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Earlier warning: a multi-indicator approach to monitoring trends in the illicit use of medicines.

https://arctichealth.org/en/permalink/ahliterature93901
Source
Int J Drug Policy. 2009 Mar;20(2):161-9
Publication Type
Article
Date
Mar-2009
Author
Mounteney Jane
Haugland Siren
Author Affiliation
Department of Public Health/Bergen Clinics Foundation, University of Bergen, N-5009 Bergen, Norway. jmou@bergenclinics.no
Source
Int J Drug Policy. 2009 Mar;20(2):161-9
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Buprenorphine - adverse effects
Data Collection
Flunitrazepam - adverse effects
Humans
Models, Theoretical
Norway - epidemiology
Street Drugs - adverse effects
Substance Abuse Detection - methods
Substance-Related Disorders - epidemiology
Abstract
BACKGROUND: The availability of medicines on the illicit drug market is currently high on the international policy agenda, linked to adverse health consequences including addiction, drug related overdoses and injection related problems. Continuous surveillance of illicit use of medicines allows for earlier identification and reporting of emerging trends and increased possibilities for earlier intervention to prevent spread of use and drug related harm. This paper aims to identify data sources capable of monitoring the illicit use of medicines; present trend findings for Rohypnol and Subutex using a multi-indicator monitoring approach; and consider the relevance of such models for policy makers. METHODS: Data collection and analysis were undertaken in Bergen, Norway, using the Bergen Earlier Warning System (BEWS), a multi-indicator drug monitoring system. Data were gathered at six monthly intervals from April 2002 to September 2006. Drug indicator data from seizures, treatment, pharmacy sales, helplines, key informants and media monitoring were triangulated and an aggregated differential was used to plot trends. RESULTS: Results for the 4-year period showed a decline in the illicit use of Rohypnol and an increase in the illicit use of Subutex. CONCLUSION: Multi-indicator surveillance models can play a strategic role in the earlier identification and reporting of emerging trends in illicit use of medicines.
PubMed ID
18032012 View in PubMed
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Flunitrazepam: psychomotor impairment, agitation and paradoxical reactions.

https://arctichealth.org/en/permalink/ahliterature83349
Source
Forensic Sci Int. 2006 Jun 2;159(2-3):83-91
Publication Type
Article
Date
Jun-2-2006
Author
Bramness Jørgen G
Skurtveit Svetlana
Mørland Jørg
Author Affiliation
Norwegian Institute of Public Health, Department of Pharmacoepidemiology, PO Box 4404, Nydalen, NO-0403 Oslo, Norway. jorgen.bramness@labmed.uio.no
Source
Forensic Sci Int. 2006 Jun 2;159(2-3):83-91
Date
Jun-2-2006
Language
English
Publication Type
Article
Keywords
Adult
Aggression
Anti-Anxiety Agents - adverse effects - blood
Automobile Driving - statistics & numerical data
Conduct Disorder - blood - epidemiology - etiology - psychology
Crime - statistics & numerical data
Databases, Factual
Female
Flunitrazepam - adverse effects - blood
Forensic Psychiatry
Humans
Male
Norway - epidemiology
Substance-Related Disorders - blood - epidemiology - etiology - psychology
Violence - statistics & numerical data
Abstract
Benzodiazepines are sedatives used for anxiolysis, hypnosis, muscle relaxation and the treatment of epilepsy. Paradoxical reactions including agitation, talkativeness, confusion, disinhibition, aggression, violent behavior and loss of impulse control may, however, occur in some subjects. It has been claimed that high doses of flunitrazepam may cause aggression on a more regular basis in all individuals. The present study makes use of a Norwegian forensic toxicological database containing analytical results from drivers suspected of driving under the influence and suspects of violent crime to analyze the relationship between behavior and blood flunitrazepam concentration. Four-hundred and fifteen cases of drivers suspected of driving under the influence and seven cases of suspects of violent crime were studied. These selected cases had flunitrazepam as the only drug in blood samples and had been evaluated by a clinical test for impairment (CTI) performed by a police physician at the time of blood sampling. The impaired drivers had higher blood flunitrazepam concentrations than the not impaired drivers. Multivariate analysis revealed that both blood flunitrazepam concentration and age of the suspected drivers had independent impact on impairment, indicating tolerance with age. Most of the effects measured were sedative effects of flunitrazepam and these effects were related to flunitrazepam level. Possible paradoxical reactions were observed in a subgroup of 23 individuals (6%), but these reactions did not relate to blood flunitrazepam concentration. The suspects of violent crime showed similar degree impairment and had not more paradoxical reactions than the suspected drugged drivers. The findings were in agreement with other research that claims paradoxical reactions should be viewed as a reaction in certain individuals, and does not support the notion that flunitrazepam in high concentration produces aggression in all individuals taking the drug.
PubMed ID
16087304 View in PubMed
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The importance of a urine sample in persons intoxicated with flunitrazepam--legal issues in a forensic psychiatric case study of a serial murderer.

