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CORK Bibliography: Contaminants

59 citations. 2007 to present

Prepared: March 2010

Aitken CK; Fry TRL; Farrell L; Pellegrini B. Smokers of illicit tobacco report significantly worse health than other smokers. Nicotine & Tobacco Research 11(8): 996-1001, 2009. (34 refs.)

Introduction: The aim of this study was to ascertain whether the health of past and current smokers of illicit tobacco (chop-chop) differs from that of smokers of licit tobacco. Methods: The design was a telephone survey, stratified by state, using computer aided telephone interviewing, with households selected by random digit dialing from the telephone white pages. Setting was all Australian states and territories, 1,621 regular tobacco smokers aged 18+ years. Measures were social and personal characteristics of tobacco smokers, smoking histories and patterns, and health status (SF-8 and disability weights). Binary logistic regression was used to identify variables associated with current and lifetime chop-chop use. Results: Compared with licit-only tobacco smokers, current users of chop-chop had significantly greater odds of beginning smoking aged <16 years (odds ratio [OR] 1.65, 95% CI = 1.09-2.50), of reporting below-average social functioning (OR 1.61, 95% CI = 1.06-2.44), and of a measurable disability (OR 1.95, 95% CI = 1.08-3.51). Lifetime chop-chop users were relatively likely to be less than 45 years of age (OR 1.82, 95% CI = 1.38 2.39), report below-average mental health (OR 1.61, 95% CI = 1.22-2.13) and above-average bodily pain (OR 1.40, 95% CI = 1.06-1.85), smoke more than 120 cigarettes/week (OR 1.39, 95% CI = 1.06-1.83), and to have begun smoking aged < 16 years (OR 1.33, 95% CI = 1.01-1.75). Discussion: Current and lifetime users of chop-chop report significantly worse health than smokers of licit tobacco. Investigation of how to communicate this finding to current and potential chop-chop smokers is warranted.

Akhter R; Hassan NMM; Aida J; Takinami S; Morita M. Relationship between betel quid additives and established periodontitis among Bangladeshi subjects. Journal of Clinical Periodontology 35(1): 9-15, 2008. (36 refs.)

Aim: To determine the relationship between betel quid chewing additives and established periodontitis in Bangladeshi subjects. Material and Methods: A total of 864 subjects participated in this study. Among them, 140 pairs of sex- and age-matched case subjects and control subjects were selected. A case was defined as a person who had at least two sites with a clinical attachment level (CAL)>= 6 mm and at least one site with probing depth (PD)>= 5 mm. Subjects who did not fulfill these criteria were considered as controls. Information on sociodemographic variables, psychological stress, dental health behaviour, smoking and betel quid chewing habits was obtained. Results: Multiple logistic regression analysis showed that current betel quid chewers had greater probabilities of having established periodontal disease than did non-chewers (odds ratio=3.97, p < 0.05). Mean PD, mean CAL, mean percentage of bleeding on probing and number of missing teeth were significantly higher in chewers of betel quid with tobacco and masala than in chewers of betel quid without such additives adjusting for age, sex, smoking habit, body mass index, dental visit pattern, stress and plaque index. Higher frequency and longer duration of betel quid chewing showed a significant relation to an increase in periodontal parameters. Conclusions: The results indicate that betel quid additives might significantly enhance periodontitis in the population studied.

Armentia A. Adverse reactions to wine: Think outside the bottle. (review). Current Opinion in Allergy and Clinical Immunology 8(3): 266-269, 2008. (9 refs.)

Purpose of review: Wine contains chemical and biological contaminants. Symptoms such as facial flushing, asthma and oral allergic swelling and burning (oral syndrome) have been attributed to these contaminants and food additives. Their clinical implications should be known. Recent findings: Recent studies have reported a high prevalence of hypersensitivity symptoms after intake of alcoholic drinks in the general population. Red wine was the most common beverage implicated. Wine contains many contaminants. Some of them come from Hymenoptera insects that fall into the wine when grapes are collected and pressed. We have found patients with allergic symptoms related to wine consumption who are sensitized to Hymenoptera venom without previous stings. The aim of this study is to assess the potential importance of their sensitization to Hymenoptera antigens as the cause of their symptoms and also to comment on other recent studies on wine hypersensitivity. Summary: We found patients with allergic symptoms related to wine consumption who are sensitized to Hymenoptera venoms. Challenges were negative with sulfites, other additives and aging wines, but positive with young wines. Sera from all the patients detected Hymenoptera. venom antigens. We report the first cases of sensitization to venom antigens by the oral route.

Balharry D; Sexton K; BeruBe KA. An in vitro approach to assess the toxicity of inhaled tobacco smoke components: Nicotine, cadmium, formaldehyde and urethane. Toxicology 244(1): 66-76, 2008. (52 refs.)

One of the first lines of defence to inhaled toxins is the barrier formed by the tracheobronchial epithelium, making this the ideal region for studying the toxicity of inhaled substances. This study utilises a highly differentiated, three-dimensional, in vitro model of human upper respiratory tract epithelium (EpiAirway-100) to measure the acute toxicological responses to well-characterised tobacco smoke components. To determine the suitability of this model for screening inhaled toxicants, the EpiAirway tissue model (ETM) was treated apically with tobacco smoke components (nicotine, formaldehyde, cadmium, urethane) which are known to induce a variety of toxic effects (e.g. cytotoxic, thrombogenic, carcinogenic). A range of concentrations were used to model different mechanisms and severity of toxicity which were then compared to known in vivo responses. Similar trends in stress response occurred, with distinct alterations to the tissue in response to all four toxins. At high concentrations, cell viability decreased and tight junctions were degraded, but at sub-toxic concentrations epithelial resistance (indicating tissue integrity) increased 20-60% from control. This peak in resistance coincided with an increase in secreted protein levels, elevated cytokine release and goblet cell hyperplasia and hypertrophy. In conclusion, acute exposure to tobacco smoke components induces measurable toxic responses within human respiratory epithelium. Sub-toxic concentrations appear to illicit a protective response by increasing mucus secretion and mediating immune responses via cytokine release. These responses are comparable to human in vivo responses, indicating potential for the ETM as a tool for screening the toxicity of inhaled compounds.

Bloor RN; Wang TS; Spanel P; Smith D. Ammonia release from heated 'street' cannabis leaf and its potential toxic effects on cannabis users. Addiction 103(10): 1671-1677, 2008. (27 refs.)

Aims" To use selected ion flow tube mass spectrometry (SIFT-MS) to analyse the molecular species emitted by heated 'street' cannabis plant material, especially targeting ammonia. Materials and methods: Samples of 'street' cannabis leaf, held under a UK Home Office licence, were prepared by finely chopping and mixing the material. The samples were then heated in commercially available devices. The air containing the released gaseous compounds was sampled into the SIFT-MS instrument for analysis. Smoke from standard 3% National Institute on Drug Abuse (National Institute on Drug Abuse) cannabis cigarettes was also analysed. Findings: For 'street' cannabis, ammonia was present in the air samples from the devices at levels approaching 200 parts per million (p.p.m.). This is compared with peak levels of 10 p.p.m. using National Institute on Drug Abuse samples of known provenance and tetrahydrocannabinol content (3%). Several other compounds were present at lower levels, including acetaldehyde, methanol, acetone, acetic acid and uncharacterized terpenes. Conclusions: Awareness of the risks of inhaling the smoke directly from burning cannabis has led to the development of a number of alternative methods of delivery, which are claimed to be safer than direct smoking. Ammonia at toxic levels is produced from heating 'street' cannabis in these commercially available devices. Thus, the use of these devices to deliver 'street' cannabis is now open to question and further research is needed to investigate their safety.

Brunt TM; Rigter S; Hoek J; Vogels N; van Dijk P; Niesink RJM. An analysis of cocaine powder in the Netherlands: Content and health hazards due to adulterants. Addiction 104(5): 798-805, 2009. (38 refs.)

Aims: To report on trends in the content and adulterants present in street cocaine ( powder) in the Netherlands and to describe the associated health hazards. Design and participants Drug consumers handed in samples of cocaine powder from 1999 to 2007 for analysis. Reports were compiled of users' experiences with the samples received. Measurements and analysis Linear regression analysis was used to assess the trend in adulterated cocaine powder across the study period, and comparison of reported adverse effects of adulterated with those of unadulterated cocaine by Fisher's exact test. Findings There has been a statistically significant upward trend in the occurrence of adulterated cocaine powder over the years. Adulterated cocaine was associated more frequently with reported adverse effects than unadulterated cocaine. Phenacetin, hydroxyzine and diltiazem appeared to be three adulterants contributing to these adverse effects. Conclusions An increase in adulterants was detected in the analysed cocaine powder between 1999 and 2007. This increase is associated with relatively more adverse effects with cocaine use. The cardiac and hallucinatory effects that were reported more frequently are not understood clearly. Adverse effects are likely to be due to several factors, including interactions of adulterants with cocaine and the route of administration.

Busse FP; Fiedler GM; Leichtle A; Hentschel H; Stumvoll M. Lead poisoning due to adulterated marijuana in Leipzig. Deutsches Arzteblatt International 105(44): 757-I, 2008. (47 refs.)

Background: Between August and December 2007, a mass poisoning due to adulterated marijuana was uncovered in the area of Leipzig, Germany. Methods: Retrospective reports of patients with lead poisoning who were treated at Leipzig University Hospital. Analysis of data from the local health office, where marijuana consumers could have their blood lead concentration determined. Results: At Leipzig University Hospital, 35 patients (7 female; age 24.2 +/- 4.4 years) had to be treated for lead poisoning (blood lead levels 1063.3 +/- 864.0 mu g/L). Five hundred ninety-seven marijuana consumers (439 men, 158 women; age 26.9 +/- 4.8 years) had their blood lead levels measured at the local health office. Among them, 27.3% had lead levels above the HBM-II threshold, 12.2% had concentrations that required monitoring, and 60.5% had levels below the HBM-I threshold. Conclusion: Drug consumption should be considered in otherwise unexplained anemia and abdominal colic. Several hundred people suffered lead poisoning presumably resulting from the desire of drug dealers to maximize profits.

Caulkins JP. Price and purity analysis for illicit drug: Data and conceptual issues. Drug and Alcohol Dependence 90(Supplement 1): S61-S68, 2007. (52 refs.)

