Hepatotoxicity upon using niacin to pass a drug test: A case report.

OBJECTIVES: To report a case of hepatotoxicity when niacin was used by a patient with HIV to pass a drug test. METHODS: Niacin is a soluble pyridine derivative widely used in the management of dyslipidemia. Common adverse effects include flushing, nausea, gastrointestinal discomfort, and hepatotoxicity. The use of niacin for nonmedical purposes has been increasing in prevalence in recent years, particularly in attempts to alter or mask results of urine drug tests. Although there is no scientific evidence that niacin can alter a urine drug screen result, easily retrievable information exists on the Internet touting niacin as a potential way to prevent detection of tetrahydrocannabinol (THC). The following report describes a case of hepatotoxicity in an HIV-infected adult who reported using niacin to mask THC in urine drug screen results. RESULTS: The patient developed marked elevations in his liver enzymes (aspartate aminotransferase greater than 25 times the upper limit of normal and alanine aminotransferase greater than 3 times the upper limit of normal) that resolved after discontinuation of the drug. Because of the patient's self-reported use and discontinuation of niacin, the Naranjo Adverse Drug Reaction Probability Scale demonstrated a "definite" relationship between the development of hepatotoxicity and the ingestion of over-the-counter sustained-release niacin. The patient did not develop further clinical abnormalities proposed to be secondary to niacin toxicity in previously published case reports, including glucose abnormalities, coagulopathies, metabolic acidosis, QTc prolongation, and myalgias. CONCLUSION: Health care providers should be aware of this nonmedical use of niacin to alter or mask a drug test, especially when discerning the cause of hepatotoxicity. In addition, pharmacists in the community setting should be aware of this use of niacin when encountering patients purchasing over-the-counter niacin, particularly in patients who may be more likely to use illicit substances.

False-positive phencyclidine (PCP) on urine drug screen attributed to desvenlafaxine (Pristiq) use.

We report a likely false-positive phencyclidine (PCP) result detected with a urine drug screen (UDS) (Medtox, St Paul, Minnesota, USA) in the setting of therapeutic desvenlafaxine (Pristiq) use. Desvenlafaxine (O-desmethylvenlafaxine) is the active metabolite of venlafaxine (Effexor). Prior reports have confirmed venlafaxine use resulting in a false-positive for PCP on a UDS. However, there has been a paucity of reporting of commercially available desvenlafaxine formulations (Pristiq, Khedezla) resulting in false-positives for PCP on a UDS.

Real-time mobile detection of drug use with wearable biosensors: a pilot study.

While reliable detection of illicit drug use is paramount to the field of addiction, current methods involving self-report and urine drug screens have substantial limitations that hinder their utility. Wearable biosensors may fill a void by providing valuable objective data regarding the timing and contexts of drug use. This is a preliminary observational study of four emergency department patients receiving parenteral opioids and one individual using cocaine in a natural environment. A portable biosensor was placed on the inner wrist of each subject, to continuously measure electrodermal activity (EDA), skin temperature, and acceleration. Data were continuously recorded for at least 5 min prior to drug administration, during administration, and for at least 30 min afterward. Overall trends in biophysiometric parameters were assessed. Injection of opioids and cocaine use were associated with rises in EDA. Cocaine injection was also associated with a decrease in skin temperature. Opioid tolerance appeared to be associated with a blunted physiologic response as measured by the biosensor. Laterality may be an important factor, as magnitude of response varied between dominant and nondominant wrists in a single patient with bilateral wrist measurements. Changes in EDA and skin temperature are temporally associated with intravenous administration of opioids and cocaine; the intensity of response, however, may vary depending on history and extent of prior use.

Illicit drug detection with laser 1: investigation of optimal parameters in stomach tissue.

