Clarke's Analysis of Drugs and Poisons is the definitive source of analytical data for drugs and poisons. Written by over 40 international experts, the resource also boasts an editorial advisory board of over 45 world renowned scientists. This reference work has been completely revised and updated for the new edition, and comprises two volumes. The book is essential for all forensic and clinical toxicologists, pathologists, hospital pharmacists, pharmaceutical analysts, clinical pharmacologists, clinical and forensic laboratories, and poison information centres.
Results: Mean ( standard deviation) concentrations of Hg-B from schoolgirls (2.19 0.5 μg/L; n = 405) and schoolboys (2.29 0.3 μg/L; n = 468) did not exceed the regulatory limits of the United States Environmental Protection Agency (US EPA), the German Commission on Human Biological Monitoring (HBM I, II) or Clarke's analysis of drugs and poisons reference values. Nevertheless, 67 children (34 girls and 33 boys) had individual values that exceeded the lowest of these standards (4 μg/L).
Radovanovic et al. assessed the prevalence and trend of different psychoactive substances in Kuwait from 1992 to 1997 by screening 3781 biological samples . According to the study, the most used substances were as follows: cannabinoids, benzodiazepines, opiate, and amphetamine. Other drugs were also identified but at insignificant levels; these included methadone, cocaine, and phencyclidine . However, the information gained in that study was based only on a preliminary analysis (screening tests) of biological samples and is now outdated. Consequently, the current study is aimed to identify the types of narcotic drugs and psychotropic substances that were seized and consumed in Kuwait from 2015 to 2018. This was achieved using a Mass Spectrometric (MS) based approach for the analysis of drug (6220) and toxicological (17755) samples, providing a clear picture on the recent drug situation in Kuwait which provide local, regional and international public health workers and forensic analysts with data that are normally scarce in this region.
Seized narcotic drugs and psychotropic substances were received by the Narcotic and Psychotropic Laboratory (NPL) of Kuwait, a division of the Forensic Laboratories, General Department of Criminal Evidence. NPL is the only accredited laboratory in Kuwait that conducts drug-related investigations and routine drug testing to provide expert opinion (reports) for the court of law. Seized materials were sent to the NPL by several governmental agencies. Additionally, drug samples brought in for analysis included details of the origin of the sample e.g. place of seizure, date, physical appearance, name of suspect. Toxicological samples data included the type of sample (blood, urine), date, name of suspect.
All procedures were performed according to the required legal provisions and the chain of custody. Regarding the analysis of seized drugs, we followed the recommendations of the Scientific Working Group for the Analysis of Seized Drugs (SWGDRUG) . The mission of SWGDRUG is to recommend minimum standards for the forensic examination of seized drugs and to seek the international acceptance of these standards .
The abovementioned abused substances were found to be abused alongside other combinations of illicit drugs (Fig. 5). For instance, heroin was frequently abused, along with amphetamine, methamphetamine, and benzodiazepines. Cannabis was abused with amphetamine, benzodiazepines, methamphetamine, and heroin. All these abused combinations are shown in Fig. 5. Our four-year analysis shows that some of these combinations of abuse include heroin and amphetamine, heroin and benzodiazepines, and methamphetamine and cannabis. The number of males who abused two substances was in all cases higher than the number of female abusers. More interestingly, some combinations, such as heroin and cannabis and amphetamine and cannabis were rarely (in 2015) or never abused by females (in 2016, 2017 and 2018). Quantitative information for sex-based abusers of one and two illicit drugs are listed in the Additional files 5 and 6, respectively.
Biological samples of deceased individuals were received from the Forensic Medicine Unit of the General Department of Criminal Evidence. The Toxicology Laboratory analyzed the samples to check for the presence of illicit drugs (qualitative analysis). No quantitative investigations were conducted in the present study, and thus, abused drugs were not necessarily the causative agent for the death. The possibility that the deceased subjects may have received prescribed medication cannot be ignored. Thus, data reported herein identify the prevalence of illicit drugs in postmortem specimens from suspected drug-related deaths.
The initial objective of our study was to determine the different types of narcotic drugs and psychotropic substances that were seized and consumed in Kuwait from 2015 to 2018. In addition, the study aimed to identify mortalities associated with the consumption of these illicit substances. Our analysis reports the different types and quantities of illicit drugs that were seized in Kuwait from 2015 to 2018 (Figs. 1 and 2). The variety of drugs seized is primarily associated with the geographical situation of Kuwait relative to major drug-producing countries, including Afghanistan, Pakistan, Iraq, and Iran . However, the variety of drugs seized may also reflect the rapid financial development of Kuwait; its economic prosperity may have made the country an excellent target for the illicit drugs market. The data revealed annual fluctuations in the quantities of the same seized substances. These variations may be associated with the changes in 1) flow of the illicit drugs from the country of origin; 2) smuggling strategies (methods and routes); and 3) activities of Kuwaiti law enforcement.
Furthermore, different two-drugs cocktails were identified. Heroin-benzodiazepines cocktail is the most common two-drug combination detected in postmortem specimens. Other combinations were also identified, including cannabis-benzodiazepines and cannabis-amphetamines (including methamphetamine) (Fig. 7). The qualitative detection of these substances during postmortem analysis is inadequate to verify drug misuse as the primary cause of death. Drug-related deaths are complex to confirm and require thorough investigative information, including quantitative drug analysis, medical history, crime-scene details, and physiological findings of the autopsy . Thus, our reported data should be interpreted with caution in terms of drug-related mortality due to the qualitative nature of the toxicological investigation. 59ce067264