Dennis J. Crouch

A Comparison of the Cell Phone Driver and the Drunk Driver

Objective: The objective of this research was to determine the relative impairment associated with conversing on a cellular telephone while driving. Background: Epidemiological evidence suggests that the relative risk of being in a traffic accident while using a cell phone is similar to the hazard associated with driving with a blood alcohol level at the legal limit. The purpose of this research was to provide a direct comparison of the driving performance of a cell phone driver and a drunk driver in a controlled laboratory setting. Method: We used a high-fidelity driving simulator to compare the performance of cell phone drivers with drivers who were intoxicated from ethanol (i.e., blood alcohol concentration at 0.08% weight/volume). Results: When drivers were conversing on either a handheld or hands-free cell phone, their braking reactions were delayed and they were involved in more traffic accidents than when they were not conversing on a cell phone. By contrast, when drivers were intoxicated from ethanol they exhibited a more aggressive driving style, following closer to the vehicle immediately in front of them and applying more force while braking. Conclusion: When driving conditions and time on task were controlled for, the impairments associated with using a cell phone while driving can be as profound as those associated with driving while drunk. Application: This research may help to provide guidance for regulation addressing driver distraction caused by cell phone conversations.

Effects of intrathecal morphine on the ventilatory response to hypoxia.

BACKGROUND Intrathecal administration of morphine produces intense analgesia, but it depresses respiration, an effect that can be life-threatening. Whether intrathecal morphine affects the ventilatory response to hypoxia, however, is not known. METHODS We randomly assigned 30 men to receive one of three study treatments in a double-blind fashion: intravenous morphine (0.14 mg per kilogram of body weight) with intrathecal placebo; intrathecal morphine (0.3 mg) with intravenous placebo; or intravenous and intrathecal placebo. The selected doses of intravenous and intrathecal morphine produce similar degrees of analgesia. The ventilatory response to hypercapnia, the subsequent response to acute hypoxia during hypercapnic breathing (targeted end-tidal partial pressures of expired oxygen and carbon dioxide, 45 mm Hg), and the plasma levels of morphine and morphine metabolites were measured at base line (before drug administration) and 1, 2, 4, 6, 8, 10, and 12 hours after drug administration. RESULTS At base line, the mean (+/-SD) values for the ventilatory response to hypoxia (calculated as the difference between the minute ventilation during the second full minute of hypoxia and the fifth minute of hypercapnic ventilation) were similar in the three groups: 38.3+/-23.2 liters per minute in the placebo group, 33.5+/-16.4 liters per minute in the intravenous-morphine group, and 30.2+/-11.6 liters per minute in the intrathecal-morphine group (P=0.61). The overall ventilatory response to hypoxia (the area under the curve) was significantly lower after either intravenous morphine (20.2+/-10.8 liters per minute) or intrathecal morphine (14.5+/-6.4 liters per minute) than after placebo (36.8+/-19.2 liters per minute) (P=O.003). Twelve hours after treatment, the ventilatory response to hypoxia in the intrathecal-morphine group (19.9+/-8.9 liters per minute), but not in the intravenous-morphine group (30+/-15.8 liters per minute), remained significantly depressed as compared with the response in the placebo group (40.9+/-19.0 liters per minute) (P= 0.02 for intrathecal morphine vs. placebo). Plasma concentrations of morphine and morphine metabolites either were not detectable after intrathecal morphine or were much lower after intrathecal morphine than after intravenous morphine. CONCLUSIONS Depression of the ventilatory response to hypoxia after the administration of intrathecal morphine is similar in magnitude to, but longer-lasting than, that after the administration of an equianalgesic dose of intravenous morphine.

Quantitative analysis of capsaicinoids in fresh peppers, oleoresin capsicum and pepper spray products.

Liquid chromatography-mass spectrometry was used to identify and quantify the predominant capsaicinoid analogues in extracts of fresh peppers, in oleoresin capsicum, and pepper sprays. The concentration of capsaicinoids in fresh peppers was variable. Variability was dependent upon the relative pungency of the pepper type and geographical origin of the pepper. Nonivamide was conclusively identified in the extracts of fresh peppers, despite numerous reports that nonivamide was not a natural product. In the oleoresin capsicum samples, the pungency was proportional to the total concentration of capsaicinoids and was related by a factor of approximately 15,000 Scoville Heat Units (SHU)/microg of total capsaicinoids. The principle analogues detected in oleoresin capsicum were capsaicin and dihydrocapsaicin and appeared to be the analogues primarily responsible for the pungency of the sample. The analysis of selected samples of commercially available pepper spray products also demonstrated variability in the capsaicinoid concentrations. Variability was observed among products obtained from different manufacturers as well as from different product lots from the same manufacturer. These data indicate that commercial pepper products are not standardized for capsaicinoid content even though they are classified by SHU. Variability in the capsaicinoid concentrations in oleoresin capsicum-based self-defense weapons could alter potency and ultimately jeopardize the safety and health of users and assailants.