Data on illicit drug purity and prices are invaluable but challenging. Academic purists argue they are unsuitable for economic analysis [Manski, C.F., Pepper, J.V., Petrie, C.V., 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. National Academy Press, Washington, DC], but in practice they are used frequently [ONDCP, 2001 a. What America's Users Spend on Illegal Drugs. Office of National Drug Control Policy, The White House, Washington, DC; ONDCP, 2001 b. The Price of Illicit Drugs: 1981 Through the Second Quarter of 2000. Office of National Drug Control Policy, The White House, Washington, DC; ONDCP, 2004. The Price and Purity of Illicit Drugs: 1981 Through the Second Quarter of 2003. Office of National Drug Control Policy, The White House, Washington, DC; Grossman, M., 2004. Individual behaviors and substance use: the role of price. Plenary Address for the 24th Arne Ryde Symposium on Economics of Substance Abuse at Lund University, Lund, Sweden, August 13-14, 2004]. This paper reviews data and conceptual issues that people producing, analyzing, and consuming drug price and purity series should understand in order to reduce the likelihood of misinterpretation. It also identifies aspects of drug markets that are both poorly understood and relevant to some of these issues. They constitute a useful research agenda for health and law enforcement communities who would benefit from better data on the supply, availability, and use of illicit drugs.

Cowan RL; Roberts DM; Joers JM. Neuroimaging in human MDMA (ecstasy) users: A cortical model. Annals of the New York Academy of Sciences. Drug Addiction: Research Frontiers and Treatment Advances 1139: 291-298, 2008. (46 refs.)

MDMA (3,4 methylenedioxymethamphetamine) has been used by millions of people worldwide as a recreational drug. The terms "MDMA" and "Ecstasy" are often used synonymously, but it is important to note that the purity of Ecstasy sold as MDMA is not certain. MDMA use is of public health concern, not so much because MDMA produces a common or severe dependence syndrome, but rather because rodent and nonhuman primate studies have indicated that MDMA (when administered at certain dosages and intervals) can cause long-lasting reductions in markers of brain serotonin (5-HT) that appear specific to fine-diameter axons arising largely from the dorsal raphe nucleus (DR). Given the popularity of MDMA, the potential for the drug to produce long-lasting or permanent 5-HT axon damage or loss, and the widespread role of 5-HT function in the brain, there is a great need for a better understanding of brain function in human users of this drug. To this end, neuropsychological, neuroendocrine, and neuroimaging studies have all suggested that human MDMA users may have long-lasting changes in brain function consistent with 5-HT toxicity. Data from animal models leads to testable hypotheses regarding MDMA's effects on the human brain. Because neuropsychological and neuroimaging findings have focused on the neocortex, a cortical model is developed to provide a context for designing and interpreting neuroimaging studies in MDMA users. Aspects of the model are supported by the available neuroimaging data, but there are controversial findings in some areas and most findings have not been replicated across different laboratories and using different modalities. This paper reviews existing findings in the context of a cortical model and suggests directions for future research.

Cox LA. Could removing arsenic from tobacco smoke significantly reduce smoker risks of lung cancer? Risk Analysis 29(1): 3-17, 2009. (61 refs.)

If a specific biological mechanism could be determined by which a carcinogen increases lung cancer risk, how might this knowledge be used to improve risk assessment ? To explore this issue, we assume (perhaps incorrectly) that arsenic in cigarette smoke increases lung cancer risk by hypermethylating the promoter region of gene p16INK4a, leading to a more rapid entry of altered (initiated) cells into a clonal expansion phase. The potential impact on lung cancer of removing arsenic is then quantified using a three-stage version of a multistage clonal expansion (MSCE) model. This refines the usual two-stage clonal expansion (TSCE) model of carcinogenesis by resolving its intermediate or "initiated" cell compartment into two subcompartments, representing experimentally observed "patch" and "field" cells. This refinement allows p16 methylation effects to be represented as speeding transitions of cells from the patch state to the clonally expanding field state. Given these assumptions, removing arsenic might greatly reduce the number of nonsmall cell lung cancer cells (NSCLCs) produced in smokers, by up to two-thirds, depending on the fraction (between 0 and 1) of the smoking-induced increase in the patch-to-field transition rate prevented if arsenic were removed. At present, this fraction is unknown (and could be as low as zero), but the possibility that it could be high (close to 1) cannot be ruled out without further data.

Cunningham JK; Liu LM; Callaghan R. Impact of US and Canadian precursor regulation on methamphetamine purity in the United States. Addiction 104(3): 441-453, 2009. (62 refs.)

Reducing drug purity is a major, but largely unstudied, goal of drug suppression. This study examines whether US methamphetamine purity was impacted by the suppression policy of US and Canadian precursor chemical regulation. Autoregressive integrated moving average (ARIMA)-intervention time-series analysis. Continental United States and Hawaii (1985-May 2005). US federal regulations targeting precursors, ephedrine and pseudoephedrine, in forms used by large-scale producers were implemented in November 1989, August 1995 and October 1997. US regulations targeting precursors in forms used by small-scale producers (e.g. over-the-counter medications) were implemented in October 1996 and October 2001. Canada implemented federal precursor regulations in January 2003 and July 2003 and an essential chemical (e.g. acetone) regulation in January 2004. Monthly median methamphetamine purity series. US regulations targeting large-scale producers were associated with purity declines of 16-67 points; those targeting small-scale producers had little or no impact. Canada's precursor regulations were associated with purity increases of 13-15 points, while its essential chemical regulation was associated with a 13-point decrease. Hawaii's purity was consistently high, and appeared to vary little with the 1990s/2000s regulations. US precursor regulations targeting large-scale producers were associated with substantial decreases in continental US methamphetamine purity, while regulations targeting over-the-counter medications had little or no impact. Canada's essential chemical regulation was also associated with a decrease in continental US purity. However, Canada's precursor regulations were associated with purity increases: these regulations may have impacted primarily producers of lower-quality methamphetamine, leaving higher-purity methamphetamine on the market by default. Hawaii's well-known preference for 'ice' (high-purity methamphetamine) may have helped to constrain purity there to a high, attenuated range, possibly limiting its sensitivity to precursor regulation.

Duterte M; Jacinto C; Sales P; Murphy S. What's in a label? Ecstasy sellers' perceptions of pill brands. Journal of Psychoactive Drugs 41(1): 27-37, 2009. (45 refs.)

This article presents selected findings from a qualitative study of Ecstasy sellers and their sales practices, knowledge of distribution networks, buyer-seller relationships, and self-reported drug use. In-depth interviews were conducted with 80 men and women who had sold five or more hits of Ecstasy five or more times in the six months prior to the interview. Study participants described their perceptions of the various types of Ecstasy they had distributed or used themselves. The participants had experience with a variety of Ecstasy labels, from the popular "Blue Dolphin" tablets to the powdered form called "Molly." We tracked pill brand mentions on Ecstasy-related websites to compare with interviewees' descriptions of Ecstasy brands. This study examines Ecstasy sellers' ideas about the role of brand names in Ecstasy markets and their relationship to their beliefs about different types of Ecstasy's purity and quality. We demonstrate that considering Ecstasy branding increases our understanding of buyer and seller relationships.

Exley C; Ahmed U; Polwart A; Bloor RN. Elevated urinary aluminium in current and past users of illicit heroin. Addiction Biology 12(2): 197-199, 2007. (12 refs.)

The use of illicit heroin is associated with aberrant neurology of unknown aetiology and various psychiatric illnesses. Aluminium, which is a proven neurotoxin, is present in significant amounts in illicit heroin and may also be volatilized and inhaled following the vaporization of heroin off aluminium foil ('Chasing the Dragon'). The purpose of this study was to establish if the use of illicit heroin was associated with an increase in the body burden of aluminium. We have used graphite furnace atomic absorption spectrometry to measure the aluminium and iron contents of the urine of current and past users of illicit heroin and used these data to estimate body burdens of aluminium. Urinary excretion of aluminium is the most effective non-invasive indicator of the body burden of aluminium and was found to be significantly (P < 0.001) higher in users of illicit heroin, range 14-3382 nmol/mmol creatinine (mean +/- SD; 222 +/- 491 nmol/mmol creatinine), than in a normal non-drug abusing control population, range 23-74 nmol/mmol creatinine (mean +/- SD; 43 +/- 19 nmol/mmol creatinine). Exposure to aluminium from the use of illicit heroin may be of particular significance because the urinary excretion of iron, another major contaminant of illicit heroin, in users (mean +/- SD; 53 +/- 63 nmol/mmol creatinine) was not significantly different (P > 0.05) from the control population (mean +/- SD; 38 +/- 18 nmol/mmol creatinine). We have shown for the first time that the use of illicit heroin may be a significant contributor to the body burden of aluminium. Further research will be required to determine if adventitious aluminium has a role in heroin use-related neuropathology and neurology.

Friedman LS. Real-time surveillance of illicit drug overdoses using poison center data. Cllinical Toxicology 47(6): 573-579, 2009. (29 refs.)

Background. In early 2006, government and media sources reported that crime syndicates were mixing fentanyl with heroin. This was followed by an increase in heroin overdoses and opiate-related deaths. The most recent fentanyl outbreak illustrated the need for identifying and establishing effective and responsive real-time surveillance tools to monitor drug overdoses in the United States. Objective. In this study, poison call center data from Illinois were evaluated to determine whether the data could have detected the outbreak that occurred in Illinois in early 2006 and whether it could be used for real-time surveillance. Methods. For this analysis, a two-step approach was used to analyze potential heroin-related calls. First, the data were analyzed retrospectively to identify whether any significant temporal shifts occurred, then a prospective analysis was conducted to simulate real-time surveillance. Results. Between 2002 and 2007, there were a total of 1,565 potential heroin-related calls, and the calls increased by 63.6% in 2006 compared to 2005. In the prospective analysis, the principal model would have identified the outbreak in March 2006. Conclusions. If there had been a real-time surveillance program using poison center data, the outbreak would have been identified I month before the initial postmortem reports to the Centers for Disease Control and Prevention at the end of April 2006. Poison center data provide the potential for an earlier warning system than postmortem data sources, because the reports are usually made within hours of the exposure. Poison center data can be effectively used to monitor heroin-related exposures.

Hammond D; O'Connor RJ. Constituents in tobacco and smoke emissions from Canadian cigarettes. Tobacco Control 17(Supplement 1): i24-i31, 2008. (46 refs.)