https://arctichealth.org/en/permalink/ahliterature9615
Source
Forensic Sci Int. 2003 Oct 14;137(1):21-7
Publication Type
Article
Date
Oct-14-2003
Author
Anna Maria Dåderman
Hans Strindlund
Nils Wiklund
Svend-Otto Fredriksen
Lars Lidberg
Author Affiliation
Department of Psychology, Division of Biological Psychology, Stockholm University, SE-106 91 Stockholm, Sweden. amd@psychology.su.se
Source
Forensic Sci Int. 2003 Oct 14;137(1):21-7
Date
Oct-14-2003
Language
English
Publication Type
Article
Keywords
Adult
Aggression - psychology
Amnesia, Anterograde - chemically induced
Anti-Anxiety Agents - adverse effects - pharmacokinetics - urine
Female
Flunitrazepam - adverse effects - pharmacokinetics - urine
Forensic Psychiatry - methods
Homicide - psychology
Humans
Impulsive Behavior - chemically induced
Male
Substance Abuse Detection - methods
Substance-Related Disorders - diagnosis - urine
Sweden
Violence - psychology
Abstract
The sedative-hypnotic benzodiazepine flunitrazepam (FZ) is abused worldwide. The purpose of our study was to investigate violence and anterograde amnesia following intoxication with FZ, and how this was legally evaluated in forensic psychiatric investigations with the objective of drawing some conclusions about the importance of urine sample in a case of a suspected intoxication with FZ. The case was a 23-year-old male university student who, intoxicated with FZ (and possibly with other substances such as diazepam, amphetamines or cannabis), first stabbed an acquaintance and, 2 years later, two friends to death. The police investigation files, including video-typed interviews, the forensic psychiatric files, and also results from the forensic autopsy of the victims, were compared with the information obtained from the case. Only partial recovery from anterograde amnesia was shown during a period of several months. Some important new information is contained in this case report: a forensic analysis of blood sample instead of a urine sample, might lead to confusion during police investigation and forensic psychiatric assessment (FPA) of an FZ abuser, and in consequence wrong legal decisions. FZ, alone or combined with other substances, induces severe violence and is followed by anterograde amnesia. All cases of bizarre, unexpected aggression followed by anterograde amnesia should be assessed for abuse of FZ. A urine sample is needed in case of suspected FZ intoxication. The police need to be more aware of these issues, and they must recognise that they play a crucial role in an assessment procedure. Declaring FZ an illegal drug is strongly recommended.
Notes
Comment In: J Am Acad Psychiatry Law. 2004;32(4):467-815704634
PubMed ID
14550609 View in PubMed
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Road traffic accident risk related to prescriptions of the hypnotics zopiclone, zolpidem, flunitrazepam and nitrazepam.

https://arctichealth.org/en/permalink/ahliterature93713
Source
Sleep Med. 2008 Dec;9(8):818-22
Publication Type
Article
Date
Dec-2008
Author
Gustavsen Ingebjørg
Bramness Jørgen G
Skurtveit Svetlana
Engeland Anders
Neutel Ineke
Mørland Jørg
Author Affiliation
Division of Forensic Toxicology and Drug Abuse, Norwegian Institute of Public Health, Oslo, Norway. ingebjorg.g.gustavsen@fhi.no
Source
Sleep Med. 2008 Dec;9(8):818-22
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - statistics & numerical data
Adolescent
Adult
Aged
Azabicyclo Compounds - adverse effects
Female
Flunitrazepam - adverse effects
Follow-Up Studies
Humans
Hypnotics and Sedatives - adverse effects
Incidence
Male
Middle Aged
Nitrazepam - adverse effects
Norway - epidemiology
Piperazines - adverse effects
Pyridines - adverse effects
Risk factors
Sleep Initiation and Maintenance Disorders - drug therapy
Young Adult
Abstract
BACKGROUND: Despite the high prescription rate of benzodiazepine-like hypnotics (z-hypnotics), there is limited information on the road traffic accident risk associated with the use of these drugs. We wanted to investigate whether filling a prescription for zopiclone or zolpidem was associated with increased risk of road traffic accidents at a national population level. Nitrazepam and flunitrazepam were used as comparator drugs. METHOD: All Norwegians 18-69 years (3.1 million) were followed-up from January 2004 until the end of September 2006. Information on prescriptions, road traffic accidents and emigration/death was obtained from three Norwegian population-based registries. The first week after the hypnotics had been dispensed was considered to be the exposure period. Standardized incidence ratios (SIRs) were calculated by comparing the incidence of accidents in the exposed person-time to the incidence of accidents in the unexposed person-time. RESULTS: During exposure, 129 accidents were registered for zopiclone, 21 for zolpidem, 27 for nitrazepam and 18 for flunitrazepam. The SIRs were (SIR for all ages and both sexes combined; 95% CI): z-hypnotics (zopiclone+zolpidem) 2.3; 2.0-2.7, nitrazepam 2.7; 1.8-3.9 and flunitrazepam 4.0; 2.4-6.4. The highest SIRs were found among the youngest users for all hypnotics. CONCLUSIONS: This study found that users of hypnotics had a clearly increased risk of road traffic accidents. The SIR for flunitrazepam was particularly high.
PubMed ID
18226959 View in PubMed
Less detail
Source
Lakartidningen. 2001 Feb 21;98(8):868
Publication Type
Article
Date
Feb-21-2001

