Conversion factors for assessment of driving impairment after exposure to multiple benzodiazepines/z-hypnotics or opioids

Strand, Maren Cecilie; Mørland, Jörg; Slørdal, Lars; Riedel, Bettina; Innerdal, Cato; Aamo, Trond; Mathisrud, Grete; Vindenes, Vigdis

doi:10.1016/j.forsciint.2017.10.022

Cited by 19 publications

(15 citation statements)

References 135 publications

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“…For opioids, this relationship has been little investigated, but two studies [23,24] also suggested a linear concentration-effect relationship for opioids [15]. Due to the partial antagonist effect of buprenorphine and lack of evidence regarding the impairing effects of tramadol on driving, the conversion factors for concentrations of buprenorphine and tramadol are not included in the conversion table used in the Norwegian Road Traffic Act [15,16]. We consider the inclusion of buprenorphine and tramadol when investigating drug-induced deaths to be important, and we have assumed that the conversion factors for their blood concentrations are similar to the conversion factors for equipotent doses of buprenorphine and tramadol [25].…”

Section: Methodsmentioning

confidence: 99%

“…The principle of equipotent doses, where the relative potencies of different opioids and benzodiazepines are considered, is widely acknowledged [15]. Comparable to this, we have used separate conversion factors for blood concentrations that were already implemented in the Norwegian Road Traffic Act to estimate pooled diazepam‐ and morphine‐equivalent concentrations of opioids and benzodiazepines detected postmortem in patients receiving OAT.…”

Section: Methodsmentioning

confidence: 99%

“…In the Norwegian Road Traffic Act, legal limits for non‐alcohol drugs in blood were implemented in 2012 to evaluate driving under the influence of drugs and ensure equal jurisdiction [15]. Concentration limits corresponding to impairment comparable to blood alcohol concentrations were defined and conversion factors for concentrations of opioids and benzodiazepines were established [15,16]. Using the conversion factors from the Norwegian Road Traffic Act to estimate the pooled concentrations found in postmortem blood provides more information than only presenting the number of drugs detected.…”

Section: Introductionmentioning

confidence: 99%

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Postmortem toxicological analyses of blood samples from 107 patients receiving opioid agonist treatment: substances detected and pooled opioid and benzodiazepine concentrations

et al. 2020

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Aims To present the substances and their concentrations detected postmortem in patients receiving opioid agonist treatment (OAT) stratified by cause of death, estimate the pooled opioid and benzodiazepine concentrations using established conversion factors for blood concentrations from the Norwegian Road Traffic Act and explore the association between drug‐induced cause of death and the pooled opioid and benzodiazepine concentrations. Design Cross‐sectional nation‐wide study. Setting Norway. Participants One hundred and seven patients who died during OAT (i.e. within 5 days after the last intake of OAT medication) between 1 January 2014 and 31 December 2015, with postmortem femoral blood available for toxicology. Data were collected from hospital records, the Norwegian Cause of Death Registry and autopsy reports. Measurements Presence of alcohol and non‐alcohol substances in the bloodstream postmortem, determined through records of toxicology of postmortem femoral blood. Findings A median of four substances was detected across the causes of death. At least one benzodiazepine was detected in 81 (76%) patients. The median pooled opioid concentration was significantly higher in drug‐induced deaths compared with other causes of death (362 versus 182 ng/ml, P < 0.001), in contrast to the pooled benzodiazepine concentration (5466 versus 5701 ng/ml, P = 0.353). The multivariate regression analysis showed that only increasing pooled opioid concentration (ng/ml) was associated with increased odds of a drug‐induced cause of death (odds ratio = 1.003; 95% confidence interval = 1.001–1.006). Conclusions In Norway, overall opioid concentration seems to play an important role in drug‐induced deaths during opioid agonist treatment in patients prescribed methadone or buprenorphine. Patients prescribed buprenorphine tend to replace their agonist with full agonists, while patients prescribed methadone tend to have high opioid concentrations from methadone as the only opioid.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postmortem toxicological analyses of blood samples from 107 patients receiving opioid agonist treatment: substances detected and pooled opioid and benzodiazepine concentrations

et al. 2020

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“…Data on equipotent doses of e. g. benzodiazepines (45)(46)(47) and opioids (48-50) have been published. Based on these doses and pharmacokinetic properties, equipotent drug concentrations have been estimated, and drug concentrations can be converted to diazepam equivalents for benzodiazepines and morphine equivalents for opioids (51). This procedure would have improved the quality of the odds ratio estimations for benzodiazepines and opioids when grouped together.…”

Section: Assessing Drug Exposurementioning

confidence: 99%

Challenges and common weaknesses in case-control studies on drug use and road traffic injury based on drug testing of biological samples

Gjerde

Romeo

Mørland

2018

Annals of Epidemiology

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“…We wanted to investigate if the SCTI could identify individuals that had BAC above 0.5 g/kg or zopiclone concentrations in blood comparable to this BAC (i.e. 23 ng/ml) (155,156,211). A definition of sensitivity, specificity, positive and negative predictive values are given in Table 7 and the given values of these statistical parameters from the present thesis are shown in Table 8.…”

Section: Is a Clinical Test Like The Scti A Suitable Tool To Evaluatmentioning

confidence: 99%

Zopiclone concentrations in oral fluid and blood after, administration of therapeutic doses of zopiclone

Hjelmeland

Gustavsen

Øiestad

et al. 2017

Forensic Science International

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Vast intra- and interindividual differences in ZOBCR were found, and the correlation between OF and blood concentration was less pronounced than reported in former studies. In accordance with earlier studies we found a negative correlation between ZOBCR and OF volume. The ZOBCR decreases in relation to recent intake of a meal, probably because stimulated saliva production causes "dilution" of saliva. OF zopiclone concentration appeared unsuitable for estimation of blood zopiclone concentration. Due to long detection time, analysis of zopiclone in OF might be useful to detect non-recent, previous intake.

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Conversion factors for assessment of driving impairment after exposure to multiple benzodiazepines/z-hypnotics or opioids

Cited by 19 publications

References 135 publications

Postmortem toxicological analyses of blood samples from 107 patients receiving opioid agonist treatment: substances detected and pooled opioid and benzodiazepine concentrations

Postmortem toxicological analyses of blood samples from 107 patients receiving opioid agonist treatment: substances detected and pooled opioid and benzodiazepine concentrations

Challenges and common weaknesses in case-control studies on drug use and road traffic injury based on drug testing of biological samples

Zopiclone concentrations in oral fluid and blood after, administration of therapeutic doses of zopiclone

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