The main purpose of this study is to establish radiation-safe scanning of passersby at high security areas, such as airports and customs. The stomach was selected as the organ to be analyzed. In order to determine whether a substance found inside a human body as wrapped in a plastic bag is filled narcotics or not, many substances in white powder form including morphine-HCL were inspected. Inspection was carried out with on-ionizing radiation by irradiating stomach tissue with laser light. Optical transmittance of lamb stomach tissue was analyzed at different wavelengths. We showed that detection by 650-nm diode laser irradiation would be suitable for such a radiation-safe scan. Different materials were also investigated for absorptive properties, and closed system Raman studies were performed. The spectrum of a molecule found inside white powder placed behind the lamb stomach tissue was detected as a fingerprint. This allowed the detection of target substances without any physical contact or damage to the biological tissue.

Acute water intoxication during military urine drug screening.

Random mandatory urine drug screening is a routine practice in the military. The pressure to produce a urine specimen creates a temptation to consume large volumes of water, putting those individuals at risk of acute water intoxication. This occurs when the amount of water consumed exceeds the kidney's ability to excrete it, resulting in hyponatremia owing to excess amount of water compared to serum solutes. The acute drop in serum osmolality leads to cerebral edema, causing headaches, confusion, seizures, and death. There has been increasing awareness of the danger of overhydration among performance athletes, but dangers in other groups can be underappreciated. We present the case of a 37-year-old male Air Force officer who developed acute water intoxication during urine drug screening. Our case demonstrates the need for a clear Air Force policy for mandatory drug testing to minimize the risk of developing this potentially fatal condition.

Consumo de drogas y estilo de vida en estudiantes de medicina de la FCM Julio Trigo López año 2009 / Julio Trigo Lopez's Medical Students Life Style and Drug Abuse, 2009. doc

Mediante una investigación descriptiva transversal que utilizó una encuesta que contempla variables sociodemográficas, de estilo de vida y prevalencias de consumo de drogas, se caracteriza el consumo de drogas legales e ilegales (tipificando el consumo de alcohol) y se cuantifica los resultados de una dieta alimentaria y de la práctica de ejercicios en estudiantes cubanos y extranjeros del 1ro al 5to año de la carrera de medicina en la Facultad Julio Trigo López, en el año 2009. La prevalencia de consumo de vida fue de 83 por ciento para el alcohol y el consumo actual de 37 por ciento. El 13 por ciento reconoce consumirlo semanalmente, además un 7 por ciento tiene un consumo de riesgo y un 6 por ciento un consumo perjudicial. El alcohol es la droga más consumida. El consumo de drogas ilegales es inferior a los resultados internacionales consultados. Menos de la cuarta parte del alumnado realiza dieta y menos de la mitad ejercicios físicos como parte de un estilo de vida saludable(AU)

Through a descriptive, transversal research that used a questionnaire with social demographic variables of life style and drug abuse it is characterized the consumption of legal and illegal drugs (taking into consideration alcohol consumption) and the results of a nutritional diet and the practice of sports by Cuban and foreign students from 1st to 5th year of medicine specialty from the Medical School Julio Trigo Lopez in 2009. The prevalence for the consumption was of 83 percent and now is about 37 percent. The 13 percent of the students recognize the weekly consumption; also a 7 percent of the students present risk consumption while a 6 percent has a harmful consumption. Alcohol is the most frequent drug. The illegal consumption of drugs is less than the international results consulted. Less than the fourth part of the students make diet and less than the half part practice exercises as a healthy style of life(AU)

Conocimientos y actitudes de un grupo de adolescentes acerca de las drogas, Policlínico Jimmy Hirtzel / Knowledge and behavior of a group of teenagers about drugs. Jimmy Hirtzel policlinic. 2003

Se realizó un estudio cualitativo, utilizando la técnica de grupos focales con 40 estudiantes de la Escuela Secundaria Básica 30 Aniversario de la Batalla de Guisa, con el objetivo de conocer sus actitudes y los conocimientos que poseen acerca de las drogas. La mayoría de los adolescentes consideran que las drogas son sustancias que producen efectos adversos al organismo, identificando como tales las drogas ilícitas y como efectos nocivos la falta de control de los impulsos y daños sobre el sistema nervioso central; consideran que la adicción puede sobrevenir con un solo consumo el cual se realiza por imitación o curiosidad. La mayoría también considera que los drogadictos son enfermos que requieren tratamiento médico y apoyo familiar(AU)

