Journal of analytical toxicology最新文献

{"title":"Changes in blood cannabinoid concentrations over multiple collection times in driving under the influence of drugs casework.","authors":"Brianna L Peterson, Meaghan R Hessler","doi":"10.1093/jat/bkaf052","DOIUrl":"10.1093/jat/bkaf052","url":null,"abstract":"<p><p>Δ9-Tetrahydrocannabinol (THC) is the most frequently used illicit drug in the world, yet interpretation of THC concentrations in driving under the influence of drug (DUID) cases is difficult due to possible residual THC concentrations. This study determined the concentrations of cannabinoids in blood collected across multiple time points from drivers in suspected impaired driving cases to evaluate if changes in concentrations over time can provide clarification on the time of cannabis use. This study examined cannabinoid-positive DUID cases reported from January 2019 to December 2023 to identify those that tested multiple blood draws. Thirty-five cases were identified that had multiple blood draws for a total of 81 different samples with collection times ranging from 00:32 to 12:42 hours between incident and blood draw. Cannabinoid testing was performed using a liquid chromatography-tandem mass spectrometry analysis with reporting limits of 1.0, 5.0, and 0.5 ng/mL for 11-hydroxy-THC (11-OH-THC), 11-nor-9-carboxy-THC (THC-COOH), and THC, respectively. THC concentrations (n = 81) ranged from 0.74 to 40 ng/mL. Eleven samples had an increase in THC concentration at a later collection time point. 11-OH-THC concentrations (n = 60) ranged from 1.0 to 16 ng/mL. THC-COOH concentrations (n = 81) ranged from 7.1 to 470 ng/mL. The results of this study underscore the difficulty in interpretation and drawing conclusions regarding time of cannabis use, even when multiple samples are obtained from the same subject over time from a single incident.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"576-586"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug transfer during intimate moments can produce an adverse analytical finding during a doping control: A case report with ligandrol.","authors":"Pascal Kintz, Laurie Gheddar","doi":"10.1093/jat/bkaf041","DOIUrl":"10.1093/jat/bkaf041","url":null,"abstract":"<p><p>Selective androgen receptor modulators (SARMs) are a new class of substances that have similar properties to anabolic steroid agents, but with marked reduced androgenic properties. As SARMs have the potential to be misused for performance enhancement in sport due to their anabolic properties as well as their ability to stimulate androgen receptors in the muscle and the bone, they have been prohibited at-all-times by the World Anti-Doping Agency (WADA) since 2008 under section S1.2 of the List. Ligandrol is one of the more popular SARMs. A WADA-accredited laboratory identified bishydroxy-ligandrol in the urine of a female athlete, the major ligandrol metabolite at approximately 90 pg/mL (specimen A) and 200 pg/mL (specimen B). The athlete challenged this anti-doping rule violation and requested a hair test to document possible incidental exposure. About 7 weeks after urine collection, a hair specimen (brown in color and > 20 cm in length) was collected and segmented in 6 × 1 cm segments. Ligandrol was tested by liquid chromatography-tandem mass spectrometry after alkaline incubation and extraction. With a limit of quantitation at 1 pg/mg, no ligandrol was identified. It appears that the athlete was unaware her husband was taking the substance, which was confirmed by his hair test (ligandrol at 7 and 8 pg/mg in 2 × 2.5 cm segments). The Court of Arbitration for Sports accepted the athlete's explanation that she had been exposed to ligandrol through the exchange of bodily fluids with her husband and lifted her provisional ban. This case demonstrates that drug transfer between two subjects is possible during intimate moments.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"615-619"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel screening workflow for nitazene analogs using LC-MS/MS precursor ion scan acquisition.","authors":"Amanda L Pacana, Britni N Skillman","doi":"10.1093/jat/bkaf046","DOIUrl":"10.1093/jat/bkaf046","url":null,"abstract":"<p><p>A persistent problem in the detection of novel psychoactive substances (NPS) is the inability of traditional screening methodologies to rapidly adapt to evolving drug trends. As such, high-resolution mass spectrometry (HRMS) screening methods have gained popularity in recent years for the ability to use non-targeted acquisition to detect a wide variety of compounds without necessarily returning to method development. However, these instruments may be unattainable