The frequency of alcohol, illicit and licit drug consumption in the general driving population in South-East Hungary.

In the framework of the DRUID (Driving under the Influence of Drugs, Alcohol, and Medicines) EU-6 project, a roadside survey was performed in South-East Hungary to determine the incidence of alcohol and the most frequent illicit and licit drug consumption (amphetamines, THC, illicit and medical opiates, cocaine, ketamine, benzodiazepines, zopiclone and zolpidem) in the general driving population. All 3110 drivers stopped between 01 January 2008 and 31 December 2009 were checked for alcohol, and among them 2738 persons (87.7%) participated in the further examinations, on a voluntary basis. Licit and illicit drugs were determined from their oral fluid samples by GC-MS analysis. Illicit drugs were detected in 27 cases (0.99%), licit drugs in 85 cases (3.14%), and alcohol (cut off: 0.1g/l) was found in 4 (0.13%) cases. Illicit drug consumption was the highest among men of the ages 18-34, during the spring, and on the week-end nights. With respect to licit drugs, the highest incidence was found among women over the age of 50, during the summer, and on the week-days. All alcohol positive cases were men over the age of 35. In comparison to international European averages, the alcohol and illicit drug consumption was low, but the licit drug consumption was over the European average.

[A new designer drug: methylone related death]. / Új dizájner drog: metilonfogyasztással összefüggo haláleset.

This report presents a fatal case related to the consumption of methylone, a relatively new cathinone type designer drug. A 16-year-old boy suddenly lost his consciousness in a party. Resuscitation had been continued for about 1.5 hours at the intensive care unit, but it was unsuccessful. His previous history included cardiac malformation detected at infancy and bronchial asthma had been diagnosed one year before his death. Signs of sudden cardiac death were observed during autopsy. Methylone intake was proved in blood and liver extract using gas chromatography/mass spectrometry; its concentration was 272 ng/ml in the blood, and 387 ng/g in the liver. Pathohistology revealed microvascular steatosis in the liver, which raised the possibility of chronic use of toxic substances. In addition, striated heart muscle damage was observed, which could be due to the use of an amphetamine-like substance. The authors presume that steatosis of the heart muscle, congenital heart disease and bronchial asthma could be predisposing factors for sudden cardiac death that occurred in the presence of relatively low levels of methylone. Access to various designer drugs is easy, fast and broad. Consequently, the potential abuse or overdose should be taken into consideration in the emergency practice. The use of "non-illicit" drugs does not require formal intervention by the authorities, but the medical service must alarm the stakeholders.

[Mephedrone -- an old-new drug of abuse]. / Egy régi-új kábítószer - a mefedron.

UNLABELLED: New natural and synthetic compounds are continuously introduced into the illicit drug market. Their origin, composition, main and side-effects are often not exactly known by the users themselves. Thus, the control of these substances is extremely difficult. AIMS: In year 2008, a new synthetic drug called mephedrone (2-metilamino-1-(4-metilfenil) propan-1-on) appeared in Hungary. This work summarizes its frequency in biological samples investigated for illicit drugs, and experiences of the medical examination of mephedrone-users. METHODS: Toxicological analyses of biological samples (urine and/or blood) were carried by GC-MS at the Institute of National Toxicology and at Department of Forensic Medicine, University Szeged. RESULTS: Altogether 5386 samples were analyzed in 2010 (4922 in Budapest and 464 in Szeged), and mephedrone was identified in 363 cases (7%). CONCLUSIONS: Mephedrone is banned in Hungary since January 1st, 2011, but it still available in the illegal drug market. At present we do not have sufficient experience with its long-term effects, tolerance, addiction, withdrawal symptoms or toxic dose. Thus, it is difficult to establish whether addiction and/or mental disorder occurred.

Myocardium and striated muscle damage caused by licit or illicit drugs.

Illicit and central nervous system active licit drug consumption related deaths are mainly the consequences of either unintentional or intentional overdose. According to the data in the relevant literature occurrences of different organ damages are also observable and this can play a role in death, as well. Organ damages may appear simultaneously with overdosing or can be extended in time, which may lead to proving the cause of death and establishing the relationships with previous medication difficult. The most frequent damage observed is rhabdomyolysis syndrome, which has been mainly described after cocaine or opium consumption. Authors present four cases from the autopsy documentation of the period between 2003 and 2008 at the Institute of Forensic Medicine, University of Szeged, Hungary in which illicit drug consumption or neuroleptic licit drug medication resulted in development of myocardium and striated muscle damage. The dominant clinical symptoms were hyperthermia, renal and circulatory failure. The laboratory tests showed renal and liver insufficiency; in addition the CK and CK-MB level increase suggested damage in striated muscles. The focal myocardium and striated muscle damage could be assessed as the cause of death in one case, but microscopic investigation proved the presence of damage in each.

The role of licit and illicit drugs in traffic (Hungary 2000-2007).

The authors analyzed the biological samples available in suspected DWI cases between 2000 and 2007. The result of the on-the-spot clinical test is not informative, especially at the simultaneous presence of alcohol. The average age (males 26.92 years, females 27.6 years) of the apprehended drivers is higher than in case of illicit drug users, and male dominance (1652 males--94% and 88 females--6%) is also more expressed. This male-female ratio corresponds to the epidemiological figures of drunken-driving, which may indicate identical driving attitude. Licit or illicit drugs in the urine could be detected in 1293 people out of 1740 (74.31%) whereas in 319 (18.33%) cases there was some substance present in the blood. The occurrence of multiple drug use was high. The use of THC, amphetamine and methamphetamine derivates are the most frequent. An increase in cocaine consumption has been observed for the last few years. The joint use of alcohol and drugs has increased, but the observed blood-alcohol concentrations are much lower than in simple drunken-driving cases. The evaluation of clinical symptoms on its own is not enough to evaluate the effects of drugs, especially when the effect of alcohol is to be considered at the same time.