Thesis (Ph.D.)--Ohio University, November, 2004. / Includes bibliographical references (p. 163-171)

Thesis (M.S.W.)--University of Hong Kong, 1995. / Includes bibliographical references (leaf 87-95).

Thesis (Ph.D.)--Ohio University, November, 2004. / Title from PDF t.p. Includes bibliographical references (p. 163-171)

Edited by Samuel S. Epstein, with associate editors: Joshua Lederberg [and others] / "Based on a symposium cosponsored by the Center for Studies of Narcotic and Drug Abuse, NIMH, and by the Environmental Mutagen Society, San Francisco, October 29 and 30, 1969." / Includes bibliographies.

Tendo em vista a iniciativa do Ministério da Saúde de instituir aos indivíduos com problemas pelo uso abusivo de álcool e/ou outras drogas serviços de saúde mental de base comunitária nos moldes do Sistema Único de Saúde e em conformidade com as preconizações das atuais políticas de saúde mental; objetivou-se neste estudo conhecer as intervenções previstas pelos documentos que embasam as práticas de Centro de Atenção Psicossocial do município de Alegrete/RS, buscando, complementarmente, evidenciar tais ações no contexto prático dos trabalhadores na atenção aos indivíduos sob tratamento pelo uso abusivo de substâncias psicoativas. Estruturado nos moldes de uma pesquisa qualitativa, adotou-se como referencial teórico para sustentação da análise dos dados, a Política Nacional sobre Drogas, a Política do Ministério da Saúde para Atenção Integral dos Usuários de álcool e drogas e as preconizações da Organização Mundial da Saúde com relação à prevenção e controle do uso abusivo de drogas. No tocante aos aspectos metodológicos, adotou-se a técnica de análise documental e a observação-participante (682 horas). Para apresentação dos resultados foram organizados quatro capítulos: \"Dados de identificação e aspectos históricos do serviço de saúde mental de Alegrete\"; \"Apresentação dos documentos utilizados na pesquisa\"; \"Descrição das intervenções: da documentação à prática cotidiana\" e \"Intervenções comunitárias: reflexões sobre o processo de exclusão social e possibilidades de construção da cidadania\". O serviço apresentou uma boa articulação para atuação em rede, flexibilidade para ações intersetoriais e constante preocupação e empenho para a capacitação dos profissionais da equipe; no entanto, evidenciouse a dificuldade de consolidação das ações na comunidade, falta de articulação com o Programa de Redução de Danos do município e atuação incipiente nos problemas de ordem social (por exemplo, nenhuma iniciativa efetiva relacionada à geração de trabalho e renda, exceto a venda de produtos da oficina de artesanato). Enfim, este estudo reforça o desafio lançado aos serviços de saúde mental, sobretudo àqueles que atendem indivíduos usuários de drogas, de \"exteriorização\" de suas práticas. / The treatment by service of mental health with action in the community is the present orientation of the Department of the Health on Brazil for the care of patients that abuse of the drugs. The aim of this study was to know the interventions registered in the documents that organize the actions of the service of mental health of Alegrete/RS and to observe the work of the professionals for confirm these actions in the attention of patients that abuse of the drugs. This is a qualitative study and data analysis was based on: the National Politics about Drugs; Politics of the Health\'s Department in Brazil for Integral attention of patients that abuse the drugs and orientation of the World Organization of the Health for prevention and control the abuse of drugs. Methodology: was utilized the documentary analysis and the participant observation (682 hours). The results was organized in four chapters: \"identification and historic aspects of the service of mental health of Alegrete/RS\"; \"Presentation of the documents used in the research\"; \"Description of the interventions: the documents and the practical routine\"; \"Professional practices in the community: reflections about the process of social exclusion and possibilities of construction of the citizenship\". Results: the actions of the service are articulated in a healthcare network; the service has flexibility for actions in partnership with social and healthcares sectors; there is a constant worry and endeavor for the qualification of the professionals. However, there is difficulty in carry out actions in the community; is lacking working in partnership with the Harms\' Reduction Program of the town; there are necessity more professionals actions for attend the social problems (for example, effective interventions with the objective of generate work and yield for the users). Finally, the results of this research reinforce the challenge put to the service of mental health of \"it put for outside\" their professional practices.

