Members posters

Khat chewing is becoming more popular in the UK due to migration. There are a number of concerns about the long term health risks of using this currently legal drug. The UK case studies presented here illustrate some of the key issues related to the consumption of khat. These include: (a) psychological effects – (i) impaired judgement leading to accidents and violence, (ii) causing or exacerbating psychoses or causing depression leading to suicide and even homicide; (b) physiological effects – toxicity (i) causing heart problems leading to fatal heart attacks, and (ii) liver failure; (c) mechanical problems e.g. choking on pieces of the plant.

In April 2004 Cardiff Bioanalytical Services Ltd, circulated a UKNEQAS blood sample containing cathinone, cathine and norephedrine for quantitative toxicology. Only one participant returned a result for each analyte, suggesting that most laboratories either do not routinely screen for khat or do not have methodology in place for its detection. Given the rise in usage and the abuse potential of this herbal drug, toxicology laboratories should have in place methodology for its detection.

Four capsules contained both EC and 4-MMC, in addition to caffeine; six capsules and the powder contained 3-FMC, with three of these also containing caffeine. The products ordered from BioRepublik were packaged together labelled as ‘Multivitamin’ and, although the capsules were different colours, it was not possible to identify the individual products by name.

In case 1, the pathologist attributed the cause of death to pregabalin and zopiclone toxicity. In case 2 the cause of death was attributed to mixed drug poisoning, primarily venlafaxine and pregabalin. In both cases there was supporting evidence of excessive pregabalin consumption.

Based upon toxic morphine concentrations, medical negligence or opiate abuse might be viewed as contributing factors to death in trauma cases. However, as previous studies and our own findings suggest, caution must be applied with interpretation, as elevated concentrations of morphine may be due to the decrease in drug clearance and volume of distribution as well as the extension of its half-life.

Hair analysis is needed to demonstrate chronic cocaine use: Cocaine use is widespread, in the cases studied the user’s age varied from 18 to 64 years old. Deaths associated with its use may go undetected. Cocaine causes very few acute deaths, but chronic use may cause fatal cardiac disease and may be linked to depression leading to suicide.

Death from the deliberate inhalation of butane to achieve a change in mental state (Volatile Substance Abuse, VSA) is well known. Almost 50 deaths occur every year in the UK1 from VSA - many of them are teenagers. In the absence of clear evidence of deliberate inhalation, pathologists and toxicologists have attributed deaths to cardiac arrhythmia resulting from the accidental inhalation of butane from the incautious use of aerosols in confined spaces. We explore the likelihood of this occurring.

The UK launch of the Quantum Diagnostics Six Test Rapid-Tox™ and Single Test Rapid-Tox™ heralded one of the first urine drugs of abuse point-of-care devices (POCD) to include buprenorphine both in combination and in single drug form. With increasing use of POCD by drug treatment centres, our objective was to compare the performance of these devices against our routine buprenorphine method (Cozart™ ELISA). We assessed sensitivity and specificity above and below the 5.0 µg/L cut-off concentration as well as the potential cross reaction with dihydrocodeine which has previously been identified as a potential interference with the antibody based Microgenics CEDIA™ method.

This poster is available from the London Drug Policy Forum. It is intended for use in a variety of applications either in the professional services, doctors surgeries, dental practices, support services or fire police or ambulance establishments as well as for general public information. The actual size of the poster is A1. For paper copies please email peter.jackson@cityoflondon.gov.uk

The diastereoisomers quinine and quinidine are used in the treatment of Plasmodium falciparum infection, as well as nocturnal cramp (quinine) and cardiac arrhythmia (quinidine). The ability to distinguish between these compounds may be important in cases of suspected poisoning, and is usually
achieved using reversed-phase HPLC1. However, poor peak shapes and complex extraction procedures are typical. Using strong cation-exchange (SCX)-modified 5 =m packings with non-aqueous eluents gives good peak shapes, and allows direct injection of sample extracts2. Traditional ‘analytical’ SCX
columns (150 x 4.6 mm i.d.) cannot differentiate between quinine and quinidine under these conditions3. However, using a ‘fast LC’ column (100 x 2.1 mm i.d.) packed with 5 =m SCX particles and low dead-volume LC equipment allows resolution of quinine and quinidine.

We have developed a sensitive method for the analysis of both buprenorphine and norbuprenorphine in urine based on enzymatic hydrolysis of the glucuronide conjugates followed by strong cation-exchange liquid chromatography with MS/MS detection.

Buprenorphine, norbuprenorphine, and their respective deuterated internal standards fragment poorly in LC-MS/MS. Optimum sensitivity was gained by monitoring surviving MH+ ions in Q3. Selectivity was ensured by ramping collision energy voltages to produce qualifier ion fragments for buprenorphine and norbuprenorphine at m/z 396.3 and 101.2, respectively