Polypharmacy, Infectious Diseases, Sexual Behavior, and Psychophysical Health Among Anabolic Steroid-Using Homosexual and Heterosexual Gym Patrons in San Francisco's Castro District.

BACKGROUND: Limited studies based in England and Australia reported misuse of anabolic-androgenic steroids (AAS) among homosexual men to enhance body image. Anecdotally, AAS are also being misused by homosexual men in the United States. Since many AAS and certain performance enhancing drugs (PEDs) are administered via injection, this poses a potential vector for the spread of infectious disease in an already at-risk population. OBJECTIVES: This study compared and contrasted homosexual and heterosexual male gym clients regarding use of AAS and PEDs, use of alcohol and illicit drugs, seroprevalence of infectious disease, engagement in risky injection practices and sexual behaviors, and presence of psychiatric conditions. METHODS: Recruitment and data collection occurred outside four exercise gyms in the San Francisco Castro District area between October 25, 2014 and March 10, 2015. Two hundred and twenty homosexual men and 73 heterosexual men completed the 114-item cross-sectional survey. RESULTS: Ten percent of homosexual men reported lifetime AAS use. Homosexual men had almost four times more sexual partners and were over 14 times more likely to knowingly have unprotected intercourse with a known HIV positive person than heterosexual men. In addition, a quarter of homosexual men who injected drugs admitted to sharing used syringes or needles with another person. Conclusions/Importance: The current study is the first to confirm AAS use among homosexual men in the United States. Homosexual men partook in high-risk sexual behaviors and injection practices which may place them at greater risks for contracting and spreading HIV and other infectious diseases.

Valproic acid-induced hyperammonemia and minimal hepatic encephalopathy prevalence among psychiatric inpatients.

BACKGROUND: Our purpose was to evaluate the relationship between valproic acid (VPA)-induced hyperammonemia (HA) and the prevalence of minimal hepatic encephalopathy (MHE) cognitive impairment among psychiatric inpatients. METHODS: Fifty-two psychiatric inpatients prescribed VPA were tested for MHE impairment after achieving steady-state VPA and ammonia concentrations during hospitalization between December 2013 and June 2014. The relationship between steady-state VPA and ammonia concentration was tested by correlation coefficient. Patients completed a battery of 5 psychometric tests that determined a Psychometric Hepatic Encephalopathy Score (PHES), which was used to test the association between a PHES <-4 cutoff for MHE impairment and HA exposure (ammonia >50 µmol/L) by chi-square testing. RESULTS: Steady-state VPA plasma concentration was not correlated significantly with ammonia concentration (r = 0.24, P = .093). The patients with HA did not have a higher proportion of MHE cognitive impairment than patients with normal ammonia exposure (43.8% vs 66.7% respectively, P = .806). CONCLUSIONS: Steady-state VPA concentration was not correlated with ammonia concentration and VPA-induced HA was not associated with a greater prevalence of MHE impairment. This suggests that the MHE impairment PHES cutoff might not detect VHE in psychiatric inpatients without cirrhosis, especially because inpatients could experience cognitive impairment related to acute mental illness.

Serotonin syndrome vs neuroleptic malignant syndrome: a contrast of causes, diagnoses, and management.

BACKGROUND: Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are uncommon but potentially life-threatening adverse reactions associated with psychotropic medications. Polypharmacy and the similar presentation of SS and NMS make diagnosis of the 2 syndromes problematic. METHODS: A MEDLINE search was performed for the period 1960 to 2011 for case reports, review articles, and studies pertaining to SS and NMS. RESULTS: The majority of available literature on SS and NMS consists of case reports, case-control studies, and retrospective reviews. In addition, diagnostic criteria have been developed to aid in the diagnosis and management of SS and NMS. CONCLUSIONS: SS presents as mental status changes, autonomic nervous system disturbances, neurologic manifestations, and hyperthermia. Similarly, NMS presents as muscle rigidity, hyperpyrexia, mental status changes, and autonomic instability. However, the clinical laboratory profile of elevations in creatine kinase, liver function tests (lactate dehydrogenase, aspartate transaminase), and white blood cell count, coupled with a low serum iron level, distinguishes NMS from SS among patients taking neuroleptic and serotonin agonist medications simultaneously. For both SS and NMS, immediate discontinuation of the causative agent is the primary treatment, along with supportive care. For NMS, dantrolene is the most effective evidence-based drug treatment whereas there are no evidence-based drug treatments for SS. A 2-week washout of neuroleptic medication minimizes the chance of recurrence.

