Poor Identification of Emergency Department Acute Recreational Drug Toxicity Presentations Using Routine Hospital Coding Systems: the Experience in Denmark, Switzerland and the UK.

BACKGROUND: Understanding emergency department and healthcare utilisation related to acute recreational drug toxicity (ARDT) generally relies on nationally collated data based on ICD-10 coding. Previous UK studies have shown this poorly captures the true ARDT burden. The aim of this study was to investigate whether this is also the case elsewhere in Europe. METHODS: The Euro-DEN Plus database was interrogated for all presentations 1st July to 31st December 2015 to the EDs in (i) St Thomas' Hospital, London, UK; (ii) Universitätsspital Basel, Basel, Switzerland; and (iii) Zealand University Hospital, Roskilde, Denmark. Comparison of the drug(s) involved in the presentation with the ICD-10 codes applied to those presentations was undertaken to determine the proportion of cases where the primary/subsequent ICD-10 code(s) were ARDT related. RESULTS: There were 619 presentations over the 6-month period. Two hundred thirteen (34.4%) of those presentations were coded; 89.7% had a primary/subsequent ARDT-related ICD-10 code. One hundred percent of presentations to Roskilde had a primary ARDT ICD-10 code compared to 9.6% and 18.9% in Basel and London respectively. Overall, only 8.5% of the coded presentations had codes that captured all of the drugs that were involved in that presentation. CONCLUSIONS: While the majority of primary and secondary codes applied related to ARDT, often they did not identify the actual drug(s) involved. This was due to both inconsistencies in the ICD-10 codes applied and lack of ICD-10 codes for the drugs/NPS. Further work and education is needed to improve consistency of use of current ICD-10 and future potential ICD-11 coding systems.

Ayahuasca no tratamento da farmacodependência à cocaína: possíveis intervenções terapêuticas? / Ayahuasca in the treatment of cocaine addiction: possible therapeutic interventions?

Alucinógenos (ALU) são substâncias psicoativas que não induzem o indivíduo à dependência, possuem perfil de segurança de uso mais alto quando comparado a outras drogas e baixa capacidade de causar tolerância ao uso. Estudos recentes propõem o uso de ALU como tratamento a algumas doenças e transtornos relacionados ao sistema nervoso central, como a depressão, ansiedade e dependência. Dentre os ALU, a ayahuasca (AYA), cujo princípio ativo é a dimetiltriptamina (DMT), é uma bebida psicoativa amplamente utilizada pelas populações indígenas em rituais religiosos. Existem evidências de que pode ser eficaz no tratamento de dependência relacionada ao álcool e nicotina. No entanto, para a cocaína, a segunda droga ilícita mais utilizada no Brasil e na Europa, não existem muitos estudos. O objetivo deste trabalho foi avaliar o potencial da AYA em prevenir a expressão da sensibilização comportamental (SC) induzida pela cocaína e as repercussões neuroquímicas do tratamento em camundongos C57Bl/6. Para tanto, foi avaliada a influência da administração aguda de AYA (1,76; 3,0; 17,6; 30,0 mg/kg de DMT v.o.) na atividade locomotora dos animais em campo aberto (CA). Como não houve diferença estatística na distância percorrida durante a análise, as duas menores doses (1,76 e 3,0 mg/kg de DMT v.o.) foram escolhidas como doses iniciais para a realização do protocolo de prevenção à expressão da SC induzida pela cocaína. Inicialmente, os animais foram habituados no CA durante 3 dias consecutivos após a administração de solução salina 0,9% i.p. No 4o dia experimental, os animais receberam, durante 10 dias alternados, cocaína 10 mg/kg ou salina 0,9% i.p. e foram submetidos diretamente à avaliação da atividade locomotora no CA por 30 minutos. Vinte e quatro horas depois, receberam, durante 8 dias consecutivos, água ou AYA (1,76 ou 3,0 mg/kg de DMT v.o.) e após 30 minutos da administração, foram colocados no CA por 30 minutos para análise da atividade locomotora. No dia seguinte, os camundongos foram desafiados com uma administração de salina. E, no último dia experimental, foi realizado um desafio com cocaína, sempre colocando o animal no CA por 30 minutos. Nessas doses, a AYA não foi eficaz em prevenir a expressão da SC induzida pela cocaína. Dessa forma, avaliamos doses superiores de AYA (15, 30 e 45 mg/kg de DMT v.o.), as quais foram capazes de prevenir a expressão da SC à cocaína. Assim, o protocolo experimental foi novamente realizado com a menor dose (15 mg/kg de DMT v.o.), ao término do protocolo experimental, os animais foram eutanasiados e tiveram seu córtex pré-frontal, estriado e hipocampo dissecados para análise por immunoblotting dos receptores serotoninérgicos 5-HT1A e 5-HT2A. No entanto, não foram não observadas diferenças significativas ao comparar o nível proteico dos receptores nos grupos experimentais. Dessa forma, esses resultados sugerem que a AYA pode ser uma boa estratégia terapêutica para a dependência em cocaína, abrindo caminho para novos estudos

