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Doshi A, Marche C, Chernyavskiy P, Glass G, Hartka T. Comparison of Deep Learning Approaches for Conversion of International Classification of Diseases Codes to the Abbreviated Injury Scale. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.06.24303847. [PMID: 38562696 PMCID: PMC10984072 DOI: 10.1101/2024.03.06.24303847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The injury severity classifications generated from the Abbreviated Injury Scale (AIS) provide information that allows for standardized comparisons in the field of trauma injury research. However, the majority of injuries are coded in International Classification of Diseases (ICD) and lack this severity information. A system to predict injury severity classifications from ICD codes would be beneficial as manually coding in AIS can be time-intensive or even impossible for some retrospective cases. It has been previously shown that the encoder-decoder-based neural machine translation (NMT) model is more accurate than a one-to-one mapping of ICD codes to AIS. The objective of this study is to compare the accuracy of two architectures, feedforward neural networks (FFNN) and NMT, in predicting Injury Severity Score (ISS) and ISS ≥16 classification. Both architectures were tested in direct conversion from ICD codes to ISS score and indirect conversion through AIS for a total of four models. Trauma cases from the U.S. National Trauma Data Bank were used to develop and test the four models as the injuries were coded in both ICD and AIS. 2,031,793 trauma cases from 2017-2018 were used to train and validate the models while 1,091,792 cases from 2019 were used to test and compare them. The results showed that indirect conversion through AIS using an NMT was the most accurate in predicting the exact ISS score, followed by direct conversion with FFNN, direct conversion with NMT, and lastly indirect conversion with FFNN, with statistically significant differences in performance on all pairwise comparisons. The rankings were similar when comparing the accuracy of predicting ISS ≥16 classification, however the differences were smaller. The NMT architecture continues to demonstrate notable accuracy in predicting exact ISS scores, but a simpler FFNN approach may be preferred in specific situations, such as if only ISS ≥16 classification is needed or large-scale computational resources are unavailable.
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Affiliation(s)
- Ayush Doshi
- University of Virginia, School of Medicine, 200 Jeanette Lancaster Way, Charlottesville, VA 22905, United States
| | - Charbel Marche
- University of Virginia, School of Medicine, 200 Jeanette Lancaster Way, Charlottesville, VA 22905, United States
| | - Pavel Chernyavskiy
- University of Virginia, Department of Public Health, 1215 Lee St., Charlottesville, VA 22905, United States
| | - George Glass
- University of Virginia, Department of Emergency Medicine, 1215 Lee St., Charlottesville, VA 22905, United States
| | - Thomas Hartka
- University of Virginia, Department of Emergency Medicine, 1215 Lee St., Charlottesville, VA 22905, United States
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2
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Bunaim MK, Damanhuri HA, Yow HY, Yaakob NS, Makmor-Bakry M, Azmi N. Understanding methiopropamine, a new psychoactive substance: an in-depth review on its chemistry, pharmacology and implications to human health. Int J Legal Med 2024:10.1007/s00414-024-03201-7. [PMID: 38424369 DOI: 10.1007/s00414-024-03201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
Methiopropamine or 1-(thiophen-2-yl)-2-methylaminopropane (MPA) is a thiophene ring-based structural analogue of methamphetamine, first synthesized in 1942 but become popular when it started to be available for purchase on websites selling 'legal highs' since 2010. While it is legally controlled in many countries, it remains readily accessible and frequently encountered in recreational settings. The growing prevalence of MPA use results in new therapeutic challenges. Relatively few studies have focused on its pharmacodynamics and pharmacokinetics, making it important to better understand its potential risks and harmful effects in humans in terms of its toxicity. This review provides a comprehensive profiling of MPA toxicological properties, including its chemical properties, analytical methods, prevalence, patterns of use, and legal status. Additionally, it discusses the drug's effects on the central nervous system, its potential for addiction, and its adverse physical and mental health effects. Improving the understanding of safety aspects of MPA and how it imposes health threats for public health will guide the development of therapeutic approach of its intoxication and guide the authorities in deciding its legal status.