Weightlifting's risky new trend: a case series of 41 insulin users.

Use of performance-enhancing drugs (PEDs) is common among strength-trained individuals, and a growing concern is the misuse of insulin. A 99-item Internet-based survey was posted on discussion boards of various fitness, bodybuilding, weightlifting, and anabolic steroid Web sites between February and June 2009. A case series of 41 nondiabetic insulin users is described. The typical insulin user was 30.7 ± 9.2 years old, male (97.6%), and Caucasian/white (86.8%) who classified himself as a "recreational exerciser" (47.5%). The average insulin user also used anabolic steroids (95.1%) and practiced polypharmacy by incorporating 16.2 ± 5.6 PEDs in his or her yearly routine. Hypoglycemia was reported by most of the subjects (56.8%), and one individual reported unconsciousness. Insulin was obtained most commonly from local sources (e.g., friends, training partners, gym member/dealer; 40.5%) and community pharmacies (37.8%), with most (80.6%) finding it "easy" to acquire their insulin. Strategies aimed to prevent insulin misuse are needed.

Diabetes prevalence estimates in schizophrenia and risk factor assessment.

BACKGROUND: Atypical antipsychotics have been indirectly associated with the diagnosis of type 2 diabetes mellitus (T2DM) in patients with schizophrenia. The purpose of this cross-sectional study was to determine the prevalence of T2DM and to examine the risk factors associated with T2DM among outpatients diagnosed with schizophrenia. The study also sought to determine which risk factors are of particular screening importance in monitoring the metabolic status of these patients. METHODS: This study included 202 patients diagnosed with schizophrenia. Data on a number of known and hypothesized risk factors for T2DM were collected. RESULTS: Risk factors for T2DM identified by bivariate analyses in this sample included older age, waist-to-hip ratio >1.0, sedentary lifestyle, number of hours worked per week, hyperlipidemia, previous screening for T2DM, higher random blood glucose, and number of years on atypical antipsychotics risperidone or olanzapine. However, further scrutiny using multiple logistic regression identified only sedentary lifestyle, waist-to-hip ratio ≥1.0, and a diagnosis of hyperlipidemia as significant risk factors in these patients. Similar to other studies, there was an 11.5% (22/192) lifetime prevalence rate of diabetes among this population. CONCLUSIONS: Risk factors traditionally associated with T2DM, as well as waist-to-hip ratio, are the factors most strongly associated with increased risk of diabetes in patients with schizophrenia.

Use of actigraphy and sleep diaries to assess sleep and academic performance in pharmacy students.

INTRODUCTION: Sleep parameters have been shown to correlate with academic performance. Current studies assessing sleep in doctor of pharmacy (PharmD) students rely on self-reported sleep parameters and academic performance. The objectives of this study were to describe and compare sleep parameters in pharmacy students using actigraphy and sleep diaries and to assess the correlation of sleep parameters with academic performance. METHODS: This prospective cohort study with convenience sampling assessed sleep parameters in pharmacy students. Thirty-five students completing the second year of a PharmD program participated in the study. Participants wore actigraph watches and maintained sleep diaries for seven consecutive days during the spring and fall semesters, while classes were in session, except for one week prior to exams and the week of exams. Academic performance was tracked during fall and spring semesters. RESULTS: Actigraphy and sleep diaries showed significant differences in sleep latency (SL), actual sleep time (AST), wake bouts, and sleep efficiency (SE). Actigraphy results indicated that the participants fell asleep faster (SL), slept a shorter duration (AST), had more wake bouts, and lower SE than results reported in the sleep diaries. SE and SL from the sleep diaries positively correlated with the fall semester pharmaceutical sciences course and overall spring semester academic performance. Actigraphy recorded AST correlated with performance in both semesters' clinical sciences courses. CONCLUSIONS: The results of actigraphy differed from the sleep diaries. More studies are needed to assess differences in detection of sleep parameters using sleep diaries and actigraphs.

