Toxicology findings from drivers suspected of drug-impaired driving in Ontario (2008-2019).

OBJECTIVE: This study examines the results of toxicological tests performed on blood and urine samples collected from suspected drug-impaired drivers in Ontario from 2008 to 2019. The report examines the results of toxicological analysis of the samples submitted, the characteristics of those drivers from whom samples were collected, and the temporal and situational circumstances that led to police investigations and sample collection to better understand drug-impaired driving behavior and to assist in the development and implementation of countermeasure strategies and programs. METHODS: Blood and urine samples were sent to the Center of Forensic Sciences where they were analyzed using standardized comprehensive toxicological analysis to test for a wide variety of potentially impairing drugs. Demographic and temporal information for each case from which a sample was collected were also examined to describe the circumstances and characteristics of these driving incidents. RESULTS: During the 12-year period examined, 5,388 samples collected from suspected drug-impaired drivers were analyzed. The number of samples collected increased substantially following the implementation of the Drug Evaluation and Classification Program (DECP) in July 2008, the enactment of legislation facilitating the collection of blood samples from suspects, and the legalization of cannabis for nonmedical purposes in 2018. The number of samples submitted shows temporal correlation with the number of police officers certified as Drug Recognition Experts (DRE) in the province. Over the 12-year period of this study, cannabis was the most frequently detected substance in drivers (52.8% of cases), followed by cocaine (44.3%) and methamphetamine (24.8%). In 80% of cases, more than one substance was detected. CONCLUSIONS: Examining the characteristics of suspected drug-impaired drivers, the temporal circumstances, and the drug findings throughout the large geographic area of Ontario and over the extended period of this study enhances our understanding of drug-impaired driving behavior. These characteristics can assist in the development and/or evaluation of enforcement strategies and enhanced countermeasure activities.

Carfentanil Blood Concentrations in Impaired Driving Investigations in Ontario, Canada.

Carfentanil is a potent opioid with no medical use in humans; it presents a serious threat to public health and road safety due to its presence in the illicit drug supply, the potency of the drug and instances of use prior to the operation of a motor vehicle. The identification and quantitation of carfentanil using liquid chromatography with tandem mass spectrometry was performed in blood samples obtained through impaired driving-related investigations from 2017 to 2019. In a series of 66 cases submitted to the Centre of Forensic Sciences in Ontario, Canada, blood concentrations of carfentanil ranged from <0.04 to 2.1 ng/mL in the population studied. Driving behaviors frequently came to the attention of concerned citizens, decreased levels of consciousness were commonly reported and a variety of medical interventions were required, in some cases, to preserve life due to apparent opioid toxicity.

Characteristics of COVID-19 Workplace Clusters in Rhode Island.

The COVID-19 pandemic has impacted certain workplace settings disproportionately, putting some industries at a higher risk for workplace transmission than others. This study examines workplace clusters in Rhode Island between March 2020 and May 2021. There were 14,580 cases associated with 2784 clusters during this period, with the largest number of workplace clusters occurring in manufacturing, food services, and retail. A better understanding of most impacted industries can inform sector-specific COVID-19 guidance and policy changes.

Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces.

We describe coronavirus disease (COVID-19) among US food manufacturing and agriculture workers and provide updated information on meat and poultry processing workers. Among 742 food and agriculture workplaces in 30 states, 8,978 workers had confirmed COVID-19; 55 workers died. Racial and ethnic minority workers could be disproportionately affected by COVID-19.

Update: COVID-19 Among Workers in Meat and Poultry Processing Facilities - United States, April-May 2020.

