The impact of traditional kava (Piper methysticum) use on cognition: Implications for driver fitness.

ETHNOPHARMACOLOGICAL RELEVANCE: Few studies have examined the impact of kava (Piper methysticum G. Forst. f.) on cognition when consumed at traditionally influenced volumes; most have used modified tablet-form kava, with the results erroneously overlaid on naturalistic kava consumption. Kava is a culturally significant Pacific drink with similar effects to Benzodiazepine. Traditionally influenced kava use sessions last, on average, 6 h in which attendees consume 3.6 L (7.6 pints) each of beverage kava, with some then driving home. AIM OF THE STUDY: This study evaluated the impact of traditionally influenced kava consumption on participants' neurological functioning. Testing occurred before, throughout and immediately following a typical faikava (kava-drinking) session, with the data then used to assess kava's potential impacts on driver functionality and safety. METHODS: Kava using participants (n = 20) were assessed with the Brain Gauge following and during a traditionally influenced kava session and compared against control (n = 19). Brain Gauge measures slight changes to six cognitive faculties: Speed, Accuracy, Temporal Order Judgement (TOJ), Timing Perception, Plasticity, and Focus. RESULTS AND CONCLUSIONS: Comparisons of the within-cohort data showed a positive change in the Focus for the active group at the final testing point following 6-h of kava consumption. Between-cohort data showed a significant level of regression in the active participants' TOJ at the final testing point. No statistically significant level of impairment for the other five cognitive domains was detected. Although the results suggest that kava when consumed at traditional levels may have a slight positive effect on Focus, this result needs to be treated with caution, given the significant level of impairment noted at the final testing point for participants' TOJ. Temporal Order Judgement is associated with executive function, including decision making, behavioral control and information processing, all crucial aspects of driver safety. This is a new finding and suggests kava effects following traditional use differ from those caused by other substances commonly used for social or recreational purposes, such as cannabis, alcohol and other euphoric substances, and may impair driver safety, although again, in a different way to other commonly consumed recreational substances. The findings also add quantitative understanding to ethnographic data on kava effects, suggesting the often-used term 'kava intoxication' is misleading and incorrect.

Toxicological Assessment of the Role of Alcohol and Drugs in Drug-Facilitated Sexual Assault Cases in New Zealand.

This report details the toxicology profile of victims of drug-facilitated sexual assault (DFSA) in New Zealand from 2015 to 2018. This study represents all of the toxicology results for DFSA cases in New Zealand during this time period, of which there were 161 cases. Blood and urine samples were screened for legal and illicit drugs in addition to testing for alcohol and correlating alcohol concentration with sampling delay. Our results indicate that increased delay in sampling time resulted in a corresponding decrease in alcohol concentration. In victims who had declared alcohol use but of which none was detected, the average sampling time was 14 hours for blood and 17 hours for urine, which is in excess of the average sampling delay for even the lowest alcohol-positive samples. The most frequently detected alcohol concentration was in the range of 51-80 mg/100 mL for blood and 121-200 mg/100 mL for urine with an average sampling time of 8.5 and 6.5 hours, respectively. We also examined acetone concentrations in alcohol-positive samples, and our results indicate that 82% of blood alcohol-positive samples contained acetone at concentrations between 5 and 10 mg/L and 68% of alcohol-positive urine samples contained acetone at a concentration >20 mg/L. It may be that the nature of sexual assault affects an individual's metabolism of alcohol and results in increased acetone production. Cannabis was the most commonly detected illicit drug, followed by methamphetamine. In relation to medicinal drugs, there was a high usage of antidepressants and antipsychotics, suggesting the victims may have been people of vulnerable personality. Based on case information, it does not appear there are many cases where stupefaction by unknown administration of a drug has occurred, instead loss of consent through voluntary alcohol and drug consumption is more common and poses a greater risk than surreptitious drug administration.

An outbreak of deaths associated with AMB-FUBINACA in Auckland NZ.

BACKGROUND: AMB-FUBINACA is a synthetic cannabinoid that has been associated with periodic outbreaks of acute poisonings, but few fatalities. In late May, June and July 2017 Auckland, New Zealand, experienced an outbreak of deaths associated with AMB-FUBINACA that continued at a rate of about 2-3 per month through February 2019. The aim of this study was to define the demographic, circumstantial, pathological and toxicological characteristics of this outbreak. METHODS: All records of the Northern Forensic Pathology Service, Auckland Hospital, were reviewed in which the word "AMB-FUBINACA" was referenced, including initial police reports, autopsy reports and toxicology reports. Recorded data included age, sex, race/ethnicity, times and locations, cause of death, autopsy and toxicology findings, and a brief summary of the circumstances of death. Descriptive statistics were performed using IBM® SPSS® Statistics Version 24 and Microsoft® Excel® Version 14.7.2. FINDINGS: Sixty-four cases were identified. One sudden infant death and five cases where cause of death was due to trauma were excluded. Of the remaining 58 cases, 88% were male. Mean age was 42 years. In 95% of the deaths, AMB-FUBINACA alone or in combination with alcohol or another drug was listed as the primary or contributory cause of death. In 41 cases postmortem blood concentrations of AMB-FUBINACA acid were available, ranging from <45 ng/mL to >1000 ng/mL, mean 229 ng/mL, median 140 ng/mL. Comorbidities identified included mixed intoxications (29%), heart disease (47%) and obesity (16%). A mental health diagnosis was reported in 50%, and 40% were on antipsychotic medications. INTERPRETATION: This study presents characteristics, comorbidities and toxicological findings in a unique outbreak of deaths associated with the synthetic cannabinoid AMB-FUBINACA in Auckland, NZ. FUNDING: All work was funded as part of the usual employment of the authors in their respective institutions. No special funding sources are reported.

Simultaneous analysis of 29 synthetic cannabinoids and metabolites, amphetamines, and cannabinoids in human whole blood by liquid chromatography-tandem mass spectrometry - A New Zealand perspective of use in 2018.

We describe the validation of a method for the simultaneous analysis of 29 synthetic cannabinoids (SCs) and metabolites, 4 amphetamines, and 2 cannabinoids in human whole blood. This method enables one analysis to cover what previously required multiple analyses for these classic and novel drugs-of-abuse with diverse physicochemical properties. The scope of targeted analytes was based on the most prevalent drugs-of-abuse and SCs encountered at the New Zealand border in 2017 and included parent compounds and metabolites belonging to the indole and indazole carboxamide, quinolinyl indole carboxylate, and naphthoylindole classifications. Samples were prepared by supported-liquid-extraction (SLE) followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis with positive electrospray ionization (ESI). The method was validated with respect to selectivity, matrix effects, process efficiency, sensitivity, repeatability, extract stability, and carryover for qualitative confirmation. Linearity as well as accuracy and precision data at target decision concentrations were also evaluated. The limits of detection and confirmation ranged from 0.1 to 6.0 ng/mL and 1.0 to 6.0 ng/mL, respectively. The described method was successfully applied to the analysis of 564 ante- and post-mortem blood samples in 2018. There were 132 cases (23%) with positive findings of at least one SC, with the five most commonly detected SCs being AMB-FUBINACA and/or acid (61%), 5F-ADB and/or acid (40%), ADB-FUBINACA (11%), 5F-MDMB-PICA acid (6%), and MDMB-FUBINACA acid (6%). The results also demonstrate the predominant presence of metabolites at higher levels than the unchanged parent SCs in blood, highlighting the need to maintain forensic screening methods capable of the simultaneous detection of both parent compounds and metabolites.