Psychedelics (PSY) are psychoactive substances that do not induce the individual to addiction, have a higher use safety profile when compared to other drugs and low ability to cause tolerance to use. Recent studies propose the use of PSY as a treatment for some diseases and disorders related to the central nervous system, such as depression, anxiety and addiction. Among the PSY, ayahuasca (AYA), whose active component is dimethyltryptamine (DMT), is a psychoactive drink widely used by indigenous populations in religious rituals. There is evidence that it may be effective in treating alcohol and nicotine addiction. However, for cocaine, the second most widely used illicit drug in Brazil and Europe, there are not many studies. The aim of this study was to evaluate the potential of AYA in preventing cocaine-induced behavioral sensitization (BS) expression and the neurochemical repercussions of this treatment in C57Bl/6 mice. Thus, we evaluated the influence of acute administration of AYA (1.76; 3.0; 17.6; 30.0 mg/kg of DMT, orally) on the locomotor activity of animals in the open field (OF). As there was no statistical difference in the distance travelled during the analysis, the two lowest doses (1.76 and 3.0 mg/kg of DMT, orally) were chosen as initial doses to perform the cocaine-induced expression prevention protocol. First, animals were habituated to OF for 3 consecutive days following administration of saline 0.9% i.p. On the fourth experimental day, the animals received for 10 alternate days cocaine 10 mg/kg or saline 0,9% i.p. and were directly submitted to the evaluation of locomotor activity in OF for 30 minutes. Twenty-four hours later they received, for 8 consecutive days, water or AYA (1.76 or 3.0 mg/kg of DMT, orally), and 30 minutes after administration, they were placed in the OF for 30 minutes for analysis of locomotor activity. The next day, the mice were challenged with saline administration. On the last experimental day, a cocaine challenge was performed, always placing the animal in the OF for 30 minutes. At these doses, AYA was not effective in preventing cocaine-induced expression of BS. Thus, we evaluated higher doses of AYA (15, 30 and 45 mg/kg of DMT, orally), which were able to prevent the expression of cocaine-induced BS. Thus, the experimental protocol was again performed with the lowest dose (15 mg/kg of DMT, orally). At the end of the experimental protocol, the animals were euthanized and their prefrontal cortex, striatum and hippocampus were dissected for serotonergic receptor 5-HT1A and 5-HT2A by immunoblotting. However, no significant differences were observed when comparing receptor protein level in the experimental groups. Thus, these results suggest that AYA may be a good therapeutic strategy for cocaine addiction, paving the way for further studies

Rapid classification and quantification of cocaine in seized powders with ATR-FTIR and chemometrics.