O humor vítreo (HV) é um gel aquoso, transparente e incolor, situado entre o cristalino e a retina. Ele pode ser uma ferramenta para determinação de drogas de abuso, sobretudo quando é impossível fazer a determinação em sangue devido à sua ausência ou sua deterioração, por exemplo em casos de exsanguinação, embalsamento e carbonização. As drogas e seus metabólitos passam para o HV por difusão passiva e, de modo geral, a concentração dos analitos no HV é similar às concentrações obtidas no sangue. A cocaína e a benzoilecgonina são facilmente detectadas na matriz. Por outro lado, a difusão da morfina é bem limitada. O maior interesse do estudo de opioides é a análise de 6-acetilmorfina, que pode diferenciar o uso de heroína e morfina. O delta-9-tetrahidrocanabinol é uma molécula muito polar e fortemente ligada a proteínas plasmáticas, o que limita a sua difusão para o HV. Entre as anfetaminas, a metilenodioximetanfetamina e a metanfetamina são as moléculas mais estudadas no HV. Foi desenvolvido e validado um método utilizando GC-MS para análise simultânea de cocaína, anfetaminas, opioides, canabinoides e respectivos metabólitos em HV. Os analitos de interesse foram extraídos do HV utilizando extração em fase sólida e analisadas por GC-MS, utilizando o modo de aquisição SIM. A faixa de linearidade foi de 10 a 1000 ng/mL para todos os analitos, com exceção do éster de metilanidroecgonina (10 a 750 ng/mL). A exatidão variou de 95,6 a 104,0%, a precisão inter-ensaio variou de 1,2 a 10,0% e a precisão intra-ensaio foi menor que 10,4% para todos os analitos. O limite de quantificação para todas as drogas foi de 10 ng/mL e a recuperação variou de 70,4 a 100,1% para compostos básicos e neutros, entretanto os compostos ácidos apresentaram baixa recuperação - menor que 40%. A dosagem de etanol foi realizada por GC-FID e extração por headspace. Os métodos validados foram aplicados em 250 amostras de HV coletadas de vítimas de morte violentas nos anos de 2011 e 2012 que foram necropsiadas no Departamento Médico Legal de Vitória - ES. A maioria das vítimas era do sexo masculino (85,4%) e a causa mais comum de morte foi homicídio (46,2%), destes, 89,5% foram mortos por disparo de arma de fogo. Os acidentes de trânsito corresponderam a 44,1%; suicídio, 2,4%; e outras mortes totalizaram 7,2% das amostras. Substâncias psicoativas (álcool e drogas) foram positivas em 60,4% dos casos. Em 23,2% das amostras foi quantificada cocaína e/ou seu metabólito, e em um terço destes foi identificado o uso de crack. O álcool estava presente em 19,2% dos casos e a associação entre cocaína e álcool em 12,8% dos casos. Outras drogas incluíram anfetaminas (13 casos) e codeína (1 caso). Quando comparadas as concentrações das drogas pesquisadas no sangue e HV, a anfetamina e metanfetamina mostraram boa correlação entre as duas matrizes. A 6-acetilmorfina encontrada no HV foi utilizada para demonstrar o uso de heroína, uma vez que as concentrações foram mais altas do que no sangue. Entretanto, o HV não pode ser utilizado como amostra alternativa para detecção de canabinoides. / Vitreous humor is the aqueous gel located between the lens and retina. Vitreous humor is a useful alternative postmortem matrix for the detection of drugs, particularly in death investigations where postmortem blood is not available or is of limited quality or quantity (e.g. after hemorrhagic shock, burns, embalming or decomposition processes). Drugs and their metabolites enter the vitreous humor by passive diffusion from blood across the blood-vitreous barrier. Vitreous humor concentrations are often similar to the drug concentrations in the circulation blood. Cocaine and benzoylecgonine are easily detected in this matrix. On the order hand, morphine diffusion is limited. The interest in opiates is due to 6-acetylmorphine, which is stable in vitreous humor and can confirm heroin abuse. Drugs that are highly protein-bound, such as THC, achieve lower vitreous humor concentrations as only the free fraction can cross the blood-vitreous barrier. Methamphetamine and methylenodioxymetamphetamine are also detected in vitreous humor. A GC-MS method for simultaneous analysis of cocaine, amphetamines, opiates, cannabinoids and its metabolites in vitreous humor was developed and fully validated. Vitreous humor samples were extracted using solid phase extraction and analyzed by GC-MS in SIM mode. For all analytes the linearity ranged from 10 to 1000 ng/mL, excepted for anydroecgonine methylester which ranged from 10 to 750 ng/mL. Inter-assay imprecision ranged from 1.2 to 10.0% and intra-assay imprecision was less than 10.4% for all analytes at all QC concentrations. Accuracy ranged from 95.6 to 104.0% and recoveries ranging from 70.4 - 100.1% for basic and neutral compounds, the acids compounds had poor recovery (less than 40%). The limits of detection were up to 1.0 ng/mL. Ethanol was quantified by headspace extraction and GC-FID. The validated methodology was applied to 250 vitreous humor samples collected from violent death victims between 2011 and 2012 in the Departamento Médico Legal de Vitória - ES. Most of the victims were male (85.4%) and the most common cause of death was homicide (46.2%), in which 89.5 occurred by firearm shot. Traffic accident represented 44.1%, suicide 2.4% and other deaths 7.2%. Psychoactive substances (alcohol and?or drugs of abuse) were positive in 60.4% of the cases. Cocaine was quantified in 23.2% of the samples and one third was positive for crack cocaine. Ethanol was present in 19.2% of the cases and the association between cocaine and alcohol in 12.8%. Other drugs included amphetamines (13 cases) and codeine (1 case). When comparing the drug concentrations in blood and vitreous humor, amphetamine and methamphetamine showed a good correlation. 6-acetylmorphine in vitreous humor can demonstrate heroine abuse and its concentration is higher in vitreous humor than in blood. However, vitreous humor is not a good matrix for the detection of cannabinoids.

