The Association Between State-Level Prenatal Substance Use Policies and Rates of Maternal Mortality in the United States: A Legal Epidemiology Study.

Little research has explored relationships between prenatal substance use policies and rates of maternal mortality across all 50 states, despite evidence that prenatal substance use elevates risk of maternal death. This study, utilizing publicly available data, revealed that state-level mandated testing laws predicted maternal mortality after controlling for population characteristics.

The return of drugs courts: Some important considerations.

Drugs courts can be praised for the rehabilitative health-treatment response they deliver to people with drugs dependence problems. This is when contrasted with traditional courts that operate on adversarial and retributive justice principles and do little to alleviate cycles of repeat drugs offending. Whilst drugs courts have been met with success and embraced in several jurisdictions worldwide, fundamental points need to be raised on the model that is re-emerging in England and Wales. Indications are it will involve drugs testing and a 'graduated sanctions and incentives system' that comprises short custodial sentences for non-compliance. This essay discusses the newly emerging drugs court model as signposted within different legislative and public policy documents and raises questions relating to the precise model these courts will take; whether they prioritise harm reduction or if 'abstinence' goals will predominate. We question whether people with drugs dependence problems should be sanctioned to short custodial prison sentences if in breach of a drugs court order. And perhaps more fundamentally: do we need drugs courts in the English and Welsh justice system?

Inferences and Legal Considerations Following a Blood Collection Tube Recall.

In mid-2019, medical, forensic and legal communities were notified that a certain shipment of evacuated blood sampling tubes were recalled by the manufacturer. This recall order described that the preservative sodium fluoride (100 mg) and anticoagulant potassium oxalate (20 mg) were missing from a small batch of 10-mL evacuated tubes. This gave cause for concern for possible implications in criminal justice (e.g., in drink-driving offenses) when blood-alcohol concentrations are interpreted. In reality, the lack of an anticoagulant would have been immediately obvious during sample preparation, owing to the formation of a large clot in the tube when received. Certain impairing drugs (e.g., cocaine and 6-acetylmorphine) are unstable in blood and tend to degrade without an enzyme inhibitor, such as sodium fluoride, present. In reviewing available literature related to current practices and the stability of ethanol in stored blood samples, there does not appear to be a clear consensus regarding the amount of sodium fluoride preservative necessary, if any at all, when blood is taken from living subjects under sterile conditions for typical forensic ethanol analysis.

Comentarios a las infracciones por presencia de drogas en carretera y argumentos para establecer tasas mínimas de detección en sangre / Comments on offenses due to the presence of drugs on the road and arguments to establish minimum detection rates in blood

El presente trabajo tiene como objeto la revisión de la bibliografía científica relativa a la afectación de las drogas en la conducción así como la revisión de toda la legislación del Derecho comparado que regula las sanciones administrativas y penales por conducir bajo los efectos o con presencia de drogas en el organismo. Este documento hace especial referencia al caso español, criticando, mediante los principios de la ciencia, la lógica y el Derecho, el Auto del Pleno del Tribunal Constitucional español nº 174/2017 de 19 de diciembre, que declaró constitucional sancionar la mera presencia de una mínima cantidad de droga en el organismo cuando se está conduciendo, expresando que esto no vulnera derechos fundamentales de la persona usuaria de drogas a pesar de no acreditar la afectación a las capacidades psicofísicas. El estudio acaba dando unos consejos a ciudadanos y administraciones para intentar que la protección de la seguridad vial se realice de la manera más justa y proporcional posible y sin vulnerar derechos fundamentales de la persona usuaria de drogas, haciendo alusión a los puntos de corte o tasas, tanto en saliva como en sangre, que existen en los diferentes aparatos de detección de sustancias psicoactivas, ya sea con el aparato presuntivo de carretera (test de antígenos) que con la prueba confirmatoria en el laboratorio (GC-MS).(AU)

The purpose of this work is to review the scientific bibliography on the effects of drugs on driving as well as the review of all comparative law legislation that regulates administrative and criminal sanctions for driving under the influence or with the presence of drugs. in the body. This document makes special reference to the Spanish case, criticizing, through the principles of science, logic and law, the Order of the Plenary of the Spanish Constitutional Court No. 174/2017 of December 19, which declared it constitutional to sanction the mere presence of a minimum amount of drug in the body when driving, stating that this does not violate the fundamental rights of the person who uses drugs despite not proving the effect on psychophysical capacities. The study ends by giving some advice to citizens and administrations to try that the protection of road safety is carried out in the most fair and proportional way possible and without violating the fundamental rights of the person who uses drugs, referring to the cut-off points or rates, both in saliva and in blood, which exist in the different psychoactive substances detection devices, either with the presumptive road device (antigen test) or with the confirmatory laboratory test (GC-MS). (AU)

Variation in States' Implementation of CAPTA's Substance-Exposed Infants Mandates: A Policy Diffusion Analysis.