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Affiliation(s)
- Mohd Khairulanwar Bunaim
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
- Department of Biomedical Sciences and Therapeutics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah (UMS), 88400, Kota Kinabalu, Sabah, Malaysia
| | - Hanafi Ahmad Damanhuri
- Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Hui-Yin Yow
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nor Syafinaz Yaakob
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Norazrina Azmi
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia.
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3
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Tuv SS, Bergh MSS, Andersen JM, Steinsland S, Vindenes V, Baumann MH, Huestis MA, Bogen IL. Comparative Neuropharmacology and Pharmacokinetics of Methamphetamine and Its Thiophene Analog Methiopropamine in Rodents. Int J Mol Sci 2021; 22:ijms222112002. [PMID: 34769427 PMCID: PMC8585037 DOI: 10.3390/ijms222112002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 12/26/2022] Open
Abstract
Methiopropamine is a novel psychoactive substance (NPS) that is associated with several cases of clinical toxicity, yet little information is available regarding its neuropharmacological properties. Here, we employed in vitro and in vivo methods to compare the pharmacokinetics and neurobiological effects of methiopropamine and its structural analog methamphetamine. Methiopropamine was rapidly distributed to the blood and brain after injection in C57BL/6 mice, with a pharmacokinetic profile similar to that of methamphetamine. Methiopropamine induced psychomotor activity, but higher doses were needed (Emax 12.5 mg/kg; i.p.) compared to methamphetamine (Emax 3.75 mg/kg; i.p.). A steep increase in locomotor activity was seen after a modest increase in the methiopropamine dose from 10 to 12.5 mg/kg, suggesting that a small increase in dosage may engender unexpectedly strong effects and heighten the risk of unintended overdose in NPS users. In vitro studies revealed that methiopropamine mediates its effects through inhibition of norepinephrine and dopamine uptake into presynaptic nerve terminals (IC50 = 0.47 and 0.74 µM, respectively), while the plasmalemmal serotonin uptake and vesicular uptake are affected only at high concentrations (IC50 > 25 µM). In summary, methiopropamine closely resembles methamphetamine with regard to its pharmacokinetics, pharmacodynamic effects and mechanism of action, with a potency that is approximately five times lower than that of methamphetamine.
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Affiliation(s)
- Silja Skogstad Tuv
- Department of Forensic Sciences, Oslo University Hospital, 0456 Oslo, Norway; (S.S.T.); (M.S.-S.B.); (J.M.A.); (S.S.); (V.V.)
- Department of Pharmacology, Oslo University Hospital, 0372 Oslo, Norway
| | - Marianne Skov-Skov Bergh
- Department of Forensic Sciences, Oslo University Hospital, 0456 Oslo, Norway; (S.S.T.); (M.S.-S.B.); (J.M.A.); (S.S.); (V.V.)
| | - Jannike Mørch Andersen
- Department of Forensic Sciences, Oslo University Hospital, 0456 Oslo, Norway; (S.S.T.); (M.S.-S.B.); (J.M.A.); (S.S.); (V.V.)
| | - Synne Steinsland
- Department of Forensic Sciences, Oslo University Hospital, 0456 Oslo, Norway; (S.S.T.); (M.S.-S.B.); (J.M.A.); (S.S.); (V.V.)
| | - Vigdis Vindenes
- Department of Forensic Sciences, Oslo University Hospital, 0456 Oslo, Norway; (S.S.T.); (M.S.-S.B.); (J.M.A.); (S.S.); (V.V.)
| | - Michael H. Baumann
- Designer Drug Research Unit, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD 21224, USA;
| | - Marilyn A. Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Inger Lise Bogen
- Department of Forensic Sciences, Oslo University Hospital, 0456 Oslo, Norway; (S.S.T.); (M.S.-S.B.); (J.M.A.); (S.S.); (V.V.)
