratory using standard analytical methods. The WSP results served as reference standards to calculate performance metrics of the in-house methods. Sensitivities, specificities, and predictive values ranged from good to poor depending on the method, drug, and evidence type. Certain drugs were often associated with specific evidence types. Acetaminophen was frequently found in combination with fentanyl. Fentanyl test strips gave good scores for detecting fentanyl; otherwise, in-house methods using handheld devices had poor performance scores with novel drugs and drugs diluted in mixtures. The results showed that in-house testing of drug evidence has value for medical examiner overdose surveillance, but it is resource intensive, and success depends on collaboration with forensic laboratories.

Isolated cerebral mucormycosis: A case discussion

We report a case of a 32-year-old male with a history of type 1 diabetes, inhaled drug use, and alcohol use disorder, who presented with encephalopathy, holocranial headaches, neck pain, confusion, and generalized tonic-clonic seizures. The patient initially presented at a rural community hospital with a fever and was found to be in diabetic ketoacidosis (DKA). He was also hemodynamically stable but stuporous, prompting intubation to protect his airway. Despite initial treatment measures, his neurological condition worsened and he remained ventilator-dependent. Key findings include a high glucose level, presence of ketones, and evidence of drug use. Blood cultures showed no growth, but his febrile state persisted. Cerebrospinal fluid (CSF) analysis revealed mild pleocytosis, hyperglycorrhachia but normal protein, with no growth. Neuroimaging showed right hemispheric slowing on EEG and diffusion restriction in the right frontal lobe on MRI. The patient's neurological status worsened on the second day of admission, manifesting as sluggish pupillary reflexes, right third nerve palsy, and decerebrate posturing. Emergent MRI suggested cerebral edema, leading to initiation of hypertonic saline. This case highlights the diagnostic challenges and critical management considerations in a patient with multiple comorbidities presenting with unexplained neurological deterioration, emphasizing the importance of a comprehensive and timely approach to diagnosis and treatment.

Detection of drugs and metabolites in hair before and after treatment with freely available agents chosen to effectively remove drugs from the hair matrix – A case study

Hair analysis is commonly used to control abstinence or provide evidence for drug use or drug exposure. While dyeing and coloration of hair have been proven to potentially reduce drug concentrations in hair, relatively little is known about the reduction of drug concentrations after extensive use of ‘household remedies’. In this study, a male subject with known past drug intake applied multiple washing procedures including the use of egg yolk, olive oil and vinegar in addition to common hair shampoo for one week in order to intentionally reduce drug concentrations in hair. Solutions with varying compositions were applied to the head for one hour per day. Hair samples were taken before and after the washing procedure from different parts of the skull. For drug analysis the samples were divided into two segments (0–3 cm and 3–6 cm). The analyses comprised methanol extraction and LC-MS/MS detection of cocaine and metabolites, designer stimulants, opioids and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH) as well as alkaline hydrolysis followed by liquid-liquid extraction and GC MS/MS detection for Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabinol (CBN). The following drugs or drug metabolites were detected in the hair samples before the washing procedure in accordance with the information given by the subject: cocaine, benzoylecognine, cocaethylene, amphetamine, MDMA, nortilidine, 3-fluorophenmetrazine, ketamine, norketamine and the cannabinoids THC, CBD, CBN and THC-COOH. The concentrations differed depending on the location of hair sampling. After the washing procedure, drug concentrations in hair were significantly reduced (up to about 70%). In some cases, the drug concentrations fell below the values mentioned in the ‘CTU’ criteria for driving liability diagnostics. It is possible to significantly reduce drug concentrations in hair with products available for everyone. In cases with initial drug concentrations close to ‘cut-off’ values, such procedures might lead to ‘false negative’ results.

Antisocial Personality disorder. A case report

IntroductionAntisocial disorder is characterised by difficulty to adapt to social norms that normally rule different aspects of the person’s conduct in adolescence and adulthood. According to DSM-V, this disorder’s prevalence stands between 0.2% and 3%, and is more frequent in men.ObjectivesNumerous studies have been made about the influence between the environment and genetics for the development of this disorder, finding in several patients a punctual mutation of the monoamine oxidase gen (MAOA); although impulsive behaviour has also been associated to the 5-HT tranporte gene (5-HTT), and the protein coding gene for Tryptophan Hydroxylase TPH1MethodsThe hospital admission for these patients must be made when there’s autoregressive or hetero aggressive behaviour, suicide attempts, psychotic symptoms, or symptoms that generate important repercussions in the person’s normal functions. Nevertheless, is important to identify during the hospitalization the improvement possibilities of these patients in order to make drug or psychotherapy adjustments; in the case that we don’t observe treatment benefits, the patient will be released from the hospitalizationResultsThe main treatment is psychotherapy.ConclusionsThere’s not much evidence of drug use in this disorder, however, mood stabilizers, antidepressants, atypical antipshychotics and benzodiazepines are used for rage control, impulsiveness, anxiety and aggressiveness.DisclosureNo significant relationships.