[Rohypnol should be classified as a narcotic]

https://arctichealth.org/en/permalink/ahliterature10710
Source
Lakartidningen. 1999 Mar 3;96(9):1005-7
Publication Type
Article
Date
Mar-3-1999
Author
A. DÃ¥derman
L. Lidberg
Author Affiliation
Sektionen för rättspsykiatri, Karolinska institutet, Huddinge.
Source
Lakartidningen. 1999 Mar 3;96(9):1005-7
Date
Mar-3-1999
Language
Swedish
Publication Type
Article
Keywords
Adult
Aggression - drug effects
Alcohol Drinking
Anti-Anxiety Agents - adverse effects
Crime
Drug and Narcotic Control
English Abstract
Flunitrazepam - adverse effects
Forensic Psychiatry
Humans
Male
Substance-Related Disorders - diagnosis - etiology - psychology
Sweden
Abstract
Flunitrazepam, widely known by its trade names (e.g. Rohypnol), may cause severe violence, especially in combination with alcohol. Flunitrazepam abusers become cold-blooded, ruthless and violent, and do not remember their violence. Reputedly it is supplied to professional hit-men and enforcers by their bosses to promote ruthless efficacy. One case report describes how a young man, intoxicated with flunitrazepam and involved in causing serious knife and gunshot wounds and taking hostages, felt so invincible that he openly challenged the police, threatening them with an assault rifle, but was himself shot. Flunitrazepam may exert pharmacological effects on GABA-ergic systems, thus lowering serotonin levels. The impulsive execution of violent crimes and suicide attempts in which a violent method (hanging, shooting, self-stabbing) has been used are associated with the presence of low serotonin levels. It is therefore recommended that flunitrazepam should be classified as a controlled substance in Sweden as it is elsewhere.
Notes
Comment In: J Am Acad Psychiatry Law. 2004;32(4):467-815704634
PubMed ID
10093441 View in PubMed
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Violent behavior, impulsive decision-making, and anterograde amnesia while intoxicated with flunitrazepam and alcohol or other drugs: a case study in forensic psychiatric patients.

https://arctichealth.org/en/permalink/ahliterature9938
Source
J Am Acad Psychiatry Law. 2002;30(2):238-51
Publication Type
Article
Date
2002
Author
Anna Maria Dåderman
Björn Fredriksson
Marianne Kristiansson
Lars-Håkan Nilsson
Lars Lidberg
Author Affiliation
Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Huddinge, Sweden. anna.daderman@neurotec.ki.se
Source
J Am Acad Psychiatry Law. 2002;30(2):238-51
Date
2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Amnesia, Anterograde - chemically induced
Anti-Anxiety Agents - adverse effects
Antisocial Personality Disorder - psychology
Criminal Psychology
Decision Making
Diagnosis, Dual (Psychiatry)
Flunitrazepam - adverse effects
Forensic Psychiatry
Homicide - psychology
Humans
Impulsive Behavior - chemically induced
Male
Research Support, Non-U.S. Gov't
Substance-Related Disorders - complications
Sweden
Violence - psychology
Abstract
It is known that many male juvenile delinquents commit violent crimes while intoxicated with flunitrazepam (FZ), often in combination with alcohol or other drugs. We have also noted the combined abuse of FZ with, for example, alcohol in male forensic psychiatric patients. Our objective was to study violent behavior, impulsive decision-making, and amnesia in male forensic psychiatric patients who were intoxicated predominantly with FZ, to increase knowledge of the abuse of FZ in vulnerable subjects. We studied five forensic psychiatric patients, all of whom were assessed in 1998. All of the subjects reported earlier reactions to FZ, including hostility and anterograde amnesia. At the time of their crimes they were all intoxicated with FZ, often in combination with alcohol or other drugs, such as amphetamine or cannabis. In contrast to their behavior based on their ordinary psychological characteristics, their crimes were extremely violent, and the subjects lacked both the ability to think clearly and to have empathy with their victims. Our observations support the view that FZ abuse can lead to serious violent behavior in subjects characterized by vulnerable personality traits, and that this effect is confounded by the concurrent use of alcohol or other drugs. It is evident that FZ causes anterograde amnesia. Previous research and the results presented herein allow us to draw the following conclusion: on the basis of the neuropsychopharmacologic properties of FZ, legal decisions, such as declaring FZ an illegal drug, are needed in countries where it is now legal.
Notes
Comment In: J Am Acad Psychiatry Law. 2004;32(4):467-815704634
PubMed ID
12108561 View in PubMed
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7 records – page 1 of 1.