Background: There is relatively little information available about the chemical constituents of tobacco and individual toxic emissions from cigarettes and other tobacco products. Objective: To characterise 21 constituents in whole tobacco and 41 constituents in the smoke emissions of Canadian cigarettes, as well as to compare differences between domestic and imported brands. Methods: All data were released as part of Canada's Tobacco Reporting Regulations. Data are reported for 247 brands tested in 2004. Results: The results indicate significant differences in the constituent levels of domestic and imported cigarette tobacco. Levels of ammonia compounds were significantly higher in imported "US blended'' tobacco compared to domestically manufactured brands. Toxic emissions for tobacco-specific nitrosamines were significantly higher for imported cigarettes under both the ISO and Canadian Intense testing methods; however domestic cigarettes had higher levels of other toxic constituents, including benzo[a] pyrene. The findings also highlight the extent to which nicotine, heavy metals and tobacco-specific nitrosamines are "transferred'' from the whole tobacco to the smoke. Conclusions: The findings illustrate important differences between domestically manufactured Virginia flue-cured cigarettes and imported US blended cigarettes. Although the findings suggest that domestic cigarettes had lower levels of constituents such as ammonia, which are associated with increased "additives'', Canadian cigarettes were by no means "additive-free.'' Overall, these findings provide important benchmarks for making historical and international comparisons across brands on key constituents.

Hatsukami DK; Ebbert JO; Anderson A; Lin H; Le C; Hecht SS. Smokeless tobacco brand switching: A means to reduce toxicant exposure? Drug and Alcohol Dependence 87(2/3): 217-224, 2007. (40 refs.)

The purpose of this study was to examine the effects of smokeless tobacco (ST) brand switching on biomarkers of ST exposure and on ST use. Subjects seeking treatment to reduce their use were randomized to ST brand switching with controlled ST topography, brand switching with ad libitum ST use, or a waitlist control with subsequent randomization to one of these two conditions. The waitlist control group was included to assess whether changes were a consequence of time effect. During the intervention, Copenhagen or Kodiak ST users were asked to switch to products that were sequentially lower in nicotine content: Skoal Long Cut Straight or Wintergreen for 4 weeks and then Skoal Bandits for the subsequent 4 weeks. Measures were obtained during the course of treatment and at 12-week follow-up. Significant reductions in total urinary cotinine and 4-(methylnitrosamino)-L-(3-pyridyl)-L-butanol (NNAL) plus its glucuronides (total NNAL) were observed with no significant differences between the controlled topography and ad libitum conditions. Significant reductions were also observed in the amount and duration of dips with a significant intervention effect for durational measures. At 12 weeks, the 7-day biochemically-verified tobacco abstinent rate was 26% in the ad libitum group. ST brand switching may be a feasible alternative intervention for ST users interested in quitting but unwilling to Stop ST use completely.

Hong KP; Kang YS; Jung DC; Park SR; Yoon JH; Lee SY et al. Exposure to ethyl carbamate by consumption of alcoholic beverages imported in Korea. Food Science and Biotechnology 16(6): 975-980, 2007. (41 refs.)

Determination of ethyl carbamyate content in imported alcoholic beverages in Korea and an exposure assessment were conducted. In gas chromatography/mass spectrometry/selected ion monitoring (GC/MS/SIM) analysis, 2.5-39, 8-263, 6.3-112, 11.3-23.5, 53-94, 8.5-38.5, 7-9.5, 21.3-31.5, 5-832.5, and 10.5-364.8 mu g/L of ethyl carbamate were detected in imported beers, sakes, whiskies, vodkas, Chinese liquors, cognacs, tequilas, rums, liqueurs, and wines, respectively. The exposure assessment indicated that the exposure of Korean adults to ethyl carbamate were lower than 20 ng/kg BW per day, (the virtual safe dose) indicating that the amount of ethyl carbamate exposed through fermented food and alcoholic beverages including imported products are currently in the 'no significant risk level'. However, the present low exposure to ethyl carbamate through the imported alcoholic products was not due to the low contents of ethyl carbamate in imported products, but low consumption of the imported products. Therefore, given increasing importation of alcoholic beverages in Korea, reductions of ethyl carbamate content in imported alcoholic beverages, especially non-distilled products, should be required by regulating limits on the ethyl carbamate content in the imported alcoholic beverages.

Ibanez JG; Carreon-Alvarez A; Barcena-Soto M; Casillas N. Metals in alcoholic beverages: A review of sources, effects, concentrations, removal, speciation, and analysis. (review). Journal of Food Composition and Analysis 21(8): 672-683, 2008. (116 refs.)

A critical review is offered concerning the different sources, effects, concentrations, removal methods, speciation, and analysis of metals (e.g., Al, Ca, Cd, Cu, Fe, Pb, Mg, Mn, Ni, K, Na, and Zn) present in a wide variety of alcoholic beverages.

Jaffee WB; Trucco E; Levy S; Weiss RD. Is this urine really negative? A systematic review of tampering methods in urine drug screening and testing. Journal of Substance Abuse Treatment 33(1): 33-42, 2007. (38 refs.)

Adulterants and urine substitutes that are designed to defeat drug tests are readily available and can be easily researched or purchased over the Internet. Utilizing Google, PsychInfo, and Medline, we searched the Internet and psychiatric and medical literature to identify a comprehensive list of products, compounds, and methods of urine tampering, as well as data on their efficacy. These products, compounds, and methods are described, and literature on their effectiveness in masking drug use is reviewed. Additionally, we identify and review methods for detecting tampering of urine screens and tests. It is recommended that clinicians and researchers involved in urine drug screening and testing consider the possibility of tampering when designing treatment programs and research protocols and employ methods to detect its occurrence when appropriate.

Kanteres F; Lachenmeier DW; Rehm J. Alcohol in Mayan Guatemala: Consumption, distribution, production and composition of cuxa. Addiction 104(5): 752-759, 2009. (10 refs.)

ims: To describe the consumption, distribution, production and chemical composition of alcohol, including cuxa (pronounced 'coo sha'), in Nahuala, a highland Mayan municipality in Guatemala. Cuxa is a sugarcane-derived spirit, in part produced clandestinely, that has been distributed in the community for several decades. Methods: Key informant interviews with alcohol distributors and consumers, cuxa producers and health professionals, as well as analyses of questionnaires from a sample of 47 spouses who came to the local health centre for problems related to their husband's drinking. Sampling and chemical analysis of cuxa from 12 of 13 identified sales points in the head-town of Nahuala and its nearby settlements ( 10 km radius). Fieldwork was conducted between November 2007 and March 2008. Results: Alcohol consumption was found to be integrated culturally in this community. The overall drinking culture was marked by irregular heavy drinking occasions, especially around market days, with substantial inebriation and health problems, especially among street inhabiting drinkers. Cuxa contributed to these problems, and cuxa drinking was socially stigmatized. Cuxa was produced both clandestinely and industrially, and sold legally by taverns and illegally by clandestine distributors. The alcoholic strength of the samples was typically between 17 and 19% vol.; clandestinely produced cuxa samples showed acetaldehyde contamination. Conclusions: Measures should be taken to reduce the harm associated with alcohol in this community, including efforts to reduce acetaldehyde levels in cuxa.

Katainen E; Elomaa M; Laakkonen UM; Sippola E; Niemela P; Suhonen J et al. Quantification of the amphetamine content in seized street samples by Raman spectroscopy. Journal of Forensic Sciences 52(1): 88-92, 2007. (17 refs.)

A Raman spectroscopy method for determining the drug content of street samples of amphetamine was developed by dissolving samples in an acidic solution containing an internal standard (sodium dihydrogen phosphate). The Raman spectra of the samples were measured with a CDD-Raman spectrometer. Two Raman quantification methods were used: (1) relative peak heights of characteristic signals of the amphetamine and the internal standard; and (2) multivariate calibration by partial least squares (PLS) based on second derivative of the spectra. For the determination of the peak height ratio, the spectra were baseline corrected and the peak height ratio (h(amphetamine at 994 cm)(-1)/h(internal standard at 880 cm)(-1)) was calculated. For the PLS analysis, the wave number interval of 1300-630 cm(-1) (348 data points) was chosen. No manual baseline correction was performed, but the spectra were differentiated twice to obtain their second derivatives, which were further analyzed. The Raman results were well in line with validated reference LC results when the Raman samples were analyzed within 2 h after dissolution. The present results clearly show that Raman spectroscopy is a good tool for rapid (acquisition time 1 min) and accurate quantitative analysis of street samples that contain illicit drugs and unknown adulterants and impurities.

Khan MA; Wajid A; Noor S; Khattak FK; Akhter S; Rahman IU. Effect of soil contamination on some heavy metals content of cannabis sativa. Journal of the Chemical Society of Pakistan 30(6): 805-809, 2008. (28 refs.)

Heavy metals were investigated in the medicinal plant Cannabis sativa and the soil of the area from where the plant was collected using atomic absorption spectrophotometer. The plant samples were collected from five different locations of N.W.F.P, Pakistan. The plant parts including roots stem and leaves were found to have the quantity of heavy metals corresponding to their contents in the soil. The purpose of the study is to make awareness among the people about the proper use and collection of medicinal plants, containing high level of heavy metals and their adverse health effects.

Khater AEM; El-Aziz NSA; Al-Sewaidan HA; Chaouachi K. Radiological hazards of Narghile (hookah, shisha, goza) smoking: Activity concentrations and dose assessment. Journal of Environmental Radioactivity 99(12): 1808-1814, 2008. (38 refs.)

Narghile (hookah, shisha, goza, "water-pipe") smoking has become fashionable worldwide. Its tobacco pastes, known as moassel and jurak, are not standardized and generally contain about 30-50% (sometimes more) tobacco, molasses/juice of sugarcane, various spices and dried fruits (particularly in jurak) and, in the case of moassel, glycerol and flavoring essences. Tobacco contains minute amounts of radiotoxic elements such as Pb-210, Po-210 and uranium, which are inhaled via smoking. Only very few data have been published on the concentrations of natural radionuclides in narghile tobacco mixtures. Consequently, the aim of this study was to draw first conclusions on the potential hazards of radioactivity in moassel tobacco in relation to narghile smoking. The results indicate the existence of a wide range in the radioactivity contents where the average (range) activity concentrations of U-238, Th-234 Ra-226, Pb-210, Po-210, Th-232 and K-40, in Bq/kg dry weight were 55 (19-93),11 (3-23). 3 (1.2-8),14 (3-29),13 (7-32), 7 (4-10) and 719 (437-1044) Bq/kg dry weight, respectively. The average concentrations of natural radionuclides in moassel tobacco pastes are comparable to their concentration in Greek cigarettes and tobacco leaves, and lower than that of Brazilian tobacco leaves. The distribution pattern of these radionuclides after smoking, between smoke, ash and filter, is unknown, except for Po-210 during cigarette smoking and from one existing study during moassel smoking. Radiological dose assessment due to intake of natural radionuclides was calculated and the possible radio-toxicity of the measured radionuclides is briefly discussed.

Knowles L; Buxton JA; Skuridina N; Achebe I; LeGatt D; Fan S et al. Levamisole tainted cocaine causing severe neutropenia in Alberta and British Columbia. (case report). Harm Reduction Journal 6(1): article 30, 2009. (26 refs.)

