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The frequent criticisms of the 'gateway hypothesis' have led scholars to note the importance of considering the role of intra-individual change for drug use progression. While studies employing drug use trajectories have added considerably to our understanding of drug use comorbidity, the extent to which trajectories inform drug use progression remains largely unknown despite the fact that there are several theoretical reasons to suspect that intra-individual change is important to the gateway phenomenon. The current study employs latent class growth models using a sample from the Boys Town study of adolescent drug and drinking behavior. The results demonstrate that knowing how gateway drug use changes over time provides important information above and beyond knowing frequency of gateway use for predicting harder drug use trajectories. Implications of the empirical findings and directions for future research are discussed.

The goal of this research is to better understand the role that South Florida pain management clinics may be playing in the abuse and diversion of prescription drugs. This study explores 1) the characteristics and practices of pain clinics that may be facilitating the drug-seeking endeavors of prescription drug abusers and 2) the drug-seeking behaviors of prescription drug abusers who use pain clinics as a primary source for drugs. Thirty in-depth interviews were conducted with prescription drug abusers in South Florida. Interviews were transcribed verbatim and codes were generated based on thematic analyses of the data. Using grounded theory strategies, the analyses revealed six main themes: 'pill mills,' on-site pharmacies, liberal prescribing habits, 'sponsoring' drug diversion, pain doctor/ pharmacy shopping, and falsifying symptoms/documentation. These findings should provide insights for law enforcement, regulatory agencies, and industry as they attempt to develop appropriate policy initiatives and recommendations for best practices.

U.S. Mothers' Long-Term Employment Patterns In the February 2019 issue of Demography , Alexandra Killewald and Xiaolin Zhuo argue that 'previous research on maternal employment has disproportionately focused on the [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.12.027 Byline: Marie Katrine Klose Nielsen, Sys Stybe Johansen, Petur Weihe Dalsgaard, Kristian Linnet Keywords: UPLC-TOF-MS; Hair analysis; Drugs of abuse; Pharmaceuticals Abstract: An UPLC-TOF-MS method for simultaneous screening and quantification of 52 drugs in hair was developed and validated. The selected drugs represent the most common classes of pharmaceuticals and drugs of abuse such as amphetamines, analgesics, antidepressants, antipsychotics, benzodiazepines, cocaine, ketamine and opioids. Hair samples were extracted with methanol:acetonitrile:ammonium formate (2mM, 8% acetonitrile, pH 5.3) overnight at 37[degrees]C. The target drugs were separated and quantified using a Waters ACQUITY UPLC coupled to a Waters Micromass LCT Premier XE Time-of-Flight mass spectrometer. Total chromatographic run time was 17min. The data were treated with the MassLynx software ChromaLynx XS and QuanLynx for automated identification and quantification, respectively. The limits of detection ranged from 0.01 to 0.10ng/mg using a 10-mg hair sample and the limit of quantification was 0.05ng/mg for 87% of the analytes. A good linear behaviour was achieved for most of the analytes in the range from LOQ to 10 or 25ng/mg except for the amphetamines. The method showed an acceptable precision and trueness, since the obtained CV and BIAS values were [less than or equal to]25% for 81% of the analytes. The extraction recoveries for 92% of the analytes ranged between 84 and 106% and the extraction recoveries for all analytes were better than 60%. The method was applied to 15 autopsy hair samples from forensic investigations showing a wide abuse pattern of many pharmaceuticals and drugs of abuse within a period of less than three months. The present study demonstrated that the combination of accurate mass and retention time can provide good selectivity, which demonstrates that the TOF instrument is adequate for both screening and quantification purposes. Furthermore, it was shown that screening with the ChromaLynx XS software is less sensitive and selective for some analytes than the QuanLynx software, especially in low concentrations. Author Affiliation: Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Frederik VIs vej 11, DK-2100, Denmark Article History: Received 11 June 2009; Accepted 10 August 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.12.026 Byline: Thomas Nadulski (a), Simona Bleeck (a), Johannes Schrader (b), Wolf-Rainer Bork (c), Fritz Pragst (a) Keywords: 11-Nor-delta-9-tetrahydrocannabinol-9-carboxylic