Meat and poultry processing facilities face distinctive challenges in the control of infectious diseases, including coronavirus disease 2019 (COVID-19) (1). COVID-19 outbreaks among meat and poultry processing facility workers can rapidly affect large numbers of persons. Assessment of COVID-19 cases among workers in 115 meat and poultry processing facilities through April 27, 2020, documented 4,913 cases and 20 deaths reported by 19 states (1). This report provides updated aggregate data from states regarding the number of meat and poultry processing facilities affected by COVID-19, the number and demographic characteristics of affected workers, and the number of COVID-19-associated deaths among workers, as well as descriptions of interventions and prevention efforts at these facilities. Aggregate data on confirmed COVID-19 cases and deaths among workers identified and reported through May 31, 2020, were obtained from 239 affected facilities (those with a laboratory-confirmed COVID-19 case in one or more workers) in 23 states.* COVID-19 was confirmed in 16,233 workers, including 86 COVID-19-related deaths. Among 14 states reporting the total number of workers in affected meat and poultry processing facilities (112,616), COVID-19 was diagnosed in 9.1% of workers. Among 9,919 (61%) cases in 21 states with reported race/ethnicity, 87% occurred among racial and ethnic minority workers. Commonly reported interventions and prevention efforts at facilities included implementing worker temperature or symptom screening and COVID-19 education, mandating face coverings, adding hand hygiene stations, and adding physical barriers between workers. Targeted workplace interventions and prevention efforts that are appropriately tailored to the groups most affected by COVID-19 are critical to reducing both COVID-19-associated occupational risk and health disparities among vulnerable populations. Implementation of these interventions and prevention efforts† across meat and poultry processing facilities nationally could help protect workers in this critical infrastructure industry.

Drug Recognition Evaluation and Chemical Confirmation of a 25C-NBOMe-Impaired Driver.

This case report details an individual arrested for drug-impaired driving after leaving the scene of multiple motor vehicle collisions and evading police. The driver was examined by a drug recognition expert and failed the drug recognition evaluation. The driver admitted to using cocaine, marijuana, an antidepressant medication and "N-bomb," a novel psychoactive substance that possesses hallucinogenic properties. Toxicological analyses at the Centre of Forensic Sciences' Toronto laboratory revealed only the substance 2-[4-chloro-2,5-dimethoxyphenyl]-N-[(2-methoxyphenyl)methyl]ethanamine (25C-NBOMe) in the accused's urine. This is the first report in which 25C-NBOMe was identified through DRE and toxicological analyses in a drug-impaired driver.

Community Health Teams: A Healthcare Provider's System Transformation Opportunity.

"The goal of community health teams is to develop and implement care models that integrate clinical and community health promotion and preventive services for patients." -Association of State and Territorial Health Officials (ASTHO)1 Eleven community health teams (CHTs) operate in various geographies within Rhode Island. Physicians and payers refer their highest-risk patients to CHTs that serve as community extenders. Community health workers and others work to link referred individuals to primary care and work to address the other determinants affecting their health, such as safe housing. Since much of health is driven by factors outside of the healthcare setting, CHTs compliment the work of physicians within the office environment. Transforming practices and addressing both the physical and behavioral needs of patients simultaneously is key to CHT success. This article attempts to quantify the expanding need for CHTs within Rhode Island and describes ways in which CHTs as a practice transformation resource may be leveraged by providers. [Full article available at http://rimed.org/rimedicaljournal-2016-10.asp].

Design of the national health security preparedness index.

The importance of health security in the United States has been highlighted by recent emergencies such as the H1N1 influenza pandemic, Superstorm Sandy, and the Boston Marathon bombing. The nation's health security remains a high priority today, with federal, state, territorial, tribal, and local governments, as well as nongovernment organizations and the private sector, engaging in activities that prevent, protect, mitigate, respond to, and recover from health threats. The Association of State and Territorial Health Officials (ASTHO), through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) Office of Public Health Preparedness and Response (OPHPR), led an effort to create an annual measure of health security preparedness at the national level. The collaborative released the National Health Security Preparedness Index (NHSPI(™)) in December 2013 and provided composite results for the 50 states and for the nation as a whole. The Index results represent current levels of health security preparedness in a consistent format and provide actionable information to drive decision making for continuous improvement of the nation's health security. The overall 2013 National Index result was 7.2 on the reported base-10 scale, with areas of greater strength in the domains of health surveillance, incident and information management, and countermeasure management. The strength of the Index relies on the interdependencies of the many elements in health security preparedness, making the sum greater than its parts. Moving forward, additional health security-related disciplines and measures will be included alongside continued validation efforts.

Effects of industrial metals on wild fish populations along a metal contamination gradient.

