Chemical analysis of four capsules containing the controlled substance analogues 4-methylmethcathinone, 2-fluoromethamphetamine, alpha-phthalimidopropiophenone and N-ethylcathinone.

In August 2007, four capsules containing white powders, said to have originated from an Israel-based Internet company "Neorganics", were anonymously delivered to the Royal Adelaide Hospital, South Australia. The capsules were analysed and the active components were identified including 4-methylmethcathinone, 2-fluoromethamphetamine, alpha-phthalimidopropiophenone and N-ethylcathinone, all of which were unlisted within South Australian controlled substance regulations. We examined the relevant scientific literature surrounding these chemicals and present both GCMS and NMR data for 4-methylmethcathinone and alpha-phthalimidopropiophenone, which have previously received little attention. We also present the vapour- and condensed-phase infrared spectra (IR) of 4-methylmethcathinone as these have also not been reported in the literature previously. We discuss the issues surrounding whether these chemicals can be classified as controlled substance analogues and the likely impact this could have on prosecutions of individuals distributing these products.

Terror Australis 2004: preparedness of Australian hospitals for disasters and incidents involving chemical, biological and radiological agents.

OBJECTIVE: To assess the level of preparedness of Australian hospitals, as perceived by senior emergency department physicians, for chemical, biological and radiological (CBR) incidents, as well as the resources and training available to their departments. METHODS: Detailed questionnaires were mailed to the directors of the 86 hospital emergency departments (EDs) in Australia accredited by the Australasian College for Emergency Medicine. Questions covered hospital planning, available resources and training, and perceived preparedness. RESULTS: Responses were received from 76 departments (88%): 73 reported that their ED had a disaster plan, with 60 (79%) having a contingency plan for chemical, 57 (75%) for biological, and 53 (70%) for radiological incidents. Specific staff training for managing patients from a conventional mass casualty incident was given in 83% of EDs, falling to 66% for a CBR incident. Forty-three per cent reported that their plan involved staff managing contaminated patients, but availability of personal protective equipment and decontamination facilities varied widely. Although 41% believed their ED could cope with a maximum of 20 patients in the first 2 hours after a conventional incident, this increased to 71% for a CBR incident. Staff training was considered the main funding priority (59%). CONCLUSIONS: This survey raises significant questions about the level of preparedness of Australian EDs for dealing with patients from both conventional and CBR incidents. Hospitals need to review their plans and functionality openly and objectively to ensure that their perceived preparedness is consistent with reality. In addition, they urgently require guidance as to reasonable expectations of their capacity. To that end, we recommend further development of national standards in hospital disaster planning and preparedness.

Truth hurts--hard lessons from Australia's largest mass casualty exercise with contaminated patients.

In response to the increasing threat of a mass casualty incident involving chemical, biological or radiological agents, and concern over the preparedness of our hospital system to cope with patients from such an incident, we conducted the largest hospital-based field exercise involving contaminated patients that has been held in Australia. In the present paper, we outline the background to, and methodology of, Exercise Supreme Truth, and the efforts made to increase its realism. We focus our discussion on three issues highlighted by the exercise, which we believe have enormous implications for the development of hospital chemical, biological or radiological plans and the likelihood of their success--hospital security, crowd control and decontamination.

Crocodile attack in Australia: an analysis of its incidence and review of the pathology and management of crocodilian attacks in general.

Crocodilians represent one of the oldest constant animal lineages on the planet, in no small part due to their formidable array of predatory adaptations. As both human and crocodilian populations expand, they increasingly encroach on each others' territories, bringing morbidity and mortality to both populations. In this article, the medical and herpetologic literature pertaining to injuries caused by crocodilians is reviewed, and the patterns of saltwater crocodile attacks in Australia from 1971 to 2004 are analyzed. In this review, we examine the features of crocodilians that contribute to explaining their evolutionary success, as well as the potential hazard they pose to humans. Only by understanding their capabilities is it possible to mitigate the potential threat to life and limb.

