Counterfeit 'Xanax®' tablets: A comparative study of clinical and seizure data in Victoria, Australia.

Background And Aim: There is growing evidence of counterfeit benzodiazepine products containing other substances, including non-regulated benzodiazepine-type new psychoactive substances (NPSs). This study sought to compare detections of seized suspect counterfeit alprazolam products with clinical cases that reported use of an alprazolam-containing product to better characterise community use.

Design And Setting: Observational study set in Victoria, Australia, using data from the Victoria Police Drug Sciences Group (which compiles information about seized drugs submitted for evidential analysis and intelligence purposes) and the Emerging Drugs Network of Australia - Victoria (EDNAV) project (a prospective, observational study collecting clinical and analytical data for illicit drug-related presentations across a network of hospitals in Victoria, Australia).

Novel psychoactive substances in Australian emergency departments: implications for public health practice from multi-centre prospective toxicosurveillance across five states, 2022-2023.

Background: Comprehensive toxicology testing of emergency department (ED) presentations has become a prominent data source on novel psychoactive substances (NPS) in Australia. We describe the type and frequency of analytically confirmed NPS across five Australian states and 28 EDs between 2022 and 2023.

Methods: This is a prospective series of ED presentations with at least one confirmed NPS detection identified by the Emerging Drugs Network of Australia (EDNA) and Emerging Drugs Network of Australia Victoria (EDNAV).

Changes over time in novel benzodiazepines contributing to fatal overdoses in Victoria, Australia.

Introduction: Novel benzodiazepines (NBZN) have increased in availability and use since the mid-2000s, with a corresponding rise in associated harms including deaths.

Methods: The study used data from the Victorian Overdose Deaths Register to explore which specific NBZNs and combinations of NBZNs contributed over time to Victorian overdose deaths between January 2009 and December 2023.

Results: There were 140 NBZN-involved overdose deaths in Victoria, with an observable increase in deaths from 2019 onward.

Identification of clobromazolam in Australian emergency department intoxications using data-independent high-resolution mass spectrometry and the HighResNPS.com database.

The proliferation of novel psychoactive substances (NPSs) continues to challenge toxicology laboratories. In particular, the United Nations Office on Drugs and Crime considers designer benzodiazepines to be a current primary threat among all NPSs. Herein, we report detection of a new emerging designer benzodiazepine, clobromazolam, using high-resolution mass spectrometry and untargeted data acquisition in combination with a "suspect screening" method built from the crowd-sourced HighResNPS.

A risk-based approach to community illicit drug toxicosurveillance: operationalisation of the Emerging Drugs Network of Australia - Victoria (EDNAV) project.

Introduction: The Emerging Drugs Network of Australia - Victoria (EDNAV) project is a newly established toxicosurveillance network that collates clinical and toxicological data from patients presenting to emergency departments with illicit drug related toxicity in a centralised clinical registry. Data are obtained from a network of sixteen public hospital emergency departments across Victoria, Australia (13 metropolitan and three regional). Comprehensive toxicological analysis of a purposive sample of 22 patients is conducted each week, with reporting of results to key alcohol and other drug stakeholders.

Characteristics and time course of benzodiazepine-type new psychoactive substance detections in Australia: results from the Emerging Drugs Network of Australia - Victoria project 2020-2022.

Introduction: The emergence of benzodiazepine-type new psychoactive substances (NPSs) are a growing international public health concern, with increasing detections in drug seizures and clinical and coronial casework. This study describes the patterns and nature of benzodiazepine-type NPS detections extracted from the Emerging Drugs Network of Australia - Victoria (EDNAV) project, to better characterise benzodiazepine-type NPS exposures within an Australian context.

Methods: EDNAV is a state-wide illicit drug toxicosurveillance project collecting data from patients presenting to an emergency department with illicit drug-related toxicity.

Non-fatal intoxications involving the novel benzodiazepine clonazolam: case series from the Emerging Drugs Network of Australia - Victoria project.

Introduction: Clonazolam is an unregistered novel benzodiazepine which emerged in global illicit drug markets in 2014. We describe the clinical features of four cases of non-fatal clonazolam mono-intoxications from patients presenting to emergency departments in Australia.

