14 research outputs found
Inhalant deaths in south Australia - A 20-year retrospective autopsy study
No full textA 20-year retrospective study of inhalant deaths in South Australia, autopsied at Forensic Science SA, was undertaken from January 1983 to December 2002. Thirty-nine cases were identified from an autopsy pool of 18,880 cases, with a male to female ratio of 12:1. Sixty-four percent of the victims (N = 25) died during voluntary inhalation of volatile substances and 28% (N = 11) committed suicide utilizing a volatile substance or gas. The remaining 3 cases involved a workplace accident (N = 1) and 2 cases of autoerotic death where inhalants were being used to augment solitary sexual activity. The mean age of the 28 victims of accidental inhalant death of 21 years (range, 13-45 years) was considerably less than that of the 11 suicide victims of 31.5 years (range, 17-48 years). No homicides were found. Approximately one quarter of the victims were Aboriginal (N = 11), 10 of whom had died as a result of gasoline inhalation ("petrol sniffing"). Other common substances of abuse were aliphatic hydrocarbons such as butane. The study has shown that those most at risk for accidental or suicidal inhalant deaths were young males, with 92% of victims overall being male, and with 77% of victims being under 31 years of age. Gasoline inhalation remains a significant problem in Aboriginal communities in South Australia.Regula Wick, John D. Gilbert, Peter Felgate, and Roger W. Byar
Fatalities associated with the use of gamma-hydroxybutyrate and its analogues in Australasia
No full textThe document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Objective: To identify deaths in Australasia associated with overdose of γ-hydroxybutyrate (GHB) and its precursors (γ-butyrolactone and 1,4-butanediol). Design: A retrospective search of medical and scientific information sources, as well as popular newsprint, for the period January 2000 – August 2003, with formal clinical, toxicological and forensic evaluation of retrieved data. Main outcome measure: Death associated with forensic data implicating GHB or its analogues. Results: Ten confirmed GHB-associated deaths were identified, with eight considered to be directly attributable to GHB. Only two of these eight cases were positive for ethanol toxicology. Conclusions: Our study supports the existing evidence that GHB overdose is associated with fatalities, and that fatal overdoses occur in the context of isolated use.David G E Caldicott, Fiona Y Chow, Brian J Burns, Peter D Felgate and Roger W Byar
Population drug use in Australia: A wastewater analysis
No full textAccurate information on drug use in communities is essential if health, social and economic harms associated with illicit drug use are to be addressed efficiently. In most countries population drug use is estimated indirectly via surveys, medical presentations and police and custom seizures. All of these methods have at least some problems due to bias, small samples and/or long time delays between collecting the information and analysing the results. Recently the direct quantification of drug residues in wastewater has shown promise as a means of monitoring drug use in defined geographical areas.
In this study we measured 3,4-methylenedioxymethamphetamine (MDMA), methamphetamine and benzoylecgonine in sewage inflows in metropolitan and regional areas of Australia and compared these data with published European data. Cocaine use was small compared to European cities (p < 0.001) but was compensated for by much greater consumption of methamphetamine (p < 0.001) and MDMA (p < 0.05). MDMA was more popular in regional areas (p < 0.05) whereas methamphetamine and cocaine were mainly consumed in the city (p < 0.05). Greater than 5-fold increases in MDMA use were detected on weekends (p < 0.001). This approach has the potential to improve our understanding of drug use in populations and should be further developed to improve prevention and treatment programs.Rodney J. Irvine, Chris Kostakis, Peter D. Felgate, Emily J. Jaehne, Chang Chen, Jason M. Whit
Plasma drug concentrations and physiological measures in 'dance party' participants
No full textThe increasing use of (7) 3,4-methylenedioxymethamphetamine (MDMA) in the setting of large dance parties (‘raves’) and clubs has been the source of some concern, because of potential acute adverse events, and because animal studies suggest that MDMA has the potential to damage brain serotonin (5-HT) neurons. However, it is not yet known whether MDMA, as used in the setting of dance parties, leads to plasma levels of MDMA that are associated with toxicity to 5-HT neurons in animals. The present study sought to address this question. Plasma MDMA concentrations, vital signs, and a variety of blood and urine measures were obtained prior to, and hours after, individuals attended a dance party. After the dance party, subjects were without clinical complaints, had measurable amounts of residual MDMA in plasma, and nearly half of the subjects also tested positive for methamphetamine, another amphetamine analog that has been shown to have 5-HT neurotoxic potential in animals. Plasma concentrations of MDMA did not correlate with self-reported use of ‘ecstasy’ and, in some subjects, overlapped with those that have been associated with 5-HT neurotoxicity in non-human primates. Additional subjects were likely to have had similar concentrations while at the dance party, when one considers the reported time of drug ingestion and the plasma half-life of MDMA in humans. Hematological and biochemical analyses were generally unremarkable. Moderate increases in blood pressure, heart rate and body temperature were observed in the subjects with the highest MDMA plasma concentrations. These findings are consistent with epidemiological findings that most people who use MDMA at dance parties do not develop serious clinical complications, and suggest that some of these individuals may be at risk for developing MDMA-induced toxicity to brain serotonin neurons.Rodney J Irvine, Michael Keane, Peter Felgate, Una D McCann, Paul D Callaghan and Jason M Whit
Evaluation of pre-analysis loss of dependent drugs in wastewater: stability and binding assessments
