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Postmortem Detection of Benzodiazepines
Current Issue
Volume 2, 2014
Issue 1 (February)
Pages: 1-8   |   Vol. 2, No. 1, February 2014   |   Follow on         
Paper in PDF Downloads: 49   Since Aug. 28, 2015 Views: 2092   Since Aug. 28, 2015
Hooman Rowshan , Department of Pharmacy, University of Florida, Gainesville, FL.
More than 2,000 different Benzodiazepines (BZD) have been synthesized. There are about three-dozen BZD derivatives that are also available on the market. These drugs have been implicated in sudden and unexplained deaths especially when co-ingested with alcohol. Interpretation of forensic postmortem toxicological data can be very difficult and should be done with a thorough knowledge of the case history, including autopsy results, reports from the scene, and available medical history. Experienced forensic toxicologists rely on their own case experience as well as the unique circumstances of each case under examination. Even armed with detailed toxicological data, it is still difficult to pinpoint the cause of death when multiple agents are ingested at the same time.
Pharmacology, Forensic Toxicology, Benzodiazepines, Clinical Pharmacology, Emergency Medicine, Psychiatric Drugs, Postmortem Forensic Examination, Forensic Medicine
Ashton, C.H. (2002). The benzodiazepines: what they do in the body. Benzodiazepines: How they work and how to withdrawal. Newcastle, England: University of New Castle.
Ashton, C.H. (2005). The Diagnosis and Management of Benzodiazepine Dependence. Current Opinion in Psychiatry, 18(3), 249-255. 

Cooper, J.R., Bloom, F.E., and Roth, R.H. (1996). Biochemical Basis of Neuropharmacology (7th ed.): Oxford University Press. 

Hollister, Leo E., Muller-Oerlinghausen, Bruno.,Rickels, Karl., Shader, Richard. 1993. Clinical uses of benzodiazepines. Journal of Clinical Psychopharmacology. December, Vol. 13(6, suppl 1), p. 169.
Lane, S.D., Tcheremissine, O.V., Lieving, L.M., Nouvion, S., and Cherek, D.R. (2005). Acute Effects of Alprazolam on Risky Decision Making in Humans. Psychopharmacology, 181, 364-373. 

Longo, L.P., and Johnson, B. (2000). Addiction: Part I. Benzodiazepines-Side Effects, Abuse Risk and Alternatives. American Family Physician, 61(7), 2121-2127). 

McCabe, S.E. (2005). Correlates of Nonmedical Use of Prescription Benzodiazepine Anxiolytics: Results from a National Survey of U.S. College Students. Drug and Alcohol Dependence, 79, 53-62
Nutt, D.J. and Malizia, A. L. (2001). New insights into the role of GABAA-benzodiazepine receptor in psychiatric disorder. British Journal of Psychiatry, 179, 390-396. 

Rowlett, J.K., Lelas, S., Walter, T., and Licata, S.C. (2006). Anti-conflict effects of benzodiazepines in rhesus monkeys: relationship with therapeutic doses in humans and role of GABAA receptors. Psychopharmacology, 184, 201-211. 

Schatzberg, Alan F., Nemeroff, Charles B. Essentials of Clinical Psychopharmacology. Pages 75-92. Washington, DC, US: American Psychiatric Publishing, Inc. 2001. 

Tyrer, Peter., Murphy, Siobhan 1987. The place of benzodiazepines in clinical practice. British Journal of Psychiatry. December, Vol. 151, p. 719-723. 

Vorma, H., Naukkarinen, H.H., Sarna, S.J., and Kuoppasalmi, K.I. (2005). Predictors of Benzodiazepine Discontinuation in Subjects Manifesting Complicated Dependence. Substance Use and Misuse, 40, 499-510. 

Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2008 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 26th Annual Report. ClinToxicol (Phila). Dec 2009;47(10):911-1084. 

Serfaty M, Masterton G. Fatal poisonings attributed to benzodiazepines in Britain during the 1980s. Br J Psychiatry. Sep 1993;163:386-93 

Kleber HD, Weiss RD, Anton RF, et al. Treatment of patients with substance use disorders, second edition. American Psychiatric Association. Am J Psychiatry. Aug 2006;163(8 Suppl):5-82. 


[Guideline] National Collaborating Centre for Mental Health. Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. London (UK): National Institute for Clinical Excellence (NICE). 2004;199.
Bosse GM. Benzodiazepines. In: Emergency Medicine: A Comprehensive Study Guide. 4th ed. McGraw-Hill; 1996:759-61. 

Buckley NA, Dawson AH, Whyte IM, O'Connell DL. Relative toxicity of benzodiazepines in overdose. BMJ. Jan 28 1995;310(6974):219-21 

Cairns C. Benzodiazepine overdose and withdrawal. In: Emergency Medicine: Concepts and Clinical Practice. 3rd ed. Mosby-Year Book; 1992:2684-9. 

Drummer OH, Syrjanen ML, Cordner SM. Deaths involving the benzodiazepine flunitrazepam. Am J Forensic Med Pathol. Sep 1993;14(3):238-43. 

Hoffman RS, Wipfler MG, Maddaloni MA, Weisman RS. Has the New York State triplicate benzodiazepine prescription regulation influenced sedative-hypnotic overdoses?. N Y State J Med. Oct 1991;91(10):436-9 

Longmire AW, Seger DL. Topics in clinical pharmacology: flumazenil, a benzodiazepine antagonist. Am J Med Sci. Jul 1993;306(1):49-52. 