acid ethyl ester; Alcohol marker; Cannabinoids; Hair analysis Abstract: 11-Nor-[DELTA].sup.9-tetrahydrocannabinol-9-carboxylic acid ethyl ester (THC-COOEt) can be presumed to be a mixed metabolite formed during combined consumption of cannabinoids and alcohol. In order to examine this hypothesis, THC-COOEt and its deuterated analogue D.sub.3-THC-COOEt were synthesized as reference substance and internal standard from the corresponding carboxylic acids and diazoethane and methods were developed for the sensitive detection of THC-COOEt in plasma and hair based on gas chromatography-electron impact mass spectrometry after silylation with N-methyl-N-tert-butyldimethylsilyl-trifluoroacetamide and gas chromatography-negative chemical ionization mass spectrometry (GC-NCI-MS) as well as tandem mass spectrometry (GC-NCI-MS-MS) after derivatization with pentafluoropropionyl anhydride. The methods were applied for THC-COOEt determination to plasma samples from 22 drunk driving cases which contained both ethanol (0.30-2.16mg/g) and THC-COOH (15-252ng/mL) as well as to 12 hair samples from drug fatalities which were both positive for THC (0.09-2.04ng/mg) and fatty acid ethyl esters as markers of chronic alcohol abuse (0.70-6.3ng/mg). In none of these samples THC-COOEt could be found with limits of detection of 0.3ng/mL in plasma and 2pg/mg in hair in 11 samples using GC-NCI-MS and 0.2pg/mg in one sample using GC-NCI-MS. Therefore, the use of this compound as a marker for combined cannabis and alcohol consumption could not be achieved. Author Affiliation: (a) Institute of Legal Medicine, University Hospital Charite, Hittorfstr. 18, 14195 Berlin, Germany (b) Central Institute of Medical Services of German Armed Forces, Scharnhorststr. 14, 10115 Berlin, Germany (c) Forensic Science Institute Berlin, LKA KT 41, Tempelhofer Damm 12, 12101 Berlin, Germany Article History: Received 13 July 2009; Accepted 20 July 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.12.025 Byline: Cynthia Coulter, James Tuyay, Margaux Taruc, Christine Moore Keywords: Hair; Drugs of abuse; Immunoassay Abstract: A semi-quantitative analytical screening procedure for the determination of cocaine, amphetamines, opiates, and delta-9-tetrahydrocannabinol in hair has been developed. The procedure employs an aqueous extraction buffer, uses only 10mg of hair, requires 2h of incubation for the extraction to occur, and multiple drug classes can be screened using enzyme linked immunosorbent assays. Hair calibration standards were prepared around the recommended cut-off concentrations of the Society of Hair Testing. All drug classes showed excellent linearity over the concentration range tested, indicating that immunochemical screening can be used in a semi-quantitative mode for hair analysis using an aqueous buffer, rapid extraction and a small amount of hair. Author Affiliation: Immunalysis Corporation, 829 Towne Center Drive, Pomona, CA 91767, USA Article History: Received 9 July 2009; Accepted 27 July 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.12.038 Byline: E. Marchei (a), M. Farre (b), M. Pellegrini (a), A. Garcia-Algar (c), O. Vall (c), R. Pacifici (a), S. Pichini (a) Keywords: Methylphenidate pediatrics oral fluid; Sweat Abstract: Methylphenidate (MPH) is a stimulant medication widely used for treating attention-deficit hyperactivity disorder (ADHD) in children and adolescents. Therapeutic monitoring for this drug is essentially lacking and alternative biological matrices, such as oral fluid and sweat, should be investigated for noninvasive assessment of short- and long-term history of drug use. We report the excretion profile of MHP and its metabolite ritalinic acid (RA) in oral fluid and sweat from a 12-year-old boy treated with the extended release drug formulation. Concentrations of MPH and RA in oral fluid, sweat and plasma were measured by liquid chromatography-mass spectrometry. Oral fluid-to-plasma ratio at each time interval was calculated at the start of the treatment and correlated with salivary pH. Excretion of MPH in sweat patches, collected up to 24h with PharmChek patches was also investigated. MPH and RA were both detected in oral fluid with a pharmacokinetic profile similar to that in plasma. Oral fluid peak concentrations of MPH ranged between 13.5 and 30.9ng/mL at 3.0h after drug intake. Oral fluid-to-plasma MPH ratio between 13.1 and 3.2 demonstrated an accumulation of the drug in oral fluid. Conversely, RA was found in oral fluid at peak concentration (23.4-62.9ng/mL) equivalent to one-tenth of those found in plasma. Concentration profiles of MPH and RA in oral fluid were quite constant during the four weeks of drug administration. In sweat, MPH was detected for the first time at 5h after drug administration (range: 9.3-11.2ng/patch) up