Latest Articles and News - Jun 13, 2025

Methamphetamine and Cocaine Overdose Deaths in the United States, 1999-2023.

The ongoing "fourth wave" of the U.S. overdose epidemic has been marked by rising deaths co-involving fentanyl with stimulants such as methamphetamine and cocaine. Using data obtained from the CDC WONDER Multiple Cause of Death database, this serial cross-sectional study analyzed stimulant overdose mortality trends between 1999 and 2023. We stratified crude mortality rates by sex, race and ethnicity, and opioid co-involvement. We used Joinpoint regression to examine temporal trends and estimate annual percentage changes (APC) within time segments. From 1999 to 2023, methamphetamine-involved overdose deaths increased from 547 to 34,855, with mortality rates rising from 0.20 (95% CI, 0.18-0.21) to 10.41 (95% CI, 10.30-10.52) per 100,000 (AAPC: 18.49% [95% CI, 17.67-20.17]; p < 0.001). Cocaine-involved overdose deaths increased from 3,822 to 29,449, with mortality rates rising from 1.37 (95% CI, 1.33-1.41) to 8.79 (95% CI, 8.69-8.89) per 100,000 (AAPC: 8.80% [95% CI, 8.18-9.95]; p < 0.001). Stimulants were involved in 7.95% and 10.28% of fentanyl overdoses in 1999 and 2011, respectively, but dramatically rose to 56.67% by 2023. Methamphetamine-involved overdose deaths were highest among American Indian/Alaska Native individuals, accounting for 44.50% of overdose deaths, while cocaine-involved overdose deaths were highest among Black individuals, comprising 48.47% of overdose deaths. Rising stimulant mortality, particularly in racial and ethnic minoritized populations, underscores the need for expanding access to harm reduction resources, greater funding for stimulant use disorder research, and targeted public health interventions.

Description of Acute and Chronic Cases of Poisoning by Oxalis pes-caprae.

Oxalis pes-caprae is one of the most widespread invasive plants in the Mediterranean areas, especially in central and southern Italy, Sicily, and Sardinia. It is an herbaceous species of South African origin, very common in uncultivated areas, in meadows, and at the edges of roads but also in vegetable gardens and fields, where it can become a weed. Its negative impact on the economic sector is significant due to the presence of large quantities of oxalates, which are toxic and dangerous for grazing livestock; the ingestion of high amounts of oxalates causes the accumulation of oxalate crystals, which can lead to kidney failure and anuria. This work represents a descriptive, field-based case report of epidemiological relevance, describing two cases of acute and chronic poisoning by Oxalis pes-caprae found in two different sheep farms in southern Sardinia. In February 2024, the sudden death of about 40 animals was reported in a sheep farm. On another farm, seven animals died (between March and July 2024), while others showed poisoning symptoms such as weight loss, submandibular edema, and a barrel-shaped abdomen. This manuscript aims to highlight the damage caused by poor attention in pasture management and the importance of seasonal risk management; it is necessary to pay attention to the herbaceous species present in pastures, especially in our region, where climatic temperatures no longer respect seasonality and herbaceous species that normally grow in spring are easily found also in the winter months.

Manganese Intoxication Induced by Total Parenteral Nutrition in the Intensive Care Unit: A Case Report.

Background: Manganese (Mn) is an essential trace element for humans. It has been recognized as a potential occupational toxin, but its danger as a toxin in patients under parenteral nutrition is often forgotten. Case Presentation: A 73-year-old man was logged for 210 days in the intensive care unit (ICU), receiving parenteral nutrition (PN) for a month, and was then transferred, first, to the internal medicine ward and, then, to the rehabilitation hospital, and 223 days after discharge from the ICU, he had current disease, chorea-type movements in the head and neck, and left hemibody. Diagnostic tests: The magnetic resonance imaging findings suggested manganese deposits, with a total blood manganese concentration of 34 µg·L^-1 (reference range: less than 13 µg·L^-1). Discussion: Abnormal movements can be caused by manganese poisoning due to parenteral nutrition and are associated with liver failure in the ICU. Our patient showed toxic Mn concentrations in whole blood after 31 days of receiving 300 μg·d^-1 of Mn in PN, a shorter duration than typically reported. Neurotoxicity was observed several months later (223 days). Factors such as liver dysfunction and iron deficiency can modulate neurotoxicity. Age may also be a susceptibility factor due to increased expression of Mn transport proteins. Magnetic resonance imaging (MRI) intensity in the globus pallidus is useful for detecting brain Mn accumulation, but it is not feasible for routine clinical practice. Conclusions: In this case, choreiform movements were attributed to manganese (Mn) accumulation in the basal ganglia. It is essential to monitor patients receiving parenteral nutrition (PN) solutions containing Mn, especially in those who have biomarkers of susceptibility, even if they have not yet shown neurological signs, and routinely measure whole-blood Mn concentrations, iron levels, age, and liver function. If Mn intoxication is suspected, a brain MRI examination should be conducted.

