Journal of analytical toxicology
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We report the rapidly increasing finding of fentanyl in medical examiner cases in southwestern Virginia. During the past 3 years, fentanyl cases have increased from 3 in 2000 to 12 in 2002. The first medical examiner case of 2003 was a fentanyl poisoning. ⋯ The age range of the decedents was 16-53 with an average age of 37. Southwestern Virginia is currently a "hot spot" for misuse and abuse of oxycodone and methadone. The rapid rise in the number of fentanyl cases over the past three years, the increasing availability of fentanyl patches, and the large number of case histories indicating misuse or abuse suggest that fentanyl is rapidly becoming an additional desired opioid similar to oxycodone and methadone.
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A rare fatal case of self-poisoning with nitrobenzene following oral ingestion is reported. On presentation to the hospital, severe methemoglobinemia (70%) was observed in an 82-year-old male who had ingested 250 mL of an unknown substance in the previous 24 h. ⋯ We detected that the blood contained 3.2 microg/mL of nitrobenzene. The determination of nitrobenzene was performed using the combination of GC-FID for screening analysis and quantitation and GC-MS for confirmation of the obtained results.
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In Japan, poisonings by the glyphosate (GLYP)-containing herbicide Roundup and the gluphosinate (GLUF)-based herbicide BASTA have been increasing since about 1987. We applied the gas chromatography-mass spectrometry (GC-MS) method of analysis, on which we have already reported in regard to the determination of the blood serum level of GLUF and its metabolite, for the determination of serum and urinary levels of GLYP and its metabolite aminomethyl phosphonic acid (AMPA). ⋯ In extractions for which the Isolute HAX cartridge was employed, the mean recovery rate of GLYP and AMPA added to serum to yield concentrations of 10-0.1 microg/mL (n = 5) was 91.6 +/- 10.6% (or better), whereas that of GLYP and AMPA added to urine to yield concentrations of 100-1.0 microg/mL (n = 10) was 93.3 +/- 6.6% (or better), both of which were good rates. Also, using this method of analysis, the presence of GLYP was identified in the full mass spectra obtained from the serum of a patient who may or may not have ingested Roundup.
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Case Reports Comparative Study
Oxycodone involvement in drug abuse deaths: a DAWN-based classification scheme applied to an oxycodone postmortem database containing over 1000 cases.
An oxycodone postmortem database was created from 1243 solicited cases from Medical Examiner and Coroner (ME/C) offices in 23 states in the United States over the period from August 27, 1999, through January 17, 2002. The request for cases was specific to only those cases in which the ME/C opined that the death involved oxycodone. Each case was evaluated to determine the role of oxycodone and the specific drug product OxyContin tablets in the death. ⋯ A variety of terms were employed in the COD statements to indicate multiple drug involvement such as "polydrug toxicity", "polypharmacy", "multiple drug poisoning", and "polypharmaceutical overdose". The system for death classification employed in this study recognizes the problems inherent in COD attribution when multiple drugs are involved. Use of this new system for reporting mortality data in future studies involving opioids is recommended.
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Comparative Study
An evaluation of the OnTrak Testcup-er on-site urine drug-testing device for drugs commonly encountered from emergency departments.
We evaluated the performance of the Roche OnTrak Testcup-er (TC-er), an on-site drug-testing device, for the detection of amphetamines (AMP), barbiturates (BRB), benzodiazepines (BNZ), benzoylecgonine (BE), and opiates (OPI) in urine specimens from hospital emergency departments. This device utilizes a competitive binding microparticle immunoassay to simultaneously determine the presence of the following drugs or drug classes in urine at and above the following cut-off concentrations: AMP, 1000 ng/mL; BRB, 200 ng/mL; BNZ 200 ng/mL; BE, 300 ng/mL; and OPI, 300 ng/mL. One hundred forty-nine urine specimens received from emergency departments were simultaneously tested by the EMIT II monoclonal immunoassay (Emit) and TC-er. ⋯ If the three false-positive BNZ results were also considered, the error rate would be 0.9%. TC-er demonstrated acceptable linearity around the cut-off concentration of each drug. The TC-er was determined to be a reliable device for rapid on-site testing of emergency department urine specimens.