Drug Enforcement Administration, Justice § 1308.14
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Drug & Alcohol Testing Program
Pottawattmie County Drug & Alcohol Testing Program Appendix A Table of Contents POLICY STATEMENT ...................................................................................................................................... 3 SCOPE ............................................................................................................................................................ 4 EDUCATION AND TRAINING .......................................................................................................................... 4 DESIGNATED EMPLOYER REPRESENTATIVE (DER): ....................................................................................... 5 DUTY TO COOPERATE ................................................................................................................................... 5 EMPLOYEE ADMISSION OF ALCOHOL AND CONTROLLED SUBSTANCE USE: (49 CFR Part 382.121) ... 6 PROHIBITED DRUGS AND ILLEGALLY USED CONTROLLED SUBSTANCES: ..................................................... 7 PROHIBITED BEHAVIOR AND CONDUCT: ...................................................................................................... 8 DRUG & ALCOHOL TESTING REQUIREMENTS (49 CFR, Part 40 & 382) ............................................... 10 DRUG & ALCOHOL TESTING CIRCUMSTANCES (49 CFR Part 40 & 382) .............................................. 12 A. Pre-Employment Testing: .................................................................................................... 12 B. Reasonable Suspicion Testing: ......................................................................................... -
Guidelines for the Forensic Analysis of Drugs Facilitating Sexual Assault and Other Criminal Acts
Vienna International Centre, PO Box 500, 1400 Vienna, Austria Tel.: (+43-1) 26060-0, Fax: (+43-1) 26060-5866, www.unodc.org Guidelines for the Forensic analysis of drugs facilitating sexual assault and other criminal acts United Nations publication Printed in Austria ST/NAR/45 *1186331*V.11-86331—December 2011 —300 Photo credits: UNODC Photo Library, iStock.com/Abel Mitja Varela Laboratory and Scientific Section UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna Guidelines for the forensic analysis of drugs facilitating sexual assault and other criminal acts UNITED NATIONS New York, 2011 ST/NAR/45 © United Nations, December 2011. All rights reserved. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. This publication has not been formally edited. Publishing production: English, Publishing and Library Section, United Nations Office at Vienna. List of abbreviations . v Acknowledgements .......................................... vii 1. Introduction............................................. 1 1.1. Background ........................................ 1 1.2. Purpose and scope of the manual ...................... 2 2. Investigative and analytical challenges ....................... 5 3 Evidence collection ...................................... 9 3.1. Evidence collection kits .............................. 9 3.2. Sample transfer and storage........................... 10 3.3. Biological samples and sampling ...................... 11 3.4. Other samples ...................................... 12 4. Analytical considerations .................................. 13 4.1. Substances encountered in DFSA and other DFC cases .... 13 4.2. Procedures and analytical strategy...................... 14 4.3. Analytical methodology .............................. 15 4.4. -
Withdrawing Benzodiazepines in Primary Care
PC\/ICU/ ADTiriC • CNS Drugs 2009,-23(1): 19-34 KtVltW MKIIWLC 1172-7047/I»/O(X)1«119/S4W5/C1 © 2009 Adis Dato Intocmation BV. All rights reserved. Withdrawing Benzodiazepines in Primary Care Malcolm Luder} Andre Tylee^ and ]ohn Donoghue^ 1 Institute of Psychiatry, King's College London, London, England 2 John Moores University, Liverpool, Scotland Contents Abstract ' 19 1. Benzodiazepine Usage 22 2. Interventions 23 2.1 Simple interventions 23 2.2 Piiarmacoiogicai interventions 25 2.3 Psychoiogical Interventions 26 2.4 Meta-Anaiysis ot Various interventions 27 3. Outcomes 28 4. Practicai Issues 29 5. Otiier Medications 30 5.1 Antidepressants 30 5.2 Symptomatic Treatments 30 6. Conciusions 31 Abstract The use of benzodiazepine anxiolytics and hypnotics continues to excite controversy. Views differ from expert to expert and from country to country as to the extent of the problem, or even whether long-term benzodiazepine use actually constitutes a problem. The adverse effects of these drugs have been extensively documented and their effectiveness is being increasingly questioned. Discontinua- tion is usually beneficial as it is followed by improved psychomotor and cognitive functioning, particularly in the elderly. The potential for dependence and addic- tion have also become more apparent. The licensing of SSRIs for anxiety disorders has widened the prescdbers' therapeutic choices (although this group of medications also have their own adverse effects). Melatonin agonists show promise in some forms of insomnia. Accordingly, it is now even more imperative that long-term benzodiazepine users be reviewed with respect to possible discon- tinuation. Strategies for discontinuation start with primary-care practitioners, who are still the main prescdbers. -
Benzodiazepines in Chronic Pain Why the Interest?