Traditionally, fast screening for the presence of cocaine in unknown powders is performed by means of colour tests. The major drawbacks of these tests are subjective colour evaluation depending on the operator ('50 shades of blue') and a lack of selectivity. An alternative fast screening technique is Fourier Transform InfraRed (FTIR) spectrometry. This technique provides spectra that are difficult to interpret without specialized expertise and shows a lack of sensitivity for the detection of cocaine in mixtures. To overcome these limitations, a portable FTIR spectrometer using Attenuated Total Reflectance (ATR) sampling was combined with a multivariate technique, called Support Vector Machines (SVM). Representative street drug powders (n = 482), seized during the period January 2013 to July 2015, and reference powders (n = 33) were used to build and validate a classification model (n = 515) and a quantification model (n = 378). Both models were compared with the conventional chromatographic techniques. The SVM classification model showed a high sensitivity, specificity, and efficiency (99%). The SVM quantification model determined cocaine content with a root mean squared error of prediction (RMSEP) of 6% calculated over a wide working range from 4 to 99 w%. In conclusion, the developed models resulted in a clear output (cocaine detected or cocaine not detected) and a reliable estimation of the cocaine content in a wide variety of mixtures. The ATR-FTIR technique combined with SVM is a straightforward, user-friendly, and fast approach for routine classification and quantification of cocaine in seized powders. Copyright © 2016 John Wiley & Sons, Ltd.

A genetic algorithm-based framework for wavelength selection on sample categorization.

In forensic and pharmaceutical scenarios, the application of chemometrics and optimization techniques has unveiled common and peculiar features of seized medicine and drug samples, helping investigative forces to track illegal operations. This paper proposes a novel framework aimed at identifying relevant subsets of attenuated total reflectance Fourier transform infrared (ATR-FTIR) wavelengths for classifying samples into two classes, for example authentic or forged categories in case of medicines, or salt or base form in cocaine analysis. In the first step of the framework, the ATR-FTIR spectra were partitioned into equidistant intervals and the k-nearest neighbour (KNN) classification technique was applied to each interval to insert samples into proper classes. In the next step, selected intervals were refined through the genetic algorithm (GA) by identifying a limited number of wavelengths from the intervals previously selected aimed at maximizing classification accuracy. When applied to Cialis®, Viagra®, and cocaine ATR-FTIR datasets, the proposed method substantially decreased the number of wavelengths needed to categorize, and increased the classification accuracy. From a practical perspective, the proposed method provides investigative forces with valuable information towards monitoring illegal production of drugs and medicines. In addition, focusing on a reduced subset of wavelengths allows the development of portable devices capable of testing the authenticity of samples during police checking events, avoiding the need for later laboratorial analyses and reducing equipment expenses. Theoretically, the proposed GA-based approach yields more refined solutions than the current methods relying on interval approaches, which tend to insert irrelevant wavelengths in the retained intervals. Copyright © 2016 John Wiley & Sons, Ltd.

Applicability of ultra-high performance liquid chromatography-quadrupole-time of flight mass spectrometry for cocaine profiling.

For the first time in China, the chemical profiling of cocaine specimens was performed at the National Narcotics Laboratory. An ultra-high performance liquid chromatography-quadrupole-time of flight mass spectrometry (UHPLC-QTOF-MS) method was developed and validated for simultaneous analysis of 14 cocaine alkaloids and 5 main adulterants. Among them, ecgonine methyl ester, ecgonine, benzoylecgonine, and norcocaine were identified by comparing with the standard materials; tropacocaine, 3,4,5-trimethoxycocaine, cis-/trans-cinnamoylcocaine were tentatively identified based on the exact masses of protonated molecules and product ions; six unidentified alkaloids of 182/1.47, 316/9.54, 659/9.85, 316/9.87, 420/10.34, and 420/10.85 were marked with 'extracted mass/retention time' for convenience. Minimum sample preparation and analysis time were required, which was suitable for routine analysis. Based on the semi-quantitative data set of 14 alkaloid impurities in 131 linked/unlinked cocaine samples, 50 combinations of pretreatment methods and distance/correlation measurements were tested for their potential discrimination power for cocaine profiling, and Logarithm/Pearson exhibited the best result. After hierarchical cluster analysis (HCA), 183 cocaine samples collected from 2011 to 2015 were classified into 7 major groups. Moreover, 37 groups of linked samples were found within and between provinces, which provide intelligence for the case connection and revealing of the distribution networks. Our results highlighted the practical utilities of drug profiling, especially to support the investigation through operational intelligence and to improve the knowledge related to the drug trafficking through strategic intelligence. Copyright © 2016 John Wiley & Sons, Ltd.