THE PREVALENCE OF DRUGS AND ALCOHOL IN FATALLY INJURED TRUCK DRIVERS

To assess the impact of alcohol and other drug use in the trucking industry, the National Transportation Safety Board, in collaboration with The National Institute on Drug Abuse investigated fatal-to-the-driver trucking accidents in eight states over a one year period. Comprehensive drug screens were performed on blood specimens collected from 168 fatally injured drivers. One or more drugs were detected in 67% of the drivers and 33% of the drivers had detectable blood concentrations of psychoactive drugs or alcohol. The most prevalent drugs were cannabinoids and ethanol, each found in 13% of the drivers. Cocaine or benzoylecgonine was found in 8% of the cases. Seven percent of the drivers blood specimens contained amphetamine or methamphetamine and 7% contained phenylpropanolamine, ephedrine, or pseudoephedrine. A panel of toxicologists reviewed the accident investigation report and the toxicology findings for each case and determined that impairment due to marijuana use was a factor in all cases where the delta-9-tetrahydrocannabinol concentration exceeded 1.0 ng/mL and that alcohol impairment contributed to all accidents where the blood alcohol concentration was 0.04% wt/vol or greater. In 50 of 56 cases where psychoactive drugs or alcohol were found, impairment due to substance use contributed to the fatal accident.

Determination of capsaicin, dihydrocapsaicin, and nonivamide in self-defense weapons by liquid chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry

Sensitive and selective liquid chromatography-mass spectrometry (LC-MS) and liquid chromatography-tandem mass spectrometry (LC-MS-MS) methods for the analysis of capsaicin, dihydrocapsaicin, and nonivamide in pepper spray products have been developed. Chromatographic separation of the capsaicinoid analogues was achieved using a reversed-phase HPLC column and a stepwise gradient of methanol and distilled water containing 0.1% (v/v) formic acid. Identification and quantification of the capsaicinoids was achieved by electrospray ionization single-stage mass spectrometry monitoring the protonated molecules of the internal standard (m/z 280), capsaicin (m/z 306), dihydrocapsaicin (m/z 308), and nonivamide (m/z 294) or by tandem mass spectrometry monitoring the appropriate precursor-to-product-ion transitions. The plot of concentration versus peak area ratio was linear over the range of 10-750 ng/ml using LC-MS and 10-500 ng/ml using LC-MS-MS. However, to accurately quantify the capsaicinoids in the pepper spray products calibration curves between 10 and 1000 ng were constructed and fit using a weighted quadratic equation. Using the quadratic curve, the accuracy of the assay ranged from 91 to 102% for all analytes. The intra-assay precision (RSD) for capsaicin was 2% at 25 ng/ml, 10% at 500 ng/ml, and 3% at 800 ng/ml. The inter-assay precision (RSD) for capsaicin was 6% at 25 ng/ml, 6% at 500 ng/ml, and 9% at 800 ng/ml. Similar values for inter- and intra-assay precision were experimentally obtained for both dihydrocapsaicin and nonivamide. The analysis of selected pepper spray products demonstrated that the capsaicinoid concentration in the products ranged from 0.7 to 40.5 microg/microl.

Validation of twelve chemical spot tests for the detection of drugs of abuse

Validation procedures are described for 12 chemical spot tests including cobalt thiocyanate, Dille-Koppanyi, Duquenois-Levine, Mandelin, Marquis, nitric acid, para-dimethylaminobenzaldehyde, ferric chloride, Froehde, Mecke, Zwikker and Simons (nitroprusside). The validation procedures include specificity and limit of detection. Depending on the specificity of each color test, between 28 to 45 drugs or chemicals were tested in triplicate with each of the 12 chemical spot tests. For each chemical test, the final colors resulting from positive reactions with known amounts of analytes were compared to two reference color charts. For the identification of unknown drugs, reference colors from the Inter-Society Color Council and the National Bureau of Standards (ISCC-NBS) and Munsell charts are included along with a description of each final color. These chemical spot tests were found to be very sensitive with limits of detection typically 1 to 50 microg depending on the test and the analyte.

Concentrations of Lidocaine and Monoethylglycylxylidide (MEGX) in Lidocaine Associated Deaths

Concentrations of lidocaine and MEGX were determined in a variety of tissues and other samples collected at autopsy. In 13 of the cases examined in which lidocaine was associated with death, tissue concentrations were greater than 15 mg/kg. Tissue concentrations in other patients treated with lidocaine were significantly lower.