Why the Interest? • 33 years in chronic pain rehabilitation Benzodiazepines • Many patients are dysfunctional, depressed, in Chronic Pain regressed, and cognitively impaired while taking opioids plus benzodiazepines. • Engendered a negative attitude Edward Covington, MD • Stimulated curiosity about what we Cleveland Clinic Foundation do and do not know about these drugs in pain patients, especially in combination with opioids Disclaimer History Much of the data that I could find is quite old • For centuries, humans have sought anxiolysis, euphoria • Alcohol was followed by sedatives and anxiolytics • 19th century – Bromides (“take a powder”), choral hydrate (Mickey Finn), paraldehyde • Barbiturates synthesized in 1903 • Meprobamate in 1950 Benzodiazepine Introduction Benzodiazepine Use in America • Chlordiazepoxide introduced in 1960 • BZs are the most prescribed CNS depressants • Addictiveness and lethality of barbiturates (and similar drugs) led to their replacement by BZs • Estimated past year prevalence of BZ use in • Use of BZs increased dramatically the USA = 12.9% – US sales peaked in 1975 – Anxiolytics / hypnotics accounted for 10% of all • 14.2% of these have taken the drug ≥ 12 mo prescriptions Barker MJ et al. Arch Clin Neuropsychology 2004;19:437-454 • WHO recommended scheduling BZs in the early • About 100 million prescriptions in 1999 1980s DEA Lader, M: J Subs Abuse Treatment 1991;8:53-59 1 Mechanism of Tranquilization How Reinforcing are BZs? - • GABA binding permits Cl influx Humans • Hyperpolarizes cell, •Normal (light -
Notice of Federal Scheduling Actions
TED SAKAI NEIL ABERCROMBIE DIRECTOR GOVERNOR Martha Torney Deputy Director Administration Max Otani Deputy Director Corrections Shawn Tsuha STATE OF HAWAII Deputy Director NARCOTICS ENFORCEMENT Law Enforcement DIVISION Department of Public Safety No. Posted at LT Gov office 3375 Koapaka Street, Suite D-100 3-5-14 Honolulu, Hawaii 96819 March 5, 2014 NOTICE OF FEDERAL SCHEDULING ACTIONS Section 329-11(d) states that if a substance is added, deleted or rescheduled under federal law and notice of the designation is given to the department then the department shall recommend to the legislature that a corresponding change in Hawaii law be made. The Department was given notice that the following depressant drug was placed into Schedule IV by the Federal Government: Alfaxalone 5[alpha]-pregnan-3[alpha]-ol-11,20-dione, including its salts, isomers, and salts of isomers On February 27, 2914 the Administrator of the Drug Enforcement Administration (DEA) placed the substance Alfaxalone 5[alpha]-pregnan-3[alpha]-ol-11,20-dione, including its salts, isomers, and salts of isomers into schedule IV of the Controlled Substances Act (CSA). This scheduling action is pursuant to the CSA which requires that such actions be made on the record after opportunity for a hearing through formal rulemaking. This action imposes the regulatory controls and administrative, civil, and criminal sanctions applicable to schedule IV controlled substances on persons who handle (manufacture, distribute, dispense, import, export, engage in research, conduct instructional activities with, or possess) or propose to handle Alfaxalone. Section 329-20, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows: §329-20 Schedule IV. -
Title 16. Crimes and Offenses Chapter 13. Controlled Substances Article 1