Background: Five cases of severe neutropenia (neutrophil counts < 0.5 per 109 cells/L) associated with exposure to cocaine and levamisole, an antihelimithic agent no longer available in Canada, were identified in Alberta in 2008. Alberta and British Columbia (BC) public health officials issued an advisory and urged health care professionals to report cases to public health. This paper presents the findings of the public health investigations. Methods: Cases were identified prospectively through reporting by clinicians and a retrospective review of laboratory and medical examiners data from January 1, 2006 to March 31, 2009. Cases were categorized as confirmed, probable or suspect. Only the confirmed and probable cases are included in this paper. Results: We compare cases of severe neutropenia associated with tainted cocaine (NATC) identified in Alberta and BC between January 1, 2008 to March 31, 2009. Of the 42 NATC cases: 23(55%) were from Alberta; 19(45%) were from British Columbia; 57% of these cases reported crack cocaine use (93% of those who identified type of cocaine used); 7% reported using cocaine powder; and the main route of cocaine administration was from smoking (72%). Fifty percent of the NATC cases had multiple episodes of neutropenia associated with cocaine use. Cases typically presented with bacterial/fungal infections and fever. One Alberta NATC case produced anti-neutrophil antibodies, and four were positive for anti-neutrophil cytoplasmic antibody (ANCA). Analysis of two crack pipes and one drug sample obtained from NATC cases confirmed the presence of both cocaine and levamisole. A further 18 cases were identified through the retrospective review of laboratory and medical examiner data in Alberta. Interpretation: Our findings support a link between neutropenia and levamisole tainted cocaine; particularly from smoking the crack form of cocaine. Some patients may be genetically predisposed to develop levamisole-related neutropenia. Awareness of the differential diagnosis will assist clinicians with case timely detection and appropriate management.

Ko BJ; Suh S; Suh YJ; In MK; Kim SH. The impurity characteristics of methamphetamine synthesized by Emde and Nagai method. Forensic Science International 170(2/3, Special Issue): 142-147, 2007. (15 refs.)

Impurity profiling and classification of seized methamphetamine may play an important role in the interpretation of analytical results, the determination of the synthetic method employed, and the criminal investigations of drug traffic routes. Our study is focused on classifying seized methamphetamine samples according to the groups sorted by the types and quantities of impurities present in illicit methamphetamine samples. The samples (100 mg) were dissolved in 2 mL of potassium phosphate buffer (pH 7.0), extracted with 200 mu L of ethyl acetate under basic condition, and then analyzed by gas chromatography-mass spectrometry (GC-MS) with a DB-1 capillary column (30 m x 0.25 mm i.d., 0.25 mu m). Five impurities are used as criteria for the classification of seized methamphetamine samples by Emde and Nagai method. A total of fifty-two samples of seized methamphetamine were analyzed by GC-MS and classified by five organic impurities, and then sorted into four groups, which are Nagai type, Emde Type, Undetermined I type, and Undetermined 11 type.

Koushesh HR; Afshari R. A new illicit opioid dependence outbreak, evidence for a combination of opioids and steroids. Drug and Chemical Toxicology 32(2): 114-119, 2009. (23 refs.)

Opioid abuse is common in Iran. In 2005, a new version of locally produced illicit opioid vials, so called Norgesic, appeared in the illicit market, which gained popularity rapidly and led to an improvement of stigmatizing the general appearance of dependent cases. Later, some cases suffered Cushing's-like problems. A prospective case series was designed to evaluate 18 Norgesic-dependent subjects who volunteered for abstinence therapy in a rehabilitation clinic from November 1, 2005, to December 30, 2005. In this study, we aimed to describe the clinical and paraclinical findings in detail and define the potential determinants of this Cushing's syndrome outbreak. History, physical examination, plasma cortisol level, and urine screen tests were used to describe the patients. All subjects were male with a mean (SEM) age of 29.8 +/- 1.6 years. The opioid-dependence period was 8.4 +/- 0.9 years. In an average of 4.7 +/- 0.3 months, subjects increased their usage to 5.5 +/- 0.5 vials a day. Patients claimed to gain weight. Striae were seen in 38.9%, previously documented psychological problems in 33.3%, weakness in 27.8%, high systolic blood pressure in 22.2%, moon face in 16.7%, hirsutism in 11.1%, extensive dermal infection in 11.1%, gynecomastia in 5.6%, back pain in 5.6%, insomnia in 5.6%, and lack of potency in 5.6%. Their cortisol level, on average, was 4.8 +/- 1.1 mu g/dL. Hepatitis C virus was positive in 22.2%. Urine-screening tests were positive for morphine and negative for buprenorphine. In conclusion, these new vials contain steroids as well as opioids. This combination could be more dangerous than opioids themselves.

Kowalski R; Wiercinski J. Mercury content in smoke and tobacco from selected cigarette brands. Ecological Chemistry and Engineering 16(2): 155-162, 2009. (13 refs.)

The study aimed at evaluating the total mercury content in tobacco and smoke released from selected cigarette brands. "Mechanical lips" were applied for determining the mercury concentration in cigarette smoke, and its level was calculated by balancing it in tobacco, ash, and cigarette filter. Analyses were made using mercury analyser AMA-254. The study material consisted of selected-brands cigarettes grouped according to tar and nicotine substances contents declared by a producer: 3 brands (L1, L2, and L3) filled with low-tar and low-nicotine tobacco (4 and 0.3 mg/cigarette); 5 brands (M1, M2, M3, M4, and M5) characterized by medium tar and medium nicotine contents (6 divided by 8 and 0.5 divided by 0.6 mg/cigarette), and two remaining brands (S1, S2) with high-tar and high-nicotine levels (12 and 1.0 mg/cigarette). Mercury contents in tobacco from tested cigarette brands ranged from 2.95 to 10.2 ng Hg per a single cigarette. Almost all mercury contained was released to the smoke (from 86.7 to 100%). Cigarette filters made of cellulose acetate appeared to be insufficient barrier for volatile mercury. In some cases, release of mercury from the filter into the smoke was observed. The element content in the filter was higher after than before smoking the cigarette for most brands; however, these were similar values to the metal content before smoking out. Applied filter filled with activated charcoal (single cigarette brand) contained the same amount of mercury before and after smoking the cigarette. Considering 20 smoked cigarettes as daily mean value for an individual person, it can be stated that it is a serious mercury source which supplies the smoker with a dose of 60 divided by 200 ng of the toxic element into his/her lungs every day.

Lachenmeier DW; Kanteres F; Kuballa T; Lopez MG; Rehm J. Ethyl carbamate in alcoholic beverages from Mexico (tequila, mezcal, bacanora, sotol) and cuatemala (Cuxa): Market survey and risk assessment. International Journal of Environmental Research and Public Health 6(1): 349-360, 2009. (40 refs.)

Ethyl carbamate (EC) is a recognized genotoxic carcinogen, with widespread occurrence in fermented foods and beverages. No data on its occurrence in alcoholic beverages from Mexico or Central America is available. Samples of agave spirits including tequila, mezcal, bacanora and sotol (n=110), and of the sugarcane spirit cuxa (n=16) were purchased in Mexico and Guatemala, respectively, and analyzed for EC. The incidence of EC contamination was higher in Mexico than in Guatemala, however, concentrations were below international guideline levels (< 0.15 mg/L). Risk assessment found the Margin of Exposure (MOE) in line with that of European spirits. It is therefore unlikely that EC plays a role in high rates of liver cirrhosis reported in Mexico.

Lachenmeier DW; Sarsh B; Rehm J. The composition of alcohol products from markets in Lithuania and Hungary, and potential health consequences: A pilot study. Alcohol and Alcoholism 44(1): 93-102, 2009. (42 refs.)

Aims: The rates of alcohol-attributable mortality in Lithuania and Hungary have been shown to be higher than those in most other European countries. Quality of alcohol products is investigated as a possible explanation. Methods: In a descriptive pilot study, a convenience sample of alcohol products was collected from local city markets in both countries (Lithuania n = 10, Hungary n = 15) and chemical analyses, including some that have not been done in prior studies, were conducted. The parameters studied were alcoholic strength, volatiles (methanol, acetaldehyde, higher alcohols), ethyl carbamate, anions (including nitrate) and inorganic elements (including lead). Additionally, a multi-target screening analysis for toxicologically relevant substances was conducted. Results: The majority of samples (64%) had an alcohol content between 35% vol. and 40% vol., being in accordance with the typical strength of legal spirits in Europe. Three samples containing significantly higher concentrations of alcohol above 60% vol. were found to be unrecorded alcohol products, defined as any alcohol that is outside of legal and taxed production. Screening analysis showed that those samples contained various flavourings, including the hepatotoxic substance coumarin, at concentrations above the legal limit for foods. All other substance classes under study were found to be at levels of no toxicological concern. Conclusions: Although some problems with the quality of the alcohol samples were found, there is insufficient evidence from this pilot study to conclude that alcohol quality has an influence on health as reflected in alcohol-attributable mortality rates. Given the extent of alcohol-attributable disease burden in central and eastern European countries, future research should focus on collection of large, representative samples, particularly of unrecorded sources, which was the most problematic product group in our study.

Laugesen M; Epton M; Frampton CMA; Glover M; Lea RA. Hand-rolled cigarette smoking patterns compared with factory-made cigarette smoking in New Zealand men. BMC Public Health 9: article 194, 2009. (18 refs.)

Background: Roll-your-own (RYO) cigarettes have increased in popularity, yet their comparative potential toxicity is uncertain. This study compares smoking of RYO and factory-made (FM) cigarettes on smoking pattern and immediate potential toxicity. Methods: At a research clinic, 26 RYO and 22 FM volunteer male cigarette smokers, (addicted and overnight-tobacco-abstinent) each smoked 4 filter cigarettes, one half-hourly over 2 hours, either RYO or FM according to usual habit, using the CReSSMicro flowmeter. First cigarette smoked was their own brand. Subsequent cigarettes, all Holiday regular brand, were RYOs (0.5 g tobacco with filter), or FM with filter. Cravings on 100 mm visual analogue scale, and exhaled carbon monoxide (CO) were measured before and after each cigarette smoked. Results: Smokers reported similar daily cigarette consumption (RYO 19.0, FM 17.4, p = 0.45), and similar time after waking to first cigarette. (RYO 6.1 minutes, FM 8.6 minutes, p = 0.113). First cigarette's RYO tobacco (0.45 g) weighed less than for FM (0.7 g, p < 0.001); less tobacco was burnt (0.36 g, FM 0.55 g, p < 0.001) but smoking patterns were no different. RYO smokers smoked subsequent cigarettes more intensively; inhaled 28% more smoke per cigarette (RYO 952 mL, FM 743 mL, p = 0.025); took 25% more puffs (RYO 16.9, FM 13.6, p = 0.035); puffed longer (RYO 28 seconds, FM 22 seconds, p = 0.012), taking similar puffs (RYO 57 mL, FM 59 mL). Over four cigarettes, RYOs boosted alveolar CO (RYO 13.8 ppm, FM 13.8 ppm), and reduced cravings (RYO 53%, FM 52%) no differently from FM cigarettes. Conclusion: In these smokers, RYO smoking was associated with increased smoke exposure per cigarette, and similar CO breath levels, and even with filters is apparently no less and possibly more dangerous than FM smoking. Specific package warnings should warn of RYO smoking's true risk. RYOs are currently taxed much less than FM cigarettes in most countries; similar harm merits similar excise per cigarette.

