Toxicological Testing Data Research Articles

Using data fusion with multiple imputation to correct for misclassification in self-reported exposure: a case-control study of cannabis use and homicide victimization

BackgroundCannabis use has been causally linked to violent behaviors in experimental and case studies, but its association with homicide victimization has not been rigorously assessed through epidemiologic research.MethodsWe performed a case-control analysis using two national data systems. Cases were homicide victims from the National Violent Death Reporting System (NVDRS), and controls were participants from the National Survey on Drug Use and Health (NSDUH). While the NVDRS contained toxicological testing data on cannabis use, the NSDUH only collected self-reported data, and thus the potential misclassification in the self-reported data needed to be corrected. We took a data fusion approach by concatenating the NSDUH with a third data system, the National Roadside Survey of Alcohol and Drug Use by Drivers (NRS), which collected toxicological testing and self-reported data on cannabis use for drivers. The data fusion approach provided multiple imputations (MIs) of toxicological testing results on cannabis use for the participants in the NSDUH, which were then used in the case-control analysis. Bootstrap was used to obtain valid statistical inference.ResultsThe analyses revealed that cannabis use was associated with 3.55-fold (95% CI: 2.75–4.35) increased odds of homicide victimization. Alcohol use, being Black, male, aged 21–34 years, and having less than a high school education were also significantly associated with increased odds of homicide victimization.ConclusionsCannabis use is a major risk factor for homicide victimization. The data fusion with MI method is useful in integrative data analysis for harmonizing measures between different data sources.

State cannabis laws and cannabis positivity among fatally injured drivers

BackgroundAs of November 8, 2023, 24 states and the District of Columbia have legalized cannabis for both recreational and medical use (RMCL-states), 14 states have legalized cannabis for medical use only (MCL-states) and 12 states have no comprehensive cannabis legislation (NoCL-states). As more states legalize cannabis for recreational use, it is critical to understand the impact of such policies on driving safety.MethodsUsing the 2019 and 2020 Fatality Analysis Reporting System data, we performed multivariable logistic regression modeling to explore the association between state level legalization status and cannabis positivity using toxicological testing data for 14,079 fatally injured drivers. We performed a sensitivity analysis by including multiply imputed toxicological testing data for the 14,876 eligible drivers with missing toxicological testing data.ResultsOverall, 4702 (33.4%) of the 14,079 fatally injured drivers tested positive for cannabis use. The prevalence of cannabis positivity was 30.7% in NoCL-states, 32.8% in MCL-states, and 38.2% in RMCL-states (p < 0.001). Compared to drivers fatally injured in NoCL-states, the adjusted odds ratios of testing positive for cannabis were 1.09 (95% confidence interval: 0.99, 1.19) for those fatally injured in MCL-states and 1.54 (95% confidence interval: 1.34, 1.77) for those fatally injured in RMCL-states. Sensitivity analysis yielded similar results.ConclusionsOver one-third of fatally injured drivers tested positive for cannabis use. Drivers fatally injured in states with laws permitting recreational use of cannabis were significantly more likely to test positive for cannabis use than those in states without such laws. State medical cannabis laws had little impact on the odds of cannabis positivity among fatally injured drivers.

Is marijuana use associated with decreased use of prescription opioids? Toxicological findings from two US national samples of drivers