- Correspondence:
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Foti F, Bilel S, Tirri M, Arfè R, Boccuto F, Bernardi T, Serpelloni G, De-Giorgio F, Marti M. Low-normal doses of methiopropamine induce aggressive behaviour in mice. Psychopharmacology (Berl) 2021; 238:1847-1856. [PMID: 33770233 DOI: 10.1007/s00213-021-05813-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
Recreational use of illicit methiopropamine (MPA) is a public health concern because it produces neurochemical effects comparable with those induced by methamphetamine (METH). The present study investigated the effects of MPA on the expression of an aggressive behaviour. Eighty CD-1 male mice, after receiving intraperitoneal injection of saline, MPA (0.01-10 mg/kg), METH (0.01-10 mg/kg), or AMPH (0.01-10 mg/kg), once a week over a 5-week period, underwent the resident-intruder test and spontaneous locomotor activity measurement. Results showed that all psychostimulants induce aggressive behaviour even at low doses, with a dose-dependent increase and a time-dependent sensitisation. MPA potency was similar to METH and superior to AMPH. Therefore, MPA-induced aggressive behaviour may appear even at MPA dosages free of cardiovascular or other behavioural adverse effects and could become a non-intentional side effect that users experience after increasing and repeating MPA consumption.
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Affiliation(s)
- Federica Foti
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sabrine Bilel
- Department of Translational Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Micaela Tirri
- Department of Translational Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Raffaella Arfè
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Translational Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Federica Boccuto
- Department of Chemistry and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Tatiana Bernardi
- Department of Chemistry and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Serpelloni
- Department of Psychiatry in the College of Medicine, Drug Policy Institute, University of Florida, Gainesville, FL, USA
| | - Fabio De-Giorgio
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy. .,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Matteo Marti
- Department of Translational Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Collaborative Center for the Italian National Early Warning System, Department of Anti-Drug Policies, Presidency of the Council of Ministers, Rome, Italy. .,Department of Morphology, Experimental Medicine and Surgery, Section of Legal Medicine, University of Ferrara, via Fossato di Mortara 70, 44121, Ferrara, Italy.
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Heide G, Høiseth G, Middelkoop G, Øiestad ÅML. Blood Concentrations of Designer Benzodiazepines: Relation to Impairment and Findings in Forensic Cases. J Anal Toxicol 2020; 44:905-914. [PMID: 32369173 PMCID: PMC7733327 DOI: 10.1093/jat/bkaa043] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The use of designer benzodiazepines appears to be increasing in many countries, but data concerning blood concentrations are scarce, making interpretation of concentrations difficult. The aim of this study was to report blood concentrations of clonazolam, diclazepam, etizolam, flualprazolam, flubromazepam, flubromazolam and phenazepam and to investigate the relationship between blood concentrations and impairment. The concentration data are from blood samples collected from living cases (apprehended drivers and other drug offences) and medico-legal autopsies. The blood samples were analysed for the seven designer benzodiazepines mentioned above by ultra high performance liquid chromatography–tandem mass spectrometry. Positive cases from between 1 June 2016 and 30 September 2019 were included. Blood concentrations and the conclusion from a clinical test of impairment (when available) are reported. The presented seven benzodiazepines were detected in a total of 575 cases, where 554 of these cases concerned apprehended drivers or other criminal offenders. The number of findings and the median (range) concentrations were as follows: clonazolam, n = 22, 0.0041 mg/L (0.0017–0.053 mg/L); diclazepam, n = 334, 0.0096 mg/L (0.0016–0.25 mg/L); etizolam, n = 40, 0.054 mg/L (0.015–0.30 mg/L); flualprazolam, n = 10, 0.0080 mg/L (0.0033–0.056 mg/L); flubromazepam, n = 5, 0.037 mg/L (0.0070–0.70 mg/L); flubromazolam, n = 20, 0.0056 mg/L (0.0004–0.036 mg/L); and phenazepam, n = 138, 0.022 mg/L (0.0018–0.85 mg/L). A designer benzodiazepine was the only drug detected with relevance for impairment in 25 of the 554 living cases. The physician concluded with impairment in 19 of the 25 cases. Most of the concentrations in these cases were relatively similar to or higher than the median reported concentrations. The most frequent other drugs detected were amphetamine, tetrahydrocannabinol, clonazepam and methamphetamine. The presented blood concentrations can be helpful with the interpretation of cases involving one or more of these seven benzodiazepines. The results indicate that concentrations commonly observed in forensic cases are associated with impairment.