to 24h (range: 29.8-38.7ng/patch). RA was not detected in the sweat patches during the 24h time of collection. The results suggest that measurement of MPH in oral fluid can be used as a potential alternative to drug monitoring in plasma. Moreover, MPH measurement in sweat patches can be used for noninvasive monitoring of MPH consumption and misuse in situations where detection of recent abuse is of interest. Author Affiliation: (a) Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanita, V. le Regina Elena 299, 00161 Rome, Italy (b) Bioanalysis and Analytical Services Research Group, Neuropsychopharmacology Program, Institut Municipal d'Investigacio Medica IMIM-Hospital del Mar and Universitat AutA[sup.2]noma, Barcelona, Spain (c) Unitat de Recerca Infancia i Entorn (URIE), Paediatric Service, IMIM-Hospital del Mar, Barcelona, Spain Article History: Received 17 June 2009; Accepted 19 July 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.12.040 Byline: R. Gow (a), S. Thomson (b), M. Rieder (b)(c), S. Van Uum (b), G. Koren (a)(b)(d)(e) Keywords: Hair; Cortisol; Chronic stress; Hypothalamic-pituitary-adrenal axis Abstract: Hair analyses for exogenous compounds, specifically drugs of abuse, have been a useful tool in detecting long-term drug exposure. More recently, studies have delved into the exposure of endogenous compounds in hair. Cortisol is synthesized in the adrenal cortex in response to stress-induced activation of the hypothalamic-pituitary-adrenal (HPA) axis. While catecholamines generally indicate acute stress, cortisol can be used as an indicator for sub-acute and chronic stress. Studies on the effects of chronic stress are most often subjective in nature, relying on questionnaires asking the participant to recall on past stressors. This can lead to the issue of recall and reporting bias. A new objective measure of chronic stress is needed for a more accurate understanding of the effects of chronic stress on the body. This review uses emerging evidence to describe the usefulness of hair analysis for cortisol and discusses the current methods used. Author Affiliation: (a) Department of Physiology and Pharmacology, University of Western Ontario, Canada (b) Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada (c) CIHR-GSK Chair in Pediatric Clinical Pharmcology, Children's Health Research Institute, London, Ontario, Canada (d) Ivey Chair in Molecular Toxicology, University of Western Ontario, Canada (e) Department of Clinical Pharmacology/Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada Article History: Received 12 June 2009; Accepted 2 September 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.12.024 Byline: Joey Gareri, Gideon Koren Keywords: Hair; Fetal; Neonatal; Toxicology; Drugs Abstract: Neonatal hair is a clinically important toxicological matrix, as it allows determination of in utero drug exposure. This paper serves to review the physiological development of the hair follicle and hair production during fetal life. An understanding of the mechanisms and timing of hair development in the prenatal period is critical to effectively assessing the time window of exposure determination associated with toxicological analysis of neonatal hair. Author Affiliation: Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada Article History: Received 12 June 2009; Accepted 21 July 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.12.039 Byline: R. de la Torre (a)(b), E. Civit (a), F. Svaizer (c), A. Lotti (c), M. Gottardi (c), M. Miozzo (c) Keywords: Hair testing; Immunological methods; Opiates; Cannabinoids; Ecstasy; Cocaine; Methadone; Amphetamines; Sample preparation Abbreviations: MDMA, 3,4-methylenedioxymethamphetamine; MDA, 3,4-methylenedioxyhamphetamine; MDEA, 3,4-methylenedioxyethylamphetamine; THC, delta-9-tetrahydrocannabinol; THCCOOH, 11-nor-delta-9-carboxy-tetrahydrocannabinol; CBN, cannabinol; CBD, cannabidiol; LOQ, limit of quantification; 6-MAM, 6-monoacetylmorphine; EDDP, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine; SPE, solid phase extraction; BSTFA, bis(trimethylsilyl)-trifluoroacetamide; TMCS, trimethyl-chlorosilane; TFAA, trifluoroacetic acid anhydride; ELISA, enzyme linked immunosorbent assay; EIA, enzyme immunoassay Abstract: Drug testing in hair usually requires a rather complex sample treatment before drugs are amenable to analysis by either immunological and/or chromatographic coupled to mass spectrometry methods. Immunological methods applied are usually dedicated to hair analysis as analytes present in this matrix are not always the same present in urine. Comedical s.a.s. laboratories recently commercialized reagents (VMA-T) purposely designed for hair sample treatment which are compatible with current immunometric methods used for urine drug testing. This is possible as some analytes (6-MAM and cocaine) present in hair after sample treatment are converted to those detected in urine (morphine and benzoylecgonine). A correlation study for several drug classes performed in two laboratories with 32 clinical and 12 spiked drug free (controls) hair samples shows that implementation of the method on clinical chemistry analyzers is easy and that results obtained by different operators and instruments are comparable and reproducible. The main advantage of VMA-T method is the possibility to simultaneously extract from hair main drug classes, in a period of time lower than 2h and its compatibility with immunological methods applied in urine drug testing. Author Affiliation: (a) Institut Municipal d'InvestigatiA[sup.2] Medica (IMIM-Hospital del Mar), Human Pharmacology and Clinical Neurosciences Research Group, Neuropsychopharmacology Program, Barcelona, Spain (b) Universitat Pompeu Fabra (CEXS-UPF), Barcelona, Spain (c) Laboratorio di Sanita Pubblica (LSP) - Azienda Provinciale Servizi Sanitari, Trento, Italy Article History: Received 23 July 2009; Accepted 24 September 2009

There are limited prospective data on suicide attempts (SA) during the months following treatment for substance use disorders (SUD), a period of high risk. In an analysis of the Drug Abuse Treatment Outcomes Study, a longitudinal naturalistic multisite study of treated SUDs, variables associated with SA in the 12 months following SUD treatment were examined. Participants included 2,966 patients with one or more SUDs. By 12 months, 77 (2.6%) subjects had attempted suicide. Multivariate logistic regression analyses were used to identify variables associated with SA. Variables collected at baseline that were associated with SA included lifetime histories of SA, suicidal ideation (SI), depression, cocaine as primary substance of use, outpatient methadone treatment, and short-term inpatient treatment. Male sex, older age, and minority race or ethnicity were associated with lower likelihood of SA. After controlling for baseline predictors, variables assessed at 12 months associated with SA included SI during follow-up and daily or more use of cocaine. The data contribute to a small but growing literature of prospective studies of SA among treated SUDs, and suggest that SUDs with cocaine use disorders in particular should be a focus of prevention efforts.

Deep brain stimulation (DBS) is a reversible technique that is currently used for the treatment of Parkinson disease and may be suitable for the treatment of psychiatric disorders. Whether DBS inactivates the target structure is still a matter of debate. Here, from findings obtained in rats, we propose DBS of the subthalamic nucleus (STN) as a possible treatment for cocaine addiction to be further tested in human studies. We show that STN DBS reversibly reduces the motivation to work for an i.v. injection of cocaine, and it increases motivation to work for sucrose pellets. These opposite effects may result from STN DBS effect on the positive affective properties of these rewards. Indeed, we further show that STN DBS reduces the preference for a place previously associated with the rewarding properties of cocaine, and it increases the preference for a place associated with food. Because these findings a re consistent with those observed after STN lesions [Baunez C, Dias C, Cador M, Amalric M (2005) Nat Neurosci 8:484-489], they suggest that STN DBS mimics an inactivation of the STN on motivational processes. Furthermore, given that one of the major challenges for cocaine addiction is to find a treatment that reduces the craving for the drug without diminishing the motivation for naturally rewarding activities, our findings validate STN as a good target and DBS as the appropriate technique for a promising therapeutic strategy in the treatment of cocaine addiction. addiction | basal ganglia | motivation | food | rat doi/10.1073/pnas.0908189107

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.08.010 Byline: Hadir M. Maher (a), Tamer Awad (b)(c), Jack DeRuiter (c), C. Randall Clark (c) Keywords: Dimethoxyamphetamines (DMA); Regioisomers; GC-MS; GC-IRD; Perfluoroacylation Abstract: The mass spectrum of the drug of abuse 2,5-dimethoxyamphetamine (2,5-DMA) is characterized by an imine fragment base peak at m/z 44 and additional fragments at m/z 151/152 for the dimethoxybenzyl cation and radical cation, respectively. Five positional ring isomers of dimethoxyamphetamines (DMA) have an isomeric relationship to 2,5-DMA. All six compounds have the same molecular weight and produce similar EI mass spectra. This lack of mass spectral specificity for the isomers in addition to the possibility of chromatographic coelution could result in misidentification. The lack of reference materials for the potential imposter molecules constitutes a