It was performed a qualitative study, using the techniques of focal groups with 40 students of the Secondary School 30 Anniversary of the Battle of Guisa, with the aim to know their attitudes and knowledge about drugs. Most of the teenagers considered that the drugs were substances that produced adverse effects to the organism, identifying the illicit drugs and the adverse effects like the lack of control of the impulses and damages on the central nervous system; they considered that the addiction could be caused by an only one consumption by imitation or curiosity. The majority of the students also considered that drogadicts were ill persons that required medical treatment and familiar support(EU)

Effect of storage temperature on endogenous GHB levels in urine.

Because gamma-hydroxybutyrate (GHB) is an endogenous substance present in the body and is rapidly eliminated after ingestion, toxicologists investigating drug-facilitated sexual assault cases are often asked to differentiate between endogenous and exogenous levels of GHB in urine samples. This study was designed to determine the effects of storage temperature on endogenous GHB levels in urine. Specifically, it was designed to ascertain whether endogenous levels can be elevated to a range considered indicative of GHB ingestion. Urine specimens from two subjects that had not been administered exogenous GHB were collected during a 24h period and individually pooled. The pooled specimens were separated into standard sample cups and divided into three storage groups: room temperature ( approximately 25 degrees C), refrigerated (5 degrees C), and frozen (-10 degrees C). Additionally, some specimens were put through numerous freeze/thaw cycles to mimic situations that may occur if multiple laboratories analyze the same specimen. Periodic analysis of the samples revealed increases in the levels of endogenous GHB over a 6-month period. The greatest increase (up to 404%) was observed in the samples maintained at room temperature. The refrigerated specimens showed increases of 140-208%, while the frozen specimens showed smaller changes (88-116%). The specimens subjected to multiple freeze/thaw cycles mirrored specimens that had been thawed only once. None of the stored urine specimens demonstrated increases in GHB concentrations that would be consistent with exogenous GHB ingestion.

Diferentes concentraciones de tolueno provocan el síndrome serotonérgico / Different concentrations of toluene inducing serotonergic syndrome

Los efectos sobre la conducta observados durante la inhalación de "thiner" han sido atribuidos al tolueno. Diversos estudios definen al tolueno como una droga alucinógena, que ejerce su efecto probablemente a través de mecanismos serotonérgicos. En este trabajo se estudia el efecto de la exposición aguda a diferentes concentraciones de tolueno en la presentación del síndrome serotonérgico. Grupos de ratas macho Wistar fueronm expuestos a diversas concentraciones de tolueno durante 15 minutos por única vez, mediante un sistema estático de inhalación. Se registró la presencia de los signos que integran al síndrome serotonérgico; además se evaluó el reflejo de enderezamiento. La concentración efectiva media de tolueno para provocar el síndrome serotonérgico fue de 4,878 ppm. El efecto observado sobre el reflejo de enderezamiento fue la perdida de éste a partir de 7,638 ppm; el efecto se incrementó de manera dependiente de la concentración

Acute water intoxication as a complication of urine drug testing in the workplace.

Urine drug testing is now mandatory in many industries. We report the first case, to our knowledge, of an adverse consequence of drug testing in the workplace: acute water intoxication. We discuss normal water metabolism and the adverse effects of water loading and impaired renal function on free water clearance. We present a literature review of seven other cases of acute voluntary water intoxication in patients without chronic psychiatric or neurologic illness. For workers undergoing urine drug testing we conclude that risk factors for acute water intoxication include (1) intake of more than 1 L of water and (2) impaired urine dilution. In a recently drug-tested worker, symptoms of cerebral dysfunction should suggest the possibility of water intoxication.