Cases: Four patients aged between 16 and 19 years presented to hospital with a sedative toxidrome (Glasgow Coma Scale range 8-13) and elevated heart rate (median heart rate 100 beats per minute, range 92-105) following reported benzodiazepine exposure.

Changing trends and characteristics of one punch deaths in Australia (2012-2018).

One-punch assaults also known as 'coward punches', are characterised by a single severe blow to the head causing the victim to lose consciousness, resulting in a secondary impact between the head and surrounding environment. Such impacts may result in brain injury leading to fatality or permanent neurological impairment. In a previous publication, there were 90 one punch deaths around Australia between 2000 and 2012, mostly involving young men drinking alcohol at a licensed venue at the weekend.

The onset and severity of acute opioid toxicity in heroin overdose cases: a retrospective cohort study at a supervised injecting facility in Melbourne, Australia.

Aim: To differentiate the severity of acute opioid toxicity and describe both the clinical and physiological features associated with heroin overdose in a cohort of witnessed overdose cases.

Methods: Witnessed heroin overdose cases over a 12-month period (30 June 2018 - 30 June 2019) at the Medically Supervised Injecting Room (MSIR) in Melbourne, Australia were examined. The severity of acute opioid toxicity was classified according to the level of clinical intervention required to manage the overdose cases where an escalating level of care was provided.

What are the research priorities for optimising the safe and effective use of opioids in Australian general practice?

Introduction: Persistent high rates of prescription opioid use and harms remain a concern in Australia, Europe and North America. Research priority setting can inform the research agenda, strategic responses and evidence-based interventions. The objective of this study was to establish research priorities related to the safe and effective use of prescription opioids in general practice.

Intoxications in an Australian Emergency Department Involving 'Nitazene' Benzylbenzimidazole Synthetic Opioids (Etodesnitazene, Butonitazene and Protonitazene).

Benzimidazole synthetic opioids are highly potent μ-opioid receptor agonists with heroin-like effects, including dose-dependent respiratory depression and a high risk of abuse and toxicity. Benzimidazoles were first detected in 2019 in Europe and Canada, with analytical confirmation of etodesnitazene, protonitazene and butonitazene in 2021. We report the first detections of these compounds in Australia, in two patients presenting with drug toxicity to Emergency Departments (EDs) in the state of Victoria.

The impact of codeine upscheduling on overdoses, Emergency Department presentations and mortality in Victoria, Australia.

Background And Aims: Prior to February 2018, codeine was available over-the-counter (OTC) in Australia as a pharmacist-only medicine (Schedule 3) in low-strength formulations when in combination with simple analgesics. In February 2018, The Advisory Committee on Medicines Scheduling (ACMS) upscheduled codeine-containing medicines (CCM) to Schedule 4 (prescription-only medicine). This study aimed to determine the impact of upscheduling on prescriptions, overdoses and deaths.

Fatal poisonings involving clozapine: A 16-year review of Australian coronial investigations.

Objective: Concerns about intentional and unintentional poisoning present a barrier to wider use of clozapine in treatment-resistant schizophrenia. The objective of this study was to investigate decedent demographics and trends in fatal poisonings in Australia involving clozapine.

Methods: This was a retrospective case series of all fatal drug toxicity reported to an Australian coroner between 1 May 2000 and 31 December 2016 where toxicological analysis detected clozapine.

The role of voluntary and involuntary drug and alcohol consumption and premorbid mental health factors in drug-facilitated sexual assault.

In order to better understand risk factors associated with drug-facilitated sexual assault (DFSA), this study examined complainant-specific and contextual factors, as well as the toxicological profile of DFSA in Victoria, Australia. Clinical files and toxicological analysis results collected by the Victorian Institute of Forensic Medicine (VIFM) for all cases of alleged DFSA in Victoria that occurred between 1st January 2011 - 31st December 2013 were reviewed. Two hundred and four cases of alleged DFSA were identified; complainants were predominately female (93%), and their median age was 26 years (range = 18-54).