Fentanyl novel derivative-related deaths.

OBJECTIVE: Fentanyl (FEN) is a potent, synthetic narcotic used as an anaesthetic and a pain reliever, but also illegally manufactured. For diversion purpose, it is being steadily modified to produce new analogous compounds and derivatives (FENS), categorised as novel psychoactive substances. While potential FEN abuse is already known, even in the absence of a clear lethal dosage, there is still a shortage of data on its derivatives. METHODS: A literature review of FENS-related deaths was performed, to better understand potential damage and future perspectives of FEN congeners. RESULTS: Epidemiological data, pathological findings, administration routes, average concentrations and lethal doses, toxicological issues, trends in misuses, comparison among FENS, and possible explanation for FENS abuse are reviewed and discussed in depth. CONCLUSIONS: This study provides a medical-legal and toxicological assessment of this phenomenon in order to understand the role of illegal fentanyl and its congeners in deaths from FENS overdose.

Enhancement of unsafe behaviors in simulated moped-riding performance under the influence of low dose of alcohol.

The effects of low levels of blood alcohol concentration (BAC) on motorcyclist performance are still not fully comprehended. The great majority of the studies are, in fact, focused on car driving. So far, it is known that even BAC levels below the legal limit negatively affect riding motor skills correlated with crash rate. In the present study, we used a moped riding simulator to investigate the effects of low alcohol dosages (under the limits established in Italy, and in most European countries) on the defensive riding ability of light drinkers, particularly focusing on the degree of danger characterizing their riding performance. We recruited 24 participants through a double-blind, random distribution, balanced, cross-over design. We administered moderate amounts of alcohol to participants during two sessions of moped riding simulation. The results showed that even though BAC levels were always below (mean value: 0.03 g/dL) the limit allowed by Italian traffic law (0.05 g/dL), alcohol induced a reduction in safe riding behaviors, as indicated by the greater amount of hazardous scenes faced with dangerous riding behaviors when participants were under the influence of alcohol than when they were sober. Moreover, low BAC levels had a greater detrimental influence when a certain amount of learning had already been achieved by the participants (i.e., in the last experimental session). The results suggest that the effect of a low dose of alcohol interacts with participants' self-confidence.

Effects of GHB On Psychomotor and Driving Performance.

BACKGROUND: Gamma-hydroxybutyrate (γ-hydroxybutyrate or GHB) is a physiological compound of mammalians with specific receptors in central nervous system (CNS). Apart from an endogenous production, GHB is also an exogenous molecule found in pharmaceutical as well as in illicit formulations. Products manufactured and spread in these two fields, whose borders are all but strictly defined and traced, differ for the in vivo effects and for the potential of abuse. Illicit GHB gained public attention due to its use as a sexual assault facilitator. Notwithstanding its popularity, the effects on human performances, are still not completely understood and could be more complex than expected. Therefore, there is a real public safety concern regarding psychomotor functions and driving abilities due to GHB ingestion. OBJECTIVE: To provide an updated and complete review on the effects of GHB on psychomotor, cognitive and driving performance that may be useful for judiciary expert forensic evaluation of driving under the influence of GHB (GHB-DUI). METHOD: Experimental animal-based and human-based studies and case series or epidemiological studies regarding driving under influence of GHB (and its precursors) were reviewed using main scientific databases. RESULTS: The effects of GHB on cognitive, psychomotor and driving performance are dose-related in experimental studies. In real cases of driving under the influence of GHB, severe impairment is observed. In these cases, a wide range of blood GHB levels are found. Possible long-term effects are also reported. CONCLUSION: GHB causes cognitive and psychomotor impairment and risky driving behavior. Multiple aspects and variables are still waiting clarification, such as the harmful potential of illicit preparations, the effect of precursors and impairing dosages. GHB (and its precursors) must be considered a substantial personal and public risk even in the absence of a clear dose-effects correlation.