In 2016, federal law changed state child welfare mandates related to prenatally substance-exposed infants. Little is known regarding the status or implications of policy implementation. The current study examined thematic clusters among states' policies responsive to this 2016 mandate. Cluster analysis identified four distinct categories of states' implementation: (1) "innovators/early adopters," (2) "early majority," (3) "late majority," and (4) "laggards." Innovator/early adopter states (n = 14) were most likely to have implemented plan of safe care policies consistent with Child Abuse Prevention and Treatment Act (CAPTA). Early majority states (n = 15) have started developing some aspects of CAPTA 2016 but have some aspects that are still in development. Late majority states (n = 17) have adopted few aspects of CAPTA 2016 but had implemented more CAPTA 2003 and 2010 aspects than states in the laggard cluster. Laggard states (n = 6) have implemented the fewest CAPTA prenatal substance exposure domains. In bivariate analyses, the only variable associated with clusters was Census region (e.g., New England), suggesting that states' implementation decisions may be influenced by their regional neighbors.

Investigating the New Zealand policy response to methamphetamine-contaminated houses.

The contamination of houses from clandestine methamphetamine manufacture emerged as an issue in New Zealand in the early 2000s. This perspective reviews and discusses the series of policies developed to address methamphetamine contamination in New Zealand houses over a 15-year period, ending with the reversal of the established policy approach in 2018. The policies addressing methamphetamine contamination of New Zealand properties were influenced by a range of sources including overseas scientific guidelines, local scientific reviews, public housing agency policies, and the local methamphetamine testing industry. A post-remediation methamphetamine level of 0.5 µg/100 cm2 was initially implemented in 2010, leading to the termination of public housing tenancies, suspensions from the public housing list, and financial charges for decontamination on public housing tenants. Subsequent reviews of the policy led to some increase in the thresholds (up to 1.5-3.8 µg/100 cm2 ) and the adoption of less punitive sanction processes. A scientific review in 2018 recommended a substantial threshold increase to 15 µg/100 cm2 (a 30-fold increase on the 2010 standard), resulting in HNZ initiating a plan to compensate previously sanctioned tenants. Overreliance on the "precautionary principle"; strict interpretation of scientific guidelines; and the public housing agency's "zero tolerance approach" to drug use, contributed to an overly punitive policy approach to methamphetamine contamination in New Zealand that negatively impacted vulnerable public housing tenants, landlords, and property owners. Investigation into the extent that all possible influences had on the development of the policies, as well as the consequences of their implementation, should be undertaken.

Making drug policy in summer-drug checking in Australia as providing more heat than light.

INTRODUCTION AND AIMS: There was an exceptional drug policy debate in Australia over the summer of 2018-2019 regarding the availability of drug checking (pill-testing) services at festivals. Drug checking is not a new intervention and has been available across Europe for many years. This paper aimed to analyse the nature of the policy debate. DESIGN AND METHODS: Data were sourced from public domain sites; online, TV and radio media, alongside documentation of advocacy actions. Analysis of the contents of the public debate was conducted through the theoretical lens of Science and Technology Studies, notably the work of Stengers. RESULTS: The narratives identified in favour of pill-testing focussed on the evidence available to date, the importance of informed choice and accessing a population to provide information and education. The arguments against pill-testing included the belief that there is no such thing as safe drug use, the false sense of security that pill-testing would engender and that the evidence to date is equivocal. Both those for and against pill-testing shared the same goal-saving lives. However, the beliefs and values underpinning this goal differed. As the heat increased over summer, the debate became more polarised, but shedding little light. DISCUSSION AND CONCLUSIONS: Drug policy debate, which becomes polarised, and remains focussed on matters of fact, rather than matters of concern, seems unlikely to result in productive resolutions. A more 'civilised' mode of debate that situates knowledge, engages values, is conducted with humility and encourages hesitation (following Stengers) may be more productive.

Driving Under the Influence of Drugs: When the Law Misses the Mark.