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Affiliation(s)
- Gunhild Heide
- Department of Forensic Sciences, Oslo University Hospital, 0424 Oslo, Norway
| | - Gudrun Høiseth
- Department of Forensic Sciences, Oslo University Hospital, 0424 Oslo, Norway.,Center for Psychopharmacology, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Gerrit Middelkoop
- Department of Forensic Sciences, Oslo University Hospital, 0424 Oslo, Norway
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6
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Camuto C, Pellegrini S, De-Giorgio F, de la Torre X, Marti M, Mazzarino M, Botrè F. Urinary excretion profile of methiopropamine in mice following intraperitoneal administration: A liquid chromatography-tandem mass spectrometry investigation. Drug Test Anal 2020; 13:91-100. [PMID: 32678963 DOI: 10.1002/dta.2900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
We have considered the urinary excretion profile of methiopropamine (MPA), a thiophene ring-based structural analog of methamphetamine with similar stimulant effects, with the aim of selecting the most appropriate marker(s) of intake that may be useful in forensic analysis. For this purpose, in vitro studies were preliminarily performed on human liver microsomes for tracing the phase I metabolic pathways of MPA, preselecting the best candidates as potential target analytes, and designing the optimal experimental strategy. In vivo studies were then conducted on mice, after the intraperitoneal administration of a 10-mg/kg dose. Urine samples were collected every 3 h in the first 9 h and, subsequently, from 24 to 36 h, and stored at -80°C until further analysis. The measurements were performed using a targeted procedure based on liquid/liquid extraction followed by liquid chromatography-tandem mass spectrometry analysis. Our results show that in the time interval 0-9 h after administration, MPA was extensively oxidized mainly to nor-MPA, oxo-MPA, and two hydroxylated metabolites (ie, hydroxy-aryl-methiopropamine and hydroxy-alkyl-methiopropamine). All phase I metabolites underwent phase II metabolism, with the formation of nor-hydroxy-methiopropamine only in phase II, confirmed by the results obtained after enzymatic hydrolysis with β-glucuronidase and arylsulfatase. In the time interval 24-36 h after administration, only unchanged MPA and nor-MPA were detected, suggesting that these two markers are those endowed with the highest diagnostic value. The method was validated for these two principal markers, proving to be fit for anti-doping, toxicological, and forensic analyses.
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Affiliation(s)
- Cristian Camuto
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy.,Dipartimento di Chimica, "Sapienza" Università di Roma, Rome, Italy.,Department of Health Care Surveillance and Bioetics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sheila Pellegrini
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy.,Dipartimento di Chimica, "Sapienza" Università di Roma, Rome, Italy
| | - Fabio De-Giorgio
- Department of Health Care Surveillance and Bioetics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Xavier de la Torre
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Matteo Marti
- Department of Morphology, Surgery and Experimental Medicine, Section of Legal Medicine, University of Ferrara, Italy.,Department of Anti-Drug Policies, Presidency of the Council of Ministers, Collaborative Center for the Italian National Early Warning System, Rome, Italy
| | - Monica Mazzarino
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Botrè
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy.,Dipartimento di Medicina Sperimentale, "Sapienza" Università di Roma, Rome, Italy
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7
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De-Giorgio F, Bilel S, Tirri M, Arfè R, Trapella C, Camuto C, Foti F, Frisoni P, Neri M, Botrè F, Marti M. Methiopropamine and its acute behavioral effects in mice: is there a gray zone in new psychoactive substances users? Int J Legal Med 2020; 134:1695-1711. [DOI: 10.1007/s00414-020-02302-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
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Ji Kwon N, Han E. A review of drug abuse in recently reported cases of driving under the influence of drugs (DUID) in Asia, USA, and Europe. Forensic Sci Int 2019; 302:109854. [PMID: 31255839 DOI: 10.1016/j.forsciint.2019.06.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 11/17/2022]
Abstract
Driving Under the Influence of Drugs (DUID) is considered a serious issue related to the abuse of illegal drugs. DUID cases, including deaths, are being continuously reported in Asia, USA, and Europe. This literature review focuses on illegal drug abuse in recent DUID cases reported in Asia, USA, and Europe. To determine illegal drug abuse in DUID suspects, previous studies collected and analyzed biological samples, such as blood, urine, oral fluids, and hair. In addition, there were forensic autopsies and surveys for investigation of illegal drugs in DUID cases and drivers. In previous studies, ketamine, morphine, methamphetamine (MA), and khat were mainly reported in Asia, whereas amphetamine, benzodiazepines (BZDs), and cannabinoids were mainly reported in USA, and synthetic cannabinoids (SCs), opiates, and cocaine were mainly reported in Europe. Since DUID suspects related to illegal drugs have been frequently reported in Asia, USA, and Europe, there is a need to plan for national monitoring for drivers or motor vehicles to regulate and prevent drug abuse and relevant DUID cases.