significant analytical challenge. Perfluoroacylation of the amine group reduced the nitrogen basicity and provided individual fragmentation pathways for discrimination between these compounds based on some unique fragment ions and the relative abundance of common ions. GC-IRD studies provided additional structure-IR spectra relationships and yielded confirmation level identification for each of the six regioisomeric dimethoxyamphetamines. The amines and their perfluoroacylated derivatives were resolved by capillary gas chromatography and the amines showed excellent resolution on the more polar stationary phase, Rtx-200. Author Affiliation: (a) Department of Pharmaceutical Analytical Chemistry, Alexandria University, Alexandria 21521, Egypt (b) Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Suez Canal University, Ismaillia 41552, Egypt (c) Division of Medicinal Chemistry, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA Article History: Received 21 May 2009; Revised 6 August 2009; Accepted 15 August 2009

In this study, we examine the explanation of the nonmedical use of prescription drugs. We test the comparative utility of two theories of drug use (i.e., social learning theory and self-control theory) on the nonmedical use of prescription drug use. Our contribution to social learning theory is the use of an understudied part of the theory--nonsocial reinforcement. We expect the two theories to explain the nonmedical use of prescription drugs. Using data from the 2006 Monitoring the Future Survey (MTF), we showed both theories have a link with the nonmedical use of prescription drugs. A consistent theme was that social learning theory had a consistent link with the nonmedical use of prescription drugs. However, self-control and nonsocial reinforcement have inconsistent links with the nonmedical use of prescription drugs. We discuss the policy implications of these findings.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.04.018 Byline: Francesco Mari (a), Lucia Politi (a), Annibale Biggeri (b)(c), Gabriele Accetta (c), Claudia Trignano (d), Marianna Di Padua (a), Elisabetta Bertol (a) Keywords: Waste water; Illicit drugs; 1-year study Abstract: The diffusion and trends in use of each substance is a basic information in policy planning of strategies aiming at deterrence of drug abuse or in the organization of the fight against drug trafficking. The actual diffusion of illicit drugs in a population is hardly measurable, but, among the various measures available, the analysis of waste water plants represents one of the most reliable source of data. We analyzed waste water in order to monitor illicit drug use by local population. We investigated the use of cocaine and heroin in the city of Florence, Italy, over a 1-year (July 2006-June 2007) period using state-of-the-art measuring techniques from waste water samples. Cocaine, benzoylecgonine, and morphine were determined in water samples by gas chromatography-mass spectrometer, and the amount of illicit substance was estimated. Data indicate for cocaine a bimodal distribution (December and March), while heroin showed a main peak in April. The heroin-to-cocaine use ratio in terms of estimated doses per month ranged from 0.11 to 0.76, representing new evidence of wider distribution of cocaine than heroin in Florence. Waste water analysis can become a valuable tool in monitoring use of illicit drugs over time. In particular, it can highlight changes in the magnitude and relative use of illicit drug at a population level thereby becoming useful to develop strategies against drug trafficking and abuse. If routinely performed, it can be part of Epidemiologic Surveillance Programmes on drug abuse. Author Affiliation: (a) Division of Forensic Toxicology, Department of Anatomy, Histology, and Legal Medicine, University of Florence, Viale Morgagni, 85, 50134 Florence, Italy (b) Department of Statistics 'G. Parenti', University of Florence, Italy (c) Biostatistics Unit, ISPO Institute for Cancer Prevention, Florence, Italy (d) Institute of Legal Medicine, University of Sassari, Italy Article History: Received 17 December 2008; Revised 9 April 2009; Accepted 16 April 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.04.004 Byline: F. Garcia-Bournissen (a), M. Moller (a), M. Nesterenko (a), T. Karaskov (a), G. Koren (a) Keywords: Hair analysis; Cocaine; Half-life Abstract: Methods that employ detection of drugs of abuse in hair are important for monitoring compliance with drug abstinence. Understanding the mechanisms and timeline of drug disappearance from hair is critical for clinical and forensic application of hair testing. We aimed to evaluate the kinetics of disappearance of cocaine and its metabolite, benzoylecgonine (BE), from hair after discontinuation of drug use. Author Affiliation: (a) Motherisk Program, Division of Clinical Pharmacology & Toxicology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada Article History: Received 14 November 2008; Revised 24 March 2009; Accepted 1 April 2009