No full textArticle first published online: 9 OCT 2012Wastewater analysis has the potential to provide objective and timely data on population drug consumption, but some crucial factors such as pre-analysis drug loss during sample storage and filtration could affect the accuracy and reliability of the method, and these uncertainties have yet to be fully assessed. This study was designed to evaluate analyte stability in wastewater stored under different conditions with the aim of optimizing the sample storage procedures for future studies. It also investigated whether there is significant analyte loss during filtration before sample extraction and storage after that. The studied substances and metabolites were: cotinine, cocaine and its metabolite benzoylecgonine, phenethylamines amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), opioids including codeine, methadone, 6-monoacetylmorphine (MAM) and morphine. In most situations, storing samples at 4 C is sufficient to stabilize analytes for at least 2weeks, and refrigeration is unnecessary during sample transportation within 3 days. However, additional measures need to be taken if unstable analytes such as cocaine and MAM are to be analyzed. No significant analyte loss was observed in the filtration process or in reconstituted extract stored at 4 C or 20 C for 2weeks. By choosing stable analytes and proper storage conditions, wastewater analysis has the potential to provide accurate data for estimation of community drug use.Chang Chen, Chris Kostakis, Rodney J. Irvine, Peter D. Felgate and Jason M. Whit
Marked decline in 3,4-methylenedioxymethamphetamine (MDMA) based on wastewater analysis
No full textObjective: Recent reports in Europe suggest a decline in 3,4-methylenedioxymethamphetamine (MDMA; Ecstasy) use, but quantifiable and objective measurement is unavailable. The global extent of changes in MDMA and related stimulant use is also unclear. This study aims to quantify changes in MDMA use in Australia and determine whether these changes have been accompanied by differing amounts of other stimulant use. Method: We acquired information on recent use of MDMA and related illicit stimulants in Australia using the method of wastewater analysis. Untreated wastewater samples collected from three metropolitan treatment plants in Adelaide from May to July 2009 and the same months in 2010 were analyzed. Concentrations of MDMA, methamphetamine, and benzoylecgonine (a metabolite of cocaine) were determined using solid phase extraction–liquid chromatography–tandem mass spectrometry. Weekly consumed doses of MDMA, methamphetamine, and cocaine per 1,000 people were estimated. Results: From 2009 to 2010, weekly consumption of MDMA decreased from mean of 4.52 (SEM = 0.74) doses/week per 1,000 people to 0.08 (0.01) doses/week per 1,000 people (p < .001); weekly consumption of methamphetamine increased from a mean of 48.35 (6.13) doses/week per 1,000 people to 68.13 (5.33) doses/week per 1,000 people (p < .05); and weekly consumed doses of cocaine did not significantly change. Local roadside saliva testing data also showed that the MDMA-positive test rate decreased from 0.30% to 0.05% and the methamphetamine-positive test rate increased from 1.43% to 1.52% during the past 2 years. Conclusions: This study shows a 50-fold decrease in consumed doses of MDMA with a rise in methamphetamine use in Australia over a 1-year period.Chang Chen, Chris Kostakis, Peter Harpas, Peter D. Felgate, Rodney J. Irvine, Jason M. Whit
Effects of MDMA on body temperature in humans
No full textHyperthermia is a severe complication associated with the recreational use of 3,4-methylenedioxymethamphetamine(MDMA, Ecstasy). In this review, the clinical laboratory studies that tested the effects of MDMA on body temperature are summarized. The mechanisms that underlie the hyperthermic effects of MDMA in humans and treatment of severe hyperthermia are presented. The data show that MDMA produces an acute and dose-dependent rise in core body temperature in healthy subjects. The increase in body temperature is in the range of 0.2-0.8C and does not result in hyperpyrexia (>40C) in a controlled laboratory setting. However, moderately hyperthermic body temperatures >38.0C occur frequently at higher doses, even in the absence of physical activity and at room temperature. MDMA primarily releases serotonin and norepinephrine. Mechanistic clinical studies indicate that the MDMA-induced elevations in body temperature in humans partially depend on the MDMA-induced release of norepinephrine and involve enhanced metabolic heat generation and cutaneous vasoconstriction, resulting in impaired heat dissipation. The mediating role of serotonin is unclear. The management of sympathomimetic toxicity and associated hyperthermia mainly includes sedation with benzodiazepines and intravenous fluid replacement. Severe hyperthermia should primarily be treated with additional cooling and mechanical ventilation
Evaluation of pre‐analysis loss of dependent drugs in wastewater: stability and binding assessments
No full textSetting priorities for humanitarian water, sanitation and hygiene research: a meeting report
No full textRecent systematic reviews have highlighted a paucity of rigorous evidence to guide water, sanitation and hygiene (WASH) interventions in humanitarian crises. In June 2017, the Research for Health in Humanitarian Crises (R2HC) programme of Elrha, convened a meeting of representatives from international response agencies, research institutions and donor organisations active in the field of humanitarian WASH to identify research priorities, discuss challenges conducting research and to establish next steps. Topics including cholera transmission, menstrual hygiene management, and acute undernutrition were identified as research priorities. Several international response agencies have existing research programmes; however, a more cohesive and coordinated effort in the WASH sector would likely advance this field of research. This report shares the conclusions of that meeting and proposes a research agenda with the aim of strengthening humanitarian WASH policy and practice