The touro 12-step: a systematic guide to optimizing survey research with online discussion boards.

The Internet, in particular discussion boards, can provide a unique opportunity for recruiting participants in online research surveys. Despite its outreach potential, there are significant barriers which can limit its success. Trust, participation, and visibility issues can all hinder the recruitment process; the Touro 12-Step was developed to address these potential hurdles. By following this step-by-step approach, researchers will be able to minimize these pitfalls and maximize their recruitment potential via online discussion boards.

Women and anabolic steroids: an analysis of a dozen users.

OBJECTIVE: To provide an in-depth analysis of 12 female self-reported anabolic-androgenic steroid (AAS) users. DESIGN: Web-based survey. SETTING: A Web-based survey was posted on 38 discussion boards of various fitness, bodybuilding, weightlifting, and steroid Web sites between February and June 2009. INTERVENTIONS: Participants completed a survey regarding demographics and use of AAS and other performance-enhancing agents (PEAs). PARTICIPANTS: A cohort of 1519 strength-trained subjects fully completed and submitted a valid survey. Five hundred eighteen subjects were self-reported AAS users consisting of 12 women and 506 men. One thousand one subjects were non-AAS users consisting of 230 women and 771 men. MAIN OUTCOME MEASURES: Demographic data and use of AAS and other PEAs. RESULTS: The female AAS users reported using an average of 8.8 PEAs in their routine. Compared with male AAS users and female non-AAS users, respectively, female AAS users were more likely to have met criteria for substance-dependence disorder (58.3% vs 23.4%; P = 0.01; 58.3% vs 9.1%; P < 0.001), have been diagnosed with a psychiatric illness (50.0% vs 17.4%; P = 0.01; 50.0% vs 22.2%; P = 0.04), and have reported a history of sexual abuse (41.7% vs 6.1%; P < 0.001; 41.7% vs 15.3%; P = 0.03). CONCLUSIONS: Female AAS users practice polypharmacy. Female AAS users are more likely to have qualified for substance-dependence disorder, have been diagnosed with a psychiatric illness, and have a history of sexual abuse than both male AAS users and female non-AAS users.

Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years.

