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Amphetamine abuse in Sweden: subject demographics, changes in blood concentrations over time, and the types of coingested substances.

https://arctichealth.org/en/permalink/ahliterature116200
Source
J Clin Psychopharmacol. 2013 Apr;33(2):248-52
Publication Type
Article
Date
Apr-2013
Author
Alan Wayne Jones
Anita Holmgren
Author Affiliation
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden. wayne.jones@LIU.se
Source
J Clin Psychopharmacol. 2013 Apr;33(2):248-52
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Adult
Amphetamine - administration & dosage - adverse effects - blood
Amphetamine-Related Disorders - epidemiology
Automobile Driving
Cause of Death
Databases, Factual
Drug Interactions
Female
Forensic Toxicology
Humans
Male
Middle Aged
Sex Factors
Substance-Related Disorders - epidemiology
Sweden - epidemiology
Time Factors
Young Adult
Abstract
Amphetamine is a major drug of abuse in Sweden and in the other Nordic countries. The demographics of amphetamine abusers in Sweden and the concentrations of this stimulant in blood are reported for 10 years of forensic blood samples (2001-2010). Using a forensic toxicology database (TOXBASE), we studied 1183 amphetamine-related deaths, 20,452 users of illicit drugs, and 47,366 people arrested for driving under the influence of drugs (DUID). Most amphetamine abusers were male (82%-87%), and their average age was 33 to 39 years with males being 2 to 3 years older than females (P
PubMed ID
23422398 View in PubMed
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Concentration distributions of the drugs most frequently identified in post-mortem femoral blood representing all causes of death.

https://arctichealth.org/en/permalink/ahliterature146585
Source
Med Sci Law. 2009 Oct;49(4):257-73
Publication Type
Article
Date
Oct-2009
Author
Alan Wayne Jones
Anita Holmgren
Author Affiliation
Department of Forensic Toxicology, Artillerigatan 12, 58758 Linköping, Sweden. wayne.jones@rmv.se
Source
Med Sci Law. 2009 Oct;49(4):257-73
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Central Nervous System Depressants - blood
Child
Chromatography, Gas
Ethanol - blood
Female
Forensic Toxicology
Humans
Male
Middle Aged
Pharmaceutical Preparations - blood
Street Drugs - blood
Sweden
Young Adult
Abstract
Interpreting the concentrations of drugs determined in post-mortem blood is not an easy task owing to poly-drug use, adverse drug-drug interactions, as well as a host of pre-analytical factors and various artefacts in post-mortem toxicology. Highly sensitive and specific methods (GC-FID, GC-NPD. GC-MS and LC-MS) were used to determine the concentrations of drugs in femoral blood from 24,876 autopsies representing all causes of death. Ethanol topped the list of psychoactive substances (N=8108 or 33%) at mean, median and highest concentrations of 1.43 g/L, 1.20 g/L and 8.0 g/L, respectively. In second place was paracetamol (N=2741 or 11%). Amphetamine and cannabis were the major illicit drugs at 13th and 15th positions, respectively. Newer antidepressants, citalopram (no 3), sertraline (no 14), venlafaxine (no 16) were prominent as were sedative-hypnotics, such as diazepam (no 4), zopiclone (no 5) and zolpidem (no 18). This compilation of drugs and their concentration distributions will be useful to identify and flag for a likely overdose or drug-related poisoning death. The drug concentration together with the findings at autopsy and the police report can then be used to reach a conclusion about the cause and manner of death.
PubMed ID
20025102 View in PubMed
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Concentrations of alprazolam in blood from impaired drivers and forensic autopsies were not much different but showed a high prevalence of co-ingested illicit drugs.