Drugs and Infodemic

The first year of the COVID-19 pandemic brought critical scientific advances at speeds never seen before. The information from scientific studies won the world in news and social media. However, the spread of fake news provided an infodemic among a still unknown disease and no scientifically proven treatment. The present study aimed to evaluate the content and type of information on drugs indicated for the treatment of COVID-19 without scientific evidence in Brazilian social media. Two social media, Instagram and Twitter, were selected to search for drug information related to the prevention or treatment of COVID-19. The research was carried out using hashtags: #chloroquine, #hydroxychloroquine, #ivermectin, and #nitazoxanide for Portuguese publications in March 2020 and 2021. Descriptive statistic was used to present the quantitative data. In 2020, chloroquine was the drug with the highest number of publications in both social networks analyzed. The publications addressed the evidence of drug use and shortages, and the vast majority were considered correct information. While in 2021, ivermectin was the predominant drug cited on Instagram, while chloroquine was the most published on Twitter. Both drugs were related to “early treatment” and political and ideological content, classified as mostly disinformation. Thus, it is necessary to reinforce these social media guidelines to reduce the spread of health disinformation to the population. At the same time, health education in digital media is supported to ensure that the best information on management and care for COVID-19 reaches people and promotes their quality of life.

Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety.

The opioid crisis has led to an increase in available donor hearts, although questions remain about the long-term outcomes associated with the use of these organs. Prior studies have relied on historical information without examining the toxicology results at the time of organ offer. The objectives of this study were to examine the long-term survival of heart transplants in the recent era, stratified by results of toxicological testing at the time of organ offer as well as comparing the toxicology at the time of donation with variables based on reported history. The United Network for Organ Sharing database was requested as well as the donor toxicology field. Between 2007 and 2017, 23 748 adult heart transplants were performed. United Network for Organ Sharing historical variables formed a United Network for Organ Sharing Toxicology Score and the measured toxicology results formed a Measured Toxicology Score. Survival was examined by the United Network for Organ Sharing Toxicology Score and Measured Toxicology Score, as well as Cox proportional hazards models incorporating a variety of risk factors. The number and percent of donors with drug use has significantly increased over the study period (P<0.0001). Cox proportional hazards modeling of survival including toxicological and historical data did not demonstrate differences in post-transplant mortality. Combinations of drugs identified by toxicology were not associated with differences in survival. Lower donor age and ischemic time were significantly positively associated with survival (P<0.0001). Among donors accepted for transplantation, neither history nor toxicological evidence of drug use was associated with significant differences in survival. Increasing use of such donors may help alleviate the chronic donor shortage.

Another Case Of Physical Abuse In Childhood Between Age 7-11 And Alice In Wonderland-Like Seizures Retrospectively Described By A 45 Years-Old Man In Detail

The phenomenon of Alice in Wonderland Syndrome is not considered a disease in its own right but usually occurs as an accompanying symptom of a migraine attack or as a precursor of an epileptic seizure in the form of an aura with pronounced visual perceptual disturbances [1]. However, an Alice in Wonderland syndrome can also be caused by the Epstein-Barr virus, influenza virus [18], drugs [3] or encephalitis [2]. The term "Alice in Wonderland syndrome" was named after the children's book Alice in Wonderland by Lewis Carroll and coined by John Todd as a possible, but not essential, concomitant of migraine and epilepsy [1]. Carroll suffered from migraines himself; it is believed that his experiences with the condition served as inspiration for the hallucination-like effects described in his work [1]. In addition, Carroll's narrative has been discussed as a description of a trip following consumption of mind-altering drugs. In one of the most famous sequences in the book, Alice changes size by biting off pieces from different sides of a mushroom. However, there is no evidence of drug use by Lewis Carroll. Alice in Wonderland syndrome results in changes in the perception of one's surroundings [6,7]. These changes include both micropsia and macropsia (everything appears reduced or enlarged), as well as altered auditory perception, altered tactile perception, an altered sense of time. The syndrome is particularly common in children. Attacks are often shorter and may also be completely painless, although accompanying symptoms such as nausea, vomiting, and sensitivity to light and sound is more pronounced. Neurological deficits may occur so that the affected child begins to hallucinate. He or she perceives his or her body as larger or smaller and/or begins to see "fantastic images“. The changes in perception can severely affect affected individuals, causing them to become disoriented and "unable to find their way around." In extreme cases, falls and other accidents may occur. The perceptual disturbances can lead to Alice in Wonderland syndrome being confused with other mental disorders or misinterpreted as "craziness". The primary focus is the treatment of the underlying condition, such as symptomatic treatment of migraine. Recent publications shed light on sexual abuse in childhood as the origin of AIWS-like visual disturbances [4,5].

