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Asbjørg S Christophersen

Publications and source records attributed to Asbjørg S Christophersen.

11 recordsLinked to original sources
PubMed2006

Carisoprodol intoxications: a retrospective study of forensic autopsy material from 1992-2003.

Carisoprodol is commonly prescribed as a centrally acting muscle relaxant, but it is also subject to abuse. The literature describing fatal intoxications with the drug is limited to a relatively small number of cases, and there are inconsistencies with regard to which concentration levels that are toxic. We therefore investigated all forensic autopsies at the Norwegian Institute of Public Health during the period 1992-2003 where carisoprodol was detected. The median concentrations of carisoprodol in intoxication with carisoprodol only or with only minor other analytical findings was 36 mg/l (range 8-65 mg/l; n=5). In the rest of the intoxications, the relevance of carisoprodol relative to the other drugs detected was variable (n=93). When the number of intoxications with carisoprodol each year were divided by the number of defined daily doses (DDD) sold, a fatal toxicity index between 5.6 and 6.9 deaths/1 million DDD was obtained. The total number of cases where carisoprodol was detected increased during the period studied, which correlated to sales figures for the drug. We conclude that carisoprodol can be fatal in concentrations below those indicated in some of the previously published literature. There were, however, only a small number of cases where the cause of death can be attributed to use of carisoprodol alone.

Adolescent↗
PubMed2006

A study of ethyl glucuronide in post-mortem blood as a marker of ante-mortem ingestion of alcohol.

The possibility of post-mortem production of ethanol makes correct interpretation of ethanol detection in forensic autopsy samples difficult. Even though the levels of ethanol formed post-mortem are generally low, this may be highly relevant in cases where intake of alcohol was forbidden, for instance for pilots, professional drivers and countries with low legal alcohol limits for driving. Different criteria are used to determine whether a finding of ethanol is of exogenous origin, but there is no marker for alcohol ingestion that has been studied in detail. In this study, we wanted to evaluate the sensitivity and specificity of ethyl glucuronide (EtG), a direct minor metabolite of ethanol, measured in blood, as a marker of ante-mortem alcohol ingestion. Forensic autopsy cases were divided into groups with and without ante-mortem alcohol ingestion, according to strict inclusion criteria. In 93 cases with information on ante-mortem alcohol ingestion, EtG was detected in blood in all cases, even when levels of ethanol were low. In another 53 cases where there were no indications of ante-mortem alcohol intake, EtG could not be detected in blood in a single case, also in 11 cases in which ethanol was detected and considered to be most probably formed post-mortem. In conclusion, blood EtG determination seems to be a reliable marker of ante-mortem ingestion of alcohol, and it could be considered in forensic autopsy cases when post-mortem formation of ethanol is questioned.

Adolescent↗
PubMed2006

Naltrexone implants -- duration, tolerability and clinical usefulness. A pilot study.

Naltrexone blocks opioid effects effectively, but poor compliance limits the clinical usefulness in the treatment of opioid dependence. Long-acting implanted formulations might increase the clinical feasibility. Several implants have been produced, but few clinical reports have been published. This paper describes an open trial with an Australian implant. This implant is claimed to have duration of up to six months with double implants and acceptable levels of side effects. This was explored in the present pilot study with 13 opioid-dependent patients. By single implant of 1.8 g naltrexone the duration judged by naltrexone plasma levels above 1 ng/ml naltrexone was between 2 and 4 months. Double implants maintained such plasma levels for 5-6.5 months. Clinically, the implants appeared promising. Side effects were minimal. During the period with adequate plasma levels of naltrexone, use of opioids was absent and use of other psychoactive drugs reduced. At 1-year follow-up, the patients rated the implants highly positively.

Drug Implants↗
PubMed2005

The concentrations, appearance and taste of nine sedating drugs dissolved in four different beverages.