According to Florida law, an individual is not guilty of driving under the influence of drugs unless impairment is observed and is due to one or more controlled drugs listed in the Florida Statutes. Many prescription drugs, over-the-counter drugs and novel psychoactive compounds that can cause significant impairment are not included in this list. Five other states within the USA including Alaska, Hawaii, Massachusetts, New York and Oregon have similar or other restrictive language in their impaired driving statutes. From January of 2007 to February of 2018, 1,344 blood specimens and 1,796 urine specimens were analyzed for drugs in impaired driving cases in Palm Beach County, Florida. Over the past 11 years, 21% (212 out of 1,028) of all drug-positive blood specimens and 47% (711 out of 1,527) of all drug-positive urine specimens contained at least one non-controlled drug, often mixed with controlled drugs. Despite documentation of observed impairment with the concurrent identification of impairing drugs, an impaired driving charge could not be supported due to the phrasing of the law in Florida. If the intent of drug-impaired driving laws is to improve safety by removing impaired drivers from the road, a more all-encompassing "any impairing drug" law would be more appropriate. Linking the charge to a drug possession law framework or using other restrictive language is not the most effective means to improve road safety.

HOPE-ful bottles: Examining the potential for Hawaii's opportunity probation with enforcement (HOPE) to help mainstream therapeutic jurisprudence.

This article builds on the emerging understanding of Hawaii's Opportunity Probation with Enforcement (HOPE) probation when viewed through the lens of therapeutic jurisprudence (TJ). The article commences with recent conceptualizations of TJ through the metaphor and methodology of 'wine'/'liquid' and 'bottles' (Wexler, 2014). Next, the article presents an overview of how HOPE works and clarifies a number of misconceptions about the approach taken. The article then examines the potential of the principles underlying HOPE to help in realizing the promise of mainstreaming TJ. Specifically, it is argued that HOPE is more economical than drug courts and can reach far more people. It addition, it promotes procedural justice and desistance, is flexible and can be extended across the criminal justice system.

Obstetric and Pediatric Provider Perspectives on Mandatory Reporting of Prenatal Substance Use.

OBJECTIVE: In many states, health care providers are legally required to report pregnant women who use substances, or infants affected by prenatal substance use, to child welfare authorities. The objective of this study was to characterize obstetric and pediatric providers' perceptions of and experiences with policies requiring mandatory reporting of prenatal substance use to child welfare authorities. METHODS: We conducted a qualitative interview study among 20 obstetric and pediatric providers to elicit participants' perspectives about and experience with current policy requiring mandatory reporting of prenatal substance use. Two investigators used an iterative content analysis approach to code interview transcripts and identify themes. RESULTS: Study participants included obstetrician/gynecologists (N = 7), midwives (N = 5), and pediatricians (N = 8). Providers noted that implementation of the policy was often targeted and that targeted screening can be biased. Most providers reported that they incorporated information about mandatory reporting policies into patient counseling about substance use. They described not knowing what happens to patients after mandatory reporting and concerns regarding unintended consequences. Providers indicated that changes are needed to improve outcomes for patients and their families and suggested increased research into best practices, more funding for social services, and eliminating the policy altogether. CONCLUSIONS: Health care providers expressed concern about the targeted screening process used to identify women with substance use whose children are reported to child welfare authorities. Most providers believed that mandatory reporting processes could be modified in ways that would support the health of women and children.

Australia's First Official Illicit Pill Testing at Canberra's Groovin' the Moo Music Festival: Legal Hurdles and Future Prospects.

The first official pill testing at an Australian music festival was conducted at Groovin' The Moo in Canberra on 29 April 2018. As the trial was the first of its kind in Australia, it was not without legal hurdles and uncertainty. Primarily, there was concern over the legal consequences for patrons participating in the pill testing, as well as the legal liability of those facilitating and conducting the testing. This article will discuss the legal hurdles that were overcome in order to facilitate the trial, and the future consequences and position of pill testing at Australian festivals.

Current defence strategies in some contested drink-drive prosecutions: Is it now time for some additional statutory assumptions?

The prosecution of those socially irresponsible individuals who drive when they have had too much to drink - in that their breath, blood or urine alcohol level exceeds the prescribed legal limit - has been standard practice since October 1967. The forensic analysis of whichever type of specimen is taken from the suspect operates to a high degree of accuracy. Despite this a defence industry continues to operate in which specialist privately-funded legal practitioners [solicitors and counsel], in conjunction with several 'experts' whom they routinely instruct, seek to persuade the Courts that the alcohol reading on which the Crown's case depends cannot be correct as it does not accord with what their client subsequently states he had to drink. The defence team then seek copious disclosure of documents regarding the instrumentation that was used for the analysis, in the underlying hope that these are not produced: they can then make an application to the Court that their client is unable to have a fair trial as a result. Recent case law has improved the disclosure situation, but such cases still involve a quite disproportionate time input from the Police, the CPS and the Courts. Most drink-drive prosecutions today are based on evidential breath analysis: only instruments that have been Type Approved to a Government specification are used. Each analyser is periodically tested and then checked as a part of each subject's analysis procedure to ensure it is operating accurately at that time. There is no recorded case of such an instrument having given an inaccurate reading. It is therefore time that a Statutory Assumption should be enshrined in the legislation to the effect that an evidential breath alcohol reading should be assumed to be accurate unless there is some direct evidence [as opposed to inferential evidence] to the contrary. Likewise with blood and urine specimen analysis, before a subject can challenge the Crown's result he should have his own part of the specimen analysed. The result of this should be significantly different to that of the Crown's analysis, and it should also be consistent with his stated consumption. Failing these defence requirements the Crown's reading should be assumed to be accurate. In the continued absence of these suggested Statutory Assumptions we might as well dispense with breath, blood and urine analysis altogether and simply base all drink-drive prosecutions simply on the calculation result based on the suspect's stated consumption.