BackgroundState governments in the United States are increasingly viewing marijuana legalization as a policy option for controlling the opioid epidemic under the premise that marijuana is a less harmful substitute for opioids. The purpose of this study is to assess whether marijuana use is associated with decreased odds of prescription opioid use.MethodsA cross-sectional study design was applied to toxicological testing data from two national samples of drivers: 1) the 2011–2016 Fatality Analysis Reporting System (FARS) and 2) the 2013–2014 National Roadside Survey of Alcohol and Drug Use by Drivers (NRS). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) estimated from multivariable logistic regression models were used to assess the associations of marijuana use with prescription opioid use and alcohol use.ResultsAmong the 47,602 drivers from the FARS, 15.7% tested positive for marijuana and 6.9% positive for prescription opioids. Compared with drivers testing negative for marijuana, those testing positive for marijuana were 28% more likely to test positive for prescription opioids (adjusted OR = 1.28, 95% CI = 1.15–1.42). Among the 7881 drivers from the NRS, 7.9% tested positive for marijuana and 4.5% positive for prescription opioids. Relative to drivers testing negative for marijuana, those testing positive for marijuana were twice as likely to test positive for prescription opioids (adjusted OR = 2.03, 95% CI = 1.29–3.20). In both study samples, marijuana use was associated with significantly increased odds of alcohol positivity.ConclusionsDrivers who test positive for marijuana are significantly more likely to test positive for prescription opioids. Longitudinal studies with rigorous designs and toxicological testing data are needed to further address the substitution hypothesis between marijuana and prescription opioids.

Trends in alcohol and marijuana detected in homicide victims in 9 US states: 2004\u20132016

BackgroundUse of alcohol and other drugs is a major risk factor for assaultive injuries and violent deaths. The purpose of this study was to examine the time trends in the prevalence of alcohol and marijuana detected in homicide victims.MethodsWe analyzed toxicological testing data for homicide victims (n = 12,638) from the 2004–2016 National Violent Death Reporting System in 9 US states (Colorado, Georgia, Massachusetts, New Jersey, Oregon, Rhode Island, South Carolina, Virginia, and Wisconsin). We used the Cochran-Armitage test for trend to assess the statistical significance of changes in the prevalence of alcohol and marijuana detected in these homicide victims during the study period.ResultsOverall, 37.5% of the homicide victims tested positive for alcohol, 31.0% positive for marijuana, and 11.4% positive for both substances. During the study period, the prevalence of marijuana increased from 22.3% (95% confidence interval [CI] = 19.6, 25.0) in 2004 to 42.1% (95% CI = 39.2, 44.9) in 2016 (Z = -15.7; P < .001) while the prevalence of alcohol declined slightly (Z = 1.5; P = 0.143). Marked increases in the prevalence of marijuana were observed in both sexes and across age and racial groups.ConclusionsMarijuana is increasingly detected in homicide victims irrespective of demographic characteristics. Further research is needed to assess the causal role of marijuana use and concurrent use of marijuana and alcohol in homicide victimization.

Prescription opioids, alcohol and fatal motor vehicle crashes: a population-based case-control study

BackgroundThe prevalence of prescription opioid use among drivers has increased markedly in the past two decades. The purpose of this study is to assess the associations of prescription opioid use and alcohol use with the risk of fatal crash involvement in US drivers.MethodsWe performed a population-based case-control study using toxicological testing data from two national data systems. Cases (n = 3606) were drivers involved in fatal motor vehicle crashes selected from the Fatality Analysis Reporting System and controls (n = 15,600) were drivers participating in the 2007 and 2013 National Roadside Surveys of Alcohol and Drug Use by Drivers. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) of fatal crash involvement associated with prescription opioid use with and without the presence of alcohol.ResultsOverall, cases were significantly more likely than controls to test positive for prescription opioids (5.0% vs. 3.7%, p < 0.001), alcohol (56.2% vs. 7.1%, p < 0.0001), and both substances (2.2% vs. 0.2%, p < 0.001). Relative to drivers testing negative for prescription opioids and alcohol, the adjusted ORs of fatal crash involvement were 1.72 (95% CI: 1.37, 2.17) for those testing positive for prescription opioids and negative for alcohol, 17.92 (95% CI: 16.19, 19.84) for those testing positive for alcohol and negative for prescription opioids, and 21.89 (95% CI: 14.38, 33.32) for those testing positive for both substances. The interaction effect on fatal crash risk of prescription opioid use and alcohol use was not statistically significant on either additive or multiplicative scale.ConclusionsPrescription opioid use is associated with a significantly increased risk of fatal crash involvement independently of alcohol use. Concurrent use of prescription opioids and alcohol is associated with a 21-fold increased risk of fatal crash involvement.