Leitz J; Kuballa T; Rehm J; Lachenmeier DW. Chemical analysis and risk assessment of diethyl phthalate in alcoholic beverages with special regard to unrecorded alcohol. PLoS one 4(12): e-8127, 2009. (38 refs.)

Background: Phthalates are synthetic compounds with a widespread field of applications. For example, they are used as plasticizers in PVC plastics and food packaging, or are added to personal care products. Diethyl phthalate (DEP) may be used to denature alcohol, e.g., for cosmetic purposes. Public health concerns of phthalates include carcinogenic, teratogenic, hepatotoxic and endocrine effects. The aim of this study was to develop and validate a method for determining phthalates in alcohol samples and to provide a risk assessment for consumers of such products. Methodology/Principal Findings: A liquid-liquid extraction procedure was optimized by varying the following parameters: type of extraction solvent (cyclohexane, n-hexane, 1,1,2-trichlorotrifluoroethane), the ratio extraction solvent/sample volume (1:1 to 50:1) and the number of extraction repetitions (1-10). The best extraction yield (99.9%) was achieved with the solvent 1,1,2-trichlorotrifluoroethane, an extraction solvent volume/sample volume ratio of 10: 1 and a double extraction. For quantification, gas chromatography/mass spectrometry with deuterated internal standards was used. The investigated samples were alcoholic beverages and unrecorded alcohol products from different countries (n = 257). Two unrecorded alcohol samples from Lithuania contained diethyl phthalate in concentrations of 608 mg/L and 210 mg/L. Conclusions/Significance: The consumption of the phthalate-positive unrecorded alcohols would exceed tolerable daily intakes as derived from animal experiments. Both positive samples were labelled as cosmetic alcohol, but had clearly been offered for human consumption. DEP seems to be unsuitable as a denaturing agent as it has no effect on the organoleptic properties of ethanol. In light of our results that DEP might be consumed by humans in unrecorded alcohols, the prohibition of its use as a denaturing agent should be considered.

Leon DA; Saburova L; Tomkins S; Andreev E; Kiryanov N; Mckee M et al. Hazardous alcohol drinking and premature mortality in Russia: A population based case-control study. Lancet 369(9578): 2001-2009, 2007. (35 refs.)

Background: The reason for the low life expectancy in Russian men and large fluctuations in mortality are unknown. We investigated the contribution of alcohol, and hazardous drinking in particular, to male mortality in a typical Russian city. Methods: Cases were all deaths in men aged 25-54 years living in Izhevsk occurring between Oct 20, 2003, to Oct 3, 2005. Controls were selected at random from the city population and were frequency matched to deaths by age. Interviews with proxy informants living in the same household as cases were done between Dec 11, 2003, and Nov, 16 2005, and were obtained for 62% (1750/2835) of cases and 57% (1750/3078) of controls. We ascertained frequency and usual amount of beer, wine, and spirits consumed and frequency of consumption of manufactured ethanol-based liquids not intended to be drunk (non-beverage alcohol), and markers of problem drinking. Complete information on markers of problem drinking, frequency of alcohol consumption, education, and smoking was available for 1468 cases and 1496 controls. Findings: 751 (51%) cases were classed as problem drinkers or drank non-beverage alcohol, compared with 192 (13%) controls. The mortality odds ratio (OR) for these men, compared with those who either abstained or were non-problematic beverage drinkers, was 6.0 (95% CI 5.0-7-3) after adjustment for smoking and education. The mortality ORs for drinking non-beverage alcohol in the past year (yes vs no) was 9.2 (7.2-11.7) after adjustment for age. Adjustment for volume of ethanol consumed from beverages lowered the OR to 8.3 (6.5-10.7), and further adjustment for education and smoking reduced it to 7.0 (5.5-9.0). A strong direct gradient with mortality was seen for frequency of non-beverage alcohol drinking independent of volume of beverage ethanol consumed. 43% of mortality was attributable to hazardous drinking (problem drinking or non-beverage alcohol consumption, or both) adjusted for smoking and education. Interpretation Almost half of all deaths in working age men in a typical Russian city may be accounted for by hazardous drinking. Our analyses provide indirect support for the contention that the sharp fluctuations seen in Russian mortality in the early 1990s could be related to hazardous drinking as indicated by consumption of non-beverage alcohol.

Lugon-Moulin N; Martin F; Krauss MR; Ramey PB; Rossi L. Arsenic concentration in tobacco leaves: A study on three commercially important tobacco (Nicotiana tabacum L.) types. Water, Air and Soil Pollution 192(1-4): 315-319, 2008. (16 refs.)

In recent years, arsenic (As) has received increased attention as humans may be exposed to it through occupational and environmental exposure. Tobacco (Nicotiana tabacum L.) like other crops can uptake this element from the soil, which may lead to human exposure. Here, we report on a survey on arsenic in cured or processed tobacco leaves obtained from Africa, Asia, Europe, South and North America. A total of 1,431 leaf samples of flue-cured, burley, and Oriental tobaccos were obtained from various sampling locations during 2002 to 2004. Arsenic concentration in the samples averaged 0.4 +/- 0.6 mu g g(-1) as determined by inductively coupled plasma-mass spectrometry. Recorded values from most samples showed that concentrations of arsenic were usually found at the lower end of the distribution. Significant differences were found among tobacco types, sampling locations, and crop years. Arsenic concentrations were rather low in the majority of regions investigated, which is compatible with data from the literature. However, sample size was small and sampling geographically restricted. Our results would need to be validated with a larger dataset.

Manini A; Labinson RM; Kirrane B; Hoffman RS; Rao R; Stajic M; Nelson LS. A novel neuromuscular syndrome associated with clenbuterol-tainted heroin. Clinical Toxicology 46(10): 1088-1092, 2008. (26 refs.)

Background. Clenbuterol is a potent, long-acting P-adrenergic agonist that has been reported as an adulterant of heroin. We describe an atypical syndrome in five users of clenbuterol-tainted heroin. Methods. All cases were referred to a regional Poison Control Center. Urine and blood were analyzed using gas and liquid chromatography as well as mass spectrometry. Case Series. Five heroin users presented with a syndrome characterized by muscular spasm, tremor, hyperreflexia, and elevated serum creatine phosphokinase concentrations. All patients lacked findings of acute clenbuterol toxicity but tested positive for clenbuterol and negative for strychnine and a battery of common potential adulterants. Conclusions. We report five cases of a novel neurormuscular syndrome in users of clenbuterol-adulterated heroin. It is unclear whether these reactions represent an atypical response to clenbuterol or another unidentified contaminant.

McAnulty JM; Jauncey ME; Monger CK; Hailstone ST; Alam NKM; Mannes TF et al. An epidemiological investigation into an outbreak of rash illness among methadone maintenance clients in Australia. Drug and Alcohol Review 26(3): 321-331, 2007. (13 refs.)

In late 2004, NSW Health received several reports of a serious desquamating rash among clients of the methadone program. We sought to identify the extent and likely cause of this outbreak. We initiated active surveillance for cases throughout Australia, a survey of dosing points in NSW, and a case control study of clients receiving methadone syrup (MS) at two clinics. Between October 2004 and March 2005, 388 cases were identified, largely in NSW. The dosing point survey found almost all cases were clients prescribed MS (attack rate 4.5%). In multivariate analysis of data from dosing points that dispensed MS, use of take away doses or location of the dosing point in greater western Sydney were associated with illness. In the case control study, MS injection, use of street MS, high doses of MS, frequent takeaway doses, or use of benzodiazepines were associated with illness. Testing found no abnormality in associated batches of MS. Batches of MS temporally associated with the outbreak were quarantined from use and the outbreak subsided. While a direct causal link could not be established, available evidence suggests that a contaminant may have caused the outbreak. Epidemiological analyses are important for assessing concerns about product safety following marketing approval.

McLaren J; Swift W; Dillon P; Allsop S. Cannabis potency and contamination: A review of the literature. (review). Addiction 103(7): 1100-1109, 2008. (82 refs.)

Aims: Increased potency and contamination of cannabis have been linked in the public domain to adverse mental health outcomes. This paper reviews the available international evidence on patterns of cannabis potency and contamination and potential associated harms, and discusses their implications for prevention and harm reduction measures. Methods: A systematic literature search on cannabis potency and contamination was conducted. Results Cannabis samples tested in the United States, the Netherlands, United Kingdom and Italy have shown increases in potency over the last 10 years. Some countries have not shown significant increases in potency, while other countries have not monitored potency over time. While there are some grounds to be concerned about potential contaminants in cannabis, there has been no systematic monitoring. Conclusion: Increased potency has been observed in some countries, but there is enormous variation between samples, meaning that cannabis users may be exposed to greater variation in a single year than over years or decades. Claims made in the public domain about a 20- or 30-fold increase in cannabis potency and about the adverse mental health effects of cannabis contamination are not supported currently by the evidence. Systematic scientific testing of cannabis is needed to monitor current and ongoing trends in cannabis potency, and to determine whether cannabis is contaminated. Additionally, more research is needed to determine whether increased potency and contamination translates to harm for users, who need to be provided with accurate and credible information to prevent and reduce harms associated with cannabis use.

Moir D; Rickert WS; Levasseur G; Larose Y; Maertens R; White P; Desjardins S. A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chemical Research in Toxicology 21(2): 494-502, 2008. (43 refs.)