Keep off the grass: marijuana use and acute cardiovascular events.

Marijuana is one of the most widely used recreational substances in the world, considered by many consumers as a relatively safe drug with few significant side-effects. We report the case of a 21-year-old man who suffered an acute myocardial infarction following the use of marijuana, despite having no other identifiable risk factors for an acute cardiovascular event. We review the published medical literature regarding acute cardiovascular events following marijuana use and postulate a possible mechanism for this unusual pathological consequence of marijuana use.

Survival of massive gamma-hydroxybutyrate/1,4-butanediol overdose.

Gamma-hydroxybutyrate and its metabolic precursors gamma butyrolactone and 1,4-butanediol are widely used recreational drugs known to cause short periods of deep sedation with rapid recovery. We present a case of survival with good neurological outcome following massive ingestion in which the patient remained sedated for 14 h.

Clandestine drug laboratories in Australia and the potential for harm.

The emphasis in the literature regarding illicit drugs has been overwhelmingly on the subject of harm caused by their ingestion. Little has been reported on the potential and real harm associated with the illicit manufacture of drugs. This paper describes the increasing prevalence of clandestine drug laboratories in Australia, overwhelmingly devoted to the manufacture of methamphetamine. The nature of the illicit synthetic process is reviewed together with its inherent dangers for the 'cook', first responders and bystanders including children, and the environment. We have analysed the emerging trends in manufacture and seizure in Australia, and offer suggestions to remedy significant deficiencies in knowledge and policy in the management of clandestine drug laboratories, especially with reference to clinical management issues, data collection, environmental contaminants and remediation, legislation and research. In particular, we conclude that: The problem of clandestine drug laboratories is growing in Australia, reflecting patterns world-wide. There are significant health and environmental implications of this growth. First responders should ensure that specialised expertise is available when decommissioning detected laboratories. Clinicians should familiarise themselves with the types of injuries associated with clandestine drug manufacture. Legislatures without a clandestine drug laboratory registry should establish one. Where it doesn't exist, legislation should be sought to curb the spread of this unwanted phenomenon. Significant opportunities exist for further research into the harm caused to first responders, the community, and the environment by clandestine laboratories.

Fatalities associated with the use of gamma-hydroxybutyrate and its analogues in Australasia.

OBJECTIVE: To identify deaths in Australasia associated with overdose of gamma-hydroxybutyrate (GHB) and its precursors (gamma-butyrolactone and 1,4-butanediol). DESIGN: A retrospective search of medical and scientific information sources, as well as popular newsprint, for the period January 2000-August 2003, with formal clinical, toxicological and forensic evaluation of retrieved data. MAIN OUTCOME MEASURE: Death associated with forensic data implicating GHB or its analogues. RESULTS: Ten confirmed GHB-associated deaths were identified, with eight considered to be directly attributable to GHB. Only two of these eight cases were positive for ethanol toxicology. CONCLUSIONS: Our study supports the existing evidence that GHB overdose is associated with fatalities, and that fatal overdoses occur in the context of isolated use.

Dancing with "death": p-methoxyamphetamine overdose and its acute management.

Para-methoxyamphetamine (PMA) is a substituted synthetic amphetamine used in the recreational drug scene. It is unusual because of the high incidence of significant morbidity and mortality in overdose. We report a case of PMA overdose in South Australia, and review our experience with the drug. We review the literature on PMA overdose and offer suggestions on the management of overdose with this dangerous drug.

Medical preparation for terrorism in Australia. Is luck running out for "the lucky country?

Recent world events have forced Australia to re-examine its role on the world stage and its susceptibility to terrorist attacks. The authors examine the brief historical exposure of Australia to the phenomenon of terrorism, and review the geopolitical climate and features that may render it more susceptible to attack in the future. Australia's emergency management structure is outlined, and its current state of medical preparedness for a terrorist incident is critically reviewed.