Association Between Methamphetamine Use and Psychiatric Hospitalization, Chemical Restraint, and Emergency Department Length of Stay.

Methamphetamine intoxication is an increasing cause of emergency department (ED) visits in the United States, particularly in the west. In San Francisco, California, 47% of patients visiting psychiatric emergency services are intoxicated with methamphetamine. Such patients often visit the ED due to acute psychiatric symptoms, yet ED-based research investigating the outcomes and resource utilization of these visits is limited. We examined a retrospective cohort of ED patients requiring ED-based psychiatric consultation from June 2017 to July 2018. We evaluated the association between methamphetamine visits and need for chemical restraint, psychiatric hospitalization, and length of stay (LOS). We identified 2,087 ED visits with psychiatric consults. Based on urine toxicology results and discharge diagnosis, 403 visits involved methamphetamine with or without other drugs, 480 involved other drugs without methamphetamine, and 1,204 had no evidence of drug use. Methamphetamine visits were associated with increased odds of chemical restraint compared to visits without drug use (adjusted odds ratio [AOR]= 3.2, 95% CI= 2.1 to 5.2, p<0.001), but not other drug visits (AOR= 1.2, 95% CI= 0.8 to 1.9, p=0.4). Methamphetamine visits had lower odds of psychiatric hospitalization than other drug visits (AOR= 0.62, 95% CI= 0.41 to 0.95, p=0.03) and longer adjusted LOS than visits without drug use (+4.3hours, 95% CI= 4.1 to 8.3 hours, p<0.001) but not other drug visits (+1.5hours, 95% CI= -0.6 to 3.7 hours, p=0.2). Methamphetamine ED visits were associated with increased odds of needing chemical restraint and of an increased ED LOS but not with psychiatric inpatient admission. These results indicate an opportunity to improve the efficiency of ED care for these patients.

Substance misuse and parenting: making drugs and gender in the family court

AbstractChildren tend to be represented as the quintessential victims of the ‘drug problem’, with drug-using parents, particularly mothers, characterised as vectors of the risks posed. Although evidence of drug use is not per se an impediment to retaining care of, or contact with, children (per Lady Hale inRe B[2013] UKSC 33, at para. 143), it does pose one of the greatest challenges to social and political norms about ‘good parenting’, and often has a powerful impact on decisions about care within UK family courts. While there is a considerable body of scholarship assessing criminal justice responses to drug use, there has been little research into how the family serves as an important site for the constitution of drug harms and the making of ‘drugs’ and ‘addiction’. This paper is informed by qualitative analysis of approximately 150 case reports in which drug use has been cited as relevant in the determination of guardianship/parenting. The purpose will not be to contest the difficult decisions that judges had to make in these cases but, using perspectives rooted in Science and Technology Studies and feminist drug scholarship, to remain attendant to the ontological multiplicity of objects that emerge from attempts to stabilise drug harms in legal narratives.

List-based concepts in pharmacotherapy of older and geriatric patients

Pharmacotherapy for older and geriatric patients is achallenge, especially because older and geriatric patients are particularly prone to adverse drug reactions and the evidence for drug use is limited for this patient group; therefore, several list-based recommendations have recently been developed in order to improve appropriate pharmacotherapy. These lists of recommendations differ in their criteria and the compilation of drugs, for example in terms of potentially inappropriate medication, drugs increasing the risk of falling and anticholinergic effects. This review highlights the characteristics of selected recently published lists, describes the concepts behind them and discusses the advantages and disadvantages of the individual approaches.

Large differences in neonatal drug use between NICUs are common practice: time for consensus?