Dirigir sob a influência de álcool e drogas ilícitas tem sido um tema de crescente preocupação em países desenvolvidos, contudo a pesquisa toxicológica de outras drogas, que não o álcool, em vítimas fatais de acidentes de trânsito ainda é pouco estudada. Este estudo realizou a pesquisa toxicológica de álcool e drogas ilícitas (cocaína, anfetaminas e cannabis) em 391 vítimas fatais de acidentes de trânsito atendidas pelo DML de Vitória - ES, durante os anos de 2011 e 2012. As vítimas foram compostas por 337 homens (86,2%) e 54 mulheres (13,8%), com média de idade de 37 anos (mínimo 16 e máximo 83). Amostras coletadas de motoristas representaram 59% do total de amostras (n=230), enquanto passageiros e pedestres foram responsáveis por 14% e 12%, respectivamente (n=56 e n=46). Os acidentes automobilísticos foram responsáveis por 178 mortes (46%), seguidos por acidentes motociclísticos, com 149 mortes (38%) e por atropelamentos, com 59 mortes (15%). Para a pesquisa toxicológica de drogas ilícitas em amostras de sangue total, um método analítico combinando extração em fase sólida e análise quantitativa dos analitos por GC-MS foi desenvolvido e validado. Os analitos pesquisados foram: cocaína, cocaetileno, éster de metil ecgonina (EME), éster de metilanidroecgonina (EMA), anfetamina, metanfetamina, MDMA, MDA, MDEA, femproporex, anfepramona, Delta-9 THC e 11-nor-9-Carboxi-?9-THC. A pesquisa toxicológica dos casos estudados determinou que 44,8% destes foram positivos para álcool e/ou drogas ilícitas. Não foram evidenciadas diferenças entre motoristas, passageiros e pedestres (motoristas = 45,9%, passageiros = 46,4% e pedestres = 45,6%). A detecção de álcool e/ou drogas foi mais frequente em vítimas do sexo masculino com idades entre 16 e 34 anos, positivos em 46,8% dos casos. Em geral, a droga mais prevalente foi o álcool, com 141 casos positivos (36,1%), dos quais apenas nove (2,3%) apresentaram alcoolemia inferior a 6 dg/L, seguida pela cocaína, com 47 casos positivos (12%). Anfetaminas e cannabis tiveram positividades de 4,1%, com 16 casos positivos, cada. O uso simultâneo de álcool e outras drogas foi encontrado em 36 casos, correspondendo a 9,2% das vítimas e o uso de crack foi comprovado em 27,7% dos casos positivos para cocaína através da detecção do EMA. O alto índice de casos positivos em vítimas fatais de acidentes de trânsito sugere relação com o risco aumentado ao conduzir veículos automotores sob o efeito de álcool e/ou drogas ilícitas. Para a efetiva diminuição dos acidentes de trânsito relacionados ao uso de álcool e/ou drogas ilícitas, sugere-se a intensificação de ações de fiscalização direcionadas ao uso do álcool por motoristas, a formulação de leis do tipo per se, que definam quais drogas deverão ser pesquisadas no contexto do trânsito, e o estabelecimento do chamado consentimento implícito para fornecimento de amostras para realização de análises toxicológicas, visando a segurança do coletivo em detrimento de direitos individuais, como o de se recusar a fornecer amostras para realização de exames toxicológicos. / Driving under the influence of alcohol and illicit drugs has been a topic of increasing concern in developed countries. However, the toxicological testing of drugs, other than alcohol, in victims of fatal crashes is still poorly studied. A toxicological survey of alcohol and illicit drugs (cocaine, amphetamines and cannabis) was conducted in 391 deceased victims due to traffic accidents attended by the Department of Forensic Medicine of Vitória-ES, during 2011 and 2012. Victims were composed by 337 men (86,2%) and 54 women (13,8%), with mean age of 37 years (minimum 16 and maximum 83). Samples of drivers accounted for 59% of the total sample (n=230), while passengers and pedestrians samples accounted for 14% and 12%, respectively (n=56 and n=46). Automobile accidents were responsible for the majority of deaths, a total of 178 (46%), followed by motorcycle accidents with 149 deaths (38%) and pedestrian accidents, with 59 deaths (15%). For toxicological search of illicit drugs in whole blood samples, an analytical method combining solid phase extraction and quantitative analysis of all analytes by GC-MS has been developed and validated. The analytes studied were: cocaine, cocaethylene, ecgonine methyl ester (EME), anhydroecgonine methyl ester (AEME), amphetamine, methamphetamine, MDMA, MDA, MDEA, femproporex, amphepramone, Delta-9 THC and 11-nor-9-Carboxy -?9-THC. The toxicological analysis of the samples determined that 44,8% of all cases were positive for alcohol and/or illicit drugs. No differences among drivers, passengers and pedestrians were observed (drivers = 45,9%, passengers=46,4% and pedestrians=45,6%). The detection of alcohol and/or drugs was more frequent in young males, aged 16 to 34, whose samples were positive in 46,8% of cases. In general, the most prevalent drug was alcohol, with 141 positive cases (36,1%), which only nine (2,3%) presented concentrations of alcohol below than 6,0 dg/L, followed by cocaine, with 47 positive cases (12%). Amphetamines and cannabis had positivity rates of 4,1%, with 16 positive cases each. The combined use of alcohol and other drugs was found in 36 cases, representing 9,2% of all cases. Crack use was observed in 27,7% of the positive cases for cocaine, by analytical detection of AEME. The high rate of positive cases found in deceased victims of fatal crashes suggests relation to the increased risk of driving under the influence of alcohol and/or illicit drugs. For the effective reduction of traffic accidents related to driving under influence of drugs (DUID), we suggest the intensification of enforcement actions against the use of alcohol by drivers, the formulation of per se laws, with a clear definition of which drugs should be surveyed, and the establishment of the so-called implied consent, in which the granting of driver\'s license implies the fulfillment of a series of standards for the security of the collective, rather than individual\'s own rights, such as refusing to provide samples for drug testing.