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Affiliation(s)
- Nam Ji Kwon
- College of Pharmacy, Duksung Women's University, Seoul, South Korea
| | - Eunyoung Han
- College of Pharmacy, Duksung Women's University, Seoul, South Korea.
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9
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Richeval C, Dumestre-Toulet V, Wiart JF, Vanhoye X, Humbert L, Nachon-Phanithavong M, Allorge D, Gaulier JM. New psychoactive substances in oral fluid of drivers around a music festival in south-west France in 2017. Forensic Sci Int 2019; 297:265-269. [DOI: 10.1016/j.forsciint.2019.02.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/08/2019] [Accepted: 02/16/2019] [Indexed: 11/29/2022]
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Affiliation(s)
- Maude Marillier
- Department of Continuing Education of the Faculty of Medicine Lille University Lille France
| | - Alain G. Verstraete
- Department of Diagnostic Sciences Ghent University Ghent Belgium
- Department of Laboratory Medicine Ghent University Hospital Ghent Belgium
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11
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Richeval C, Wille SMR, Nachon-Phanithavong M, Samyn N, Allorge D, Gaulier JM. New psychoactive substances in oral fluid of French and Belgian drivers in 2016. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 57:1-3. [PMID: 29631107 DOI: 10.1016/j.drugpo.2018.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 02/28/2018] [Accepted: 03/13/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Driving under the influence of drugs (DUID) is a worldwide problem with potentially major judiciary and life-threatening consequences. Up to now, only classical drugs of abuse (DOA) are tested for DUID detection. A challenging issue for drafting up-dated international drug policies is to take into account the recent and expanding new psychoactive substances (NPS) market. NPS consist in various narcotic or psychotropic drugs, most of them having a "legal" status, that replicate chemical structures and/or pharmacological effects of classical DOA. Although it is obvious that NPS can lead to impaired driving, the prevalence of NPS use in a DUID context is unknown since the applied roadside screening tests are not yet adapted for these compounds. METHODS Between January and December 2016, a total of 391 oral fluid specimens were obtained from used roadside immunochemical test devices for DOA (Drugwipe-5S® device). These specimens were analyzed using liquid chromatography coupled with tandem mass spectrometry and high resolution mass spectrometry. RESULTS NPS (mainly cathinone derivatives) were detected in 33 out of the 391 oral fluid samples. This NPS positivity rate of 8.4% in oral fluid of drivers who were submitted to a roadside drug testing in 2016 in France and in Belgium is comparable to the available blood data (NPS positivity rate of 7%) observed in 2015 in similar populations. CONCLUSION Our results demonstrate the reality of driving after NPS use in French and Belgian drivers who were submitted to a roadside DOA test. As there is a lack of on-site detection methods to screen for NPS, the detection of NPS in a rapid and cost-effective DUID detection strategy is currently impossible. The expanding use of NPS, notably by drivers as reported here, and the inability of currently used drug detection tests, should be urgently addressed by road safety and law enforcement authorities.