AimsEvidence for drug use in newborns is sparse, which may cause large differences in drug prescriptions. We aimed to investigate the differences between neonatal intensive care units (NICUs) in the Netherlands in currently prescribed drugs.MethodsThis multicentre study included neonates admitted during 12 months to four different NICUs. Drugs were classified in accordance with the Anatomical Therapeutic Chemical (ATC) classification system and assessed for on/off‐label status in relation to neonatal age. The treatment protocols for four common indications for drug use were compared: pain, intubation, convulsions and hypotension.ResultsA total of 1491 neonates (GA range 23+6–42+2 weeks) were included with a total of 32 182 patient days, 181 different drugs and 10 895 prescriptions of which 23% was off‐label in relation to neonatal age. Overall, anti‐infective drugs were most frequently used with a total of 3161 prescriptions, of which 4% was off‐label in relation to neonatal age. Nervous system drugs included 2500 prescriptions of which 31% was off‐label in relation to neonatal age. Nervous system drugs, blood and blood forming organs, and cardiovascular drugs showed the largest differences between NICUs with ranges of 919–2278, 554–1465, and 238–952 total prescriptions per 1000 patients per ATC class, respectively.ConclusionsWe showed that drug use varies widely in neonatal clinical practice. The drug classes with the highest proportion of off‐label drugs in relation to neonatal age showed the largest differences between NICUs, i.e. cardiovascular and nervous system drugs. Drug research in neonates should receive high priority to guarantee safe and appropriate medicines and optimal treatment.

An Ecodevelopmental Exploration of Mediators Between Maltreatment in Childhood and Drug use During Pregnancy.

Child maltreatment is associated with increased risk of substance abuse in adulthood. However, prior investigations have not examined substance use specifically in pregnancy, and have relied on self-report of substance use. The present study addresses these gaps via secondary analysis of 295 primarily low-income, Black postpartum women who agreed to complete a brief questionnaire and subsequently provided urine and hair samples. A clear relationship emerged between self-reported maltreatment and positive toxicology (with drug use present in 37.2% of maltreated participants and 17.1% of non-maltreated participants; p < .001). Depression and violence exposure were positively associated with maltreatment and with drug use. The combined effect of violence exposure and depression mediated the association between maltreatment and drug use during pregnancy (the bootstrapped 95% confidence interval of total indirect effect ranged from .17-.86). This investigation is the first to show an association between childhood maltreatment and toxicological evidence of drug use in pregnancy.

MP76-09 GROWTH HORMONE RELEASING PEPTIDE TREATMENT IN MEN INCREASES SERUM INSULIN-LIKE GROWTH FACTOR-1 LEVELS

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy I1 Apr 2016MP76-09 GROWTH HORMONE RELEASING PEPTIDE TREATMENT IN MEN INCREASES SERUM INSULIN-LIKE GROWTH FACTOR-1 LEVELS John T. Sigalos, Andrew Allison, Alexander Pastuszak, Samuel J. Ohlander, Amin Herati, Mark C. Lindgren, and Larry I. Lipshultz John T. SigalosJohn T. Sigalos More articles by this author , Andrew AllisonAndrew Allison More articles by this author , Alexander PastuszakAlexander Pastuszak More articles by this author , Samuel J. OhlanderSamuel J. Ohlander More articles by this author , Amin HeratiAmin Herati More articles by this author , Mark C. LindgrenMark C. Lindgren More articles by this author , and Larry I. LipshultzLarry I. Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1860AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stimulation of growth hormone (GH) secretion, rather than administration of exogenous GH, which is severely limited by FDA regulations, may afford a safer approach to obtaining the benefits of GH while avoiding the adverse effects associated with exogenous GH. Few studies have evaluated the effects of GH secretagogues on GH and insulin-like growth factor-1 (IGF-1) secretion in humans. These GH secretagogues include GH releasing peptides (GHRP) GHRP-2 and GHRP-6, and the GH releasing hormone (GHRH) analogue, sermorelin (SERM). IGF-1 serves as a surrogate marker for GH production. Here we present data evaluating the impact of GHRP/SERM therapy on IGF-1 levels. METHODS A retrospective review of medical records was performed for 105 men already on testosterone therapy seeking gains in lean body mass who were prescribed GHRP-6, GHRP-2, and SERM 3 times daily in a dose of 100 mcg of each peptide. Serum IGF-1 level were assessed in response to treatment. To gauge efficacy and compliance, study inclusion criteria included 1) evidence of drug use, assessed via frequency of prescription fills, 2) interval lab testing every 3-4 months, 3) a low-normal baseline IGF-1 (<200 ng/ml). After assessment, the 14 men who met inclusion criteria were evaluated. RESULTS Mean (SD) age within the cohort (n=14) was 33.2 (2.9) years, and baseline serum IGF-1 level was 159.5 (26.7) ng/ml. Mean (SD) duration of continuous GHRH/GHRP treatment was 134 (88) days. Post treatment IGF-1 level was 239 (54.6) ng/ml (p<0.0001). 4 of 11 men were co-administered an aromatase inhibitor and/or tamoxifen due to elevated estradiol (E2) levels and/or gynecomastia during treatment. Interestingly, decreasing E2 production or estrogen receptor blockade had a negative effect on IGF-1 production (Figure 1). CONCLUSIONS Combination therapy with GHRP-6, GHRP-2, and SERM increases serum IGF-1 levels. This effect is observed with strict compliance to 3 times daily dosing. Increases in serum IGF-1 while on treatment approached the upper limits of our laboratory reference range (250 ng/ml), but were inhibited by blocking estrogen action. Taken together, our results suggest that combination therapy with GHRP-6, GHRP-2, and SERM may be beneficial in wasting conditions. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1010 Advertisement Copyright & Permissions© 2016MetricsAuthor Information John T. Sigalos More articles by this author Andrew Allison More articles by this author Alexander Pastuszak More articles by this author Samuel J. Ohlander More articles by this author Amin Herati More articles by this author Mark C. Lindgren More articles by this author Larry I. Lipshultz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Physical Activity Measures in the Healthy Communities Study.