Enquadradas arbitrariamente no mesmo termo generalizante drogas, diversas substâncias psicoativas de diferentes efeitos e tradições foram proibidas a partir do começo do século XX por conta de interesses morais, econômicos e políticos justificados por um questionável discurso defensor da saúde pública. A proibição destas substâncias não incidiu sobre seus possíveis efeitos danosos e trouxe consigo uma série de outrosproblemas, como violência do crime e do Estado, corrupção, criminalização da pobreza,encarceramento em massa,ingerência imperial sobre territórios desejados e ingerência estatal sobre a vida privada dos cidadãos. Mesmo assim, com algumas exceções, a questão não ocupou lugar de destaque nos programas e na atuação das organizações de esquerda no Brasil, que invariavelmente ignoraram esta questão, quando não se posicionaram favoravelmente ao proibicionismo. Inspiradas em ideais de hierarquia, disciplina e sacrifício militante,e considerando o uso depsicoativosmajoritariamentepela chave explicativa da fuga da realidade, estas organizações tiveram pouca sensibilidade para propor outros meios que não o repressivo e o penal para se lidar com problemas decorrentes do abuso no uso de drogas, e menos vezes ainda para lidar com formas alternativas de exploração das tecnologias de si, como definiu Michel Foucault. Além de traçar um panorama das origens da proibição das drogas e seus efeitos, este trabalho investiga que tipo de tratamento foi dado pela esquerda à questão das drogas após 1961 ano tanto da aprovação da Convenção Única sobre Narcóticos, da ONU, quanto dos primeiros rompimentos com o PCB, processo que representou uma reconfiguração na esquerda brasileira. / Arbitrarily framed in the same generalizing term \"drugs\", several different psychoactive substances, with different traditions and effects were prohibited in the early twentieth century -because of moral, economic and political interests, justified by a questionable speech defender of \"public health.\" The prohi bition of these substances did not influence in their possible harmful effects and brought with it a lot of other problems, such as crime and violence of the State, corruption, criminalization of poverty, mass incarceration, imperial interference on desired territories and state interference on the citizens private lives. Yet, with few exceptions, the subject did not occupy a prominent place in programs and activities of leftist organizations in Brazil, which most of the time ignored this question. Inspired by the ideals of hierarchy, discipline and militant sacrifice, and considering the use of psychoactive drugs mostly by the explication of \"escape from reality\", these organizations have had little sensitivity to propose other means than the repressive and penal to deal with problems arising from drug abuse, and even less often to deal with alternative ways of operating \"technologies of the self,\" as defined by Michel Foucault. Besides from giving an overview of the origins of drug prohibition and its effects, this study investigates what kind of treatment was given to the issue of drugs by the brasilian left after 1961 -the year of the adoption of the Single Convention on Narcotic Drugs of the United Nations, and also of the first splits in the brasilian comunist party (PCB), which represented a reconfiguration process in the brazilian left.