Mullins ME. First-degree atrioventricular block in alprazolam overdose reversed by flumazenil. J Pharm Pharmacol. Mar 1999;51(3):367-70 

Verghese J, Merino J. Temazepam overdose associated with bullous eruptions. AcadEmerg Med. Oct 1999;6(10):1071.

Scott KS, Oliver JS, The use of vitreous humor as an alternative to whole blood for the analysis of benzodiazepines. J Forensic Sci. 2001 May;46(3):694-7 

Olkkola KT, Ahonen J (2008). "Midazolam and other benzodiazepines". HandbExpPharmacol 182 (182): 335-60.

Lader M, Tylee A, Donoghue J (2009). "Withdrawing benzodiazepines in primary care". CNS Drugs 23 (1): 19-34 

Fraser AD (1998).
"Use and abuse of the benzodiazepines". Ther Drug Monit 20 (5): 481-9. 

Charlson F, Degenhardt L, McLaren J, Hall W, Lynskey M (2009). "A systematic review of research examining benzodiazepine-related mortality". Pharmacoepidemiol Drug Saf 18 (2): 93-103. 

Peppers MP (1996). "Benzodiazepines for alcohol withdrawal in the elderly and in patients with liver disease". Pharmacotherapy 16 (1): 49-57 

Drummer OH (2002). "Benzodiazepines-effects on human performance and behavior". Forensic Sci Rev 14 (1-2): 1-14.
Barker MJ, Greenwood KM, Jackson M, Crowe SF (2004). "Cognitive effects of long-term benzodiazepine use: a meta-analysis". CNS Drugs 18 (1): 37-48 

Gaudreault P, Guay J, Thivierge RL, Verdy I (1991). "Benzodiazepine poisoning. Clinical and pharmacological considerations and treatment". Drug Saf 6 (4): 247-65 

Goldfrank LR (2002). Goldfrank'sToxicologic Emergencies. McGraw-Hill 

Hulse GK, Lautenschlager NT, Tait RJ, Almeida OP (2005). "Dementia associated with alcohol and other drug use". IntPsychogeriatr 17 (Suppl 1): S109-27 

Stead AH, Moffat AC. A Collection of Therapeutic, Toxic and Fatal Blood Drug Concentrations in Man. Human Toxicol 1983;3:437-464 

Repetto MR, Repetto M. Habitual, Toxic, and Lethal Concentrations of 103 Drugs of Abuse in Humans. ClinToxicol 1997;35:1-9 

Pounder DJ, Jones GR Post-mortem drug redistribution--a toxicological nightmare. Forensic Sci Int. 1990 Apr;45(3):253-63

G. R. Jones and D. J.Pounder, Site dependence of drug concentrations in postmortem blood - a case study, J. Anal. Toxicol. 1987, 11, 186-190 

M. D. Robertson and O. H.Drummer, Postmortem drug metabolism by bacteria, J. Forensic Sci. 1995, 40, 382-386
M. D. Robertson and O. H.Drummer, Stability of nitrobenzodiazepines in postmortem blood, J. Forensic Sci. 1998, 43, 5-8 

SOFT/AAFS Guidelines Committee, SOFT/AAFS Forensic Toxicology Laboratory Guidelines, Mesa, Society of Forensic Toxicologists and American Academy of Forensic Sciences Toxicology Section, 2002, pp. 1-21 

M. D. Osselton , The use of proteolytic enzymes to release high levels of drugs from biological materials submitted for toxicological analysis, Vet. Hum. Toxicol. 1979, 21(Suppl.), 177-179 

B. K. Logan and G.Lindholm, Gastric contamination of postmortem blood samples during blind-stick sample collection, Am. J. Forensic Med. Pathol. 1996, 17, 109-111
G. R. Jones and D. J.Pounder, Site dependence of drug concentrations in postmortem blood - a case study, J. Anal. Toxicol. 1987, 11, 186-190 

Beck O., Laoie P. , Odes G . , Boreus, L. O., Immunological screening of benzodiazepines in urine: improved detection of oxazepam intake, Toxicology Letters vol. 1990
V. F. Samanidou, A. P. Pechlivanidou, and I. N. Papadoyannis, J. Sep. Sci. 30 (2007) 679–687
The Guidelines on Representative Drug Sampling, ST/NAR/38, United Nations, 2009
Moore, C., Coulter, C., Crompton, K. and Zumwalt, Tetrahydrocannabinol and two of its metabolites in whole blood using liquid chromatography-tandem mass spectrometry. Journal of Analytical Toxicology 32, 653-658, 2008.
Coles R, Kushnir M, Nelson G, McMillin GA, Urry FM. (2007) Simultaneous determination of codeine, morphine, hydrocodone, hydromorphone, oxycodone and 6-acetylmorphine in urine, serum, plasma, whole blood and meconium by LC-MS/MS. Journal of Analytical Toxicology, Jan/Feb;31(1):1-10.
D. S. Ming and J. Heathcote, “Rapid and Accurate UPLC/MS/MS Method for the Determination of Benzo- diazepines in Human Urine,” Journal of Chromatography B, Vol. 879, No. 5-6, 2011, pp. 421-428.
Reactivity of commercial benzodiazepine immunoassays to phenazepam. Kyle PB, Brown KB, Bailey AP, Stevenson JL J Anal Toxicol. 2012 Apr;36(3):207-9. doi: 10.1093/jat/bks008
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