Forensic pathology and toxicological analyses: A case of fatal xylazine poisoning.

Xylazine, an α₂-adrenergic receptor agonist commonly used as a veterinary sedative, has gained notoriety for its increasing misuse in combination with opioids, such as fentanyl, to potentiate its effects. This trend has led to a rise in cases of xylazine poisoning. Although timely diagnosis and intervention have reduced fatalities, the postmortem pathological manifestations and lethal blood concentration of xylazine alone remain poorly characterized due to its common co-occurrence in toxicology with fentanyl. This study presented a case of homicide involving fatal intoxication solely from xylazine overdose without coadministration of other central nervous system drugs, detailing the multi-organ pathological changes observed and quantifying the decedent's blood xylazine concentration at 13.34 μg/mL using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The findings aimed to provide forensic practitioners with valuable insights for the identification and investigation of fatal xylazine poisoning cases.

Machine Learning-Based Prediction of Delayed Neurological Sequelae in Carbon Monoxide Poisoning Using Automatically Extracted MR Imaging Features.

Delayed neurological sequelae are among the most serious complications of carbon monoxide poisoning. However, no reliable tools are available for evaluating its potential risk. We aimed to assess whether machine learning models using imaging features that were automatically extracted from brain MRI can predict the potential delayed neurological sequelae risk in patients with acute carbon monoxide poisoning. This single-center, retrospective, observational study analyzed a prospectively collected registry of acute carbon monoxide poisoning patients who visited our emergency department from April 2011 to December 2015. Overall, 1618 radiomics and 4 lesion-segmentation features from DWI b1000 and ADC images, as well as 62 clinical variables were extracted from each patient. The entire dataset was divided into five subsets, with one serving as the hold-out test set and the remaining four used for training and tuning. Four machine learning models, linear regression, support vector machine, random forest, and extreme gradient boosting, as well as an ensemble model, were trained and evaluated using 20 different data configurations. The primary evaluation metric was the mean and 95% CI of the area under the receiver operating characteristic curve. Shapley additive explanations were calculated and visualized to enhance model interpretability. Of the 373 patients, delayed neurological sequelae occurred in 99 (26.5%) patients (mean age 43.0 ± 15.2; 62.0% male). The means [95% CIs] of the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity of the best performing machine learning model for predicting the development of delayed neurological sequelae were 0.88 [0.86-0.9], 0.82 [0.8-0.83], 0.81 [0.79-0.83], and 0.82 [0.8-0.84], respectively. Among imaging features, the presence, size, and number of acute brain lesions on DWI b1000 and ADC images more accurately predicted DNS risk than advanced radiomics features based on shape, texture and wavelet transformation. Machine learning models developed using automatically extracted brain MRI features with clinical features can distinguish patients at delayed neurological sequelae risk. The models enable effective prediction of delayed neurological sequelae in patients with acute carbon monoxide poisoning, facilitating timely treatment planning for prevention. ABL = Acute brain lesion; AUROC = area under the receiver operating characteristic curve; CO = carbon monoxide; DNS = delayed neurological sequelae; LR = logistic regression; ML = machine learning; RF = random forest; SVM = support vector machine; XGBoost = extreme gradient boosting.

Field evaluation of grit supplementation as a tool to mitigate poisoning from lead shot legacy in waterbirds.

