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Workplace drug testing in Italy: one year of experience of the Forensic Toxicology laboratory, University of Pavia
No full textDetermination of 18 cardiovascular drugs in urine and whole blood by LC-MS/MS: application in clinical and forensic toxicology
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Hair testing and self report of cocaine use
No full textIntroduction. Hair analysis is a useful tool in clinical, administrative and forensic fields; it allows to obtain long term information concerning drugs of abuse consumption, but the lack of data often does not allow to find a correlation between consumption and drug concentration in hair.
Aim. The purpose of this study was to compare the concentration of cocaine in hair with self-reported drug intake.
Methods. 113 subjects (61 Africans, 52 Caucasians) just admitted to the jail were asked to report their use of illicit drugs during the last three months and they were submitted to hair analysis. They had to answer about the class of drug used and the frequency of consumption (triple choice among: daily, 2-4 times per week, 1-2 times per month). Hair segments (3 cm) were analyzed by GC-MS for amphetamines, cannabinoids, cocaine and opiates.
Results. Useful data were obtained from 82 subjects declaring cocaine consumption: in 43 cases cocaine use was reported as daily, in 28 weekly and in 9 occasional. Cocaine (COC) and benzoylecgonine (BE) were always found in hair, and results were the following on average: daily use COC 53,93 ng/mg, BE 5,91 ng/mg; weekly use COC 28,91 ng/mg, BE 3,76 ng/mg; monthly use COC 7,65 ng/mg, BE 0,98 ng/mg. The study revealed good agreement between qualitative results and declared consumption. As regard the correlation between frequency of consumption and concentrations in hair, we often observed high concentrations against low consumption declared. There was quite good separation only between occasional and daily use (especially in Caucasian people), while concentrations found when weekly employment was reported are more scattered. Concentrations of cocaine found in Africans were very higher than in Caucasians.
Conclusions. Even if this study is based only on self-report, it provides some interesting information in order to distinguish the frequency of consumption, and particularly it underlines the great importance of racial bias on hair analysis
Methadone-related deaths: a worrying increase
No full textObjectives. Methadone has been used in Italy in maintenance programs for heroin addicts since the early 1980s. Its use requires a careful evaluation of the dosage, in relation with the opioid tolerance developed by the patient under treatment. The number of methadone-related deaths observed by our Laboratory has been increasing during the last five years: the aim of this work is to discuss the causes of such an increment, whether there has been an increase in methadone use without medical prescription, an incorrect use of the drug when take-home doses were prescribed, simultaneous consumption of alcohol or drugs, or even doctor’s carelessness at the Addiction Units when judging the appropriate methadone dosage.
Materials and Methods. Between 2006 and 2010 we observed twenty cases of lethal poisoning related to methadone administration, seven of those in the year 2010 alone. Fifteen were males and five females, the average age being 32 (min 2 - max 54). The following toxicological analyses were carried out on postmortem samples: HS-GC quantitative analysis of ethanol in blood; GC-MS systematic toxicological analysis (STA) in blood followed by quantitative determination of identified drugs; GC-NPD determination of methadone in blood and in urine when available. Whenever possible (12 cases) GC-MS quantitative determination of methadone and morphine in hair (2 cm closest to the scalp) was performed.
Results. It has been established that half of the deaths had been caused by methadone only, while in the other ten there had been contribution, besides methadone, of other substances (especially ethanol). The evaluation of the anamnestic data has allowed to observe that six of the deceased subjects were not following any methadone therapy, five had take-home methadone doses, while three other subjects had started methadone therapy just a few days earlier. In three of the remaining six cases, all involving subjects with supervised methadone consumption, blood alcohol concentration was over 200 mg/100 ml, and in one case there were high concentrations of Promethazine and Levomepromazine, the only medications found besides methadone. Highest blood methadone average concentrations (891 ng/ml) were surprisingly those related to subjects who had just started methadone treatment, followed by those of subjects with take-home doses (720 ng/ml). Lowest concentrations (455 ng/ml) were, conversely, those of subjects who had taken methadone without a doctor’s prescription and those of patients with supervised consumption by a drug treatment service (695 ng/ml).