BACKGROUND: Although community pharmacists have historically been paid primarily for drug distribution and dispensing services, medication therapy management (MTM) services evolved in the 1990s as a means for pharmacists and other providers to assist physicians and patients in managing clinical, service, and cost outcomes of drug therapy. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003) and the subsequent implementation of Medicare Part D in January 2006 for the more than 20 million Medicare beneficiaries enrolled in the Part D benefit formalized MTM services for a subset of high-cost patients. Although Medicare Part D has provided a new opportunity for defining the value of pharmacist-provided MTM services in the health care system, few publications exist which quantify changes in the provision of pharmacist-provided MTM services over time. OBJECTIVES: To (a) describe the changes over a 7-year period in the primary types of MTM services provided by community pharmacies that have contracted with drug plan sponsors through an MTM administrative services company, and (b) quantify potential MTM-related cost savings based on pharmacists' self-assessments of the likely effects of their interventions on health care utilization. METHODS: Medication therapy management claims from a multistate MTM administrative services company were analyzed over the 7-year period from January 1, 2000, through December 31, 2006. Data extracted from each MTM claim included patient demographics (e.g., age and gender), the drug and type that triggered the intervention (e.g., drug therapeutic class and therapy type as either acute, intermittent, or chronic), and specific information about the service provided (e.g., Reason, Action, Result, and Estimated Cost Avoidance [ECA]). ECA values are derived from average national health care utilization costs, which are applied to pharmacist self-assessment of the "reasonable and foreseeable" outcome of the intervention. ECA values are updated annually for medical care inflation. RESULTS: From a database of nearly 100,000 MTM claims, a convenience sample of 50 plan sponsors was selected. After exclusion of claims with missing or potentially duplicate data, there were 76,148 claims for 23,798 patients from community pharmacy MTM providers in 47 states. Over the 7-year period from January 1, 2000, through December 31, 2006, the mean ([SD] median) pharmacy reimbursement was $8.44 ([$5.19] $7.00) per MTM service, and the mean ([SD] median) ECA was $93.78 ([$1,022.23] $5.00). During the 7-year period, pharmacist provided MTM interventions changed from primarily education and monitoring for new or changed prescription therapies to prescriber consultations regarding cost-efficacy management (Pearson chi-square P<0.001). Services also shifted from claims involving acute medications (e.g. penicillin antibiotics, macrolide antibiotics, and narcotic analgesics) to services involving chronic medications (e.g., lipid lowering agents, angiotensin-converting enzyme [ACE] inhibitors, and beta-blockers; P<0.001), resulting in significant changes in the therapeutic classes associated with MTM claims and an increase in the proportion of older patients served (P<0.001). These trends resulted in higher pharmacy reimbursements and greater ECA per claim over time (P<0.001). CONCLUSION: MTM interventions over a 7-year period evolved from primarily the provision of patient education involving acute medications towards consultation-type services for chronic medications. These changes were associated with increases in reimbursement amounts and pharmacist-estimated cost savings. It is uncertain if this shift in service type is a result of clinical need, documentation requirements, or reimbursement opportunities.

Consistency of antidepressant and chronic nonpsychiatric medication use in a high-risk clinical population.

BACKGROUND: Antidepressant nonadherence is a significant threat to clinical outcomes and can be divided into 2 primary domains, persistence and consistency. Although antidepressant persistence has been well described, little is known about consistency patterns. OBJECTIVES: The primary objective of this study was to characterize consistency among persistent antidepressant users. Patients with depression may also exhibit poor adherence to medications for chronic comorbid conditions. Thus, a second objective was to compare their consistency with chronic, nonpsychiatric medications with that of nonantidepressant users. METHODS: Continuously eligible adult patients were selected from the Iowa Medicaid Pharmaceutical Case Management program based on receiving an antidepressant or a selected chronic nonpsychiatric medication for at least the first 4 months after program enrollment. Consistency over the first year of enrollment was determined from prescription refill patterns, using the MED-OUT index. RESULTS: The mean consistency rate was 86% among the 1122 persistent antidepressant users. Consistency was not significantly different among polyantidepressant users or across the antidepressant classes. Among antidepressant users, consistency with antidepressants was not significantly different from consistency with chronic nonpsychiatric medications. Antidepressant users were not significantly less consistent with chronic nonpsychiatric medications than nonantidepressant users, after controlling for the confounding factors of age, sex, and total number of medications. CONCLUSIONS: Consistency with medications in this population of persistent antidepressant users with medical illnesses was fairly good, and comparable to that of nonantidepressant users. The unique population may have influenced consistency rates. Focusing on persistent antidepressant users may have limited the expected impact of depression on medication consistency.

Population Pharmacokinetic/Pharmacodynamic Modeling of Depot Testosterone Cypionate in Healthy Male Subjects.

A randomized, double-blind clinical trial was conducted to investigate long-term abuse effects of testosterone cypionate (TC). Thirty-one healthy men were randomized into a dose group of 100, 250, or 500 mg/wk and received 14 weekly injections of TC. A pharmacokinetic/pharmacodynamic (PK/PD) model was developed to characterize testosterone concentrations and link exposure to change in luteinizing hormone and spermatogenesis following long-term TC administration. A linear one-compartment model best described the concentration-time profile of total testosterone. The population mean estimates for testosterone were 2.6 kL/day for clearance and 14.4 kL for volume of distribution. Weight, albumin, and their changes from baseline were identified as significant covariates for testosterone. The estimated potency of total testosterone (tT) with respect to suppression of luteinizing hormone (LH) synthesis was 9.33 ng/mL. Simulation based on the indirect response model suggests the suppression of endogenous testosterone secretion, LH synthesis, and spermatogenesis was more severe and of greater duration in the 250 mg and the 500 mg dose groups.

