https://www.hopkinsmedicine.org/Press_releases/2008/Griffiths.pdf

Caffeinated energy drinks--a growing problem.

Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

Neonatal Abstinence Syndrome

Congratulations to Dr. Baselt for the publication of his 10th edition and the expansion of his classic toxicology text to cover over 1,500 medications and chemicals. This enduring work provides a c...

Disposition of Toxic Drugs and Chemicals in Man

Caffeine use is increasing worldwide. The underlying motivations are mainly concentration and memory enhancement and physical performance improvement. Coffee and caffeine-containing products affect the cardiovascular system, with their positive inotropic and chronotropic effects, and the central nervous system, with their locomotor activity stimulation and anxiogenic-like effects. Thus, it is of interest to examine whether these effects could be detrimental for health. Furthermore, caffeine abuse and dependence are becoming more and more common and can lead to caffeine intoxication, which puts individuals at risk for premature and unnatural death. The present review summarizes the main findings concerning caffeine's mechanisms of action (focusing on adenosine antagonism, intracellular calcium mobilization, and phosphodiesterases inhibition), use, abuse, dependence, intoxication, and lethal effects. It also suggests that the concepts of toxic and lethal doses are relative, since doses below the toxic and/or lethal range may play a causal role in intoxication or death. This could be due to caffeine's interaction with other substances or to the individuals' preexisting metabolism alterations or diseases.

/pdf/caffeine-cognitive-and-physical-performance-enhancer-or-g4hz4es15z.pdf

Caffeine: Cognitive and Physical Performance Enhancer or Psychoactive Drug?

http://physiology.elte.hu/gyakorlat/cikkek/Caffein%20use%20in%20children_what%20we%20know,%20what%20we%20have%20lft%20to%20learn%20and%20why%20we%20should%20worry.pdf

Caffeine use in children: what we know, what we have left to learn, and why we should worry.

Mitragynine (MG) is the principal psychoactive alkaloid in kratom. The drug produces a variety of dose-dependent effects that appeal to recreational drug users and individuals seeking therapeutic benefits in the absence of medical supervision. In light of documented intoxications, hospitalizations and fatalities, MG and other alkaloids from Mitragyna speciosa are of growing importance to the forensic toxicology community. However, the chemical stability of these compounds has not been thoroughly described. In this report, the stability of MG, 7-hydroxymitragynine (MG-OH), speciociliatine (SC), speciogynine (SG) and paynantheine (PY) are investigated. Short-term stability of the Mitragyna alkaloids was determined over a range of pH (2-10) and temperature (4-80°C) over 8 hours. Liquid chromatography--quadrupole/time-of-flight mass spectrometry was used to estimate half-lives and identify degradation products where possible. The stability of MG and other alkaloids was highly dependent on pH and temperature. All of the Mitragyna alkaloids studied were acid labile. Under alkaline conditions, MG undergoes chemical hydrolysis of the methyl ester to produce 16-carboxymitragynine. MG-OH was the most unstable alkaloid studied, with significant drug loss at 8 hours experienced at temperatures of 40°C and above. No significant drug losses were observed for MG in aqueous solution (pH 2-10) at 4, 20 or 40°C. Diastereoisomers of MG (SC and SG) demonstrated even greater stability. These findings are discussed within the context of the identification of Mitragyna alkaloids in toxicological specimens.

Temperature and pH-Dependent Stability of Mitragyna Alkaloids.

Cathinone stability in authentic urine specimens.

A new antibody to lysergic acid diethylamide (LSD) was used to develop a novel indirect ELISA for the quantification of drug in urine. Evaluation of the new assay with the commercially available LSD ELISA (STC Diagnostics) shows improved performance. The test requires 50 μL of urine, which is used to measure concentrations of drug in the μg/L to ng/L range. The limit of detection was 8 ng/L compared with 85 ng/L in the commercial assay, and analytical recoveries were 98–106%. Our test detected 0.1 μg/L of LSD in urine with an intraassay CV of 2.4% (n = 8) compared with 6.0% for a 0.5 μg/L sample in the commercial assay (n = 20). The upper and lower limits of quantification were estimated to be 7 μg/L and 50 ng/L, respectively. Specificity was evaluated by measuring the extent of cross-reactivity with 24 related substances. Drug determination using the new assay offers both improved sensitivity and precision compared with existing methods, thus facilitating the preliminary quantitative estimation of LSD in urine at lower concentrations with a greater degree of certainty.

/pdf/indirect-enzyme-linked-immunosorbent-assay-for-the-oee56iqtnf.pdf

Indirect enzyme-linked immunosorbent assay for the quantitative estimation of lysergic acid diethylamide in urine

In vitro metabolism of desomorphine.

The abuse of fentanyl and its analogs (fentalogs) is of growing concern globally. Forensic toxicology laboratories must detect these emerging drugs in biological evidence, and immunoassay is the most widely used screening technique. In this study, the cross-reactivity of 13 fentalogs were investigated using five commercially available kits. Dose–response curves were generated using six N-acyl-substituted fentalogs (4-ANPP, acetylfentanyl, butyrylfentanyl, furanylfentanyl, isobutyrylfentanyl, valerylfentanyl), one desphenethyl fentalog (norfentanyl), two piperidine-modified [(+)-cis-3-methylfentanyl, carfentanil], and four phenethyl and piperidine substituted fentalogs (alfentanil, norcarfentanil, remifentanil, sufentanil). Cross-reactivities were estimated for each assay to determine its overall effectiveness for fentalog screening in toxicological samples. Several commercial assays were able to detect either N-acyl or piperidine-modified fentalogs, but none was capable of detecting both. Although this is an inherent disadvantage of the immunoassay approach, it arises from the diverse structural nature of the fentanyl analogs themselves.

Sarah Kerrigan

Papers

Temperature and pH-Dependent Stability of Mitragyna Alkaloids.

Cathinone stability in authentic urine specimens.

Indirect enzyme-linked immunosorbent assay for the quantitative estimation of lysergic acid diethylamide in urine

In vitro metabolism of desomorphine.

Immunoassay-based detection of fentanyl analogs in forensic toxicology