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Affiliation(s)
- Camille Richeval
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France; University of Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000 Lille, France.
| | - Sarah Maria Richarda Wille
- Federal Public Service Justice, National Institute of Criminalistics and Criminology, Brussels, Belgium.
| | | | - Nele Samyn
- Federal Public Service Justice, National Institute of Criminalistics and Criminology, Brussels, Belgium.
| | - Delphine Allorge
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France; University of Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000 Lille, France.
| | - Jean-Michel Gaulier
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France; University of Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000 Lille, France.
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12
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Glerum KM, Zonfrillo MR. Validation of an ICD-9-CM and ICD-10-CM map to AIS 2005 Update 2008. Inj Prev 2017; 25:90-92. [DOI: 10.1136/injuryprev-2017-042519] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/23/2017] [Accepted: 10/23/2017] [Indexed: 11/04/2022]
Abstract
Although the Abbreviated Injury Scale (AIS) is the most widely used severity scoring system for traumatic injuries, hospitals are required to document and bill based on the International Classification of Diseases (ICD). An expert panel recently developed a map between ICD-9-CM and ICD-10-CM to AIS 2005 Update 2008. This study aimed to validate the recently developed map using a large trauma registry. The map demonstrated moderate to substantial agreement for maximum AIS (MAIS) scores per body region based on expert chart review versus map-derived values (range: 44%–86%). Injury Severity Scores (ISSs) calculated from expert coders versus map-derived values were also compared and demonstrated moderate agreement (ICD-9-CM: 48%, ICD-10-CM: 54%). Although not a perfect conversion tool, the new ICD-AIS map provides a systematic method to assign injury severity for datasets with only ICD-9-CM and ICD-10-CM codes available and can be used for future injury-related research and data analysis.
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Wille SMR, Richeval C, Nachon-Phanithavong M, Gaulier JM, Di Fazio V, Humbert L, Samyn N, Allorge D. Prevalence of new psychoactive substances and prescription drugs in the Belgian driving under the influence of drugs population. Drug Test Anal 2017. [DOI: 10.1002/dta.2232] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- S. M. R. Wille
- Laboratory of Toxicology; National Institute of Criminalistics and Criminology; Brussels Belgium
| | - C. Richeval
- CHU Lille, Unité Fonctionnelle de Toxicologie; Lille France
- University Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine; Lille France
| | | | - J. M. Gaulier
- CHU Lille, Unité Fonctionnelle de Toxicologie; Lille France
- University Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine; Lille France
| | - V. Di Fazio
- Laboratory of Toxicology; National Institute of Criminalistics and Criminology; Brussels Belgium
| | - L. Humbert
- CHU Lille, Unité Fonctionnelle de Toxicologie; Lille France
| | - N. Samyn
- Laboratory of Toxicology; National Institute of Criminalistics and Criminology; Brussels Belgium
| | - D. Allorge
- CHU Lille, Unité Fonctionnelle de Toxicologie; Lille France
- University Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine; Lille France
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Karinen R, Høiseth G. A literature review of blood concentrations of new psychoactive substances classified as phenethylamines, aminoindanes, arylalkylamines, arylcyclohexylamines, and indolalkylamines. Forensic Sci Int 2017; 276:120-125. [DOI: 10.1016/j.forsciint.2017.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/19/2017] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
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Mdege ND, Meader N, Lloyd C, Parrott S, McCambridge J. The Novel Psychoactive Substances in the UK Project: empirical and conceptual review work to produce research recommendations. PUBLIC HEALTH RESEARCH 2017. [DOI: 10.3310/phr05040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundAlthough illegal drug use has largely been declining in the UK over the past decade, this period has witnessed the emergence of a range of novel psychoactive substances (NPS) (‘legal highs’). These are new, mostly synthetic, substances that mimic the effects of existing drugs). Despite there being many causes for concern in relation to NPS, there has been little prior study of the burden associated with their use in public health terms. Clarity is lacking on research priorities in this rapidly developing literature.ObjectivesTo inform the development of public health intervention research on NPS by reviewing existing data on their use, associated problems and potential responses to such problems.DesignA scoping review and narrative synthesis of selected bodies of evidence was undertaken to summarise and evaluate what is known about NPS use and the related harms of, and responses to, such use. Relevant literature was identified from electronic