This book includes detailed information on many of the factors surrounding injuries--the man-made systems and products involved, the groups at greatest risk, and effective ways to protect people from injuries. The circumstances under which injuries occur, the etiologic agents, and the characteristics of the people involved are examined. Chapter 2 summarizes the importance of injuries in relation to other prominent health problems. Subsequent chapters describe injury mortality and, in cases where good population-based studies are available, nonfatal injuries. The analyses in Chapters 3-15 are primarily of injury deaths during 1977-1979, the most recent years for which detailed mortality data were available in mid-1983 for deaths other than those related to motor vehicles. Most of these data were collected by the U.S. Department of Health and Human Services, National Center for Health Statistics (NCHS). Chapters 16-20 summarize data on deaths from motor vehicle-related injuries. Most of these detailed data were obtained from the U.S. Department of Transportation, National Highway Traffic Safety Administration (NHTSA). Data from the 1980 census provided denominators for the rates throughout the book, except for trendline calculations which were based on interpolations between census years. The purpose of this book is to improve understanding of the nature and magnitude of the injury problem in the United States. Although it includes some discussion of ameliorative approaches, there is no comprehensive coverage of injury research, theory, or prevention, since these have been comprehensively discussed elsewhere. This book is a thorough documentation of the injury problem. Most of the information presented is new, the product of analyses not previously published in any form.

https://link.springer.com/content/pdf/10.2307%2F3342319.pdf

The injury fact book

US Epidemiology of Cannabis Use and Associated Problems

This discussion by a leading expert on drug use illuminates the factors that permit some people to use such highly addictive and dangerous substances as alcohol, marijuana, psychedelics, and opiates in a controlled fashion.

Understanding and Controlling Drug Users@@@Trafficking in Drug Users: Professional Exchange Networks in the Control of Deviance.@@@Substance Abuse, Habitual Behavior, and Self-Control.@@@Drug, Set, and Setting: The Basis for Controlled Intoxicant Use.

Dysregulation of the endogenous lipid mediators endocannabinoids and their G-protein-coupled cannabinoid receptors 1 and 2 (CB1R and CB2R) has been implicated in a variety of cardiovascular pathologies. Activation of CB1R facilitates the development of cardiometabolic disease, whereas activation of CB2R (expressed primarily in immune cells) exerts anti-inflammatory effects. The psychoactive constituent of marijuana, Δ9-tetrahydrocannabinol (THC), is an agonist of both CB1R and CB2R, and exerts its psychoactive and adverse cardiovascular effects through the activation of CB1R in the central nervous and cardiovascular systems. The past decade has seen a nearly tenfold increase in the THC content of marijuana as well as the increased availability of highly potent synthetic cannabinoids for recreational use. These changes have been accompanied by the emergence of serious adverse cardiovascular events, including myocardial infarction, cardiomyopathy, arrhythmias, stroke, and cardiac arrest. In this Review, we summarize the role of the endocannabinoid system in cardiovascular disease, and critically discuss the cardiovascular consequences of marijuana and synthetic cannabinoid use. With the legalization of marijuana for medicinal purposes and/or recreational use in many countries, physicians should be alert to the possibility that the use of marijuana or its potent synthetic analogues might be the underlying cause of severe cardiovascular events and pathologies.

Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly.

Preanalytic aspects in postmortem toxicology.

Synthetic cannabinoid drug use as a cause or contributory cause of death

Drug overdose is now the leading cause of unintentional death nationwide, driven by increased prescription opioid overdoses. To better understand urban opioid overdose deaths, this paper examines geographic, demographic, and clinical differences between heroin-related decedents and prescription opioid decedents in San Francisco from 2010 to 2012. During this time period, 331 individuals died from accidental overdose caused by opioids (310 involving prescription opioids and 31 involving heroin). Deaths most commonly involved methadone (45.9%), morphine (26.9%), and oxycodone (21.8%). Most deaths also involved other substances (74.9%), most commonly cocaine (35.3%), benzodiazepines (27.5%), antidepressants (22.7%), and alcohol (19.6%). Deaths were concentrated in a small, high-poverty, central area of San Francisco and disproportionately affected African-American individuals. Decedents in high-poverty areas were significantly more likely to die from methadone and cocaine, whereas individuals from more affluent areas were more likely die from oxycodone and benzodiazepines. Heroin decedents were more likely to be within a younger age demographic, die in public spaces, and have illicit substances rather than other prescription opioids. Overall, heroin overdose death, previously common in San Francisco, is now rare. Prescription opioid overdose has emerged as a significant concern, particularly among individuals in high-poverty areas. Deaths in poor and affluent regions involve different causative opioids and co-occurring substances.