TITLE 16. CRIMES AND OFFENSES CHAPTER 13. CONTROLLED SUBSTANCES ARTICLE 1. GENERAL PROVISIONS § 16-13-1. Drug related objects (a) As used in this Code section, the term: (1) "Controlled substance" shall have the same meaning as defined in Article 2 of this chapter, relating to controlled substances. For the purposes of this Code section, the term "controlled substance" shall include marijuana as defined by paragraph (16) of Code Section 16-13-21. (2) "Dangerous drug" shall have the same meaning as defined in Article 3 of this chapter, relating to dangerous drugs. (3) "Drug related object" means any machine, instrument, tool, equipment, contrivance, or device which an average person would reasonably conclude is intended to be used for one or more of the following purposes: (A) To introduce into the human body any dangerous drug or controlled substance under circumstances in violation of the laws of this state; (B) To enhance the effect on the human body of any dangerous drug or controlled substance under circumstances in violation of the laws of this state; (C) To conceal any quantity of any dangerous drug or controlled substance under circumstances in violation of the laws of this state; or (D) To test the strength, effectiveness, or purity of any dangerous drug or controlled substance under circumstances in violation of the laws of this state. (4) "Knowingly" means having general knowledge that a machine, instrument, tool, item of equipment, contrivance, or device is a drug related object or having reasonable grounds to believe that any such object is or may, to an average person, appear to be a drug related object. -
Pharmacological Treatments in Insomnia
Pharmacological treatments in insomnia Sue Wilson Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College, London Drugs used in insomnia Licensed for insomnia •GABA-A positive allosteric modulators •melatonin (modified release) •promethazine •diphenhydramine •doxepin (USA) Unlicensed prescribed frequently •antihistamines (and OTC) •antidepressants Sometimes prescribed drugs for psychosis Some GABA-A positive allosteric modulators Drugs acting at the GABA-A benzodiazepine receptor zopiclone zolpidem zaleplon benzodiazepines eg temazepam, lorazepam (safe in overdose, as long as no other drug involved) Drugs acting at the barbiturate/alcohol receptor chloral hydrate/chloral betaine clomethiazole (dangerous in overdose) GABA calms the brain Gamma aminobutyic acid (GABA) is the main inhibitory transmitter in the mammalian central nervous system. It plays the principal role in reducing neuronal excitability and its receptors are prolific throughout the brain, in cortex, limbic system, thalamus and cerebellum sedative Increase anticonvulsant GABA anxiolytic function ataxia, memory effects Effects of GABA-A positive allosteric modulators •These drugs enhance the effect of GABA, the main inhibitory neurotransmitter in the brain •They all produce sedation, sleep promotion, ataxia, muscle relaxation, effects on memory, anticonvulsant effects •Therefore for insomnia the duration of action of the drug is important – these effects are unwanted during the day Effects of these GABA-ergic drugs on sleep EEG/PSG • Appearance of -
124.210 Schedule IV — Substances Included. 1
1 CONTROLLED SUBSTANCES, §124.210 124.210 Schedule IV — substances included. 1. Schedule IV shall consist of the drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, listed in this section. 2. Narcotic drugs. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation containing any of the following narcotic drugs, or their salts calculated as the free anhydrous base or alkaloid, in limited quantities as set forth below: a. Not more than one milligram of difenoxin and not less than twenty-five micrograms of atropine sulfate per dosage unit. b. Dextropropoxyphene (alpha-(+)-4-dimethylamino-1,2-diphenyl-3-methyl-2- propionoxybutane). c. 2-[(dimethylamino)methyl]-1-(3-methoxyphenyl)cyclohexanol, its salts, optical and geometric isomers and salts of these isomers (including tramadol). 3. Depressants. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances, including its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation: a. Alprazolam. b. Barbital. c. Bromazepam. d. Camazepam. e. Carisoprodol. f. Chloral betaine. g. Chloral hydrate. h. Chlordiazepoxide. i. Clobazam. j. Clonazepam. k. Clorazepate. l. Clotiazepam. m. Cloxazolam. n. Delorazepam. o. Diazepam. p. Dichloralphenazone. q. Estazolam. r. Ethchlorvynol. s. Ethinamate. t. Ethyl Loflazepate. u. Fludiazepam. v. Flunitrazepam. w. Flurazepam. x. Halazepam. y. Haloxazolam. z. Ketazolam. aa. Loprazolam. ab. Lorazepam. ac. Lormetazepam. ad. Mebutamate. ae. Medazepam. af. Meprobamate. ag. Methohexital. ah. Methylphenobarbital (mephobarbital). -
Tetrazepam-Containing Medicines Suspended Across the EU (PDF
29 May 2013 EMA/402567/2013 – Rev 1 Tetrazepam-containing medicines suspended across the EU On 24 April 2013, following the recommendation by the Pharmacovigilance Risk Assessment Committee (PRAC), the Co-ordination Group for Mutual Recognition and Decentralised Procedures – Human (CMDh) endorsed by majority the PRAC recommendation to suspend the marketing authorisations of tetrazepam-containing medicines across the European Union (EU). The CMDh, a body representing EU Member States, is responsible for ensuring harmonised safety standards for medicines authorised via national marketing authorisation procedures across the EU. Tetrazepam, a medicine of the benzodiazepine class, is used in several EU Member States to treat painful contractures (such as in low back pain and neck pain) and spasticity (excessive stiffness of muscles). The review of tetrazepam was triggered by the French National Agency for the Safety of Medicine and Health Products (ANSM), following reports of serious skin reactions with this medicine in France. Having assessed all available data on the risk of skin reactions, including post-marketing data in the EU and the published literature, the PRAC concluded that tetrazepam is associated with a low but increased risk of serious skin reactions (including Stevens-Johnson syndrome, toxic epidermal necrolysis and DRESS syndrome) compared with other benzodiazepines. The Committee also noted that, in the light of the risks identified, the available data on the effectiveness of tetrazepam were not sufficiently robust to support its use in the authorised indications. The CMDh agreed with the PRAC conclusion that the benefits of these medicines do not outweigh their risks, and adopted a final position that the marketing authorisations should be suspended throughout the EU. -
S1 Table. List of Medications Analyzed in Present Study Drug
S1 Table. List of medications analyzed in present study Drug class Drugs Propofol, ketamine, etomidate, Barbiturate (1) (thiopental) Benzodiazepines (28) (midazolam, lorazepam, clonazepam, diazepam, chlordiazepoxide, oxazepam, potassium Sedatives clorazepate, bromazepam, clobazam, alprazolam, pinazepam, (32 drugs) nordazepam, fludiazepam, ethyl loflazepate, etizolam, clotiazepam, tofisopam, flurazepam, flunitrazepam, estazolam, triazolam, lormetazepam, temazepam, brotizolam, quazepam, loprazolam, zopiclone, zolpidem) Fentanyl, alfentanil, sufentanil, remifentanil, morphine, Opioid analgesics hydromorphone, nicomorphine, oxycodone, tramadol, (10 drugs) pethidine Acetaminophen, Non-steroidal anti-inflammatory drugs (36) (celecoxib, polmacoxib, etoricoxib, nimesulide, aceclofenac, acemetacin, amfenac, cinnoxicam, dexibuprofen, diclofenac, emorfazone, Non-opioid analgesics etodolac, fenoprofen, flufenamic acid, flurbiprofen, ibuprofen, (44 drugs) ketoprofen, ketorolac, lornoxicam, loxoprofen, mefenamiate, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, pranoprofen, proglumetacin, sulindac, talniflumate, tenoxicam, tiaprofenic acid, zaltoprofen, morniflumate, pelubiprofen, indomethacin), Anticonvulsants (7) (gabapentin, pregabalin, lamotrigine, levetiracetam, carbamazepine, valproic acid, lacosamide) Vecuronium, rocuronium bromide, cisatracurium, atracurium, Neuromuscular hexafluronium, pipecuronium bromide, doxacurium chloride, blocking agents fazadinium bromide, mivacurium chloride, (12 drugs) pancuronium, gallamine, succinylcholine -