Effects of chronic marijuana use on driving performance.

OBJECTIVES: The effects of marijuana on driving pose a significant public health concern. More studies on chronic marijuana use in driving are needed. The study objectives were to (1) assess differences in the Standardized Field Sobriety Test (SFST) and driving performance outcomes between chronic medical marijuana users and nonusers and (2) identify a cutoff tetrahydrocannabinol (THC) concentration above which chronic medical marijuana users demonstrate driving impairment. METHODS: This prospective cross-sectional study assessed 31 chronic marijuana users and 41 nonusers. Rapid Detect Saliva Drug Screen 10-panel was administered to all participants. Participants were given a simple visual reaction time test (SVRT) and SFST consisting of the horizontal gaze nystagmus (HGN), the one leg stand (OLS), and the walk and turn (WAT) tests. The STISIM Drive M100 driving simulator assessed driving performance. Driving parameters included standard deviation of speed (SDS), deviation of mean lane position, off-road accidents, collisions, pedestrians hit, and car-following modulus, delay, and coherence. Cannabinoid blood plasma was obtained from marijuana users. RESULTS: Marijuana users and nonusers did not differ in age (40.06 ± 13.92 vs. 41.53 ± 15.49, P = .6782). Marijuana users were more likely to fail the SFST (P = .005) and the WAT (P = .012) and HGN (P = .001) components. Marijuana users had slower SVRT (P = .031), less SDS (P = .039), and lower modulus (P = .003). Participants with THC >2 ng/mL (P = .017) and TCH >5 ng/mL (P = .008) had lower SDS. Participants with THC >2 ng/mL (P = .021) and THC >5 ng/mL (P = .044) had decreased modulus. CONCLUSION: Chronic marijuana users had slower reaction times, deviated less in speed, and had difficulty matching a lead vehicle's speed compared to nonusers. The effects on SDS and modulus were present at cutoffs of 2 and 5 ng/mL.

Ethanol Forensic Toxicology.

Ethanol abuse can lead to negative consequences that oftentimes result in criminal charges and civil lawsuits. When an individual is suspected of driving under the influence, law enforcement agents can determine the extent of intoxication by measuring the blood alcohol concentration (BAC) and performing a standardized field sobriety test. The BAC is dependent on rates of absorption, distribution, and elimination, which are influenced mostly by the dose of ethanol ingested and rate of consumption. Other factors contributing to BAC are gender, body mass and composition, food effects, type of alcohol, and chronic alcohol exposure. Because of individual variability in ethanol pharmacology and toxicology, careful extrapolation and interpretation of the BAC is needed, to justify an arrest and assignment of criminal liability. This review provides a summary of the pharmacokinetic properties of ethanol and the clinical effects of acute intoxication as they relate to common forensic questions. Concerns regarding the extrapolation of BAC and the implications of impaired memory caused by alcohol-induced blackouts are discussed.

Driving performance comparing older versus younger drivers.

OBJECTIVES: A cross-sectional study was conducted at the Touro University California campus to compare differences in reaction times and driving performance of younger adult drivers (18-40 years) and older adult drivers (60 years and older). Each test group consisted of 38 participants. METHODS: A Simple Visual Reaction Test (SVRT) tool was used to measure reaction times. The STISIM Drive M100 driving simulator was used to assess driving parameters. Driving performance parameters included mean lane position, standard deviation of mean lane position measured, mean speed, standard deviation of mean speed, car-following delay, car-following modulus, car-following coherence, off-road accidents, collisions, pedestrians hit, and traffic light tickets. RESULTS: Compared to younger participants, older drivers experienced significantly slower reaction times (510.0 ± 208.8 vs. 372.4 ± 96.1 ms, P =.0004), had more collisions (0.18 ± 0.39 vs. none, P =.0044), drove slower (44.6 ± 6.6 vs. 54.9 ± 11.7 mph, P <.0001), deviated less in speed (12.6 ± 4.3 vs. 16.8 ± 6.3, P =.0011), and were less able to maintain a constant distance behind a pace car (0.42 ± 0.23 vs. 0.59 ± 0.24; P =.0025). CONCLUSIONS: Differences exist in driving patterns of older and younger drivers as measured by reaction times and driving simulator outcomes. These results are the first to compare these 2 specific adult age groups' driving performance as measured by a standardized driving simulator scenario. Identifying these differences is essential in addressing them and preventing future traffic injuries.