The risk of obesity is reduced when youth engage in recommended levels of physical activity (PA). For that reason, public health organizations in the U.S. have encouraged communities to implement programs and policies designed to increase PA in youth, and many communities have taken on that challenge. However, the long-term effects of those programs and policies on obesity are largely unknown. The Healthy Communities Study is a large-scale observational study of U.S. communities that is examining the characteristics of programs and policies designed to promote healthy behaviors (e.g., increase PA and improve diet) and determining their association with obesity-related outcomes. The purpose of this paper is to describe the methods used to measure PA in children and the personal and community factors that may influence it. The study used both self-reported and objective measures of PA, and measured personal, family, and home influences on PA via three constructs: (1) PA self-schema; (2) parental support; and (3) parental rules regarding PA. Neighborhood and community factors related to PA were assessed using three measures: (1) child perceptions of the neighborhood environment; (2) availability of PA equipment; and (3) attributes of the child's street segment via direct observation. School influences on children's PA were assessed via three constructs: (1) school PA policies; (2) child perceptions of the school PA environment; and (3) school outdoor PA environment. These measures will enable examination of the associations between characteristics of community PA programs and policies and obesity-related outcomes in children and youth.

Validation of the Drug Abuse Screening Test (DAST-10): A study on illicit drug use among Chinese pregnant women.

We assessed the Chinese version of the Drug Abuse Screening Test (DAST-10) for identifying illicit drug use during pregnancy among Chinese population. Chinese pregnant women attending their first antenatal visit or their first unbooked visit to the maternity ward were recruited during a 4-month study period in 2011. The participants completed self-administered questionnaires on demographic information, a single question on illicit drug use during pregnancy and the DAST-10. Urine samples screened positive by the urine Point-of-Care Test were confirmed by gas chromatography-mass spectrometry. DAST-10 performance was compared with three different gold standards: urinalysis, self-reported drug use, and evidence of drug use by urinalysis or self-report. 1214 Chinese pregnant women participated in the study and 1085 complete DAST-10 forms were collected. Women who had used illicit drugs had significantly different DAST-10 scores than those who had not. The sensitivity of DAST-10 for identify illicit drug use in pregnant women ranged from 79.2% to 33.3% and specificity ranged from 67.7% to 99.7% using cut-off scores from ≥1 to ≥3. The ~80% sensitivity of DAST-10 using a cut-off score of ≥1 should be sufficient for screening of illicit drug use in Chinese pregnant women, but validation tests for drug use are needed.

