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Kalk NJ, Chiu CT, Sadoughi R, Baho H, Williams BD, Taylor D, Copeland CS. Fatalities associated with gabapentinoids in England (2004-2020). Br J Clin Pharmacol 2022; 88:3911-3917. [PMID: 35435281 PMCID: PMC9543893 DOI: 10.1111/bcp.15352] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022] Open
Abstract
The gabapentinoids were reclassified as Schedule II medications and Class C drugs in the UK in 2019 due to their potential misuse. In this study we examined deaths following gabapentinoid use in England reported to the National Programme on Substance Abuse Deaths. A total of 3051 deaths were reported (gabapentin: 913 cases; pregabalin: 2322 cases [both detected in 184 cases]). Prescribed and illicitly obtained gabapentinoids accounted for similar proportions of deaths (gabapentin illicit 38.0%, prescribed 37.1%; pregabalin illicit 41.0%, prescribed 34.6%). Opioids were co‐detected in most cases (92.0%), and co‐prescribed in a quarter (25.3%). Postmortem blood gabapentinoid concentrations were commonly (sub)therapeutic (65.0% of gabapentin cases; 50.8% of pregabalin cases). In only two cases was gabapentinoid toxicity alone attributed in causing death. Gabapentinoids alone rarely cause death. Clinically relevant doses can, however, prove fatal, possibly by reducing tolerance to opioids. Doctors and patients should be aware of this interaction. Gabapentinoid–opioid co‐prescribing needs urgent revision.
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Affiliation(s)
- Nicola J Kalk
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, KCH Alcohol Care Team, London, UK
| | - Ching-Ting Chiu
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical. Science, King's College London, London, UK
| | - Rasa Sadoughi
- Population Health Research Institute, St George's, University of London, London, UK
| | - Heli Baho
- Population Health Research Institute, St George's, University of London, London, UK
| | | | - David Taylor
- South London and Maudsley NHS Foundation Trust, KCH Alcohol Care Team, London, UK.,Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical. Science, King's College London, London, UK
| | - Caroline S Copeland
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical. Science, King's College London, London, UK.,Population Health Research Institute, St George's, University of London, London, UK
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2
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Rostam-Abadi Y, Gholami J, Noroozi A, Ansari M, Baheshmat S, Hamzehzadeh M, Ghadirzadeh MR, Vahdani B, Ekhtiari H, Mojtabai R, Rahimi-Movaghar A. Public health risks associated with methadone in Iran: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 100:103529. [PMID: 34826790 DOI: 10.1016/j.drugpo.2021.103529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 09/25/2021] [Accepted: 10/30/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There has been a marked growth in methadone maintenance treatment (MMT) in Iran in the past two decades with positive health outcomes. We conducted a systematic review of studies on the prevalence of non-prescribed methadone use, methadone use disorder, and methadone-related poisoning and mortality in Iran. METHODS We searched International and Iranian databases up to May 2020 and contacted relevant experts. The pooled proportions were estimated through random-effects model. Methadone-related adverse outcomes were evaluated over time. RESULTS Sixty-five studies were included. The pooled estimates of non-prescribed methadone use in the last 12-month were 2.7% (95%CI: 0.9-5.4) and 0.1% (95%CI: 0.03-0.2) in the male and female general population, respectively. Among people who use drugs, 8.4% reported daily non-prescribed use in 2018. Four heterogeneous studies in drug treatment centers reported the existence of treatment-seeking for methadone use disorder. Methadone was responsible for 10.4% (95%CI: 4.5-18.3) of cases of acute poisoning in adults and 16.0% (95%CI: 9.3-24.1) in children. Methadone was reported as a cause of death in 53.5% of substance-related deaths referred to the Legal Medicine Organization while being the only cause in 35.8% of all cases. CONCLUSION Non-prescribed use of methadone in the general population is much less than opiates and some other available prescription opioids, like tramadol. However, notwithstanding the large and successful MMT program in Iran, increasing trends in methadone-related poisoning and deaths pose serious public health concerns. There is an urgent need to explore these fatal and non-fatal poisoning cases and implement policies to curb the harms associated with methadone use.