https://arctichealth.org/en/permalink/ahliterature117883
Source
J Psychopharmacol. 2013 Mar;27(3):276-81
Publication Type
Article
Date
Mar-2013
Author
Alan Wayne Jones
Anita Holmgren
Author Affiliation
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden. wayne.jones@rmv.se
Source
J Psychopharmacol. 2013 Mar;27(3):276-81
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Alcoholism - complications
Alprazolam - adverse effects - blood
Amphetamine - blood - toxicity
Anti-Anxiety Agents - adverse effects - blood
Automobile Driving
Crime
Databases, Factual
Female
Forensic Toxicology - methods
Heroin - blood - toxicity
Humans
Male
Marijuana Abuse - complications
Psychotropic Drugs - adverse effects - blood
Street Drugs - blood - toxicity
Substance Abuse Detection
Substance-Related Disorders - blood - complications - mortality
Sweden - epidemiology
Wounds and Injuries - blood - etiology - mortality
Abstract
Alprazolam is a benzodiazepine anxiolytic widely prescribed for treatment of panic-disorder and social phobias, although this medication is also subject to abuse. In this paper, the concentrations of alprazolam in venous blood samples from impaired drivers were compared with femoral blood samples from forensic autopsies classified as intoxication or other causes of death (e.g. natural, trauma). After liquid-liquid extraction (n-butyl acetate) alprazolam was determined in blood by capillary gas chromatography with a nitrogen-phosphorous detector. The mean (median) and range of alprazolam concentrations in blood from impaired drivers (n = 773) were 0.08 mg/L (0.05 mg/L) and 0.02-3.9 mg/L, respectively. Many traffic offenders had co-ingested ethanol (13%), amphetamine (46%), cannabis (32%), or heroin (14%), as well as other drugs. In deaths attributed to drug intoxication, the mean (median) and range of alprazolam concentrations in blood (n = 438) were 0.10 mg/L (0.06 mg/L) and 0.02-1.6 mg/L, respectively, which were not much different from other causes of death (n = 278); 0.08 mg/L (0.05 mg/L) and 0.02-0.9 mg/L. Median concentrations of alprazolam in blood from living and deceased persons did not seem to depend on the number of co-ingested substances. The result of this pharmacoepidemiological study suggests that alprazolam is a fairly innocent drug when used as monotherapy, but toxicity problems arise when co-ingested with illicit drugs and/or psychoactive medication.
PubMed ID
23257168 View in PubMed
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Concentrations of unconjugated morphine, codeine and 6-acetylmorphine in urine specimens from suspected drugged drivers.

https://arctichealth.org/en/permalink/ahliterature10017
Source
J Forensic Sci. 2002 Mar;47(2):366-8
Publication Type
Article
Date
Mar-2002
Author
Gunnel Ceder
Alan Wayne Jones
Author Affiliation
Department of Forensic Chemistry, University Hospital, Linköping, Sweden.
Source
J Forensic Sci. 2002 Mar;47(2):366-8
Date
Mar-2002
Language
English
Publication Type
Article
Keywords
Automobile Driving
Codeine - blood - urine
Heroin - urine
Humans
Morphine - blood - urine
Morphine Derivatives - urine
Reference Values
Substance Abuse Detection - methods
Abstract
Concentrations of unconjugated morphine, codeine and 6-acetylmorphine (6-AM), the specific metabolite of heroin, were determined in urine specimens from 339 individuals apprehended for driving under the influence of drugs (DUID) in Sweden. After an initial screening analysis by immunoassay for 5-classes of abused drugs (opiates, cannabinoids, amphetamine analogs, cocaine metabolite and benzodiazepines), all positive specimens were verified by more specific methods. Opiates and other illicit drugs were analyzed by isotope-dilution gas chromatography-mass spectrometry (GC-MS). The limits of quantitation for morphine, codeine and 6-AM in urine were 20 ng/mL. Calibration plots included an upper concentration limit of 1000 ng/mL for each opiate. We identified the heroin metabolite 6-AM in 212 urine specimens (62%) at concentrations ranging from 20 ng/mL to > 1000 ng/mL. The concentration of 6-AM exceeded 1000 ng/mL in 79 cases (37%) and 31 cases (15%) were between 20 and 99 ng/mL. When 6-AM was present in urine the concentration of morphine was above 1000 ng/mL in 196 cases (92%). The concentrations of codeine in these same urine specimens were more evenly distributed with 35% being above 1000 ng/mL and 21% below 100 ng/mL. These results give a clear picture of the concentrations of unconjugated morphine, codeine and 6-acetylmorphine that can be expected in opiate-positive urine specimens from individuals apprehended for DUID after taking heroin.
PubMed ID
11908609 View in PubMed
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Demographics and post-mortem toxicology findings in deaths among people arrested multiple times for use of illicit drugs and/or impaired driving.