Relationship Between Grit with Academic Performance and Attainment of Postgraduate Training in Pharmacy Students.

Objective. To determine if Grit-S scores correlate with academic success in a doctor of pharmacy (PharmD) program, as well as the pursuit and attainment of pharmacy postgraduate (residency or fellowship) training. Methods. A 28-item survey was administered to third- and fourth-year (P3 and P4) pharmacy students. Variables queried included Grit-S score, demographics, pharmacy experience prior to the PharmD program, and factors that may affect academic performance during didactic coursework. Didactic coursework GPA was used as a surrogate for academic success. Information about pursuit and attainment of a postgraduate training position was also documented and used in the analyses. Results. There was no significant correlation between Grit-S scores and variables related to academic success. However, students were more likely to pursue postgraduate training with higher academic success and higher Grit-S. Lastly, students with higher Grit-S were also more likely to obtain a postgraduate training position. Conclusion. Grit-S scores correlated with the pursuit and successful attainment of postgraduate training, but not with academic success during the didactic years of a PharmD program.

The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity.

Anticholinergic Drug Scale (ADS) scores were previously associated with serum anticholinergic activity (SAA) in a pilot study. To replicate these results, the association between ADS scores and SAA was determined using simple linear regression in subjects from a study of delirium in 201 long-term care facility residents who were not included in the pilot study. Simple and multiple linear regression models were then used to determine whether the ADS could be modified to more effectively predict SAA in all 297 subjects. In the replication analysis, ADS scores were significantly associated with SAA (R2 = .0947, P < .0001). In the modification analysis, each model significantly predicted SAA, including ADS scores (R2 = .0741, P < .0001). The modifications examined did not appear useful in optimizing the ADS. This study replicated findings on the association of the ADS with SAA. Future work will determine whether the ADS is clinically useful for preventing anticholinergic adverse effects.

Comparison of rates of potentially inappropriate medication use according to the Zhan criteria for VA versus private sector medicare HMOs.

BACKGROUND: Inappropriate prescribing in the elderly is common, but rates across different health care systems and the impact of formulary restrictions are not well described. OBJECTIVE: To determine if rates of inappropriate medication use in the elderly differ between the Veterans Affairs (VA) health care system and the private sector Medicare health maintenance organization (HMO) patients. METHODS: A cross-sectional study design compared administrative pharmacy claims from 10 distinct geographic regions in the United States in the VA health care system and 10 analogous regions for patients enrolled in Medicare HMOs. The cohorts included 123,633 VA and 157,517 Medicare HMO patients aged 65 years and older. Inappropriate medication use was identified using the Zhan modification of the Beers criteria, which categorizes 33 potentially inappropriate drugs into 3 major classifications: "always avoid," "rarely appropriate," and "some indications." Comparisons between the VA health care system and the private sector Medicare HMO were performed for overall differences and stratified by gender and age. The drug formulary status of the Zhan-criteria drugs was known for the VA health system but not for the Medicare HMO patients. RESULTS: Compared with private sector patients, VA patients were less likely to receive any inappropriate medication (21% vs. 29%, P <0.001), and in each classification: always avoid (2% vs. 5%, P <0.001), rarely appropriate (8% vs. 13%, P<0.001), and some indications (15% vs. 17%, P <0.001). The rate of inappropriate drug use was lower in the VA compared with the private sector for males (21% vs. 24%, P <0.001) and females (28% vs. 32%, P <0.001). Differences were consistent when stratified by age. CONCLUSION: Compared with private sector Medicare HMOs, elderly VA patients were less likely to receive medications defined by the Zhan criteria as potentially inappropriate. A restrictive formulary that excludes 12 of the 33 Zhan criteria drugs may be a factor in the reduction of undesired prescribing patterns in elderly populations.