The ban of lead shot for hunting over wetlands at national and continental scales is essential to reduce the risk of lead poisoning in waterbirds, but the high persistence of lead shot in wetland sediments highlights the need for exploring additional mitigation measures. Grit supplementation has been proposed as a method to reduce the probability of lead shot ingestion by waterbirds, that would add to the regulatory actions. Here we hypothesize that (1) the lead shot ban would reduce lead shot ingestion and (2) grit supplementation would reduce overall shot ingestion (lead+steel) in waterfowl. To test this, waterbirds harvested by hunters during the pre-ban (seasons 1991/1992- 1995/1996, n=379), post-ban (seasons 2007/2008 to 2008/2009, n=254), and post-ban plus grit supplementation (seasons 2009/2010 to 2014/2015, n=1378) periods were monitored in the Ebro delta (Spain). Grit supplementation was performed in collaboration with local hunters to achieve a grit particle:lead shot pellet proportion above 2:1. Lead shot ingestion prevalence declined by 29.1-77.0% in the five granivorous species of ducks with the highest prevalence of lead shot ingestion before the ban (i.e. Northern pintail, common pochard, mallard, Northern shoveler and common teal). Shot pellet ingestion (lead+steel) decreased by 33.8% and 53.4% during the grit supplementation period in the Northern pintail and common pochard, respectively. We highlight the need for monitoring the lead shot ban compliance and its effectiveness to reduce lead poisoning in waterbirds because other mitigation actions, such as grit supplementation, may be necessary in the short to medium-term before lead shot pellets disappear from wetlands or become unavailable for birds.

β-Blocker and Colchicine Coingestion in the Setting of Cocaine Intoxication.

Framing coalitions and the Canadian overdose crisis: The case of opioid marketing.

The overdose crisis remains one of the most pressing public health emergencies in North America, with the marketing of prescription opioids identified as a key contributor to its escalation. Notwithstanding, the role of prescription opioids in the current overdose crisis, as well as the extent to which marketing and education can be distinguished, remains highly debated. Using qualitative framing analysis of four separate consultations obtained through two Access to Information and Privacy (ATIP) requests, this study examines how stakeholders framed prescription opioids and the overdose crisis as policy problems, the culpability of marketing and education in the crisis, and how these framings both reflected and influenced the often-conflicting objectives of the opioid industry and public health. Findings show that while some stakeholders acknowledged problematic prescription opioid use, many reframed the crisis as an "illicit overdose crisis" and minimized the role of marketing practices. Stakeholders commonly opposed any restrictions related to prescription opioids for fear that they would bring undue attention to chronic pain patients. Overall, debates surrounding marketing and education served as proxy disagreements around safe supply, harm reduction, illicit and prescription opioids, and the appropriate role of the pharmaceutical industry in the healthcare system. Applying the analytic framework of "framing coalitions," the study highlights how stakeholders' framings and policy interests can differ and shift across overdose crisis priorities, leading to complex, overlapping constructions of the crisis. Given the crisis's varied social constructions, this research sheds light on the deep-seated tensions that fuel the deep divisions surrounding overdose crisis policies.

Development of an LC-MS/MS detection method for cardiac glycosides (cerberin, neriifolin, and tanghinin) in human blood serum: Application to a Cerbera odollam poisoning case.

The globalization of commerce through the Internet has facilitated the trade of poisonous plants and their seeds, resulting in the occurrence of severe cases of poisoning even in regions where these plants do not grow naturally. Cerbera odollam is one such plant. Although not native to Japan, its seeds can easily be purchased online as ornaments, leading to several suicide cases in Japan. C. odollam contains several cardiac glycosides, including cerberin, neriifolin, and tanghinin, which are thought to be responsible for its toxic effects. In this study, we developed a method for detecting cerberin, neriifolin, and tanghinin in blood serum using a MonoSpin® cartridge combined with liquid chromatography-tandem mass spectrometry. The detection limits of the method for each compound were 0.15 ng/mL (cerberin), 0.18 ng/mL (neriifolin), and 0.14 ng/mL (tanghinin). The quantification limits were 0.6 ng/mL (the lowest point of the calibration curves) for all compounds. In addition, we successfully applied this method to an actual case of C. odollam poisoning, where neriifolin was detected in the patient's sera. Neriifolin concentrations in serum samples collected between 0.25 h and 63 h after admission ranged from 14.4 to 1.57 ng/mL, with a calculated biological half-life of 19.2 h. These results provide valuable data that may aid in the treatment of Cerbera poisoning. Furthermore, the developed method could help detect unnoticed crimes and suicides involving Cerbera species.