databases (covering January 2006 to June 2016 inclusive), Google (Google Inc., Mountain View, CA, USA), relevant websites and online drug forums and by contacting experts. Articles were included if they were primary studies, secondary studies involving the analysis and interpretation of primary research or discussion papers. A conceptual framework postulating an evidence-informed public health approach to NPS use in the UK was developed through a pragmatic literature review, the iterative development of concepts and finalisation in light of the results from the empirical review work. The process also involved feedback from various stakeholders. Research recommendations were developed from both strands of work.ResultsA total of 995 articles were included in the scoping review, the majority of which related to individual-level health-related adverse effects attributable to NPS use. The prevalence of lifetime NPS use varied widely between (e.g. with higher prevalence in young males) and within population subgroups. The most commonly reported adverse effects were psychiatric/other neurological, cardiovascular, renal and gastrointestinal manifestations, and there is limited evidence available on responses. In these and other respects, available evidence is at an early stage of development. Initial evidence challenges the view that NPS should be treated differently from other illicit drugs. The conceptual framework indicated that much of the evidence that would be useful to inform public health responses does not yet exist. We propose a systems-based prevention approach that develops existing responses, is multilevel and life course informed in character, and emphasises commonalities between NPS and other legal and illegal drug use. We make 20 recommendations for research, including nine key recommendations.LimitationsScoping reviews do not interrogate evidence in depth, and the disjunction between the scoping review and the conceptual framework findings is worthy of careful attention.ConclusionsKey research recommendations build on those that have previously been made and offer more evidence-based justification and detail, as previous recommendations have not yet been acted on. The case for decision-making on commissioning new research based on these recommendations is both strong and urgent.Future workThe validity of recommendations generated through this project could be enhanced via further work with research commissioners, policy-makers, researchers and the public.Study registrationThe systematic review element of this study is registered as PROSPERO CRD42016026415.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, University of York, York, UK
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Charlie Lloyd
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
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Nachon-Phanithavong M, Wille S, Richeval C, Di Fazio V, Samyn N, Humbert L, Gaulier JM, Allorge D. New psychoactive substances in a drugged driving population: Preliminary results. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Høiseth G, Tuv SS, Karinen R. Blood concentrations of new designer benzodiazepines in forensic cases. Forensic Sci Int 2016; 268:35-38. [PMID: 27685473 DOI: 10.1016/j.forsciint.2016.09.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/01/2016] [Accepted: 09/10/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION A number of new designer benzodiazepines have reached the illegal drug market over the past years. Toxicological interpretation of concentrations of these drugs in blood is quite challenging as very limited human data have previously been published. The aim of this study was to report blood concentrations of new designer benzodiazepines in a population of drugged drivers as well as some other criminal offenders, and to relate this to clinical impairment. METHODS The present material represents cases involving new designer benzodiazepines (clonazolam, diclazepam, flubromazepam, flubromazolam and pyrazolam) and etizolam, submitted for analyses during the period July 1, 2013-May 31, 2016. Analyses were performed using an ultra-performance liquid chromatography-tandem mass spectrometry method. Blood concentrations and results from the clinical test of impairment are reported. RESULTS New designer benzodiazepines were detected in 77 cases during the study period. The median (range) concentrations were 0.012mg/L (0.00048-0.10) for flubromazolam (n=25), 0.055mg/L (0.0047-1.2) for flubromazepam (n=24), 0.013mg/L (0.0021-0.057) for diclazepam (n=15), 0.050mg/L (0.019-0.17) for etizolam (n=14), 0.0053mg/L (0.0019-0.011) for clonazolam (n=7) and 0.074mg/L for pyrazolam (n=1). In six cases, designer benzodiazepines were the only drugs detected in blood, and in two of those cases, the physician had given the conclusion of "considerably impaired" upon performing the clinical test for impairment. CONCLUSION Given the lack of previously published data on human concentrations, results presented in this study could be helpful in interpretation of blood concentrations of new designer benzodiazepines. This is crucial for the assessment of the importance of toxicological results in suspected drugged drivers, rape victims, etc.