Multicriteria wavenumber selection in cocaine classification.

Cocaine ATR-FTIR spectra consist of a large number of wavenumbers that typically decreases the performance of exploratory and predictive multivariate techniques. This paper proposes a framework for selecting the most relevant wavenumbers to classify cocaine samples into two categories regarding chemical composition, i.e. salt and base. The proposed framework builds a wavenumber importance index based on the Bhattacharyya distance (BD) followed by a procedure that removes wavenumbers from the spectra according to the order suggested by the BD index. The recommended wavenumber subset is chosen based on multiple criteria assessing classification performance, which are recalculated after each wavenumber is eliminated. The method was applied to ATR-FTIR spectra from 513 samples of cocaine, remarkably reducing the percent of retained wavenumbers and yielding near to perfect classifications in the testing set. In addition, we compared our propositions with other methods tailored to wavenumber selection; we found that the proposed framework, which relies on simple mathematical fundamentals, yielded competitive results.

Determination of delta13 CV-PDB and delta15NAIR values of cocaine from a big seizure in Germany by stable isotope ratio mass spectrometry.

In this study, delta(13)C(V- PDB) and delta(15)N(AIR) values of 132 cocaine samples from a big seizure in Germany in 2002 were determined using elemental analyser isotope ratio mass spectrometry. The 1.2 tons of cocaine were packed in 1 kg packages and the cocaine bricks inside these packages showed certain logos. Twenty different logos could be identified. Results show a large variability among some samples, for delta(15)N(AIR) values ranging from-17 to -2 per thousand. Furthermore, the possibility of linking samples with the same logo was checked. The results show that, in general, there is no relationship between the determined isotope ratio and a certain logo.

Cocaína: aspectos farmacológicos / Cocaine: pharmacologic aspects

Existen diferentes formas de abuso de la cocaína (hojas de coca, sulfato de cocaína, clorhidrato de cocaína y cocaína base o crack) que condicionan la farmacocinética; la actividad farmacológica, la toxicidad y el grado de adicción de la droga. En nuestro medio, la cocaína se fuma o se esnifa fundamentalmente, pero también se usa por vía intravenosa. La cocaína atraviesa las membranas celulares de forma rápida. Esnifada o administrada por vía intravenosa se encuentran niveles de cocaína en el cerebro en 30 segundos, mientras que fumada sólo tarda 5 segundos en tener efectos centrales. La cocaína es rápidamente metabolizada, generalmente por hidrólisis enzimática para producir benzolyecgonina, ecgonina metil ester y posteriormente ecgonina. Sin embargo, en presencia de etanol, la cocaína es transesterificada a cocaetileno que posee actividad farmacológica y tóxica. La cocaína es un potente inhibidor de la recaptación tipo I de noradrenalina, dopamina y serotonina, lo que facilita la acumulación de esos neurotransmisores en la hendidura sináptica. Las acciones farmacológicas se caracterizan por manifestaciones de actividad noradrenérgica y dopaminérgica fundamentalmente, que afecta a los distintos aparatos; la intoxicación aguda se manifiesta por una hiperactividad de estos sistemas (AU)