for some forensic laboratories due to the associated high capital costs. The described method provides an alternative screening method using precursor ion scan (PIS) acquisition on a liquid chromatography-tandem mass spectrometry (LC-MS/MS) platform to screen for nitazene analogs. Four ions were evaluated (m/z 72.1, 98.0, 100.1, and 112.1) for d0 analytes and one ion (m/z 104.1) for the metodesnitazene-d4 internal standard. Using a liquid-liquid extraction in whole blood, the method was validated with a 0.5 ng/mL limit of detection and 1.0 ng/mL administrative cutoff. Observed matrix effects did not affect limit of detection and there was no demonstration of carryover or interferences. As a proof-of-concept study, authentic (n = 3) and blind fortified (n = 20) samples were evaluated using this method, which was able to identify all nitazenes with no false negatives or positives. Several nitazenes not initially included in the scope of method development or validation were also presumptively identified. To accommodate this novel instrumental analysis, a workflow is also proposed to assist in the identification of known and emerging nitazene analogs. LC-MS/MS is widely available among forensic laboratories and presents a viable alternative to HRMS screening for nitazene analogs when operated in PIS acquisition, in such cases that HRMS is unavailable for assessing emerging NPS threats.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"520-528"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medetomidine quantitation and enantiomer differentiation in biological specimens collected after fatal and non-fatal opioid overdoses.","authors":"Sara E Walton, Brianna N Stang, Sherri Kacinko, Donna M Papsun, Barry K Logan, Alex J Krotulski","doi":"10.1093/jat/bkaf040","DOIUrl":"10.1093/jat/bkaf040","url":null,"abstract":"<p><p>Medetomidine is an alpha-2 agonist and non-opioid sedative. Its presence in illicit fentanyl and heroin drug supplies poses significant risks to user health caused by cardiac effects and sedation. Medetomidine exists in two enantiomeric forms: dexmedetomidine and levomedetomidine. Dexmedetomidine is used in humans in medical settings, while dexmedetomidine alone and a racemic mixture of dexmedetomidine and levomedetomidine are used in animals in veterinary settings. Little information is known about circulating blood concentrations of medetomidine or its enantiomers in humans in situations involving synthetic opioids (e.g. fentanyl) and other sedatives (e.g. xylazine, benzodiazepines). A new toxicological workflow using liquid chromatography-tandem quadrupole mass spectrometry (LC-QQQ-MS) was developed and validated for the quantitation of medetomidine and the qualitative enantiomeric separation of dexmedetomidine and levomedetomidine. The assays were applied to a case series of 100 authentic specimens from emergency department admissions and forensic postmortem investigations containing medetomidine, fentanyl, xylazine, and metabolites, among other substances. Medetomidine blood concentrations in non-fatal overdoses ranged 0.1-16 ng/mL (median: 1.5 ng/mL) and in fatal overdoses ranged 0.1-32 ng/mL (median: 0.31 ng/mL). Xylazine was co-detected in 76% of cases with higher median concentrations: 8.3 ng/mL (non-fatal) and 15 ng/mL (fatal). Fentanyl was co-detected in 93% of cases with median concentrations of 5.2 ng/mL (non-fatal) and 21 ng/mL (fatal). Dexmedetomidine and levomedetomidine were identified in 90% of cases; the remaining cases were confirmed or suspected medical-setting administration of dexmedetomidine. These findings demonstrate that medetomidine is arising from veterinary or clandestine sources, and we hypothesize the latter. Recreational medetomidine use causes adverse effects such as profound bradycardia and heightened sedation, especially when combined with fentanyl and xylazine. Forensic laboratories must remain aware of adulterants, like medetomidine, appearing in traditional opioid products (e.g. fentanyl, heroin), updating testing methods to capture these emerging adulterants in real-time.