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Affiliation(s)
- Gudrun Høiseth
- Norwegian Institute of Public Health, Domain of Forensic Sciences, P.O. Box 4404, Nydalen, N-0403 Oslo, Norway.
| | - Silja Skogstad Tuv
- Norwegian Institute of Public Health, Domain of Forensic Sciences, P.O. Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Ritva Karinen
- Norwegian Institute of Public Health, Domain of Forensic Sciences, P.O. Box 4404, Nydalen, N-0403 Oslo, Norway
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Daveluy A, Castaing N, Cherifi H, Richeval C, Humbert L, Faure I, Labadie M, Allorge D, Haramburu F, Molimard M, Titier K. Acute Methiopropamine Intoxication After "Synthacaine" Consumption. J Anal Toxicol 2016; 40:758-760. [PMID: 27474360 DOI: 10.1093/jat/bkw073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 04/26/2016] [Accepted: 05/08/2016] [Indexed: 11/13/2022] Open
Abstract
Use of methiopropamine (MPA), a synthetic metamfetamine analog, has been detected since 2011 in Europe, but there is limited information on its acute toxicity. A 30-year-old man was admitted to the emergency department in a confused state, with paranoid delusion, auditory and visual hallucinatory experiences, and incoherent speech following the use of "synthacaine" (a slang term derived from "synthetic" and "cocaine"). Toxicological screening for pharmaceuticals and drugs of abuse by liquid chromatography-diode-array detector, gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry (LC-MS-MS) detected MPA, which was subsequently quantified by a specific LC-MS-MS method. Of note, 13 h after presentation to the emergency department, the plasma concentration of MPA was 14 ng/mL. This case report confirms the toxicity of MPA and the need for toxicological analysis to confirm the substance actually ingested by users of new psychoactive substances.
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Affiliation(s)
- A Daveluy
- Service de pharmacologie médicale, centre d'addictovigilance, CHU Bordeaux
| | - N Castaing
- Service de pharmacologie médicale, laboratoire de pharmacologie-toxicologie, CHU Bordeaux
| | | | - C Richeval
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France
| | - L Humbert
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France
| | - I Faure
- Service des urgences, CHU Bordeaux
| | | | - D Allorge
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France
| | - F Haramburu
- Service de pharmacologie médicale, centre d'addictovigilance, CHU Bordeaux
| | - M Molimard
- Service de pharmacologie médicale, laboratoire de pharmacologie-toxicologie, CHU Bordeaux
| | - K Titier
- Service de pharmacologie médicale, laboratoire de pharmacologie-toxicologie, CHU Bordeaux
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Krabseth HM, Tuv SS, Strand MC, Karinen RA, Wiik E, Vevelstad MS, Westin AA, Øiestad EL, Vindenes V. Novel psychoactive substances. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:714-7. [PMID: 27143461 DOI: 10.4045/tidsskr.15.1278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
There has been a significant increase in the number of new intoxicants on the illegal drugs market globally, also in Norway. The substances are given the name NPS: Novel Psychoactive Substances, and are mainly sold over the Internet. Uncertain dosage of potent substances entails a risk of accidental overdose, and therefore serious intoxication and death. In this article we provide an overview of current knowledge with regard to these substances.
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Affiliation(s)
| | - Silja S Tuv
- Divisjon for rettsmedisinske fag Folkehelseinstituttet
| | | | | | | | | | | | | | - Vigdis Vindenes
- Divisjon for rettsmedisinske fag Folkehelseinstituttet og Senter for rus og avhengighetsforskning Institutt for klinisk medisin Universitetet i Oslo
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Tuv SS, Krabseth HM, Strand MC, Karinen RA, Wiik E, Vevelstad MS, Westin AA, Øiestad EL, Vindenes V. Nye rusmidler rett fra nett. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:721-3. [DOI: 10.4045/tidsskr.15.1276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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