The routes of administration of cocaine are different depending on the cocaine source (leaves, sulphate, hydrochloride and crack), and this affects not only its pharmacokinetics but also its pharmacological effects, as well as other aspects such as toxicity, tolerance, dependence and withdrawal effects of this drug. In our country, cocaine is mainly smoked or inhaled, and intravenous administration can be also used. Cocaine is rapidly absorbed by many routes. Cocaine produces central effects in 30 seconds after nasal or intravenous administration and in only 5 seconds when cocaine is smoked. The major route for cocaine metabolism involves hydrolysis of its ester groups producing benzoylecgonine, ecgonine methyl ester and ecgonine as metabolites. An important metabolic interaction occurs when cocaine and alcohol are taken concurrently; cocaine is then transesterified to cocaethylene, which is toxic. Cocaine is a potent inhibitor of catecholamine uptake by noradrenergic, dopaminergic and serotoninergic nerve terminals and strongly enhances the effects of these neurotransmitters Pharmacological and toxic effects are derived from its actions on the catecholaminergic system (AU)

A study of illicit cocaine seizure classification by pattern recognition techniques applied to metal data.

Fifteen metallic species, silver (Ag), aluminum (Al), calcium (Ca), cadmium (Cd), chromium (Cr), copper (Cu), iron (Fe), potassium (K), magnesium (Mg), manganese (Mn), sodium (Na), nickel (Ni), lead (Pb), strontium (Sr) and zinc (Zn), were determined in 46 cocaine samples confiscated by the Spanish police in Galicia (northwest Spain). Classification of these cocaine samples according to their geographic origin (Colombia and Venezuela) was achieved by the application of pattern recognition techniques to the metallic content data. Cocaine samples, around 0.5 g, were directly dissolved in 2 mL of 35.0% (v/v) HNO3, diluted to 10 mL with ultrapure water. The metals were quantified by means of electrothermal atomic absorption spectrometry (Ag, Al, Cd, Cr, Cu, Mn, Ni, Pb and Sr), flame atomic absorption spectrometry (Ca, Fe, Mg and Zn), and flame atomic emission spectrometry (K and Na). Results show that two geographic origins can be established through the presence of trace and major elements.

Investigacion cientifica sobre las propiedades y usos legales de la hoja de coca: Analisis historico y contemporaneo

La legalidad del consumo de la hoja de coca en si, del ya mundialmente discutido mate de coca y sus propiedades terapeuticas se convirtio de una constumbre tradicional permitida por la misma ley 1008 en una politica nacional, es asi que ante los Estados Unidos y las mismas Naciones Unidas se presento la diplomacia de la coca la que fue defendida con entusiasmo

Trafico Ilicito de Cocaina / Ilegal trafic of cocaine

Contiene: Fiscalizacion control y prohibicion de los precursores y las substancias quimicas, para evitar la fabricacion de cocaina, la fabricacion de cocaina a la luz del "Iter Criminis", el delito, culpabilidad y las substancias quimicas, necesidad de una urgente modificacion; anexos

Trafico Ilicito de Cocaina: los precursore y las substancias químicas en la ley 1008

Fiscalización control y prohibición de los precursores y las substancias quimicas, para evitar la fabricación de cocaina, la fabricación de cocaina a la luz del "Iter Criminis", el delito, culpabilidad y las substancias quimicas, necesidad de una urgente modificación; anexos

Statutory classification of cocaine as a narcotic: an illogical anachronism.

Although cocaine is pharmacologically not a narcotic, federal and state drug control laws have classified it as one from 1922 through the present. In many states and under federal law, the classification is part of a statutory scheme that imposes substantially more severe penalties for offenses involving cocaine than for offenses involving other nonnarcotic drugs. This Note examines the circumstances surrounding the adoption and maintenance of the legal classification of cocaine as a narcotic. It then reviews two of the many cases that have rejected claims that the classification is unconstitutional. The Note concludes that, despite its constitutionality, the inaccurate classification is not only illogical and unnecessary to a legislative goal of strictly penalizing cocaine offenses, but is counterproductive as well.