The chemical composition of tobacco smoke has been extensively examined, and the presence of known and suspected carcinogens in such smoke has contributed to the link between tobacco smoking and adverse health effects. The consumption of marijuana through smoking remains a reality and, among youth, seems to be increasing. There have been only limited examinations of marijuana smoke, including for cannabinoid content and for tar generation. There have not been extensive studies of the chemistry of marijuana smoke, especially in direct comparison to tobacco smoke. In this study, a systematic comparison of the smoke composition of both mainstream and sidestream smoke from marijuana and tobacco cigarettes prepared in the same way and consumed under two sets of smoking conditions, was undertaken. This study examined the suite of chemicals routinely analyzed in tobacco smoke. As expected, the results showed qualitative similarities with some quantitative differences. In this study, ammonia was found in mainstream marijuana smoke at levels up to 20-fold greater than that found in tobacco. Hydrogen cyanide, NO, NOx, and some aromatic amines were found in marijuana smoke at concentrations 3-5 times those found in tobacco smoke. Mainstream marijuana smoke contained selected polycyclic aromatic hydrocarbons (PAHs) at concentrations lower than those found in mainstream tobacco smoke, while the reverse was the case for sidestream smoke, with PAHs present at higher concentrations in marijuana smoke. The confirmation of the presence, in both mainstream and sidestream smoke of marijuana cigarettes, of known carcinogens and other chemicals implicated in respiratory diseases is important information for public health and communication of the risk related to exposure to such materials.

Navarro-Alarcon M; Velasco C; Jodral A; Terres C; Olalla M; Lopez H et al. Copper, zinc, calcium and magnesium content of alcoholic beverages and by-products from Spain: Nutritional supply. Food Additives and Contaminants 24(7): 685-694, 2007. (42 refs.)

Levels of copper, zinc, calcium and magnesium were measured in alcoholic beverages (whiskies, gins, turns, liquors, brandies, wines and beers) and by-products (non-alcoholic liquors and vinegars) using flame atomic absorption spectrometry (FAAS). Mineral concentrations were found to be significantly different between the nine alcoholic and nonalcoholic by-products studied (p < 0.001). In distilled alcoholic beverages, concentrations measured in turns and brandies were statisticallv lower than those determined in gins and alcoholic liquors (p = 0.001). For Cu, measured concentrations were statistically different for each of the five groups of distilled alcoholic beverages studied (p < 0.001). In fermented beverages, Zn, Ca and Mg levels were significantly higher than those concentrations determined in distilled drinks (p < 0.005). Contrarily, Cu concentrations were statistically lower (p < 0.001). Wines designated as sherry had significantly higher Ca and Mg levels (p < 0.005). White wines had significantly higher Ca and Zn levels (p < 0.05) compared with red wines and, contrarily, Cu concentrations were significantly lower (p < 0.005). In wine samples and corresponding by-products (brandy and vinegar), statistical differences were established for all minerals analysed (p < 0.01). Remarkably, for Cu, the concentrations determined in brandies were statistically higher. On the basis of element levels and the official data on consumption of alcoholic beverages and by-products in Spain, their contribution to the daily dietary intake (DDI) was calculated to be 124.6 mu g Cu day(-1) and 193.3 mu g Zn day(-1), 40.3 mg Ca day(-1) and 19.9 mg Mg day(-1). From all studied elements, Cu was the one for which alcoholic beverages constitute a significant source (more than 10% of recommended daily intake). These findings are of potential use to food composition tables.

Novak B; Meinardi S; Blake D. Methyl chloride and the US cigarette. Nicotine & Tobacco Research 10(11): 1621-1625, 2008. (28 refs.)

Various brands and types of cigarettes were purchased at retail locations in southern California. Volatile gas samples were analyzed using multicolumn/multidetector gas chromatography. Results showed methyl chloride (CH3Cl) levels as much as four orders of magnitude higher than typical urban levels, about 30-500ppmv (1.5-5.3mg/cigarette), compared with about 500pptv in urban air. The concentration of CH3Cl correlated well with the levels of both CO (r 2=0.63) and CO2 (r 2=0.77), showing the link between CH3Cl and combustion. In some brands, CH3Cl levels were well above the U.S. Environmental Protection Agency's maximum exposure limit of 200ppmv. Light branded cigarettes tended to have higher CH3Cl levels than the heavier and filtered brands, possibly showing the dependence of cigarette packing on CH3Cl production. In addition, CH3Cl emitted from cigarette smoke may prove to be an important anthropogenic source of CH3Cl in the United States, at about 5%.

Papastefanou C. Radioactivity of tobacco leaves and radiation dose induced from smoking. International Journal of Environmental Research and Public Health 6(2): 558-567, 2009. (30 refs.)

The radioactivity in tobacco leaves collected from 15 different regions of Greece and before cigarette production was studied in order to find out any association between the root uptake of radionuclides from soil ground by the tobacco plants and the effective dose induced to smokers from cigarette tobacco due to the naturally occurring primordial radionuclides, such as Ra-226 and Pb-210 of the uranium series and Ra-228 of the thorium series and/or man-made radionuclides, such as Cs-137 of Chernobyl origin. Gammaray spectrometry was applied using Ge planar and coaxial type detectors of high resolution and high efficiency. It was concluded that the activities of the radioisotopes of radium, Ra-226 and Ra-228 in the tobacco leaves reflected their origin from the soil by root uptake rather than fertilizers used in the cultivation of tobacco plants. Lead-210 originated from the air and was deposited onto the tobacco leaves and trapped by the trichomes. Potassium-40 in the tobacco leaves was due to root uptake either from soil or from fertilizer. The cesium radioisotopes Cs-137 and Cs-134 in tobacco leaves were due to root uptake and not due to deposition onto the leaf foliage as they still remained in soil four years after the Chernobyl reactor accident, but were absent from the atmosphere because of the rain washout (precipitation) and gravitational settling. The annual effective dose due to inhalation for adults (smokers) for Ra-226 varied from 42.5 to 178.6 mu Sv/y (average 79.7 mu Sv/y), while for Ra-228 from 19.3 to 116.0 mu Sv/y (average 67.1 mu Sv/y) and for Pb-210 from 47.0 to 134.9 mu Sv/y (average 104.7 mu Sv/y), that is the same order of magnitude for each radionuclide. The sum of the effective doses of the three radionuclides varied from 151.9 to 401.3 mu Sv/y (average 251.5 mu Sv/y). The annual effective dose from Cs-137 of Chernobyl origin was three orders of magnitude lower as it varied from 70.4 to 410.4 nSv/y (average 199.3 nSv/y).

Park SR; Ha SD; Yoon JH; Lee SY; Hong KP; Lee EH et al. Exposure to ethyl carbamate in alcohol-drinking and nondrinking adults and its reduction by simple charcoal filtration. Food Control 20(10): 946-952, 2009. (34 refs.)

The risk of exposure to ethyl carbamate from the consumption of kimchi, soy sauce, and alcoholic beverages was assessed in alcohol-drinking and nondrinking adults. An alcohol-drinking adult obtains 5.6-9.2 ng/kg bw/day of ethyl carbamate through the addition of kimchi and soy sauce, while a nondrinking adult receives 3.3-4.0 ng/kg bw/day via kimchi and soy sauce alone. The average excess cancer risk of an alcohol-drinking adult (3.9 x 10(-7)) was also twice higher than that of an adult who does not drink (1.9 X 10(-7)). We achieved a maximum of 47% and 45% removal of the ethyl carbamate present in diluted spirits and soy sauce, respectively, through a simple charcoal filtration process. This resulted in a reduction of the average daily intakes of ethyl carbamate through diluted spirits and soy sauce from 1.7 and 2.2 ng/kg bw/day to 0.9 and 1.2 ng/kg bw/day, respectively.

Parna K; Lang K; Raju K; Vaeli M; McKee M. A rapid situation assessment of the market for surrogate and illegal alcohols in Tallinn, Estonia. International Journal of Public Health 52(6): 402-410, 2007. (25 refs.)

Objectives: To understand the phenomenon of consumption of surrogate and illegal alcohols in Tallinn, capital of Estonia. Methods: This study, conducted in Tallinn in May 2006, used rapid situation assessment. Interviews with key informants in relevant settings such as emergency departments of hospitals, accommodation for the homeless, police etc. (n = 22), with alcohol abusers (n = 33), natural observations of surrogate sale and consumption venues (n = 46), and tracking of trade data were carried out. Results: Key informants confirmed that consumption of illegal and surrogate alcohols are widely used by alcohol abusers, a finding confirmed by the alcohol abusers. Availability of surrogates varied by area of the city, mainly sold from street kiosks. Illegally produced spirits were also easily available. Sales of surrogates appear to have increased in recent years. Conclusion: A range of alcohol-containing substances that appear to be easily available at low cost, and that have high concentration of ethanol or contaminants known to be toxic, were identified in Tallinn. Alcohol policies in Estonia should address the consumption and availability of these substances.

Reuter N; Ta ML; Vagi S. Agranulocytosis Associated with Cocaine Use --- Four States, March 2008--November 2009. MMWR. Morbidity and Mortality Weekly Review 58(49): 1381-1385, 2009. (9 refs.)

In April 2008, a clinical reference laboratory in New Mexico notified the New Mexico Department of Health (NMDOH) of a cluster of unexplained agranulocytosis cases confirmed by bone marrow histopathology during the preceding 2 months. NMDOH began an investigation, which identified cocaine use as a common exposure in 11 cases of otherwise unexplained agranulocytosis during April 2008--November 2009. In the midst of the NMDOH investigation, in November 2008, public health officials in British Columbia and Alberta, Canada, reported detecting levamisole (an antihelminthic drug used mainly in veterinary medicine and a known cause of agranulocytosis) from clinical specimens and drug paraphernalia of cocaine users with agranulocytosis. In January 2009, NMDOH posted a notification of its findings on CDC's Epidemic Information Exchange (Epi-X) and notified poison control centers. In a separate investigation during April--November 2009, public health officials in Seattle, Washington, identified 10 cases of agranulocytosis among persons with a history of cocaine use. Of the 21 cases, levamisole was detected from clinical specimens in four of the five patients tested. According to the Drug Enforcement Administration (DEA), as of July 2009, 69% of seized cocaine lots coming into the United States contained levamisole as an added agent. This report summarizes the investigations in New Mexico and Washington, which suggested that levamisole in cocaine was the likely cause of the agranulocytosis. Health-care providers should consider these findings in the differential diagnosis of agranulocytosis, and public health officials should be aware of cases of agranulocytosis associated with cocaine use. [ NB. Agranulocytosis is an uncommon condition (7.2 cases per 1 million population per year, excluding patients with cancer and patients receiving cytotoxic drugs, that carries a risk for opportunistic infections and can be fatal in approximately 7%--10% of cases. ]

Public Doman

Risser D; Uhl A; Oberndorfer F; Honigschnabl S; Stichenwirth M; Hirz R et al. Is there a relationship between street heroin purity and drug-related emergencies and/or drug-related deaths? An analysis from Vienna, Austria. Journal of Forensic Sciences 52(5): 1171-1176, 2007. (39 refs.)