Critical analysis of forensic cut-offs and legal thresholds: A coherent approach to inference and decision.

In this paper we critically discuss the definition and use of cut-off values by forensic scientists, for example in forensic toxicology, and point out when and why such values - and ensuing categorical conclusions - are inappropriate concepts for helping recipients of expert information with their questions of interest. Broadly speaking, a cut-off is a particular value of results of analyses of a target substance (e.g., a toxic substance or one of its metabolites in biological sample from a person of interest), defined in a way such as to enable scientists to suggest conclusions regarding the condition of the person of interest. The extent to which cut-offs can be reliably defined and used is not unanimously agreed within the forensic science community, though many practitioners - especially in operational laboratories - rely on cut-offs for reasons such as ease of use and simplicity. In our analysis, we challenge this practice by arguing that choices made for convenience should not be to the detriment of balance and coherence. To illustrate our discussion, we will choose the example of alcohol markers in hair, used widely by forensic toxicologists to reach conclusions regarding the drinking behaviour of individuals. Using real data from one of the co-authors' own work and recommendations of cut-offs published by relevant professional organisations, we will point out in what sense cut-offs are incompatible with current evaluative guidelines (e.g., [31]) and show how to proceed logically without cut-offs by using a standard measure for evidential value. Our conclusions run counter to much current practice, but are inevitable given the inherent definitional and conceptual shortcomings of scientific cut-offs. We will also point out the difference between scientific cut-offs and legal thresholds and argue that the latter - but not the former - are justifiable and can be dealt with in logical evaluative procedures.

Stability of Synthetic Piperazines in Human Whole Blood.

While circumventing legislative controls, synthetic piperazines are encountered as "legal" alternatives to ecstasy. Unforeseeable challenges may delay quantitative analysis of these compounds in biological fluids. Enzymatic reactions, matrix interferences and limited knowledge of analyte stability further complicate interpretation of calculated concentrations. The objective of this study was to investigate the stability of synthetic piperazines in human blood under various storage conditions over time. All samples were prepared by spiking certified reference standards (Cayman Chemical, MI, U.S.A.) of eight synthetic piperazine into certified drug-free human whole blood (UTAK Laboratories, Inc., CA, U.S.A.) independently at 1000 ng/mL as well as mixtures containing all tested piperazines in this study. Samples were stored at room temperature (~20°C), 4°C and -20°C for 1, 3, 6, 9 and 12 months in dark sealed containers. Solid phase extraction (SPE) was performed using mixed-mode copolymeric cartridges (Clean Screen®, UCT Inc., PA, U.S.A.). Analytes were assessed on their degrees of degradation using a Shimadzu Ultra-Fast Liquid Chromatograph with SCIEX 4000 Q-Trap Electrospray Ionization Tandem Mass Spectrometer (UFLC-ESI-MS/MS) in positive ionization mode. Of the two categories, benzyl piperazines were more stable than phenyl piperazines under all storage conditions, in which 1-(4-methylbenzyl)-piperazine (MBZP) had more than 70% (769-1,047 ng/mL) remaining after 12 months. 1-(4-methoxyphenyl)-piperazine (MeOPP) was not detected under room and refrigerated temperatures after 6 months and was the least stable. Matrix interferences and drug-drug interaction were observed. Storing samples at room temperature should be avoided due to detrimental impacts on stability of piperazine compounds. For backlog situations, case samples suspected to contain synthetic piperazines should be kept frozen or refrigerated even for time periods as short as 30 days for optimal result. Phenyl piperazines stored for more than 6 months showed analyte degradation and loss of parent compounds after extended storage regardless of storage conditions.

European guidelines for workplace drug testing in oral fluid.

These guidelines for Legally Defensible Workplace Drug Testing have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing should use these guidelines as a template for accreditation. These guidelines are relevant to laboratory-based testing only. These guidelines follow current best practices and are constantly under review.