A number of dramatic breakthroughs in the neurobiology of addiction have occurred in the past 40 years. Two domains will be highlighted: the neurocircuitry of addiction and the molecular biology of addiction targets. The neurobiological substrates for the reinforcing effects of drugs of abuse have been largely identified both at the initial site of action and in the circuitry involved. In human imaging studies, decreases in dopaminergic function have been identified as a key element of addiction, lending support for research on the role of dopamine in addiction. Three novel areas currently are emerging: the role of deficits in frontal cortex functioning, changes in the brain neurocircuitry that convey long-term vulnerability to relapse, and the role of nondopaminergic systems in the neuroadaptations associated with the development of drug dependence. Parallel to these functional changes have been major advances in our understanding of the molecular biology of addiction; the greatest contribution has been in the understanding of the molecular mechanisms of opioid action. This paper reviews the major developments in our understanding of the molecular biology of the endogenous opioid system and the use of genomics to advance our knowledge of the function and regulation of opioid receptors and endorphins.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.02.007 Byline: R.A. Lahti (a), H. Korpi (b), E. Vuori (a) Keywords: Illicit drug use; Toxicological findings; Cause of death; Death certification; Statistical classification; Cause-of-death statistics Abstract: National cause-of-death data are important for national health administration, international comparisons and epidemiological research. The process of compiling mortality statistics starts with determination of causes of death, continues with medical death certification and concludes in coding of causes and selection of the underlying cause of death at statistical office. This study assesses how unequivocally and specifically the toxicologically verified intoxication of cannabinoids, opiates, amphetamines and cocaine is represented in diagnostic entries on death certificates and the national cause-of-death database and, ultimately, in the cause-of-death statistics. Drug-positive deaths, i.e. deaths with blood-positive drug finding(s), the corresponding death certificates and the information entered in Statistics Finland's cause-of-death database were reviewed for the entire years of 2000, 2002 and 2004. Drug influence at the time of death may or may not be related to death. A drug-related condition was reported as the cause of death in 52% of cannabinoid-positive, in 81% of amphetamine-positive, in 98% of opiate-positive and in 100% of cocaine-positive deaths, calculated from the combined three-year material. At Statistics Finland, after validation of the reported information, the distribution was practically the same. From the cause-of-death database, the specific drug-related diagnosis could be identified in 21% of cannabinoid-positive, in 89% of opiate-positive and in 57% of amphetamine-positive deaths. The corresponding proportions of specific drug-related underlying causes in the cause-of-death statistics were even smaller for cannabinoids and amphetamines, 10% and 39%, respectively. In multiple-drug cases, identification was possible only if each drug had been assigned an additional drug-specific code from 'T categories' of ICD-10 Chapter XIX. What is noteworthy, however, is that a third of cannabinoid-related and a quarter amphetamine-related cause-of-death diagnoses were assigned unspecific categories of ICD-10 in the multiple-cause database and, more notably, in cause-of-death statistics based on selected underlying causes. For the better specification of drug-related causes of death, we propose that the next ICD revision provide each drug with the code of its own, e.g. one comparable to ATC (Anatomical Therapeutic Chemical Classification Index) codes, to be used for its specification in all positions and combinations, or at least provide compatibility with the ATC's coding system. For classification and describing the trends of drug-related deaths, equal and specific definitions for drug-related deaths would also be needed. Author Affiliation: (a) Department of Forensic Medicine, University of Helsinki, Helsinki, Finland (b) Statistics Finland, Helsinki, Finland Article History: Received 25 June 2008; Revised 23 January 2009; Accepted 8 February 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.01.012 Byline: Mu'men S. Hadidi (a), Mudhaffar I. Ibrahim (b), Imad M. Abdallat (c), Kamal A. Hadidi (c) Keywords: Trend; Drug abuse; Fatality; Jordan Abstract: This study is the first study that addresses drug abuse associated fatalities in Jordan. It is aimed to give a close picture to the demography, toxicological data, manner, cause of death and other associated findings in such cases. Postmortem forensic pathology reports for all autopsies examined in the National Institute of Forensic Medicine were reviewed over a 5-year period and drug abuse associated deaths were selected. The study revealed that 44 cases (0.76%) out of the 5789 total autopsies were attributed to drug abuse associated deaths. The age range was from 20 to 60 years (mean[+ or -]S.D.