Sedating drugs are reported to be used in cases where people have been drugged unwittingly. In the present experiments we studied whether nine sedating medicinal drugs would dissolve in four different beverages to reach concentrations which could possibly cause impairment and whether the drugs altered the appearance and taste of the beverages. Nine sedating medicinal drugs were added separately to water, beer, Coca-Cola and ethanol. Drug concentrations were measured 5, 10, 20 and 40 min after spiking. The amount of drug in one swallow (50 mL) was calculated. Appearance and taste were recorded after 10 min. Flunipam, Sobril, Valium and Xanor dissolved faster than Rohypnol, Imovane, Somadril, Rivotril and Dolcontin. Ten minutes after adding Flunipam, Sobril, Imovane (in beer and Coca-Cola), Valium and Xanor, the concentrations had reached more than 50% of maximum theoretical concentration. Most of the drugs caused sediment, pieces and/or turbidity in one or more of the beverages. Some of the solutions were dyed from added Rohypnol (turquoise or green), Dolcontin (red) and Valium (yellow). Flunipam and Valium caused extensive frothing in beer. The tastes of Imovane and Somadril were distinct in all the beverages, while the taste of other drug solutions was less distinct. The ingestion of all solutions could probably have caused impairment. All the nine drugs were, however, apparent to the consumer from the altered appearance and/or taste of the beverages.

Beverages↗
PubMed2005

Mortality among subjects previously apprehended for driving under the influence of traffic-hazardous medicinal drugs.

BACKGROUND: Most studies in the field of impaired driving have focused on the hazards represented by impaired drivers to the rest of society; there has been little follow-up of the drivers themselves. The aim of this study was to establish mortality rates among subjects previously apprehended for driving under the influence of traffic-hazardous medicinal drugs, alone or in combination with alcohol. METHODS: A prospective cohort study of all drivers aged 20-49 years, apprehended in Norway in 1992-1996 and testing positive for traffic-hazardous medicinal drugs in blood, outcome variable: death. STUDY POPULATION: 805 drivers (598 males, 207 females). Mean follow-up period: 6.8 years. Information on deaths was collected from Statistics Norway. RESULTS: During the follow-up period, 139 of the previously apprehended drivers died (110 males, 29 females). The calculated standardised mortality ratio (SMR) was 15.8 (95% CI: 13.0-19.0) for male and 20.0 (95% CI: 13.4-28.7) for female drivers. CONCLUSIONS: Apprehension on suspicion of driving under the influence of drugs, combined with detection of traffic-hazardous medicinal drugs in the blood, seems to indicate an elevated risk of premature death in the age group 20-49 years. Secondary prevention of continued drug use could save lives in this drug user group.

Adult↗
PubMed2004

Plasma concentrations during naltrexone implant treatment of opiate-dependent patients.

AIMS: To evaluate individual variations in plasma concentrations over time in patients with naltrexone implants. METHODS: Ten opioid-dependent patients received up to four implants. Plasma samples were collected regularly for the analyses of naltrexone and the metabolite beta-naltrexol. RESULTS: The median naltrexone C(max) was 12.3 (range 5.8-22.1) ng ml(-1), the median T(max) was 1 day (range 3 h to 35 days), and the median length of time that plasma concentrations were above 1 ng ml(-1) was 55 (range 30-80) days. Two patients reported heroin use without experiencing any effect. Tissue reactions were recorded in two patients after repeated implantation. CONCLUSION: Marked individual and intraindividual variations in naltrexone concentrations were observed. Further studies should be performed to evaluate the need for therapeutic drug monitoring during naltrexone implant treatment.

Adult↗
PubMed2003

[Impaired driving as an indicator of drug abuse: what consequences for treatment?].

UNLABELLED: Driving under the influence of drugs is a growing problem as the number of apprehended drivers in Norway has increased 2.5 times since 1990. At least two drugs are usually detected. The majority of offenders have been arrested earlier. This paper gives an overview of studies of impaired drivers. MATERIAL AND METHODS: The re-arrest rate among 1102 drivers under the influence of drugs was followed for 7.5 years and compared with a group of 850 drivers under the influence of alcohol. Another study included 874 drivers with benzodiazepine detections followed retrospectively for 11 years. Earlier arrests and drugs detected first time were recorded. The third study recorded deaths among drugged (n = 918) and drunken (n = 2531) drivers for 7.5 years, compared with same age group in the general population. RESULTS: 57% of drugged and 28% of drunken drivers were re-arrested. More the 60% of drivers with benzodiazepine detections had been arrested earlier. Alcohol was most the commonly detected substance at first arrest. The standardised mortality ratio for male drugged drivers was 18.1 (14.9-21.8), for drunken drivers 3.7 (2.9-4.7). INTERPRETATION: Our results show that drugged drivers represent risk groups with multi-drug use, frequent re-arrests and early death. Other efforts combined with fines, prison and withdrawal of driving licence should be considered. Some countries have follow-up programmes that include control of drug use by urine testing before a re-issue of the driving licence is considered.

