Toxicological investigations of drivers killed in road traffic accidents in Norway during 2006–2008

Gjerde, Hallvard; Christophersen, AsbjÃ ̧rg S.; Normann, Per T.; Mørland, Jörg

doi:10.1016/j.forsciint.2011.05.021

Cited by 66 publications

(43 citation statements)

References 27 publications

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“…This is lower than all of the similar studies reported in the literature, including the 21% in Sweden (limit = 20 mg/100 mL) [17], 11% in France (limit = 50 mg/100 mL) [11], 25% in Norway (limit = 20 mg/100 mL) [14], 36% in Brazil (zero tolerance) [8], and 29% in Australia (limit = 50 mg/100 mL) [7]. Of the alcohol-positive drivers, 75%…”

Section: Resultscontrasting

confidence: 59%

“…Surveys of the incidence of drugs and alcohol in MVCs have been carried out in numerous countries, including Australia [7], Brazil [8], Canada [1], England & Wales [9,10], France [11], Jordan [12], New Zealand [13], Norway [14,15], Spain [16], Sweden [17] and other Northern European Countries [18], and the USA [19]. However, little is known about how frequently drugs are involved in fatal MVCs in Scotland, with the last detailed study having been published in 1999, and then only for the Strathclyde region [20].…”

Section: Introductionmentioning

confidence: 99%

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Toxicological findings in driver and motorcyclist fatalities in Scotland 2012–2015

Hamnett

Ilett

Izzati

et al. 2017

Forensic Science International

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Highlights  The toxicological findings in driver and motorcycle fatalities in Scotland have been examined. Fifty-seven percent of the cases examined were positive for drugs and/or alcohol. The most common findings were alcohol and cannabinoids. AbstractFatal motor vehicle crashes (MVCs) continue to be a common occurrence worldwide. This paper presents a retrospective analysis of the toxicological investigation of drivers and motorcyclists fatally injured in MVCs in Scotland from 2012 to 2015. One hundred and eighteen cases with full toxicological analysis, i.e., alcohol, drugs of abuse and prescription drugs, were examined. Of those 118 MVC cases, 74 (63%) were car drivers, 32 (27%) were motorcyclists and the remaining were drivers of other vehicles such as large goods vehicles. The majority of deceased drivers and motorcyclists were male (N = 104, 88%). For the toxicological findings, 51 (43%) were negative, and of the 67 (57%) positive cases, alcohol and cannabinoids were the most frequently detected substances, followed by opiates and benzodiazepines. Fifteen percent of all drivers and motorcyclists were over the prescribed blood alcohol limit at the time of analysis. In comparison to previous reports

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Section: Resultscontrasting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Toxicological findings in driver and motorcyclist fatalities in Scotland 2012–2015

Hamnett

Ilett

Izzati

et al. 2017

Forensic Science International

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“…In drug-facilitated crimes, where higher doses may have been administered, maximum recommended time intervals for Zdrug detection is 48 h in blood and 72 h in urine [54]. Therapeutic maximal concentrations (C max ) and those found in fatalities are shown in Table 4 [47,51,53,[55][56][57][58][59][60][61][62].…”

Section: Analysis and Detection Of Z-drugsmentioning

confidence: 99%

“…Postmortem levels are in whole blood; blood/plasma ratio for zopiclone and zaleplon is 1. References include [47,51,53,[55][56][57][58][59][60][61][62] C max maximal concentration pharmacokinetic profile may contribute to its apparent lower rate of toxicity and fatalities; a confounder to this postulate is that the detection window is more limited and zaleplon ingestion may be missed. In an American Poison Control Center study, zolpidem overdose was more likely to lead to intensive care admission when co-ingested with over-thecounter cold and flu preparations, other psychotropic medication, or ethanol [69].…”