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"551-558"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of professional best practices in postmortem forensic toxicology.","authors":"Michael T Truver, Chris W Chronister, Gregory G Davis, Teresa R Gray, Rebecca L Hartman, Joseph H Kahl, Erin L Karschner, Sarah Kerrigan, Robert Kronstrand, Alex J Krotulski, Dayong Lee, Barry K Logan, Diane M Moore, Luke N Rodda, Svante Vikingsson, Ruth E Winecker, Bruce A Goldberger","doi":"10.1093/jat/bkaf061","DOIUrl":"10.1093/jat/bkaf061","url":null,"abstract":"<p><p>Postmortem forensic toxicology plays a critical role in medicolegal death investigations through the identification and quantitation of drugs and other substances in postmortem fluids and tissues. Due to the complexity of this sub-discipline, consistent application of best practices is critical for ensuring accurate and reliable results, particularly in the context of challenges such as emerging novel psychoactive substances, complex poly-drug interactions, postmortem drug redistribution, and analytical limitations inherent with postmortem specimens. Although there has been significant progress in the development of consensus-based forensic toxicology standards, their scope is intentionally broad to accommodate human performance, postmortem, regulated and non-regulated employment drug testing, court-ordered toxicology, and other applications. Consequently, some aspects specific to postmortem toxicology and medicolegal death investigation are not addressed within the standards. This manuscript seeks to fill these gaps by demonstrating how current standards can be applied in a postmortem toxicology setting and presenting best practices in situations where no established standards exist. These best practices will aid laboratories in prioritizing changes to workflows, allocating resources more efficiently, improving analytical accuracy and reproducibility, ensuring interpretative consistency, and strengthening forensic defensibility in administrative and legal proceedings. Key topics addressed include specimen collection and case submission protocols, method validation approaches tailored for postmortem analysis, optimized analytical workflows based on testing scope and case classification, and quality assurance requirements. Considerations for data review, reporting, and result interpretation are discussed in the context of accurate determination of cause and manner of death. Emphasis is placed on integrating toxicological findings with investigative and autopsy information obtained through ongoing communication with stakeholders. By integrating the application of existing consensus standards with the best community practices for postmortem toxicology, this manuscript aims to support the generation of robust and reliable toxicological data, with the goal of improving forensic investigations, public health surveillance, and drug policy development.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"529-541"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabinoid profiling across toxicology samples in adolescents and young adults by route of administration and in relation to depression symptoms.","authors":"Natasha E Wade, Alexander L Wallace, Rachel Baca, Gianna Andrade, Joseph P Happer, Kelly E Courtney, Uwe Christians, Cristina Sempio, Jost Klawitter, Marilyn A Huestis, Joanna Jacobus","doi":"10.1093/jat/bkaf051","DOIUrl":"10.1093/jat/bkaf051","url":null,"abstract":"<p><p>Cannabis use is common, with diversity in cannabis products contributing to difficulty in accurately assessing the impact of cannabis use in vulnerable populations such as emerging adults. This study describes and assesses concurrence across toxicological matrices (oral fluid, plasma, urine, and hair) and self-reported cannabis use days. Further, it examines whether 11-nor-9-carboxy-tetrahydrocannabinol (THCCOOH, the primary metabolite of Δ9-tetrahydrocannbinol [THC]) concentration or use patterns varies by administration route (smoked flower or vaped concentrate) or predicts depression symptoms. Here, cannabis using (n = 70) and non-using (n = 24) adolescents and young adults (64% female; ages 18-21) were asked to contribute oral fluid, blood, urine, and hair for toxicological testing and self-reported past-90 days of cannabis use, including route of administration. Positive and negative toxicological results by matrix are presented, with sensitivity and specificity calculated. Correlations between THCCOOH concentration across matrices and self-report use were run. Analysis of variance models (ANOVAs) tested whether product type (smoked flower v. vaped concentrate) influenced cannabis use patterns, use to avoid withdrawal, or THCCOOH concentration. Regressions assessed cannabis metrics predicting depression symptoms, controlling for biological sex. All matrices demonstrated excellent specificity (100%), with largely adequate sensitivity (63-74%) except for oral fluid (12%). Self-report and toxicological metrics were significantly correlated (r's = .41-.97), except for avoiding withdrawal. THCCOOH concentration across matrices did not differ by route of administration group; groups also did not differ by self-reported use days or avoiding withdrawal symptoms (p's = .16-.66). Only plasma THCCOOH concentration predicted depression symptoms (beta = 4.43, p < .001). Taken together, toxicological matrices and self-reported cannabis use offer concurrent information in adolescents and young adults who regularly use cannabis. Plasma THCCOOH concentration uniquely predicted self-reported depression symptoms, indicating utility of toxicological cannabinoid concentration predicting clinical outcomes. Given the complexity of measuring cannabis use due to the plethora of available products and rise of new popular cannabinoids, use of toxicological results may offer new insights into clinical outcomes in those who frequently use cannabis.