Conclusion. By evaluating the results we came to the following conclusions: 1) the death of three patients during induction into methadone treatment have been caused by administration of excessive starting doses; 2) when take-home doses are prescribed, sometimes patients display a tendency to irregular assumption of the drug, this being documented through the occasional findings of unconsumed syrup bottles at the patient’s domicile and through hair analysis, subsequently increasing the risk of overdosing; 3) in one single case, take-home methadone has indirectly lead to the death of a two years old girl who has drunk the syrup left unattended by her father; 4) among subjects with supervised consumption, high blood concentrations have generally not been observed, but there has been simultaneous alcohol or psychotropic drugs intake; 5) the abuse of methadone illegally obtained, often through patients allowed to carry it home, is rather common. Special caution has to be exercised in prescribing take-home doses, together with a more careful evaluation during induction into methadone treatment when tolerance is unclear.
Key Words: Methadone, intoxication, blood level
Analytical Challenge in Postmortem Toxicology Applied to a Human Body Found into a Lake after Three Years Immersion
No full textThe body of a 30-year-old woman was found in Como lake at a depth of about 120 meters in her own car after 3 years of immersion. The aim of this study was to evaluate psychoactive drugs as well as alcohol biomarkers in biological matrices. The following analyses were initially performed: GC-MS systematic toxicological analysis on biological fluids and tissues; GC-MS analysis of drugs of abuse on pubic hair; direct ethanol metabolite determination in pubic hair by LC-MS/MS. After 7 years, the samples, that had been stored at -20°C, were re-analyzed and submitted to an LC-MS/MS targeted screening method, using multiple reaction monitoring mode. These analyses detected citalopram (150-3000 ng/mL), desmethylcitalopram (50-2300 ng/mL), clotiapine (20-65 ng/mL), and ethyl glucuronide (97 pg/mg). The methods showed an acceptable reproducibility, and the concentrations of citalopram and desmethylcitalopram calculated through the two analytical techniques did not significantly differ in biological fluids
Studio di distribuzione del cisatracurium e metabolita mediante GC-MS, HPLC-UV-DAD e HPLC-FL
No full textHair analysis in workplace drug testing and driving licence regranting as a tool to disclose patterns of drug use
No full textBackground: In Italy, hair analysis is used in the second level-tests of workplace drug testing (WDT) protocol and for driving licence regranting/renewal (DLR). The WDT National Protocol includes two-level tests. The second level of the protocol is required when in the first level-tests urine sample results positive. In this case, the worker is obliged to go to the Public Drug Treatment Unit to undergo an eventual diagnosis of drug dependence. The second level-tests consist of analysing both urine and hair for opiates, cocaine, amphetamines, cannabinoids, methadone and buprenorphine.
As far as driving licence regranting/renewal is concerned, subjects are instead always obliged to undergo toxicological analyses if they have either a documented past or a suspect present history of drug abuse, ( art. 187 “Driving under influence of drugs”), or if they are forced by the prefecture or by the traffic control authority. In some Regions such as Lombardy, hair analysis is used to rule out illicit drug use.
This study presents the data obtained from hair analysis performed in the Laboratory of Forensic Toxicology of the University of Pavia in the last two years.
Method: A total of 1017 hair samples were analysed for WDT (322) and DLR (695). Analyses were carried out by GC-MS using the method routinely applied on hair samples.