The association of alcohol-induced blackouts and grayouts to blood alcohol concentrations.

The primary aim of this study was to investigate the association between measured blood alcohol concentration (BAC) and the presence and degree of amnesia (no amnesia, grayout, or blackout) in actively drinking subjects. A secondary aim was to determine potential factors other than BAC that contribute to the alcohol-induced memory loss. An interview questionnaire was administered to subjects regarding a recent alcohol associated arrest with a documented BAC greater than 0.08 g/dL for either public intoxication, driving under the influence, or under age drinking was administered. Demographic variables collected included drinking history, family history of alcoholism, presence of previous alcohol-related memory loss during a drinking episode, and drinking behavior during the episode. Memory of the drinking episode was evaluated to determine if either an alcohol-induced grayout (partial anterograde amnesia) or blackout (complete anterograde amnesia) occurred. Differences in (1) mean total number of drinks ingested before arrest, (2) gulping of drinks, and (3) BAC at arrest were found for those having blackouts compared with no amnesia; while differences in drinking more than planned were found between the no amnesia and grayout groups. A strong linear relationship between BAC and predicted probability of memory loss, particularly for blackouts was obvious. This finding clinically concludes that subjects with BAC of 310 g/dL or greater have a 0.50 or greater probability of having an alcoholic blackout.

Effects of valerian on subjective sedation, field sobriety testing and driving simulator performance.

INTRODUCTION: The availability of herbal medicines over-the-counter (OTC) has increased the use of natural products for self-treatment. Valerian has been used to effectively treat generalized anxiety disorder and insomnia. Studies suggest that valerenic acid may increase gamma-aminobutyric acid (GABA) modulation in the brain. Benzodiazepines have a similar mechanism of action and have been linked to an increased risk of hospitalizations due to traffic accidents. Despite the risk of somnolence, the safety of driving while under the influence of valerian remains unknown. PURPOSE: The purpose of the study was to determine the effects of a one-time valerian 1600mg dose on subjective sedation effects, standardized field sobriety testing (SFST) and driving simulator performance parameters. METHODS: The study design was a randomized, placebo-controlled, double-blind, cross-over trial. For each session, participants received either a dose of valerian or placebo. The outcome measures included a simple visual reaction test (SVRT), subjective sleepiness scales, SFST performance scores, and driving simulator performance parameters. RESULTS: There were no significant differences in the SVRT or sleepiness scales between placebo and valerian exposures, but the study may have been underpowered. SFST total and individual test failure rates were not significantly different between the two exposures. The driving simulator performance parameters were equivalent between the two exposure conditions. CONCLUSIONS: A one-time valerian 1600mg dose, often used to treat insomnia, does not appear to impair driving simulator performance after acute ingestion.

The Effects of Dextromethorphan on Driving Performance and the Standardized Field Sobriety Test.

Dextromethorphan (DXM) is abused most commonly among adolescents as a recreational drug to generate a dissociative experience. The objective of the study was to assess driving with and without DXM ingestion. The effects of one-time maximum daily doses of DXM 120 mg versus a guaifenesin 400 mg dose were compared among 40 healthy subjects using a crossover design. Subjects' ability to drive was assessed by their performance in a driving simulator (STISIM® Drive driving simulator software) and by conducting a standardized field sobriety test (SFST) administered 1-h postdrug administration. The one-time dose of DXM 120 mg did not demonstrate driving impairment on the STISIM® Drive driving simulator or increase SFST failures compared to guaifenesin 400 mg. Doses greater than the currently recommended maximum daily dose of 120 mg are necessary to perturb driving behavior.