Section: Clinical Toxicology Of Z-drugsmentioning

confidence: 99%

The Clinical and Forensic Toxicology of Z-drugs

Gunja

2013

J. Med. Toxicol.

158

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The Z-drugs zolpidem, zopiclone, and zaleplon were hailed as the innovative hypnotics of the new millennium, an improvement to traditional benzodiazepines in the management of insomnia. Increasing reports of adverse events including bizarre behavior and falls in the elderly have prompted calls for caution and regulation. Z-drugs have significant hypnotic effects by reducing sleep latency and improving sleep quality, though duration of sleep may not be significantly increased. Z-drugs exert their effects through increased γ-aminobutyric acid (GABA) transmission at the same GABA-type A receptor as benzodiazepines. Their pharmacokinetics approach those of the ideal hypnotic with rapid onset within 30 min and short half-life (1-7 h). Zopiclone with the longest duration of action has the greatest residual effect, similar to short-acting benzodiazepines. Neuropsychiatric adverse events have been reported with zolpidem including hallucinations, amnesia, and parasomnia. Poisoning with Z-drugs involves predominantly sedation and coma with supportive management being adequate in the majority. Flumazenil has been reported to reverse sedation from all three Z-drugs. Deaths from Z-drugs are rare and more likely to occur with polydrug overdose. Zdrugs can be detected in blood, urine, oral fluid, and postmortem specimens, predominantly with liquid chromatography-mass spectrometry techniques. Zolpidem and zaleplon exhibit significant postmortem redistribution. Zaleplon with its ultra-short half-life has been detected in few clinical or forensic cases possibly due to assay unavailability, low frequency of use, and short window of detection. Though Z-drugs have improved pharmacokinetic profiles, their adverse effects, neuropsychiatric sequelae, and incidence of poisoning and death may prove to be similar to older hypnotics.

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“…Drug use assessed from self reports by the Norwegian Institute for Alcohol and Drug Research (SIRUS) may possibly be underestimated (4). Few epidemiological studies have assessed findings of drugs and drug patterns in post-mortem cases in Norway (2,(5)(6)(7). As far as we know, trends in drug use in the general Norwegian population and changes in drug patterns over time have not previously been investigated in forensically examined deaths.…”

Section: Introductionmentioning

confidence: 99%

Surveillance of abused drugs in forensic autopsy cases in Norway

Konstantinova-Larsen¹,

Normann²,

Arnestad³

et al. 2011

Nor J Epidemiol

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High drug related mortality has been registered in Norway. Although comparison between countries relies on a standard international coding system of diseases, different practices in verifying cause of death and applying codes could lead to variation. The comparison gives no information on drug findings or drug patterns underlying the cause of deaths. To evaluate deaths involving illicit drugs in Norway, we examined drug patterns in 2735 forensically examined post-mortem samples collected from 15-64 year-old individuals from 2000 to 2009. There were four times as many men as women among the deceased illicit drug users, and the majority were in the age group 25-44 years. The number of deceased showing signs of illicit drug use has gradually declined during the study period. The decline was found among younger individuals, while a larger proportion of the deceased were above 45 years of age in 2009, compared to 2000. Cases positive for heroin, ethanol, ecstasy and flunitrazepam were fewer in 2009, while the prevalence of amphetamine, cannabis, methadone and other opioids has increased. The prevalence of methamphetamine has increased ten fold, and the prevalence of benzodiazepines doubled. Thus, the drug pattern and age of the deceased has changed markedly during the last 10 years. Heroin and ethanol use has partly been substituted by use of amphetamines, cannabis, benzodiazepines and other opioids. This change could possibly be explained by the prolonged survival of drug users on substitution treatment and by the reduced toxicity of consumed drugs.

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Toxicological investigations of drivers killed in road traffic accidents in Norway during 2006–2008

Cited by 66 publications

References 27 publications

Toxicological findings in driver and motorcyclist fatalities in Scotland 2012–2015

Toxicological findings in driver and motorcyclist fatalities in Scotland 2012–2015

The Clinical and Forensic Toxicology of Z-drugs

Surveillance of abused drugs in forensic autopsy cases in Norway

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