The purpose of this study was to examine relationships among water, sediment, and fish tissue metal concentrations as they relate to fish diversity, tissue metal accumulation, and fish morphometric and reproductive condition. Fish were captured in 12 lakes near Sudbury, Ontario, Canada, that ranged in their degree of metal contamination. In general, metal concentrations in water and sediment decreased with increasing distance from industrial operations. However, only Cu and Ni demonstrated this trend in sediments. Although 20 fish species were identified in the 12 lakes, only one species, yellow perch (Perca flavescens), was common to all 12 lakes. Fish diversity was only associated with sediment metals, suggesting that short-term processes are much less important than long-term processes for fish community recovery in metal-contaminated lakes. Multivariate characterization of water metal concentrations resulted in three lake clusters: Group 1 consisted of reference lakes; Group 2 lakes had high alkalinity, conductivity, hardness, pH, waterborne metals (especially Se), and sediment Cu and Ni concentrations; Group 3 lakes had high pH, waterborne and sediment Cu, and sediment Ni, intermediate alkalinity, conductivity, and waterborne metals (except Al and Fe), and low hardness and waterborne Al and Fe. Liver Cd, Cu, Ni, Pb, and Zn, muscle Zn, and intestinal Cd and Zn were highest, and muscle Cu and male gonadosomatic index (GSI) were lowest, in Group 3 fish. Liver, muscle, and intestinal Se concentrations, and Fulton's condition factor (FCF), hepatosomatic index (HSI), and male GSI were highest in Group 2 fish. Group 1 fish had the highest muscle Hg concentrations and female GSI. Muscle Se appeared to have an antagonistic effect on muscle Hg accumulation as a function of distance from smelting operations. Neither Cu nor Ni, both metals of concern in the Sudbury area, was useful for predicting fish condition, probably because of homeostatic regulatory control. Liver Cd accumulation, which was negatively related to FCF (r = -0.16; P < 0.05), exhibited strong, nonlinear inhibition (r2 = 0.99; P < 0.0001) as a function of water hardness. Because Cd was not detected in water samples in this study, we suspect that branchial Ca2+ uptake may play some role in reducing dietary Cd uptake in hard water lakes. Selenium has received relatively little attention in the contaminated systems around Sudbury, yet our results demonstrated that tissue Se was related to all condition metrics studied. Moreover, evidence was provided that suggests that there is a gender-specific interaction between dietary Se and Cu uptake that may contribute to decreased female reproductive condition in wild yellow perch.

Morphometric and metabolic indicators of metal stress in wild yellow perch (Perca flavescens) from Sudbury, Ontario: a review.

Eighteen lakes studied near Sudbury and across Northeastern Ontario (Canada) over a five-year period provided a wide contamination gradient of cadmium (Cd), copper (Cu) and other metals such as nickel (Ni) and zinc (Zn). All were inhabited by yellow perch (Perca flavescens), which was sometimes the only species present. Liver Cd and Cu concentrations were monitored in these lakes, in some cases for several consecutive years and for multiple seasons. This data suggests that yellow perch from clean to mildly-contaminated environments loosely control their hepatic Cu concentrations between 7 and 50 microg g dry weight(-1), and a threshold of 50 microg g dry weight(-1) is suggested as the normal range of homeostatic control. Similar data collected by others support this value. Liver Cd concentrations appeared more variable among lake samples, but consistently remained below 10 microg g dry weight(-1) in clean to mildly-contaminated lakes, also supported by data collected elsewhere. Condition factors allowed the discrimination between clean and polluted yellow perch, a conclusion consistent with data for the same species collected in the Rouyn-Noranda area (Quebec, Canada). Values of weight-to-length scaling coefficient lower than 3.0 also discriminated between clean and metal-polluted yellow perch. Finally, three studies indicated that chronic metal exposure can lead to an impairment of aerobic capacities in wild yellow perch, as indicated by lower muscle activity of citrate synthase (CS), aerobic swim performance and respiration rate. We propose that the combination of liver metal concentrations, scaling coefficient, condition factor and an indicator of physiological impairment such as muscle CS activity can provide a suitable range of parameters to adequately assess the effects of metal contamination on the health of yellow perch. Although yellow perch are ubiquitous in North America, this approach can potentially be applied to other small fish species more suitable to other study areas.