Determination of alprazolam and α-hydroxyalprazolam in human plasma by gas chromatography/negative-ion chemical ionization mass spectrometry

A sensitive and specific method was developed for the determination of alprazolam and its major metabolite alpha-hydroxyalprazolam in plasma. After the addition of deuterium-labeled internal standards, plasma samples were buffered to pH 9 with 1 ml of saturated sodium borate buffer, extracted with toluene-methylene chloride (7:3) and evaporated to dryness. The residues were treated with N,O-bis(trimethylsilyl)trifluoroacetamide containing 1% of trimethylchlorosilane and analyzed on a Finnigan-MAT mass spectrometer operated in the negative-ion chemical ionization mode with methane as the reagent gas. Chromatographic separation was achieved on a Restek-200 capillary column using hydrogen as the carrier gas. The assay was linear from 0.25 to 50 ng ml-1 for both compounds. The intra-assay precision for alprazolam was 16.1% at 0.5 ng ml-1 and 4.6% at 50 ng ml-1 and that for alpha-hydroxyalprazolam was 15.8% at 0.5 ng ml-1 and 4.2% at 50 ng ml-1. The method was used to determine alprazolam and alpha-hydroxyalprazolam in human plasma samples collected after a single 2 mg oral does of alprazolam. A peak concentration of 32.9 ng ml-1 of alprazolam was detected at 1 h following the dose.

A comparison of ONTRAK TESTCUP, abuscreen ONTRAK, abuscreen ONLINE, and GC/MS urinalysis test results.

This study was designed to compare results obtained from two separate on-site drug testing kits (ONTRAK TESTCUP and Abuscreen ONTRAK) with those obtained from laboratory based immunoassay and GC/MS. Abuscreen ONLINE immunoassay was used to select 250 negative samples and 100 presumptive-positive samples each for cocaine/metabolites, opiates and cannabinoids. Presumptive-positive samples were selected if the immunoassay response was > or = 300 ng/mL for cocaine/metabolites (BZE), > or = 300 ng/mL for opiates or > or = 50 ng/mL for cannabinoids (THC-COOH). GC/MS was used to confirm that each selected sample contained > or = 150 ng/mL BZE, > or = 300 ng/mL morphine/codeine or > or = ng/mL THC-COOH. TESTCUP results had a 100% agreement with GC/MS and a > 99% agreement with ONLINE when testing negative samples. The agreement between TESTCUP and ONLINE results for samples containing opiates was 100%. Results of testing samples containing BZE with TESTCUP demonstrated a 98% agreement with both GC/MS and ONLINE. Both discrepant samples contained BZE at concentrations < or = 300 ng/mL. The least agreement between TESTCUP and ONLINE results was found when testing samples containing THC-COOH. The agreement with ONLINE and GC/MS was 92% and all discrepant samples had GC/MS determined THC-COOH concentrations less than 50 ng/mL. A 100% agreement was obtained between expected and recorded TESTCUP results for QC samples fortified to contained BZE, morphine or THC-COOH at concentrations within 120% of the screening cutoffs. ONTRAK had a 100% agreement with both GC/MS and ONLINE when testing negative samples and samples that contained opiates. ONTRAK had a 91% agreement with GC/MS and ONLINE for testing of samples that contained BZE. The least agreement between ONTRAK and ONLINE results was found when testing samples that contained THC-COOH. The agreement was 89%, however, all discrepant samples contained GC/MS concentrations of THC-COOH less that the 50 ng/mL cutoff. With ONTRAK, a 100% agreement was obtained between expected and recorded results QC samples that contained morphine or THC-COOH and a 97.7% agreement was obtained between expected and recorded results on QC samples that contained BZE.

Detection of alprazolam in hair by negative ion chemical ionization mass spectrometry

A sensitive and specific method for the quantitative determination of alprazolam (AL) in hair has been developed. After the addition of deuterium labeled triazolam as an internal standard, hair samples (20 mg) were digested with 1 N NaOH at 40 degrees C overnight. Calibrators containing known concentrations of AL dried onto drug-free hair were also prepared and digested. After digestion, the solution was cooled, adjusted to pH 9 with 6 N HCl and 1 ml of saturated sodium borate buffer was added. The digested solutions were extracted with toluene:methylene chloride (7:3) and the organic phase was evaporated to dryness. Extract residues were treated with BSTFA and 1% TMCS and analyzed on a Finnigan-MAT mass spectrometer in the negative-ion chemical ionization mode with methane as the reagent gas. Chromatographic separation was achieved on a Restek-200 capillary column using hydrogen as the carrier gas. The assay was capable of detecting 25 pg/mg of AL and was linear to 250 pg/mg. Intra-assay precision was 11.1% at 25 pg/mg and 5.4% at 150 pg/mg. Inter-assay precision was 11.2% at 25 pg/mg and 5.3% at 150 pg/mg. This method has been used to study the hair incorporation of AL into Long-Evans rats who received 5.0 mg/kg or 7.5 mg/kg i.p. twice a day for 5 days. Preliminary results indicate that the AL concentration in the pigmented and non-pigmented hair on day 14 ranged from 60 to 100 pg/mg.