Results and Discussion: The positive rate for the WDT second leve-test was 45% versus the 10% for the DLR. The different percentage of positive results demonstrate how hair analysis is useful both for the diagnosis of drug dependence and as deterrent of drug consumption. As regard to positive results distribution, a cocaine abuse emerged in 74.6% of workers, while drivers resulted positive mainly for cannabinoids (41%), and cocaine (39%). On the contrary, the second main consumption in WDT analysis resulted the polydrug abuse (16,5%). Opiates percentage was 1.4% in both cases while positive samples for methadone were 9 in the DLR analysis versus 3 in the WDT one. MDMA was present only in two workers and in association with cocaine
Alcohol and drugs fatal road accidents between 1999 and 2009
No full textIntroduction: The Italian National Institute of Statistics recorded 5.131 fatal road accidents in 2007. One of the main causes of traffic crashes is driving under the effects of alcohol and/or psychoactive substances (illicit drugs or some medication). In Italy the legal limit of blood alcohol concentration passed from 0.8 g/L to 0.5 g/L in 2007 and the Court can decide if also psycoactive substances have to analysed in blood in fatal accidents.
Aims: A retrospective study was carried out to produce epidemiological data concerning the role played by alcohol and psychoactive substances in fatal road accidents. The focus of this study was to establish the dimension of this problem and to describe the characteristics of people involved in road fatalities under psychoactive substance effects.
Methods: The material studied is made up of 487 subjects deceased in consequence of road accidents and examined at the Department of Legal Medicine, University of Pavia, during the period from 01-01-1999 to 30-06-2009. More than 70% of people involved in traffic accident were mothorvehicle driver, while pedestrian and cyclist are equally represented. Blood specimens were analyzed for alcohol and in 262 cases also for illicit and therapeutic drugs. Drugs when present were quantitated. Urine, when available, was submitted to immunochemical screening of drugs of abuse and confirmation of positive results by GC-MS.
Results:. Alcohol above 0.1 g/L was detected in 205 cases (42.2%) and the concentration measured was above the legal limit (0.5 g/L) in the 70.7% of these cases. A blood alcohol concentration (BAC) between 1.5 g/L e 2.5 g/L was mesured in 55 cases (27%) while 28 subjects (14%) had a BAC higher than 2,5 g/l. Central nervous system active drugs were detected in 23.3% (62 cases). Cocaine and metabolites (29%) and cannabinoids (25%) are the most represented drugs of abuse; opioids were detected in 24 cases, morphine was detected in 9 cases and methadone in 15 ones, and no amfetamine and derivatives are founded. Association with alcohol was found in 25.4% of positive cases for illicit drugs.
Conclusions: The incidence of alcohol and drugs among the population involved in fatal traffic accidents highlight the importance of performing qualitative and quantitative blood analyses to assess the effective role of alcohol and drugs in driving impairment
Fatal intoxication due to dichloromethane exposure: a case report
No full textIntroduction. Dicholomethane (DCM) is a solvent, industrially used also as component of paint and varnish removers. Due to its high volatility, its use in confined spaces can cause a serious health hazard as a result of accumulation of the solvent vapour. At high levels, DCM acts on the central nervous system, major toxic effect being narcosis, depression and at last death. A case of accidental death in working place is described.
Materials and Methods. A 50-year-old white male was found dead at his working place. He was found on one's back on tank border he was cleaning without using a gas mask.The tank contained paint residuals. The following toxicological analyses were carried out on post-mortem samples: at first sistematic toxicological analysis (STA) by GC-MS, ethanol and volatile substances detection by headspace gas chromatography (HS-GC) were performed in blood. A positive result for dichloromethane emerged and so quantitation in biological fluids, organs and viscera was performed after optimization of the headspace gas chromatography-flame ionization detection technique (GC-HS-FID). Carboxyhemoglobin levels were also measured by spectrophotometric tecnique.
Results. No drugs neither ethanol were found in blood sample. The following concentrations of DCM were measured: cardiac blood (220 mg/L), urine (25 mg/L), gastric content (22 mg/L), brain (170 mg/kg), fat (170 mg/kg), liver (250 mg/kg), lung (330 mg/kg), and kidney (160 mg/kg). Carboxyhemoglobin resulted at a level of 8%.
Conclusion.The cause of death was an accidental poisoning due to dichloromethane. The normal range of carboxyhemoglobin and the very high levels of DCM in biological samples indicated that the death was the consquence of the direct effect of dichloromethane on the central nervous system
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