Evaluation of Websites on Human Pharmacology

Popular health internet sites offer information that may affect consumer’s choice of treatment, however, may also contain inaccurate information. To enable consumers, it is imperative to evaluate content of health websites including the meta-criteria: relevance, accessibility, selection, validity, interchange, site transparency, links, quality, assurance and safeguards. Our objective is to nominate and describe the top websites on applied pharmacology and provide a general view of governmental and non-governmental sites on pharmaceuticals applied to human health. The search engine was Google and search terms were “pharmaceuticals” OR “pharmacology” OR “medicines” OR “drugs” AND “human health”, in English or Portuguese. For each website search, the first 50 results were evaluated. Sites of non-web material, aiming commerce, restricted to health professionals or by payment were excluded. Quality assessment of retrieved websites was performed with a tool adapted from HON, HITI and American Medical Association (J Health Inform, 2009, 1:27–33). Top sites were defined as those that presented all of the nine evaluation meta-criteria. There were 40 websites with relevant and accurate information on evidence for drug use for human health that are easy-to-use, disclose information about sponsorship, purpose/scope, audience and intended use, currency, source/credentials and link to sources. There were 7 sites from worldwide organizations (ex: WHO, UNESCO, CIOMS); 13 sites from the Americas; 10 sites from Europe; 4 sites from Africa; 3 sites from Asia; 4 sites from Oceania. To be useful for consumer’s choice of pharmacological treatment it is necessary to evaluate the quality of the communication of knowledge provided in internet sites. The great amount of sites disclosed using search tools result in few that provide evidence of effectiveness of treatment for consumer’s information. In the meantime, it is extremely important to ensure publicity of the top websites.

GHB pharmacology and toxicology: acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome.

The illicit recreational drug of abuse, γ-hydroxybutyrate (GHB) is a potent central nervous system depressant and is often encountered during forensic investigations of living and deceased persons. The sodium salt of GHB is registered as a therapeutic agent (Xyrem®), approved in some countries for the treatment of narcolepsy-associated cataplexy and (Alcover®) is an adjuvant medication for detoxification and withdrawal in alcoholics. Trace amounts of GHB are produced endogenously (0.5-1.0 mg/L) in various tissues, including the brain, where it functions as both a precursor and a metabolite of the major inhibitory neurotransmitter γ-aminobutyric acid (GABA). Available information indicates that GHB serves as a neurotransmitter or neuromodulator in the GABAergic system, especially via binding to the GABA-B receptor subtype. Although GHB is listed as a controlled substance in many countries abuse still continues, owing to the availability of precursor drugs, γ-butyrolactone (GBL) and 1,4-butanediol (BD), which are not regulated. After ingestion both GBL and BD are rapidly converted into GHB (t½ ~1 min). The Cmax occurs after 20-40 min and GHB is then eliminated from plasma with a half-life of 30-50 min. Only about 1-5% of the dose of GHB is recoverable in urine and the window of detection is relatively short (3-10 h). This calls for expeditious sampling when evidence of drug use and/or abuse is required in forensic casework. The recreational dose of GHB is not easy to estimate and a concentration in plasma of ~100 mg/L produces euphoria and disinhibition, whereas 500 mg/L might cause death from cardiorespiratory depression. Effective antidotes to reverse the sedative and intoxicating effects of GHB do not exist. The poisoned patients require supportive care, vital signs should be monitored and the airways kept clear in case of emesis. After prolonged regular use of GHB tolerance and dependence develop and abrupt cessation of drug use leads to unpleasant withdrawal symptoms. There is no evidence-based protocol available to deal with GHB withdrawal, apart from administering benzodiazepines.

Clinical utility of inhaled iloprost in pulmonary arterial hypertension

Inhaled iloprost is a drug from the group of prostacyclins used in the treatment of pulmonary arterial hypertension. Its efficacy and safety have allowed its use as monotherapy and combination therapy. This review describes the product characteristics, amenable to treatment groups, and updated clinical evidence of drug use.

A Stash in Every Flush

This article looks at a technique for sampling sewage to provide evidence of drug use. Scientists have developed methods for isolating the by-products of drugs excreted in urine. Scientists in Italy examined the Po River on different days in different months looking for benzoylecgonine which is the waste product of cocaine. Liquid chromatography has been used with similar success and researchers say this will allow them assess the drug use of a community. INSET: Sewage Standards.

The Success of Zero-Tolerance Drug Testing: City of Houston/Department of Public Works and Engineering

The war on drugs has been an uphill battle in America for a number of years. Despite all the effort, drug use continues. Organizations, both public and private, have developed a variety of approaches to address this continued pattern of drug use and its impact in the workplace. The city of Houston has taken what some consider to be a hard-line approach to this issue—especially for a public entity. In October of 1993, the city of Houston adopted the zero-tolerance approach to drug use in the workplace. For employees, this means automatic termination when evidence of drug use is discovered. From the inception of the zero-tolerance drug policy, the percentage of employees testing positive has steadily decreased. Establishing a zero-tolerance approach to drug testing allows Houston to maintain a safe and productive work environment by identifying and removing drug users from the workplace.