/pdf/opioid-overdose-deaths-in-the-city-and-county-of-san-y2767s3ka8.pdf

Opioid Overdose Deaths in the City and County of San Francisco: Prevalence, Distribution, and Disparities

Fingernail clippings were evaluated as analytical specimens for the detection and quantitation of cannabinoids. Specimens were obtained from consenting adults attending a drug clinic, along with information concerning the drugs which they had used over the previous six months. Methods for the surface decontamination and extraction of the specimens were evaluated. Detergent, water, and methanol washes followed by alkaline hydrolysis and liquid-liquid extraction were selected for use in the study. Extracts were analyzed by radioimmunoassay (RIA) and gas chromatography-mass spectrometry (GC-MS) to detect and quantitate cannabinoids present in fingernail clippings. Positive RIA results were obtained from specimens from six known cannabis users. The mean cannabinoid concentration in fingernail clippings determined by RIA was 1.03 ng/mg. Using GC-MS, the mean delta9-tetrahydrocannabinol concentration in fingernail clippings from a further 14 known cannabis users was 1.44 ng/mg. Using GC-MS, the average 11-nor-delta9-tetrahydrocannabinol-9-carboxylic acid concentration in fingernail clippings from three known cannabis users extracted in acidic pH was 19.85 ng/mg. Based on these results, fingernails are potentially useful biological specimens for the detection of past cannabis use in cases of medicolegal interest.

/pdf/nail-analysis-for-drugs-of-abuse-extraction-and-2j20hbz7ec.pdf

Nail analysis for drugs of abuse : Extraction and determination of cannabis in fingernails by RIA and GC-MS

Cannabinoids are often excluded from postmortem toxicology screens due to their ubiquitous nature, interpretative difficulties and unanswered questions regarding their postmortem redistribution. In this study, we review 30 postmortem cases where a drug screen gave a positive cannabinoids result and a confirmation identified Δ⁹-tetrahydrocannabinol (THC), 11-hydroxy-Δ⁹-tetrahydrocannabinol (11-OH-THC), and/or 11-nor-9-carboxy-Δ⁹-tetrahydrocannabinol (THC-COOH) in peripheral (BL-P) or cardiac/central blood (BL-C) and/or urine (UR). Had cannabinoids not been included in these toxicologic evaluations, incomplete or erroneous inferences would have been drawn in a substantial number of cases regarding cause/manner of death. THC was detected in 28 BL-C and in all 30 BL-P. THC and THC-COOH were confirmed present in 2 and 23 UR, respectively. 11-OH-THC was detected in 4 BL-C, 6 BL-P, and 0 UR. The mean THC concentrations in BL-C and BL-P were 8.0 and 15.8 ng/mL, respectively. The mean THC-COOH concentrations in BL-C and BL-P were 55.2 and 60.6 ng/mL, respectively. The mean 11-OH-THC concentrations in BL-C and BL-P were 17.0 and 12.5 ng/mL, respectively. Postmortem interval (PMI) for each case was determined and evaluated in relation to BL-C/BL-P concentration ratios with THC-COOH exhibiting a possible trend. This study is the first of its kind and demonstrates the usefulness of cannabinoid analyses as part of death investigations. Furthermore, it provides distribution data that will improve the ability of toxicologists and pathologists to evaluate cannabinoid concentrations in human postmortem specimens.

Cannabinoids in postmortem toxicology.

The case of a 22-year-old male Caucasian driver is presented. He was involved in a traffic collision. At the roadside, he displayed blank stare and mellow speech with a barely audible voice. A DRE found low body temperature, rigid muscle tone, normal pulse, lack of horizontal and vertical gaze nystagmus, nonconvergence of the eyes, dilated pupil size, and normal Pupillary reaction to light. A standard toxicology DUID protocol was performed on the driver's whole blood including ELISA and GC-MS drug screens with negative results. Additional drug screening was undertaken for bath salts and synthetic cannabinoid receptor agonists by LC-MS/MS by a commercial laboratory and identified the synthetic cannabinoid receptor agonist XLR-11 in the driver's blood. XLR-11 was subsequently quantified at 1.34 ng/mL. This is the first documented case involving a driver operating a motor vehicle under the influence of the synthetic cannabinoid receptor agonist XLR-11.

/pdf/driving-under-the-influence-of-synthetic-cannabinoid-28lskgsu0m.pdf

Nikolas P. Lemos

Papers

Synthetic cannabinoid drug use as a cause or contributory cause of death

Opioid Overdose Deaths in the City and County of San Francisco: Prevalence, Distribution, and Disparities

Nail analysis for drugs of abuse : Extraction and determination of cannabis in fingernails by RIA and GC-MS

Cannabinoids in postmortem toxicology.

Driving Under the Influence of Synthetic Cannabinoid Receptor Agonist XLR‐11