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"567-575"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of DrugWipe® 6S with the WipeAlyser® reader for drug screening of drivers.","authors":"Ragnhild Elén Gjulem Jamt, Hallvard Gjerde, Grethe Brennhovd Clausen, Lihn Bache-Andreassen, Elisabeth Leere Øiestad","doi":"10.1093/jat/bkaf028","DOIUrl":"10.1093/jat/bkaf028","url":null,"abstract":"<p><p>On-site drug screening of oral fluid samples has gained attention because of its convenience and rapid results. The aim of this investigation was to compare the results of preliminary screening for drugs in oral fluid samples collected from suspected drug-impaired drivers using DrugWipe 6S and WipeAlyser reader with the results obtained from blood samples. Additionally, we compared the DrugWipe test results with findings of drug traces detected within the used DrugWipe devices. Police officers selected a sample of 355 suspected drug-impaired drivers in 2023. They used DrugWipe 6S for preliminary drug screening of drivers. After the field drug testing of oral fluid, the apprehended drivers were brought to a physician for the collection of blood samples. The collected samples (DrugWipe devices and blood samples) were submitted to the Norwegian National Forensic Toxicology Laboratory for analysis. The proportion of positive DrugWipe results that were unconfirmed when analysing blood samples was 82% for opiates, 75% for cocaine, and ∼19%-20% for amphetamines, cannabis, and benzodiazepines. The proportion of negative DrugWipe results that were found positive in blood samples was for cannabis and benzodiazepines ∼13%-14%, and for other drugs <3%. Detected drug traces in the used DrugWipe devices corresponded well with DrugWipe readouts for cannabis, amphetamines, and cocaine. The lack of correspondence between DrugWipe test results for cocaine and findings in blood may be due to the fact that the concentration of cocaine in saliva is often much higher than in blood, and the DrugWipe test is very sensitive. In addition, degradation and elimination of cocaine before the blood sample is taken may contribute to cocaine concentrations below the cut-off concentration in blood. For opiates and benzodiazepines, traces of drugs were found in relatively few DrugWipe devices. Many unconfirmed positives for opiates were most likely due to cross-reaction with substances in 'snus' (snuff tobacco).</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"442-449"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Δ9-tetrahydrocannabinol in venous and capillary blood following ad libitum cannabis smoking by occasional and daily users.","authors":"Gregory Dooley, Suneeta Godbole, Julia Wrobel, Tom Henthorn, Ashley Brooks-Russell, Sarah Limbacher, Michael Kosnett","doi":"10.1093/jat/bkaf043","DOIUrl":"10.1093/jat/bkaf043","url":null,"abstract":"<p><p>Δ9-Tetrahydrocannabinol (Δ9-THC) is the most prominent and main psychoactive cannabinoid found in cannabis. In forensic matters involving cannabis, such as drugged driving or workplace accident investigations, blood Δ9-THC determination is typically required. Venipuncture by a phlebotomist at a medical facility is often the standard blood collection protocol, but this procedure is time consuming and requires specialized training. Capillary blood collection at the site of a transportation or workplace mishap may provide a collection method that is logistically easier and may better reflect blood cannabinoid concentrations at the time of an incident. This study represents the first temporal comparison of the concentration of Δ9-THC and its primary metabolites in venous and capillary blood obtained from users following ad libitum inhalation of contemporary high-concentration cannabis products. Participants provided their own cannabis from a licensed Colorado dispensary and were instructed to smoke or vape ad libitum the amount most used for the desired effect during a 15-minute period. Capillary blood samples collected at the lateral shoulder using the