Calculating Equivalent Doses of Oral Benzodiazepines
Calculating equivalent doses of oral benzodiazepines Background Benzodiazepines are the most commonly used anxiolytics and hypnotics (1). There are major differences in potency between different benzodiazepines and this difference in potency is important when switching from one benzodiazepine to another (2). Benzodiazepines also differ markedly in the speed in which they are metabolised and eliminated. With repeated daily dosing accumulation occurs and high concentrations can build up in the body (mainly in fatty tissues) (2). The degree of sedation that they induce also varies, making it difficult to determine exact equivalents (3). Answer Advice on benzodiazepine conversion NB: Before using Table 1, read the notes below and the Limitations statement at the end of this document. Switching benzodiazepines may be advantageous for a variety of reasons, e.g. to a drug with a different half-life pre-discontinuation (4) or in the event of non-availability of a specific benzodiazepine. With relatively short-acting benzodiazepines such as alprazolam and lorazepam, it is not possible to achieve a smooth decline in blood and tissue concentrations during benzodiazepine withdrawal. These drugs are eliminated fairly rapidly with the result that concentrations fluctuate with peaks and troughs between each dose. It is necessary to take the tablets several times a day and many people experience a "mini-withdrawal", sometimes a craving, between each dose. For people withdrawing from these potent, short-acting drugs it has been advised that they switch to an equivalent dose of a benzodiazepine with a long half life such as diazepam (5). Diazepam is available as 2mg tablets which can be halved to give 1mg doses. -
Tetrazepam Allergy: a Case Series of Cutaneous Adverse Events
Acta Derm Venereol 2016; 96: 110–111 SHORT COMMUNICATION Tetrazepam Allergy: A Case Series of Cutaneous Adverse Events Inga Huseynov, Mirja Wirtz and Nicolas Hunzelmann Department of Dermatology, University Hospital of Cologne, DTZ-West, Kerpener Straße 62, DE-50937 Köln, Germany. E-mail: [email protected] Accepted May 11, 2015; Epub ahead of print May 27, 2015 Tetrazepam has been widely used in clinical praxis in many Table I. Overview of patch- and prick-testing with tetrazepam and countries for over 50 years (1). As an agent belonging to diazepam in 8 patients with drug allergy to tetrazepam the class of benzodiazepines, it has an immediate sedative, Pat. Sex/age, Prick- Patch-test Patch-test muscle relaxing, anxiolytic and anticonvulsant effect. Ac- No. years Symptoms test (tetrazepam) (diazepam) cording to the German drug prescription report for 2012, 1 F/66 EME – Pos. at D2 Not done tetrazepam was the most commonly prescribed muscle 2 F/45 Exanthemaa – Pos. at D2 Not done relaxant after botulinum toxin (2). Common adverse 3 F/47 Exanthemaa – Pos. at D3 Not done 4 F/65 Exanthemaa – Pos. at D2 Not done reactions following systemic intake are of neurological 5 M/75 ME (see Fig. S21) – Pos. at D4 Not done and gastrointestinal nature, while cutaneous reactions to 6 M/48 Exanthemaa – Pos. at D3 Not done tetrazepam are very rare, with only a few cases reported 7 M/42 ME – Pos. at D2 Not done in the literature. It has nevertheless to be assumed that 8 F/49 Exanthema – Pos. at D2 Negative only a minority of cases is reported.