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Affiliation(s)
- Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Ansari
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Baheshmat
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Hamzehzadeh
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Bita Vahdani
- Center for Disease Affairs and Transplant, Ministry of Health, Tehran, Iran
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
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3
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Horowitz MA, Moncrieff J. Are we repeating mistakes of the past? A review of the evidence for esketamine. Br J Psychiatry 2021; 219:614-617. [PMID: 32456714 DOI: 10.1192/bjp.2020.89] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Esketamine has been licensed for 'treatment-resistant depression' in the USA, UK and Europe. Licensing trials did not establish efficacy: two trials were negative, one showed a statistically significant but clinically uncertain effect, and a flawed discontinuation trial was included, against Food and Drug Administration precedent. Safety signals - deaths, including suicides, and bladder damage - were minimised.
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Affiliation(s)
- Mark A Horowitz
- Division of Psychiatry, University College London; and North East London Foundation Trust, Goodmayes Hospital, Ilford, UK
| | - Joanna Moncrieff
- Division of Psychiatry, University College London; and North East London Foundation Trust, Goodmayes Hospital, Ilford, UK
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4
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Moltó J, Bailón L, Pérez-Mañá C, Papaseit E, Miranda C, Martín S, Mothe B, Farré M. Absence of drug-drug interactions between γ-hydroxybutyric acid (GHB) and cobicistat. J Antimicrob Chemother 2021; 77:181-184. [PMID: 34561695 DOI: 10.1093/jac/dkab359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/02/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Potential interactions between CYP3A4 inhibitors and γ-hydroxybutyric acid (GHB) have been suggested as a possible explanation for cases of GHB overdose in recent years among people living with HIV engaged in chemsex. Our objective was to assess the effect of cobicistat on the pharmacokinetics of GHB. METHODS Fifteen healthy adults were enrolled in this randomized, double-blind, placebo-controlled, two-arm, crossover clinical trial. Participants underwent two 5 day treatment periods with at least a 1 week washout period between them. In each treatment period, participants received cobicistat (150 mg q24h orally) or matched placebo. On day 5 of each treatment period, participants were given a single oral dose of GHB (25 mg/kg). Plasma concentrations of GHB, subjective effects, blood pressure, heart rate and oxygen saturation were monitored for 5 h after dosing. GHB pharmacokinetic and pharmacodynamic parameters were calculated for each participant during each study period by non-compartmental analysis and were compared using linear mixed-effects models. The study was registered at https://www.clinicaltrialsregister.eu (Eudra-CT number 2019-002122-71) and at https://clinicaltrials.gov (NCT04322214). RESULTS Ten participants completed the two study periods. No drug-related adverse events that necessitated subject withdrawal or medical intervention occurred during the study. Compared with placebo, none of the primary pharmacokinetic parameters of GHB was substantially changed by the administration of GHB with cobicistat. Similarly, no differences regarding subjective or physiological effects were observed when GHB was administered alone or with cobicistat. CONCLUSIONS Neither pharmacokinetic nor pharmacodynamic drug-drug interactions between cobicistat and GHB were identified in this study.