This study examines the quality of street heroin seized in Vienna in 1999 and whether there was a relationship between the purity of street heroin and the number of heroin-related emergencies as well as the number of heroin-related deaths. Street heroin confiscated by the Viennese police, run-sheets of drug-related emergencies, and postmortem reports of drug-related deaths in Vienna in 1999 were analyzed. A total of 415 retail samples with a total weight of 128.02 g contained a median percentage of 6.5% diacetylmorphine (range: 0.0-47.0%). All the samples contained a diluent, mainly lactose, as well as adulterants, such as caffeine and/or paracetamol. During the study period, 75 heroin-related deaths and 387 heroin-related emergencies were registered in Vienna. Time-series analysis revealed no statistically significant relationship between the rate of heroin-related incidents and the diacetylmorphine concentration of street heroin samples confiscated in Vienna in 1999. The widely held belief that the number of heroin-related deaths could be explained simply through fluctuations in the purity of street heroin could not be substantiated, even though the results of this study do not rule out an association between the purity of heroin and heroin-related deaths/emergencies.

Savchuk SA; Kolesov GM; Nuzhnyi VP. Chromatographic study of the chemical composition and potential toxicity of spirits and alcoholic beverages. Journal of Analytical Chemistry 62(6): 575-582, 2007. (17 refs.)

The composition of vodkas, rectified food alcohols, cognacs, cognac spirits, and other strong alcoholic beverages was studied by chromatography and compared with the composition of industrial (synthetic and hydrolysis) ethyl alcohols, adulterated cognacs, and homemade spirits (samogon) from the illicit market. It was found that the majority of the test alcohol-containing liquids were close to commercial alcoholic beverages in terms of chemical composition and toxic properties. The samples containing ethylene glycol and enriched components of the head fraction of rectification should be considered most toxic.

Schayer S; Nowak B; Wang YL; Qu QS; Cohen B. Po-210 and Pb-210 activity in Chinese cigarettes. Health Physics 96(5): 543-549, 2009. (36 refs.)

The radon decay products lead-210 (Pb-210) and polonium-210 (Po-210) are known components of tobacco. China is the world's largest producer and consumer of cigarettes, yet no comprehensive published reports of the Pb-210 and Po-210 activity concentrations in Chinese cigarettes are available. Twelve brands of cigarettes that were commonly smoked within a group of 184 Chinese smokers were selected for Ph-210 and Po-210 activity analysis. For each brand, the tobacco from two cigarettes was isolated, dried, weighed, spiked with a (209)po tracer for yield, and digested with concentrated HNO3, followed by HCl. The polonium in each digested solution was spontaneously deposited onto a nickel disc. The polonium activity was then counted rising alpha spectroscopy. The mean (range) Po-210 activity for all brands was 23 (18-29) mBq cig(-1). The state of radioactive equilibrium between (210)To and Pb-210 in each cigarette was verified in three brands of cigarettes. Cigarettes from two brands were smoked on a machine in order to estimate the fraction of Pb-210 and Po-210 inhaled. An average of 8% of the Pb-210 and 13% of the Po-210 in the tobacco of the cigarettes was transferred to the mainstream smoke. It is thus estimated that a person smoking 20 of these cigarettes per day in China would inhale a mean (range) of 37 (29-46) mBq d(-1) of Pb-210 and 60 (47-75) mBq d(-1) of Po-210. Cigarette smoking in China may therefore be a large source of a person's daily intake of Pb-210 and Po-210.

Schifano F; Corkery J. Cocaine/crack cocaine consumption, treatment demand, seizures, related offences, prices, average purity levels and deaths in the UK (1990-2004). Journal of Psychopharmacology 22(1): 71-79, 2008. (59 refs.)

A recent trend of escalating use of cocaine/crack cocaine was observed in the UK. The number of mentions on death certificates; last year use of cocaine; treatment demand, number of drug offenders, seizures, prices and average purity levels were the indicators used for this descriptive and correlational study. Figures ( 1990-2004) were taken from official UK sources. A total of 1022 cocaine/crack cocaine death mentions ( i.e. deaths from any cause where the presence of cocaine/ crack cocaine was also detected) were identified, with cocaine/ crack cocaine being the sole drug mentioned in 36% of cases. The number of cocaine/ crack cocaine death mentions showed a year-on-year increase and correlated positively with the following cocaine ( powder) figures: last year use ( p < 0.001); number of offenders ( p < 0.001) and number of seizures ( p < 0.001), but correlated negatively with price ( p < 0.001). Furthermore, the number of cocaine/ crack cocaine death mentions correlated positively with the number of crack offenders ( p < 0.001) and seizures ( p < 0.001), but correlated negatively with both crack purity ( p < 0.001) and price ( p < 0.05). With conditions of increasing drug availability having been met in the UK, decrease in cocaine prices were associated with higher consumption levels and this, in turn, contributed to the increase in number of cocaine-related fatalities. There are limitations with the information collected, since no distinction is usually made on medical death certificates between cocaine and crack cocaine. The present study being an ecological one, it proved difficult to address the role of confounding variables that may well explain some of the associations observed.

Schroeter M; Alpers K; Van Treeck U; Frank C; Rosenkoetter N; Schaumann R. Outbreak of wound botulism in injecting drug users. Epidemiology and Infection 137(11): 1602-1608, 2009. (32 refs.)

Between October and December 2005, 16 cases of wound botulism were notified to the health authorities of North Rhine-Westphalia, Germany. All patients were injecting drug users (IDU) and the epidemiological investigations suggested contaminated injection drugs as the most probable source of infection. Clostridium botulinum was cultivated from clinical samples of six patients and molecular typing revealed that the different isolates were clonally identical. Two samples of heroin, one of them provided by a patient, were examined but C. botulinum could not be isolated. This outbreak demonstrates that IDU are at risk for acquiring wound botulism by injecting contaminated drugs. A greater awareness of this disease is needed by physicians and a close cooperation between public health authorities, street workers, operators of sheltered injecting facilities, and medical centres focusing on IDU is essential to prevent and manage outbreaks in IDU in a timely manner.

Seeman JI; Carchman RA. The possible role of ammonia toxicity on the exposure, deposition, retention, and the bioavailability of nicotine during smoking. (review). Food and Chemical Toxicology 46(6): 1863-1881, 2008. (175 refs.)

A complete and rigorous review is presented of the possible effect(s) of ammonia on the exposure, deposition and retention of nicotine during smoking and the bioavailability of nicotine to the smoker. There are no toxicological data in humans regarding ammonia exposure within the context of tobacco smoke. Extrapolation from occupational exposure of ammonia to smoking in humans suggests minimal, non-toxicological effects, if any. No direct study has examined the effect of the ammonia on the total rate or amount of nicotine reaching the arterial bloodstream or brains of smokers. Machine-smoking methods have been reported which accurately quantify >99% of the nicotine in mainstream (MS) smoke for a wide variety of commercial and test cigarettes, including a series of experimental cigarettes having a range in MS smoke ammonia yields using the US Federal Trade Commission (FTC) protocol. However, the actual exposure of nicotine to smokers depends on their own smoking behavior. The nicotine ring system is relatively thermally stable. Protonated nicotine forms nicotine which evaporates before the nicotine ring system decomposes. The experimental data indicate that neither nicotine transfer from tobacco to MS smoke nor nicotine bioavailability to the smoker increases with an increase in any of the following properties: tobacco soluble ammonia, MS smoke ammonia, "tobacco pH" or "smoke pH" at levels found in commercial cigarettes. Gas phase nicotine deposits primarily in the mouth and upper respiratory tract. To the extent that ammonia increases the deposition of nicotine in the buccal cavity and upper respiratory tract during smoking, the total rate and amount of nicotine into the arterial bloodstream and to the central nervous system will decrease. Charged nicotine analogues are actively transported in a number of tissues. This active transport system appears to be insensitive to pH and the form of nicotine in the biological milieu, suggesting that protonated nicotine may be a substrate for active transport. Neither "smoke pH" of commercial cigarettes nor "smoke pH(eff)" nor the fraction of non-protonated nicotine in tobacco smoke particulate matter are useful, practical smoke parameters for providing understanding or predictability of nicotine bioavailability to smokers. Greater than 95% of both ammonia and nicotine are in the gas phase of environmental tobacco, and both are likely to deposit in the buccal cavity and upper respiratory tract following exposure.

Shahab L; West R; McNeill A. A comparison of exposure to carcinogens among roll-your-own and factory-made cigarette smokers. Addiction Biology 14(3): 315-320, 2009. (34 refs.)

Consumption of roll-your-own (RYO) tobacco is rising, but little is known about: its in vivo delivery of toxins relative to factory-made (FM) cigarettes. To start to address this issue, this study compared the concentrations of metabolites of recognized human carcinogens in smokers of RYO tobacco and FM cigarettes. We opportunistically recruited 1.27 FM and 28 RYO cigarette smokers in central London and collected saliva and Urine samples. Saliva samples were assayed for cotinine while urinary samples were assayed for I.-hydroxypyrene (1-HOP) and total 4-(methylnitrosamino)-1(3-pyridyl)-1-butanol (NNAL), metabolic markers of polycyclic aromatic hydrocarbons and tobacco-specific N-nitrosamines, respectively. Data on socio-demographic, anthropometric and puffing characteristics were also obtained. Both unadjusted and adjusted analyses (controlling for age, sex, body mass index, puff flow, puff duration and cotinine) showed no difference in metabolic markers between RYO and FM cigarette smokers. However, significant main effects for cotinine levels and sex were observed in adjusted analyses. Greater levels of cotinine were associated with a greater concentration of both I-HOP (B = 0.002, P = 0.037) and NNAL (B = 0.002, P < 0.001). In addition, women had significantly greater concentrations of urinary I.-HOP (B = 0.679, P = 0.004) and total NNAL metabolites (B = 0.117, P = 0.024) than men, irrespective of the type of cigarettes smoked. More research is now needed to confirm these findings and gender-specific effects in a larger representative sample. However, results do not support the common belief that RYO cigarettes are less harmful than manufactured cigarettes.

Stepanov I; Jensen J; Hatsukami D; Hecht S. New and traditional smokeless tobacco: Comparison of toxicant and carcinogen levels. Nicotine & Tobacco Research 10(12): 1773-1782, 2008. (48 refs.)