=32.7[+ or -]7.2). More than 80% of cases were Jordanian males. The reported abuse substances as single drug or in combination were alcohol in 56.8%, morphine 36.4%, heroin 15.9%, benzodiazepines in 11.4% and cocaine in one body packer case. Surprisingly, neither a case with amphetamine or amphetamine analogue, nor with marijuana or methadone was recorded. In 75% of cases the death was accidental and only one case was reported to be suicidal, while in 18.2% and 4.5% death was due to sudden death and road traffic accidents, respectively. Regarding the cause of death, it was related to drug overdose in 50% of cases and in 34.1%, 11.4% and 4.5% of cases it was attributed to drug related medical complications, non-drug related complications, and trauma, respectively. Alcohol was mainly associated with accidental death; morphine and heroin were associated with drug overdose and abused through intravenous route. Injection marks were reported in 56.8% of cases and in 52.3% death occurred at home. This study confirmed the variation in the incidence and type of abused substances in Jordan compared with different countries. Author Affiliation: (a) National Institute of Forensic Medicine, Ministry of Health, Amman, Jordan (b) Department of Forensic Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan (c) Division of Forensic Medicine and Toxicology, Faculty of Medicine, The University of Jordan 11942, Amman, Jordan Article History: Received 8 July 2008; Revised 20 December 2008; Accepted 14 January 2009

Objective: The prevalence of drug and alcohol use among patrons of clubs featuring electronic music dance events was determined by using biological assays at entrance and exit. Method: Using a portal methodology that randomly selects groups of patrons on arrival at clubs, oral assays for determining level and type of drug use and level of alcohol use were obtained anonymously. Patrons provided self-reported data on their personal characteristics. A total of 362 patrons were interviewed at entrance and provided oral assay data, and 277 provided data at both entrance and exit. Results: Overall, one quarter of all patrons surveyed at entrance were positive for some type of drug use. Based on our exit sample, one quarter of the sample was positive at exit. Individual drugs most prevalent at entrance or exit included cocaine, marijuana, and amphetamines/stimulants. Only the amphetamine/stimulant category increased significantly from entrance to exit. Drug-using patrons arrive at the club already using drugs; few patrons arrive with no drug use and leave with detectable levels of drug use. Clubs vary widely in drug-user prevalence at entrance and exit, suggesting that both events and club policies and practices may attract different types of patrons. Approximately one half of the total entrance sample arrived with detectable alcohol use, and nearly one fifth arrived with an estimated blood alcohol concentration of .08 or greater. Based on our exit sample data, one third of patrons were intoxicated, and slightly less than one fifth were using both drugs and alcohol at exit. Clubs attract a wide array of emerging adults, with both genders and all ethnicities well represented. Clubs also attract emerging adults who are not in college and who are working full time. Conclusions: At clubs featuring electronic music dance events, drug use and/or high levels of alcohol use were detected using biological assays from patrons at entrance and exit from the clubs. Thus, these clubs present a potentially important location for prevention strategies designed to reduce the risks associated with drug and alcohol use for young people. Combined substance use may prove particularly important for prevention efforts designed to increase safety at clubs. Personal characteristics do not identify drug users, suggesting that environmental strategies for club safety may offer more promise for promoting health and safety., IN THE CLUB SETTING, a popular form of entertainment for emerging adults (i.e., 18- to 25-year-olds) features electronic music and dance events (EMDEs). EMDEs share some similarities with rave events, [...]