https://arctichealth.org/en/permalink/ahliterature289565
Source
Forensic Sci Int. 2016 Aug; 265:138-43
Publication Type
Journal Article
Date
Aug-2016
Author
Johan Ahlner
Anita Holmgren
Alan Wayne Jones
Author Affiliation
Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden.
Source
Forensic Sci Int. 2016 Aug; 265:138-43
Date
Aug-2016
Language
English
Publication Type
Journal Article
Keywords
Adult
Age Factors
Alcoholic Intoxication - complications - mortality
Automobile Driving
Crime
Databases, Factual
Female
Forensic Pathology
Humans
Male
Middle Aged
Postmortem Changes
Sex Factors
Substance-Related Disorders - complications - mortality
Sweden - epidemiology
Abstract
Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem.
This retrospective study (1993-2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma.
Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p
PubMed ID
26901639 View in PubMed
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Demographics and post-mortem toxicology findings in deaths among people arrested multiple times for use of illicit drugs and/or impaired driving.

https://arctichealth.org/en/permalink/ahliterature289723
Source
Forensic Sci Int. 2016 Aug; 265:138-43
Publication Type
Journal Article
Date
Aug-2016
Author
Johan Ahlner
Anita Holmgren
Alan Wayne Jones
Author Affiliation
Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden.
Source
Forensic Sci Int. 2016 Aug; 265:138-43
Date
Aug-2016
Language
English
Publication Type
Journal Article
Keywords
Adult
Age Factors
Alcoholic Intoxication - complications - mortality
Automobile Driving
Crime
Databases, Factual
Female
Forensic Pathology
Humans
Male
Middle Aged
Postmortem Changes
Sex Factors
Substance-Related Disorders - complications - mortality
Sweden - epidemiology
Abstract
Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem.
This retrospective study (1993-2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma.
Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p
PubMed ID
26901639 View in PubMed
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Demographics of suicide victims in Sweden in relation to their blood-alcohol concentration and the circumstances and manner of death.

https://arctichealth.org/en/permalink/ahliterature99453
Source
Forensic Sci Int. 2010 May 20;198(1-3):17-22
Publication Type
Article
Date
May-20-2010
Author
Anita Holmgren
Alan Wayne Jones
Author Affiliation
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Artillerigatan 12, Linköping, Sweden.
Source
Forensic Sci Int. 2010 May 20;198(1-3):17-22
Date
May-20-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Asphyxia - mortality
Central Nervous System Depressants - blood
Child
Chromatography, Gas
Drowning - mortality
Ethanol - blood
Female
Forensic Toxicology
Humans
Male
Middle Aged
Poisoning - mortality
Sex Distribution
Suicide - statistics & numerical data
Sweden - epidemiology
Wounds, Gunshot - mortality
Wounds, Stab - mortality
Abstract
Specimens of blood and other body fluids were obtained at autopsy from all deaths in Sweden classified as suicide covering a 10-year period (N=11,441 cases). The mean age (+/-standard deviation, SD) of the victims was 51.3+/-18.8 years with a clear predominance of males 71% (mean age 51.3+/-18.8 years) compared with 29% females (mean age 51.4+/-18.9 years). The concentration of ethanol in blood samples was determined in duplicate by headspace gas chromatography and a mean blood-alcohol concentration (BAC) of 0.1g/L (10mg/100mL) was the cut-off used to identify ethanol positive cases. The suicides were coded (ICD-9) as self-poisonings (N=2462, 22%), hanging (N=4474, 39%), asphyxia by gas (N=509, 4.4%), drowning (N=803, 7.0%), gun shot (N=1307, 11.4%), fall from height (N=632, 5.5%), self-inflicted cuts or sharp-force injury (N=363, 3.1%) and miscellaneous ways (N=891, 7.8%). On average 34% of all suicide victims in Sweden had consumed alcohol before death, 36% of the males and 31% of the females had a positive BAC. The mean (median) concentration of alcohol in femoral blood for men was 1.34g/L (1.3g/L) compared with 1.25g/L (1.1g/L) for women. Many victims were heavily intoxicated and the 90th percentiles of the BAC distributions ranged from 2.3 to 2.8g/L depending on manner of death. Elevated blood-alcohol was most prevalent in poisoning deaths (45%) and gas asphyxia (51%) and least prevalent in falls from height (19%) and sharp-force injury (18%). Toxicological analysis for presence of drugs other than alcohol showed a predominance of paracetamol, SSRI antidepressants, anti-psychotics, sedative-hypnotics, and centrally acting opioids. A host of psycho-social factors drive a person to commit suicide and one of the catalysts is over-consumption of alcohol and acute alcohol intoxication. Heavy drinking leads to a loss of inhibitions, impulsive behaviour, poor judgment and a tendency to take risks, all of which might increase the propensity of predisposed individuals to take their own lives.
PubMed ID
20056362 View in PubMed
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Driving under the influence of chlormethiazole.

