Guido Romano | PubMed Health

PubMed2003

Determination of drugs of abuse in hair: evaluation of external heroin contamination and risk of false positives.

One of the most controversial point regarding the validity of hair testing is the risk of false positive due to external contamination. The aim of our experience is to verify if a 5 consecutive days contamination with a small amount of a powdered mixture of heroin hydrochloride and acetylcodeine hydrochloride (10:1 w/w) will last sufficiently long to make a contaminated subject indistinguishable from active users, and if normal washing practices together with the decontamination procedure are sufficient to completely remove the external contamination. Our results suggest that decontamination procedures are not sufficient to remove drugs penetrated into hair from external source. In fact, all contaminated subjects were positive for opiates (heroin, 6-MAM, morphine, acetylcodeine and codeine) for at least 3 months. Significant 6-MAM concentrations (>0.5 ng/mg) were found in each subject until 6th week. Further, 6-MAM/morphine ratio were always above 1.3.

Analgesics, Opioid↗

PubMed2002

Lethal diltiazem poisoning.

A 60-year-old man presented to an emergency department 2 h after the ingestion of 8 g of diltiazem (about 40 slow-release capsules, 200 mg/each) in a suicide attempt. The subject was treated with a gastric lavage and activated charcoal; then, a temporary transvenous pacing was also inserted. Despite emergency pharmacological treatment, the subject died about 20 h after ingestion. Postmortem diltiazem and desacetyl-diltiazem concentrations, measured by gas chromatography-mass spectrometry, were as follows: 31.1 mg/mL diltiazem and 9.7 mg/mL desacetyl-diltiazem in blood; 33.1 mg/g diltiazem and 13.7 mg/g desacetyl-diltiazem in brain; 179.5 mg/g diltiazem and 47.5 mg/g desacetyl-diltiazem in lung; 41.8 mg/g diltiazem and 10.1 mg/g desacetyl-diltiazem in heart; 182.1 mg/g diltiazem and 47.3 mg/g desacetyl-diltiazem in liver; 49.2 mg/g diltiazem and 22.6 mg/g desacetyl-diltiazem in kidney; and 294.9 mg/mL diltiazem and 29.4 mg/mL desacetyl-diltiazem in bile. It is interesting to note that although several cases of acute diltiazem poisoning have been reported in literature, only a few were lethal. Diltiazem concentrations found in our case are notably higher than those reported in other studies, including those in which diltiazem ingestion resulted in the death of the patient. Notably, in many of these latter cases, the doses of diltiazem ingested were higher than those taken by our patient.

Administration, Oral↗