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Affiliation(s)
- José Moltó
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Fundació Lluita contra la Sida, Badalona, Spain
| | - Lucía Bailón
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Fundació Lluita contra la Sida, Badalona, Spain
| | - Clara Pérez-Mañá
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallés, Spain
| | - Ester Papaseit
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallés, Spain
| | | | - Soraya Martín
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain
| | - Beatriz Mothe
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Fundació Lluita contra la Sida, Badalona, Spain.,IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain.,Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Magí Farré
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallés, Spain
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5
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Darke S, Duflou J, Peacock A, Farrell M, Lappin J. Characteristics of fatal gabapentinoid-related poisoning in Australia, 2000-2020. Clin Toxicol (Phila) 2021; 60:304-310. [PMID: 34402696 DOI: 10.1080/15563650.2021.1965159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Gabapentinoids are centrally active GABA agonists whose use has increased substantially in the past decade. The current study aimed to provide a comprehensive clinical profile of a national case series of fatal poisonings related to gabapentinoids. METHODS Retrospective study of all deaths due to drug toxicity in Australia in which gabapentinoids were a contributory mechanism, retrieved from the National Coronial Information System (2000-2020). Information was collected on case characteristics, toxicology and major organ pathology. RESULTS A total of 887 cases were identified, with a mean age of 45.7 years and 55.2% being male. Death was due to accidental toxicity in 81.3% of cases and intentional in 18.7%. Pre-existing disease was co-contributory to drug toxicity in 19.5%. Pregabalin was present in 92.9% of cases, with a median blood concentration of 7.6 mg/L (range 0.1-850.0 mg/L). Gabapentin was present in 7.2%, with a median blood concentration of 9.5 mg/L (range 0.5-1940.0 mg/L). Both pregabalin and gabapentin were present in five cases. No other gabapentinoids were detected. Drugs other than gabapentinoids were present in 99.8%, most frequently opioids (90.1%), hypnosedatives (76.9%) and antidepressants (60.5%). A body mass index in the obese range was seen in 45.4%. Clinically significant pre-existing disease was common, notably cardiomegaly (24.9%), emphysema (20.2%), nephrosclerosis (18.7%) and severe hepatic steatosis (11.7%). CONCLUSIONS The concomitant use of other drugs was close to universal, with CNS depressants predominating. Mental health problems, chronic pain and substance misuse were prominent.
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Affiliation(s)
- Shane Darke
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Johan Duflou
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Michael Farrell
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Julia Lappin
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
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6
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Fatal poisoning in drug addicts in the Nordic countries in 2017. Forensic Sci Int 2020; 313:110343. [DOI: 10.1016/j.forsciint.2020.110343] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 01/12/2023]
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van Amsterdam J, Pennings E, van den Brink W. Fatal and non-fatal health incidents related to recreational ecstasy use. J Psychopharmacol 2020; 34:591-599. [PMID: 31909673 PMCID: PMC7249611 DOI: 10.1177/0269881119897559] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The recreational drug ecstasy (3,4-methylenedioxymethamphetamine) is currently used world-wide. Severe (including fatal) health incidents related to ecstasy have been reported but a risk assessment of acute non-fatal and fatal ecstasy-related health incidents has never been performed. METHODS In the current risk assessment review, national data of non-fatal health incidents collected in the Netherlands were combined with the nationwide exposure to ecstasy, that is, last-year prevalence of ecstasy use. In addition, the annual number of ecstasy-related deaths in Great Britain (Scotland, Wales and England) was used to assess the risk of fatal ecstasy-related cases. RESULTS In the Netherlands, the estimated risk of a moderate to severe acute health incident following the use of ecstasy is one in 900 pills (0.11%), whereas for cocaine it is one in 1600 doses (0.06%) and for gamma-hydroxybutyrate one in 95 doses (1.05%). With respect to ecstasy-related deaths in Great Britain, the estimated risk of ecstasy alone per user is 0.01-0.06%, which is close to the range of the fatality risk in chronic alcohol users (0.01-0.02%), amphetamine users (0.005%) and cocaine users (0.05%), but much lower than that of opiate use (heroin and morphine: 0.35%). CONCLUSION The current review shows that almost no data are available on the health risks of ecstasy use. The few data that are available show that ecstasy is not a safe substance. However, compared to opiates (heroin, morphine), the risk of acute ecstasy-related adverse health incidents per ecstasy user and per ecstasy use session is relatively low.