The Opioid Epidemic: Moving Toward an Integrated, Holistic Analytical Response.

In many jurisdictions, public safety and public health entities are working together to enhance the timeliness and accuracy of the analytical characterization and toxicology testing of novel synthetic opioids. The improved sharing and early detection of these analytical data are intended to inform surveillance, interdiction efforts, patient intervention and treatment, all of which are critical to curbing the opioid epidemic. Forensic practitioners working to identify novel synthetic opioids struggle to provide timely results when encountering new or unknown substances, such as the fentanyl analogs. These compounds, which mimic heroin in pharmacologic effect but can be far more potent, are inconsistently present in chemical identification libraries, and are currently largely unavailable as reference materials for analytical comparison. Additionally, federal, state and local governments as well as nongovernmental organizations require potency, toxicity and potential-for-abuse data to evaluate the potential health risks of emerging drug threats. Subsequent scheduling efforts and criminal prosecutions also require these thorough drug characterization studies. Pilot programs have demonstrated that early communication of real-time drug toxicity and analytical data significantly impacts the successful response to emerging opioids. High-quality, real-time, national-level data on chemical composition, toxicological test data, drug toxicity and overdoses, and analysis of seized materials by law enforcement are needed to track drug trends. However, the USA still lacks a national system to coordinate and communicate toxicology, medical and medical examiner and coroner data with the broader medical and law enforcement communities. Opportunities to address these gaps as well as recent advancements collected through interagency efforts and technical workshops in the toxicology and analytical chemistry communities are presented here. Opportunities for partnership, increased communication and expanding best practices to move toward an integrated, holistic analytical response are also explored.

Effects of minimum legal drinking age on alcohol and marijuana use: evidence from toxicological testing data for fatally injured drivers aged 16 to 25 years.

BackgroundAlcohol and marijuana are among the most commonly used drugs by adolescents and young adults. The question of whether these two drugs are substitutes or complements has important implications for public policy and prevention strategies, especially as laws regarding the use of marijuana are rapidly changing.MethodsData were drawn from fatally injured drivers aged 16 to 25 who died within 1 h of the crash in nine states with high rates of toxicology testing based from 1999 to 2011 on the Fatality Analysis Reporting System (N = 7,191). Drug tests were performed using chromatography and radioimmunoassay techniques based on blood and/or urine specimens. Relative risk regression and Joinpoint permutation analysis were used.ResultsOverall, 50.5% of the drivers studied tested positive for alcohol or marijuana. Univariable relative risk modeling revealed that reaching the minimum legal drinking age was associated with a 14% increased risk of alcohol use (RR = 1.14, 95% CI: 1.02 to 1.28), a 24% decreased risk of marijuana use (RR = 0.76, 95% CI: 0.53 to 1.10), and a 22% increased risk of alcohol plus marijuana use (RR=1.22, 95% CI: 0.90 to 1.66). Joinpoint permutation analysis indicated that the prevalence of alcohol use by age is best described by two slopes, with a change at age 21. There was limited evidence for a change at age 21 for marijuana use.ConclusionsThese results suggest that among adolescents and young adults, increases in alcohol availability after reaching the MLDA have marginal effect on marijuana use.