https://arctichealth.org/en/permalink/ahliterature9185
Source
Forensic Sci Int. 2005 Oct 29;153(2-3):213-7
Publication Type
Article
Date
Oct-29-2005
Author
Alan Wayne Jones
Author Affiliation
Department of Forensic Toxicology, University Hospital, 581 85 Linköping, Sweden. wayne.jones@RMV.se
Source
Forensic Sci Int. 2005 Oct 29;153(2-3):213-7
Date
Oct-29-2005
Language
English
Publication Type
Article
Keywords
Accidents, Traffic
Automobile Driving
Breath Tests
Central Nervous System Depressants - blood - urine
Chlormethiazole - blood - chemistry
Chromatography, Gas
Ethanol - blood - urine
Forensic Medicine
Humans
Hypnotics and Sedatives - blood - chemistry
Male
Middle Aged
Molecular Structure
Physician Impairment
Substance Abuse Detection
Substance-Related Disorders - diagnosis
Sweden
Abstract
This article describes a case of driving under the influence of the sedative-hypnotic-anticonvulsant drug chlormethiazole. The suspect, who was a physician, was driving dangerously on a busy highway and caused a traffic collision. When apprehended by the police, the man had bloodshot and glazed eyes and pupil size was enlarged. He could not answer the questions properly and his gait was unsteady. A roadside breath-alcohol screening test was positive but an evidential breath-alcohol test conducted about one hour later was below the legal limit for driving of 0.10 mg/L (10 microg/100 mL or 0.021 g/210 L). Because of the special circumstances of the traffic crash and the man's appearance and behaviour, the police suspected that drugs other than alcohol were involved and obtained a venous blood sample for toxicological analysis. The blood contained 0.23 mg/g alcohol, which is above the legal limit for driving in Sweden 0.20 mg/g (20 mg/100 mL or 0.020 g/100 mL), and codeine was also present at a therapeutic concentration of 0.02 mg/L. The conflict between the clinical signs of impairment and the toxicology report prompted a reanalysis of the blood sample with major focus on sedative-hypnotic drugs. Analysis by capillary GC-NPD identified chlormethiazole at a concentration of 5mg/L, the highest so far encountered in traffic cases in Sweden. In 13 other impaired driving cases over 10 years the mean (median) and range of concentrations of chlormethiazole were 1.6 mg/L (1.6 mg/L) and 0.3-3.3 mg/L. This case report underscores the need to consider clinical observations and the person's behaviour in relation to the toxicology report when interpreting and testifying in drug-impaired driving cases.
PubMed ID
15975749 View in PubMed
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Driving under the influence of drugs in Sweden with zero concentration limits in blood for controlled substances.