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Affiliation(s)
- Jan van Amsterdam
- Department of Psychiatry, Amsterdam
University Medical Center, Amsterdam, the Netherlands,Jan van Amsterdam, Department of Psychiatry,
Academic Medical Center, Meibergdreef 5, 1105 AZ Amsterdam, 1070AW, the
Netherlands. Emails: ;
| | - Ed Pennings
- The Maastricht Forensic Institute,
Maastricht, the Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam
University Medical Center, Amsterdam, the Netherlands
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8
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Lam T, Kuhn L, Hayman J, Middleton M, Wilson J, Scott D, Lubman DI, Smith K, Nielsen S. Recent trends in heroin and pharmaceutical opioid-related harms in Victoria, Australia up to 2018. Addiction 2020; 115:261-269. [PMID: 31465131 DOI: 10.1111/add.14784] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/20/2019] [Accepted: 08/08/2019] [Indexed: 12/14/2022]
Abstract
AIMS To characterize the trajectory in the years leading up to 2018 in pharmaceutical opioid and heroin morbidity in Victoria, Australia, and to assess the effect on that trajectory of reformulation of oxycodone to a form that could not be easily snorted or injected. DESIGN Interrupted time-series analyses of population-level data before versus after reformulation of oxycodone, stratified by sex. SETTING Victoria, Australia. PARTICIPANTS The population of Victoria aged 12+ years. MEASUREMENTS Ambulance patient care and emergency department (ED) records were examined using both fixed-code and free-text fields, with each record manually cleaned and checked by trained coders. These were used to derive the output variables providing an index of harm: rates of opioid-related ambulance attendances and ED attendances for pharmaceutical opioids and heroin. The input variable was pre- versus post-oxycodone reformulation. FINDINGS There were 30 045 opioid-related ambulance attendances from January 2012 to October 2018 (54% heroin-related), and 10 113 ED attendances from July 2008 to June 2018 (39% heroin-related). There was an increase in the rate (events per 100 000 people per year) of all opioid ED attendances from 2008 to 2018 [increase = 0.063; 95% confidence interval (CI) = 0.049, 0.078]. Pharmaceutical opioid ED attendances decreased from 2014 onwards (slope change = -0.083; 95% CI = -0.108, -0.059). Heroin-related ED attendances increased from 2014 to 2018; 11 324 heroin-related ambulance attendances and 1980 ED attendances were observed from April 2014 to June 2018, compared with the respective estimates of 8176, and 1661 had the pre-April 2014 trend continued (ambulance slope change = 0.296, 95% CI = 0.104, 0.489; ED slope change = 0.026, 95% CI = 0.005, 0.046). The inflection point of 2014 coincided with the re-formulation of oxycodone. CONCLUSION In Victoria, Australia, there appears to have been a trend starting around mid-2014 of increasing heroin-related harm, and a flattening of the increase or a decrease of harms relating to pharmaceutical opioids. These changes may, in part, reflect reformulation of oxycodone to reduce the extent to which it can be injected or snorted.
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Affiliation(s)
- Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Lisa Kuhn
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.,Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Jane Hayman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.,Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | - Melissa Middleton
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - James Wilson
- Turning Point, Eastern Health & Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Debbie Scott
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.,Turning Point, Eastern Health & Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.,Turning Point, Eastern Health & Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Karen Smith
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Ambulance Victoria, Victoria, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
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9
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James E, Robertshaw TL, Pascoe MJ, Chapman FM, Westwell AD, Smith AP. Using the pharmacy retail model to examine perceptions and biases of a UK population sample towards regulation of specific psychoactive drugs. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/2050324519876123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background:Contemporary research indicates that the legal classifications of cannabis (Schedule 2, Class B), 3,4-methylenedioxymethamphetamine (MDMA) (Schedule 1, Class A) and psilocybin (Schedule 1, Class A) in the United Kingdom are not entirely based on considerations of harm and therapeutic utility. The legal classifications of the substances discussed are typically determined by legislators such as Parliament and, therefore, may be a reflection of the views or perceived views of the general public.Objective:The aim of the study was to provide an indication of the underlying psychology regarding the legislated sale of alcohol, tobacco, cannabis, MDMA and psilocybin in pharmacies according to a UK general population sample.Methods:A sample of 105 UK nationals was selected for the survey. Participants were asked questions on perceived relative harm of the five substances. After viewing contemporary information on reported relative harm and therapeutic applications, the participants were asked questions related to using the pharmacy retail model for the sale of the substances discussed. Participants who opposed the substances being sold primarily in pharmacies were asked to explain their rationale according to a predetermined list of options for each of the five drugs. Participants were also asked whether they consider it a human right to be legally permitted to consume the substances.Results:The participants' perceptions of relative harm (tobacco > MDMA > psilocybin > alcohol > cannabis) were not in agreement with the relative harm reported in the literature (alcohol > tobacco > cannabis > MDMA > psilocybin). Principal objections to the currently illicit substances being legally available in pharmacies include it sending the wrong message; it feels wrong; it is too dangerous; disliking the smell of cannabis; disapproval of the people; and not liking the idea of people using psychoactive drugs for entertainment or to have mystical/religious experiences. Overall, the participants determined that being legally permitted to consume the substances discussed is an issue of relevance to human rights. A majority of the male participants concluded that being legally permitted to consume alcohol, tobacco, cannabis and Psilocybe mushrooms is a human right in contrast to the majority of female participants who solely considered alcohol consumption to be a human right.Conclusions:The data suggest that the legal classifications may not simply be based on considerations of harm. Misperceptions of the dangers, biases and non-health-related aversions likely contribute to the continuation of policies that do not reflect the state of scientific research.
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Affiliation(s)
- Edward James
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, UK
| | | | - Michael J Pascoe
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, UK
| | - Fiona M Chapman
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, UK
| | - Andrew D Westwell
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, UK
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10
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Detection of fentanyl and fentanyl analogues in biological samples using liquid chromatography-high resolution mass spectrometry. Forensic Sci Int 2019; 300:13-18. [PMID: 31063883 DOI: 10.1016/j.forsciint.2019.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/03/2019] [Accepted: 04/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fentanyl and analogues such as butyrylfentanyl, carfentanil, 4-fluorobutyrylfentanyl, and furanylfentanyl may be either added to, or sold as, heroin. Fentanyl and carfentanil have approximately 100 and 10,000 times the potency of morphine, respectively, and there is thus a high risk of death with the use of these drugs. METHODS We looked for fentanyl/fentanyl analogues using liquid chromatography-high resolution mass spectrometry (LC-HRMS) in selected biological samples obtained post-mortem February 2017-end January 2018. Suspicion of fentanyl poisoning arose from the circumstances of death, a history of heroin use, and the geographical area in which the deceased was discovered, supplemented by drugs intelligence data. RESULTS Of the 84 deaths investigated, fentanyl and/or a fentanyl analogue were detected in 40 (48%). The fentanyls encountered were carfentanil (N = 17), fentanyl (9), carfentanil and fentanyl together (12), and fentanyl, carfentanil, 4-fluorobutyrylfentanyl, and butyrylfentanyl together (2). The median (range) post-mortem blood fentanyl concentration was 2.66 (0.21-107) μg/L and the median (range) carfentanil concentration was 0.24 (0.03-1.66) μg/L. The most prevalent compounds present together with fentanyls were ethanol [N = 28, median (range) post-mortem blood concentration: 44 (<10-249) mg/dL)], benzoylecgonine [N = 22, 0.64 (<0.05-3.17) mg/L] and free morphine [N = 20, 0.05 (<0.05-0.34) mg/L]. Deaths in hospital excluded, median blood free morphine, and ethanol concentrations were significantly lower in deaths where fentanyl/fentanyl analogues were present, but there was much overlap with the blood concentrations of these analytes in the non-fentanyl related deaths. A routine drugs of abuse assay using LC-HRMS identified fentanyl with 100% sensitivity and carfentanil with 89% sensitivity. CONCLUSIONS Given their potency, misuse of fentanyl and its analogues is likely to cause severe toxicity. A simple LC-HRMS method detected all cases in which fentanyl was identified post-mortem and most of the cases in which carfentanil was detected.
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