Declining cigarette use and spreading bans on smoking in public places in the United States are encouraging the U.S. cigarette industry to turn to another tobacco category, smokeless tobacco products. Currently, a number of new brands are being test marketed, including Taboka, Marlboro Snus, Camel Snus, and Skoal Dry. We report here levels of tobacco-specific nitrosamines (TSNAs), alkaloids, anions, polycyclic aromatic hydrocarbons (PAH), and volatile aldehydes in these products, and compare them to the most popular traditional moist snuff brands. Total TSNAs averaged 1.97g/g dry weight tobacco in Taboka, Marlboro Snus, and Camel Snus, 4.54g/g tobacco in Skoal Dry, and 7.42g/g tobacco in traditional brands. The amounts of unprotonated nicotine averaged 0.961mg/g tobacco in Taboka, Marlboro Snus, and Skoal Dry, 7.22mg/g tobacco in Camel Snus, and 7.57mg/g tobacco in traditional brands. Levels of minor tobacco alkaloids were relatively high in Taboka, Marlboro Snus, and Skoal Dry, as compared to other products analyzed here. Levels of nitrite and nitrate in new U.S. smokeless tobacco products and the Swedish snus General were lower than those in the other products. Remarkably high levels of chloride and some PAH were observed in the traditional moist snuff. Crotonaldehyde levels were about five times higher in Taboka and Marlboro Snus than in traditional products. The large variation in the levels of some toxicants and carcinogens analyzed here indicates that more effort is required from the U.S. tobacco industry to further reduce their amounts in new and traditional smokeless tobacco products.

Strathdee SA; Case P; Lozada R; Mantsios AR; Alvelais J; Pu MY et al. The color of meth: Is it related to adverse health outcomes? An exploratory study in Tijuana, Mexico. American Journal on Addictions 17(2): 111-115, 2008. (12 refs.)

In a study of injection drug users (IDUs) in Tijuana, Mexico, logistic regression identified factors associated with injection of colored vs. clear methamphetamine in the prior six months (N = 613). Colors injected most often were clear (50%), white (47%), yellow (2%), and pink (1%). IDUs injecting colored meth were more likely to experience recent abscesses (34%) compared to those injecting clear meth (24%; p = 0.008), an association that persisted after adjusting for confounders. Market characteristics, possibly relating to purity or adulterants, may be associated with abscesses among methamphetamine injectors. Further study is needed to confirm and determine the mechanism of this association to better inform prevention messages.

Tahir SNA. Results of survey for assessing awareness level regarding radiological hazards of tobacco smoking. Radiation Protection Dosimetry 133(2): 111-114, 2009. (10 refs.)

Human consumption of tobacco is as old as human history. However, injurious health effects due to tobacco smoking may not be evident to the public at large. This article presents results of a questionnaire based on a survey carried out in the metropolitan city of Lahore of Pakistan with an aim to understand the awareness level of the general population about the radiological hazards associated with tobacco smoking. Some 3600 participants from different educational backgrounds from all segments of the society participated in this survey. Analysis of the data collected concluded that the awareness level of the representative participants regarding the radiological hazards associated with tobacco smoking was alarmingly poor. These results suggest that a nationwide mass media campaign may be launched by the government authorities in Health and Environment departments to enlighten the general public in this respect to avoid tobacco-smoking-associated health risks.

Vallersnes OM; Lund C; Duns AK; Netland H; Rasmussen IA. Epidemic of poisoning caused by scopolamine disguised as Rohypnol (TM) tablets. Clinical Toxicology 47(9): 889-893, 2009. (13 refs.)

Objective. An epidemic of scopolamine poisonings occurred in Oslo in 2008 among users of illicit drugs, caused by fake Rohypnol (TM) pills. The clinical features, diagnostic process, and handling of the epidemic are presented. Methods. Suspected cases of scopolamine poisoning were extracted by reviewing registration forms from an ongoing prospective clinical study of acute poisonings in Oslo. Medical records of extracted contacts were examined and cases included according to specified clinical criteria. Results. Forty-four cases of probable scopolamine poisoning were registered. Main clinical features were mydriasis, visual hallucinations, plucking behavior, agitation, and coma. No clinical diagnosis of anticholinergic syndrome was made prior to forensic analysis of the tablets, the most frequent diagnosis up to this point being unspecified drug-induced psychosis. Later in the epidemic, scopolamine poisoning became the dominating diagnosis. Ten patients were admitted to psychiatric hospitals, the rest recovered in medical units, or left health care against medical advice. Discussion. Scopolamine poisonings are rare, but the resulting anticholinergic syndrome is well described. The syndrome was not recognized until the forensic analysis result strikingly changed how the patients were diagnosed and handled. A unique aspect of this epidemic was the intoxicating agent being scopolamine-containing tablets looking like Rohypnol (TM), sold and used under the impression of being the latter. Conclusion. Recognizing the anticholinergic syndrome is important to provide proper treatment. Forensic analysis was the key to correct diagnosis in this outbreak, demonstrating its importance in verifying an epidemic of poisoning by fake drugs.

Vesper HW; Bernert JT; Ospina M; Meyers T; Ingham L; Smith A et al. Assessment of the relation between biomarkers for smoking and biomarkers for acrylamide exposure in humans. Cancer Epidemiology, Biomarkers & Prevention 16(11): 2471-2478, 2007. (44 refs.)

Smoking is an important source of acrylamide exposure in the general population. We assessed the relationship between hemoglobin adducts of acrylamide (HbAA) and glycidamide (HbGA) as biomarkers of acrylamide exposure and plasma cotinine (PC) as biomarkers of tobacco smoke exposure in 94 men and 67 women. The median (5th-95th percentile) biomarker concentrations (pmol/g Hb) in the group of individuals with PC concentrations of <= 10 ng/mL were 51 (29-155) and 34 (16-117) for HbAA and HbGA, respectively. They were significantly lower than those in the group of individuals with PC concentrations of >10 ng/mL [194 (87-403) and 107 (41-215) for HbAA and HbGA, respectively]. In individuals with PC concentrations of <1 ng/mL, HbAA and HbGA were similar to those observed in the group with PC values of <= 10 ng/mL. The intersubject variability was profoundly smaller in the group with PC values of <= 10 ng/mL compared with the group with PC values of >10 ng/mL. Although HbAA and HbGA could be categorized into distinguishable groups using PC concentration ranges commonly used to categorize presumed smokers and nonsmokers, no significant relationship was observed between these two biomarkers and PC within each group. The different exposure periods reflected by these biomarkers and the resulting different susceptibility to short-term variations in exposure patterns may in part explain these observations. The findings suggest that tobacco smoke exposure in individuals with PC values of <1 ng/mL has only a minimal effect on HbAA and HbGA.

Wilcox JA; Wilcox AH. Movement disorders and MDMA abuse. Journal of Psychoactive Drugs 41(2): 203-204, 2009. (12 refs.)

This article present the cases of two young men with chronic MDMA abuse who later developed movement disorders typical of the Parkinson's syndrome. It is worth noting that both men bought the presumed MDMA from the same illicit source. Potential risks of MDMA use and movement disorders are discussed. The risks inherent from contaminants and similar factors associated with illegal drug manufacture are discussed. The authors conclude that as long as nonpharmaceutical-grade MDMA is illicitly produced, health risks will be associated with its use.

Wong SC; Curtis JA; Wingert WE. Concurrent detection of heroin, fentanyl, and xylazine in seven drug-related deaths reported from the Philadelphia Medical Examiner's Office. Journal of Forensic Sciences 53(2): 495-498, 2008. (17 refs.)

Recreational drugs, such as cocaine and heroin, are often adulterated with other pharmacological agents to either enhance or diminish the drug effects. Between April 21, 2006 and August 8, 2006, the Philadelphia Medical Examiner's Office detected xylazine (a veterinary sedative) and fentanyl (a synthetic opioid) in specimens taken from seven cases. Initial immunoassay screening was performed on urine and blood for fentanyl, opiate, cocaine, phencyclidine (PCP), and benzodiazepines. All tests reported positive were confirmed by gas chromatography-mass spectrometry. All seven xylazine positive cases tested positive for fentanyl and six cases tested positive for 6-acetylmorphine (a metabolite and definitive marker for heroin). The seventh case was positive for morphine and had a history of heroin abuse. Xylazine was present in urine in all seven cases and blood levels were detected in three cases. The blood concentrations ranged from trace to 130 ng/mL. Fentanyl was present in the blood and urine in each case and blood concentrations ranged from 4.7 to 47 ng/mL. Adulteration of illicit drugs has become an epidemic health concern for drug users. Healthcare professionals need to be aware of this issue, so the patients can be treated in an effective, timely manner.

Zhang JX; Zhang DM; Han XG. Identification of impurities and statistical classification of methamphetamine hydrochloride drugs seized in China. Forensic Science International 182(1-3): 13-19, 2008. (19 refs.)

A total of 48 methamphetamine hydrochloride samples from eight seizures were analyzed using gas chromatography-mass spectrometry (GC-MS) and gas chromatography with a flame ionization detector (GC-FID). Major impurities detected include 1,2-dimethyl-3-phenylaziridine, ephedrine/pseudoephedrine, 1,3-dimethyl-2-phenylnaphthalene, 1-benzyl-3-methylnaphthalene. These data are suggestive of ephedrine/pseudoephedrine as the main precursor of the methamphetamine hydrochloride samples seized during 2006-2007. Additionally the presence of 1,3-dimethyl-2-phenylnaphthalene, 1-benzyl-3-methylnaphthalene is indicative that six seizures were synthesized via the more specific ephedrine/hydriodic acid/red phosphorus method. In addition, five impurities were found for the first time in methamphetamine hydrochloride samples. Seventeen impurity peaks were selected from the GC-FID chromatograms. The peak areas of the selected peaks were then grouped for cluster analysis.

Agrawal SS; Rajagopal K. Nicotine contents in various toothpowders (dant manjans): Measurement and safety evaluation. Food and Chemical Toxicology 47(3): 511-524, 2009. (24 refs.)

The use of tobacco products as dentrifice is prevalent in various parts of India. Among them toothpowder (dant manjan) is very common. These nicotine containing toothpastes/tooth powders are health hazards and is also habit forming. Health experts of India rightly banned use of nicotine containing toothpowder as early as 1992 by making proper legislation. We just made an attempt to verify whether the manufacturers complying the legislation or not. Eight leading brands of toothpowders were analyzed qualitatively by gas chromatography-mass spectrum detector and also quantitatively by gas chromatography-nitrogen phosphorus detector. Our results indicated four brands were found to contain nicotine in the range of 2.53 mu g/g to 11.50 mg/g of toothpowder. This finding further confirms that addition of nicotine in dentifrice violates the regulatory norms. Regulatory authorities should give more attention to ensure that all toothpowders are free from nicotine which is also a statutory requirement.