TAP® II microneedle device and standard venipuncture samples at the forearm were collected contemporaneously at baseline and then 10, 30, 60, 90, and 140 minutes after the last inhalation and were analyzed for Δ9-THC, 11-hydroxy-Δ9-THC, and 11-carboxy-Δ9-THC by liquid chromatography-tandem mass spectrometry. Within-subject Δ9-THC concentrations trended lower, often up to 30 to 40%, in contemporaneous capillary blood samples than in venous blood samples until 140 min after cannabis smoking. Concentrations of the Δ9-THC metabolites 11-hydroxy-Δ9-THC and 11-carboxy-Δ9-THC were equivalent at all but the first timepoint after smoking. Due to logistical advantages, capillary blood collection by microneedle devices may be a viable option for qualitative detection of Δ9-THC and its metabolites soon after an incident or a quantitative determination if the samples are collected at least 2 hours after cannabis inhalation.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"476-484"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How diquat kills: investigation of the toxicological profiles of diquat and bromide ion concentrations in serum by LC-MS-MS and capillary electrophoresis in a suicide case.","authors":"Maiko Kusano, Yoshiaki Iwamuro, Takero Terayama, Takaya Murakami, Masaya Fujishiro, Taka-Aki Matsuyama","doi":"10.1093/jat/bkaf035","DOIUrl":"10.1093/jat/bkaf035","url":null,"abstract":"<p><p>Herbicide poisoning commonly involves both paraquat and diquat (DQ); DQ poisoning alone is less frequently reported, and especially rare in Japan. We present a case of fatal DQ poisoning after attempted suicide by ingesting DQ dibromide, requiring intensive care including haemodialysis (HD). Toxicological profiles of DQ, DQ metabolites, and bromide ion in serum were investigated relative to the course of treatment. Quantitative analyses were carried out by liquid chromatography/tandem mass spectrometry (LC-MS-MS) for DQ and its oxidative metabolites and by capillary electrophoresis for bromide (Br-). The quantitated initial serum DQ concentration prior to HD#1 was 75 μg/mL. Following HD#1, DQ concentration dropped to 8.4 μg/mL but re-elevated about 12 hours later (12 μg/mL). HD#2 lowered the DQ concentration to 1.5 μg/mL but again re-elevated prior to death (2.8 μg/mL). Serum Br- concentration pre-HD#1 was 493 μg/mL and dropped to 27-49 μg/mL after HD treatment. While HD treatment seemed to have reduced the DQ concentration significantly, re-elevation of the serum DQ level suggests that it was a temporary relief not enough to prevent the patient from going into multiple organ failure. Possibility of bromism was also investigated, as the ingested herbicide contained 33% DQ dibromide, thus Br- would have also been absorbed into the body along with DQ.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"509-513"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydroxyzine in impaired driving investigations.","authors":"Jolene J Bierly, Amanda L D'Orazio","doi":"10.1093/jat/bkaf030","DOIUrl":"10.1093/jat/bkaf030","url":null,"abstract":"<p><p>Hydroxyzine (Vistaril©) is an unscheduled, first-generation antihistamine prescribed for nausea/vomiting, atopic dermatitis or eczema, and anxiety. It can produce adverse central nervous system (CNS) depressant effects such as fatigue, sedation, and impaired memory and concentration. Several clinical studies have shown hydroxyzine is able to impair driving and psychomotor function; however, no case series have been published highlighting driving performance and roadside observations in driving under the influence of drugs investigations (DUID). Between January 2017 and October 2024, 319 blood specimens submitted for DUID testing confirmed positive for hydroxyzine. Mean and median blood concentrations were 70 ± 79 and 48 ng/mL, respectively, with a range of 8.0-600 ng/mL. More than half of hydroxyzine positive drivers were female (57%) with a mean age of 42 years. Common drug combinations in this study involved antidepressants (74%), opioids (44%), and anticonvulsants (38%). Only seven cases have been reported involving a single substance, and four of these investigations have been presented. Behavioral observations included incoordination, slow and slurred speech, and difficulty following instructions on standardized field sobriety tests. Driving observations included erratic driving, crashes, driving in opposite lanes of travel, and running stop signs. This is concerning since hydroxyzine became the most identified antihistamine in this population in 2023 outpacing diphenhydramine.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"505-508"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}