Prediction of the health effects of polychlorinated biphenyls (PCBs) and their metabolites using quantitative structure–activity relationship (QSAR)

Polychlorinated biphenyls (PCBs) are a group of 209 persistent environmental contaminants that are slightly different but structurally related. PCBs are known to induce a variety of health effects and often have been toxicologically tested as complex commercial mixtures (Aroclors) but environmental exposure occurs separately to a small number of specific congeners. Recently, the Third National Report on Human Exposures to Environmental Chemicals, an assessment of exposure data of the National Health and Nutrition Examination Survey (NHANES), identified 35 individual PCB congeners in the U.S. population. These types of findings necessitate the toxicity evaluation of individual congeners but adequate toxicity data for most individual PCB congeners are not available. Due to this, a quantitative structure–activity relationship (QSAR) approach was used to assess the potential mutagenesis and carcinogenesis of individual congeners and their possible metabolites. The predictions were analyzed to define the underlying generalizations between the parent PCBs, their metabolites, and some important toxicological endpoints. This analysis reveals that (1) mono and di-chlorinated PCBs and their metabolites can be potential mutagens; (2) PCB benzoquinone metabolites could be carcinogenic but the weight of evidence is poor. These results support the hypothesis that environmental exposure to some PCBs and/or their metabolites could produce mutagenicity and/or carcinogenicity. Hence, these data should be considered as priority toxicological testing data needs. As with all computational toxicology analytical findings, these conclusions must yield to empirical data as they become available.

Center coordinates toxics data in Europe

The European Center for Ecotoxicology & Toxicology of Chemicals—ECETOC—celebrated its 18th birthday last month and assessed its accomplishments at a conference in Brussels. At that meeting, speakers noted how international demands and networking are helping to shape an even more important role for the center in the future. Based in Brussels, ECETOC is a scientific, nonprofit association financed by more than 50 companies that make or use chemicals. In a sense, it is an information clearinghouse and peer review system designed to avoid costly duplication of testing. It reviews all available toxicological test data about specific chemicals, assesses the information, and decides if more testing needs to be done. It does not, however, conduct its own research and testing, unlike the U.S.'s Chemical Industry Institute of Toxicology. ECETOC has become a mature and reliable source of chemical toxicology information on the impact of processes and products on people and the environment, said Jean-Jacques Van ...

Quantitative Risk Assessment and Cost-Benefit Analysis for Carcinogens at EPA: A Critique

A review of risk assessment at the Environmental Protection Agency (EPA) points out the serious lack of toxicological testing data for commercial chemicals and pesticides as well as a disturbing trend toward undue reliance on quantitative risk assessment (QRA) and cost-benefit analysis (CBA). The apparent precision of quantitative estimates of risk masks the many underlying value judgments and uncertainties. In an attempt to address the uncertainties in QRA, EPA has recently published Guidelines on Risk Assessment for Carcinogens. The Guidelines are generally sound; however, they do not address human variability in response and possible synergistic interactions which can lead in some cases to an underestimate of risk. Moreover, they offer a simplistic carcinogen classification scheme which has already been misused to justify less stringent regulation of waterborne carcinogens. Since 1982, EPA's ever greater use of QRA coupled to CBA has led to relaxed standards or decisions not to regulate certain sources of environmental pollutants such as benzene and radionuclides. Risk managers should not be seduced by the precision of the numbers into using QRA and CBA as the primary tool in setting public health policy. When estimated risk is inserted into a cost-benefit analysis under “benefits” or cancers avoided, its own uncertainties are compounded by those regarding the true economic impacts of the regulation.

2 Final Report on the Safety Assessment of Fossil and Synthetic Waxes

Toxicological test data on Ozokerite, Ceresin, Montan Wax, Paraffin, Microcrystalline Wax, Emulsifying Wax N.F., Synthetic Wax and Synthetic Beeswax are presented. Based on the documented animal and clinical test data, it is concluded that these waxes are safe for use as cosmetic ingredients in the present practices of concentration and use.

1 Final Report on the Safety Assessment of Candelilla Wax, Carnauba Wax, Japan Wax, and Beeswax

Toxicological test data on four waxes-Candelilla, Carnauba, Japan, and Beeswax, singularly and in combination are presented. On the basis of the documented animal and clinical test data, it is concluded that these waxes are safe for cosmetic use.