Booth: Since early in the HIV epidemic, street outreach workers, often indigenous to the target population, have served both to recruit drug injectors for interventions and to conduct interventions. The typically unstructured nature of outreach interventions present challenges in determining the nature of services actually delivered. It is recommended that both qualitative and quantitative methods be utilized to monitor intervention service delivery. Des Jarlais: The threat of AIDS has led to profound behavioral changes among drug users. These changes need to be seen primarily not as responses to public health interventions, but in terms of the competencies of drug users themselves. A Drug User Competency Model of HIV Prevention would include: 1. Competency in understanding HIV transmission, 2. Competency in reducing HIV risk behavior, and 3. The competency of altruism. Friedman: Twenty years of work on HIV among drug users highlight that we need to incorporate large-scale social dynamics in research and interventions, understand drug usersi sexual behavior and networks, and view drug users as multifaceted human beings, not just iwalking addictions. i Crucially, drug users can be highly competent at many things, so non-users can learn from their ideas and their practices. Drug users can be partners and sometimes leaders, not just idisabled addicts. i

Over the past 20 years, much exciting addiction research has been conducted. Extensive knowledge has been gathered about comorbid issues, particularly mental health disorders, HIV, and criminal justice involvement. Health services addiction research has become increasingly sophisticated, shifting its focus from patients to consider also services, organizations, and financing structures. Furthermore, through several long-term follow-up studies, empirical evidence convincingly demonstrates that drug dependence is not an acute disorder, and is best understood through a life course perspective with an emphasis on chronicity. This article highlights three major directions for future addiction research: developing strategies for chronic care (including longitudinal intervention studies), furthering cross-system linkage and coordination, and utilizing innovative methods (e.g., growth curve modeling, longitudinal mixed methods research) to strengthen the evidence base for the life course perspective on drug addiction.

Over the past twenty-five years, tremendous progress has been made in the area of drug abuse prevention research. The accumulated findings from longitudinal studies of adolescents regarding the factors associated with vulnerability to the substance use and abuse and trends from national surveys of substance use showing their association to societal perceptions of the harmfulness resulting from the use of these substances have informed the development of effective innovative prevention strategies. The 1990s saw a reversal in the perception of the value and importance of drug abuse prevention research with recognition of the fieldis approach to intervention development and implementation and its scientific rigor in demonstrating intervention impact. This paper reflects on this history anticipating both the positive and negative aspects of the future for the field.

In 1962, Thomas Kuhn wrote iThe Structure of Scientific Revolutionsi and popularized the concept of iparadigm shift.i Kuhn commented that scientific advancement is not evolutionary, but involves ia series of peaceful interludes punctuated by intellectually violent revolutions. i It is during these revolutions that ione conceptual world is replaced by another.i The presentations of the researchers at this conference represent the shifting paradigm of drug abuse research. The presentations at i40 Years of Drug Abusei Researchi will prompt future researchers to integrate the collective work of distinguished epidemiologists, ethnographers, neurobiologists, pharmacologists, as well as prevention, treatment, services, and policy researchers. As the next generation, we are called to use methods that are both transdisciplinary and translational. A transdisciplinary and translational future will require next generation drug abuse researchers to apply knowledge of basic science to prevention or treatment strategies.

The discipline of epidemiology utilizes the constructs of agent, host, vector, and environment to study the incidence and prevalence (i.e., the nature, extent, distribution, correlates) and the contexts, and consequences of drug abuse in the United States. This paper provides a selected review of the results of 40 years of epidemiological study of drug abuse using surveillance systems, general population surveys, ethnography and qualitative research approaches. It then addresses the challenges in conducting research on drug abuse epidemiology. The paper concludes with some missed opportunities and lessons learned in four decades of a large portfolio of research studies conducted by an impressive array of distinguished scientists.