https://arctichealth.org/en/permalink/ahliterature9085
Source
Traffic Inj Prev. 2005 Dec;6(4):317-22
Publication Type
Article
Date
Dec-2005
Author
Alan Wayne Jones
Author Affiliation
Department of Forensic Toxicology, University Hospital, Linköping, Sweden. wayne.jones@RMV.SE
Source
Traffic Inj Prev. 2005 Dec;6(4):317-22
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Automobile Driving - legislation & jurisprudence
Female
Humans
Male
Police
Sex Distribution
Street Drugs - blood
Substance Abuse Detection - legislation & jurisprudence - methods
Substance-Related Disorders - blood - epidemiology
Sweden - epidemiology
Abstract
OBJECTIVE: This article describes the background and implementation in Sweden of zero-concentration limits for controlled drugs in the blood of drivers. Eliminating the need to prove that a person's ability to drive safely was impaired by drugs has greatly simplified the prosecution case, which now rests primarily on the forensic toxicology report. Driving under the influence of a prescription drug listed as a controlled substance is exempt from the zero-limit law provided the medication was being used in accordance with a physician's direction and the person was not considered unfit to drive. METHODS: The prevalence of driving under the influence of drugs (DUID) in Sweden was evaluated from police reports with the main focus on the toxicological findings. A large case series of DUID suspects was compared before and after introducing zero concentration limits in blood for controlled substances on July 1, 1999. The spectrum of drugs used by typical offenders and the concentrations of various licit and illicit substances in blood were evaluated and compared. RESULTS: Immediately after the zero-limit law came into force, the number of cases of DUID submitted by the police for toxicological analysis increased sharply and is currently ten-fold higher than before the new legislation. Statistics show that about 85% of all blood samples sent for toxicological analysis have one or more banned substances present. Amphetamine is by far the leading drug of abuse in Sweden and was identified in about 50-60% of all DUID suspects either alone or together with other controlled substances. The next most frequently encountered illicit drug was tetrahydrocannabinol (THC), with positive findings in about 20-25% of cases. Various prescription drugs, mainly sedative-hypnotics like diazepam and flunitrazepam, were also highly prevalent and these occurred mostly together with illicit substances. Opiates, such as 6-acetyl morphine and morphine, the metabolites of heroin, were high on the list of substances identified. Most DUID suspects in Sweden were men (85%) who were poly-drug users combining illicit substances, like amphetamine and/or cannabis, with a prescription medication such as various benzodiazepines. CONCLUSIONS: Sweden's zero-concentration limit has done nothing to reduce DUID or deter the typical offender because recidivism is high in this population of individuals (40-50%). Indeed, many traffic delinquents in Sweden are criminal elements in society with previous convictions for drunk and/or drugged driving as well as other offenses. The spectrum of drugs identified in blood samples from DUID suspects has not changed much since the zero-limit law was introduced.
PubMed ID
16266940 View in PubMed
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Driving under the influence with blood alcohol concentrations over 0.4 g%.

https://arctichealth.org/en/permalink/ahliterature108413
Source
Forensic Sci Int. 2013 Sep 10;231(1-3):349-53
Publication Type
Article
Date
Sep-10-2013
Author
Alan Wayne Jones
Patrick Harding
Author Affiliation
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden. wayne.jones@liu.se
Source
Forensic Sci Int. 2013 Sep 10;231(1-3):349-53
Date
Sep-10-2013
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Alcoholic Intoxication - complications
Automobile Driving - legislation & jurisprudence
Central Nervous System Depressants - blood
Ethanol - blood
Female
Humans
Male
Middle Aged
Retrospective Studies
Sex Distribution
Sweden
Time Factors
Unconsciousness - etiology
Wisconsin
Abstract
The aim of this study was to evaluate the characteristics of traffic offenders with unusually high blood-alcohol concentrations (BAC>0.4 g%) when arrested. The BAC that kills one person might be easily tolerated by another, depending on, among other things, the person's age, pattern of drinking, and the development of tolerance. The archives of two forensic laboratories, one in Sweden and the other in Wisconsin (USA), were searched to find traffic offenders with BACs>0.4 g%. The results were compared in relation to the person's age and gender, mean BAC and the weekday and time of day of the arrest. The mean age (±standard deviation) of N=158 Swedish offenders was 45±9.0 y, which was not significantly different from the 43±9.4 y in N=233 Wisconsin drivers (p>0.05). Overall there were more men (78%) than women (22%) arrested with BAC's>0.4 g%, although the proportion of women in Wisconsin (35%) was higher than in Sweden (9%) (p
PubMed ID
23890659 View in PubMed
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17 records – page 1 of 2.