Accidents, Traffic↗
PubMed2003

[Naltrexone implants--a pilot project].

BACKGROUND: An increasing number of Norwegian heroin addicts have had naltrexone implants abroad without proper documentation. The authors established a joint project to study duration and safety. MATERIAL AND METHODS: Methodology to measure naltrexone in plasma was developed. 10 patients had 21 implants. Plasma samples were collected before, one and three hours after implantation, daily for one week, then weekly. Patient satisfaction, side effects and unwanted medical events were recorded. RESULTS: Patients had a protective level of naltrexone for 35-80 days. Side effects were few. Two patients had abstinence reactions caused by insufficient detoxification. Two patients had their repeat implants removed because of tissue reactions. One patient developed hepatitis C infection in the second week after implantation. One had transient increase in transaminases after heavy multi-drug use. The others were without signs of hepatic toxicity. INTERPRETATION: Use of implants secures a prolonged period of naltrexone protection. Implants are mostly well tolerated, but tissue reactions to repeat implants could be a problem. Evaluation of the patients should be thorough and the treatment integrated in a competent follow up.

Adult↗
PubMed2002

Increased mortality among previously apprehended drunken and drugged drivers.

Most studies in the field of impaired driving have focused on the hazards imposed on society by the impaired drivers, whereas little attention has been paid to the future outcome of the drivers. The aim of the study was to identify mortality rates and causes of death among drunken and drugged drivers during the years after apprehension. Prospective cohort study on apprehended drunken and drugged drivers, follow-up period: 7.5 years, outcome variable: death. Apprehended drivers 20-39 years old who provided samples positive for alcohol (n=2531) or drugs other than alcohol (n=918) constituting the total national samples of these two driver categories in 1992. The mortality rate among male drunken drivers was higher than in an age-matched Norwegian population (standardised mortality ratio, SMR=3.7 (95% Cl 2.9-4.7). The SMR for drugged drivers was 18.1 (14.9-21.8) for men and 27.9 (14.4-48.8) for women. In a subgroup of male drugged drivers using heroin, SMR was 39.8 (28.8-53.6). The dominant causes of death among drunken and drugged drivers were drug poisoning/overdose, accidents and suicide. Apprehension for drunken or drugged driving and subsequent analytical verification, is an indicator of increased risk of future premature death in the age group 20-39 years, particularly for drugged drivers. To our knowledge this is a new finding, and studies to confirm it should be carried out in other countries. If verified, the results should lead to the consideration of new public health approaches towards apprehended impaired drivers.

Adult↗
PubMed2002

Drugged drivers in Norway with benzodiazepine detections.

Norwegian drugged drivers with benzodiazepine (BZD) detections have been studied with regard to drug use pattern and rearrest rate. During 1995, 3343 drivers were apprehended by the police in Norway due to the suspicion of influence by drugs. Blood samples from all drivers were sent to the National Institute of Forensic Toxicology (NIFT). The samples were analysed using a standard program covering the most commonly abused drugs on the marked in Norway. BZDs, representing some of the most frequently detected drugs, were found in approximately 30% (n = 1051) of the cases, represented by 14% (n = 150) female and 86% (n = 901) male drivers. In 8% of the cases, one BZD only was detected, half of these cases with one BZD could reflect therapeutic use. One or more BZDs were combined with illegal drug(s) (73%), other prescribed drugs (10%), and/or alcohol (24%). 62% of the drivers with BZD detections, had earlier been arrested for the same offence, or six cases per rearrested driver. The frequency of earlier arrests were lower for female (34%) than for male (67%) drivers. Alcohol was most frequently found for those arrested for the first time before 1992, while BZD or illegal drugs were most frequently found for those with their first arrest during 1992-1995. Our study shows that apprehended drivers using BZD are mainly represented by drug abusers due to frequent multi-drug use, blood concentrations representing doses above therapeutic levels and high rearrest rate for the same offence. A treatment program or other reactions, are thus necessary in addition to fines, prison penalty and suspension of driving licence.

Adult↗