Development and application of target and non-target techniques for routine analysis, identification of transformation products, and characterization of unknown compounds in water matrices using liquid-chromatography high-resolution mass spectrometry (HRMS) were explored in this dissertation. A novel analytical method based on online-SPE-LC-HRMS was developed for the detection of 18 drugs of abuse (DOAs) in raw sewage water from a college campus. Results showed the presence of 14 DOAs for which amphetamine and 11-nor-9-carcoxy-THC (THC metabolite) were the most prevalent and had the highest potential consumption rates. A second study dedicated to the identification of transformation products (TPs) generated from DOAs was conducted using a combination of HR-MS/MS and metabolic identification and structural elucidation software. Findings confirmed the presence of multiple phase I and II DOA TPs (n=35) in raw sewage influents. Concentrations of all TPs were estimated based on the parent DOAs response factors, and used to calculate the percent mole fraction contributions of each TP to the parent concentrations. High abundance and frequency (compared to the parent drug) was determined for 9 of the TPs coming from drugs like oxycodone, morphine, codeine, methadone, LSD, cocaine, and MDEA. Non-target analysis using HRMS was explored as a tool to characterize, and compare a series of interconnected water matrices along a river system. Several thousands of formulae were generated using automated heuristic rules from the full-scan acquisition at 140,000 resolution. Samples were part of a trajectory covering upstream, effluent, effluent mixing zone, downstream, drinking water intake, and treated drinking water locations. Graphical representations of the data were used to evaluate commonalities among the system. Using this approach, a total of 64 recalcitrant components were identified throughout the samples downstream of the effluent release point. Using a combination of MS/MS and computer-aid software techniques 4 out of the 64 compounds were tentatively confirmed. In addition, comparison of drinking water intake and finalized treated drinking water sites showed the presence of 1,152 chemical entities that were common to both locations; and 1,857 that were unique to the treated drinking water. Therefore, this non-target technique could be used to identify the potential formation of treatment byproducts.

In drug analysis, different kinds of immunoassays are often used as an initial screening for urine samples. The positive screening results are then followed by a confirmatory test, which consists of mass spectrometry methods to detect the drugs. The confirmatory tests are considered to be more resistant to manipulation than the screening tests. If the tested person wants to obtain a false negative result in the drug analysis, there are a lot of different manipulation strategies available today. Manipulation of urine with oxidants before the drug analysis, oxidizes the drugs, and obtains negative results. The aim of this study was to investigate how the results of the drug analysis with the screening test; cloned enzyme donor immunoassay (CEDIA) and the confirmatory test; liquid chromatography- high resolution mass spectrometry (LC-HRMS), were affected when the urine was manipulated with oxidants before the analysis.  Four different oxidants (pyridinium chlorochromate, hypochlorite, sodium nitrite and povidone iodine) in three different concentrations, were investigated and evaluated on 37 different drugs with LC-HRMS. The most effective oxidant and the most adulterated drugs were then further investigated with LC-HRMS, CEDIA and with urine adulteration test strips. The results of the drug analysis were affected by the oxidants with both the CEDIA, and LC-HRMS analysis. All samples containing pyridinium chlorochromate and hypochlorite obtained negative results with CEDIA. With LC-HRMS, the tested samples containing 1 % hypochlorite effectively lowered the drug concentrations under the cut-off. Adulteration tests can be used to identify urine samples, manipulated with oxidants.