David M Wood

King's College London, Londinium, England, United Kingdom

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Publications (137)403.52 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective was to give an overview of self-reported recreational drug use amongst attendees of sexual health clinics in London and compare this to existing datasets. Between December 2013 and March 2014, attendees of two sexual health clinics in London were surveyed. Data collected were: sexual history, smoking and alcohol and recreational drug use. Data were analysed using SPSS (version 21). A total of 1472 respondents were included; 778 (52.9%) men, 676 (45.9%) women and 3 (0.2%) transgender (15 [1.0%] did not answer). Mean age was 30.6 ± 9.0 years. A total of 339 (43.6%) men were men who have sex with men, and 18 (2.4%) women were women who have sex with women. Lifetime prevalence of use was: alcohol 94.1%; cannabis 48.5%; 'poppers' (volatile nitrites) 28.2%; cocaine 26.8% and 3,4-methylenedioxy-methamphetamine pills 23.2%. Our population had higher current popper, methamphetamine and mephedrone use than the Crime Survey of England and Wales but lower use of cannabis, poppers and Viagra than the European MSM Internet Survey. Global Drug Survey and Part of the Picture respondents' use were higher than our population for all drugs. Drug use in this population had a different pattern to general population surveys and studies involving only men who have sex with men.
    International Journal of STD & AIDS 11/2015; DOI:10.1177/0956462415616056 · 1.05 Impact Factor
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    James H Ho · David M Wood · John R H Archer · Paul I Dargan ·

    BMJ (online) 11/2015; DOI:10.1136/bmj.h5710 · 17.45 Impact Factor

  • Clinical Toxicology 10/2015; 53(9):893-900. DOI:10.3109/15563650.2015.1088157 · 3.67 Impact Factor
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    ABSTRACT: Background: There is an association between recreational drug use, high-risk sexual activity and sexually transmissible infections. Studies have shown a higher prevalence of drug use in those accessing sexual health services; however, there are minimal data on the proportion with problematic recreational drug use. We aimed to understand whether sexual health clinics could identify problematic drug and alcohol use as a novel referral pathway into treatment services. Methods: Males attending two sexual health clinics in London completed questionnaires. Data were collected on demographics; gender of sexual partner; use of alcohol and recreational drugs; if they felt they had problematic use of drugs, alcohol or both; and if they had sought help for their problematic use. Results: In total, 867 males completed the questionnaire; 387 (44.7%) were men who have sex with men (MSM). MSM had significantly higher lifetime use of any drug compared with non-MSM (80.6% vs. 62.5%; P < 0.0001). Thirty-five (4.7%) self-identified problematic drug or alcohol use, with no difference between MSM and non-MSM (6.3% vs. 3.5%; P = 0.08). Of those with problematic drug or alcohol use, 20 were currently or had been engaged with a treatment service and 15 had never engaged with treatment services. MSM were more likely to have ever sought help for drug or alcohol problems compared with non-MSM (P = 0.003). Conclusions: Some individuals attending sexual health clinics with problematic drug use have not engaged with treatment services. It is therefore appropriate to develop screening tools for sexual health clinics to identify these individuals and novel referral pathways to engage them in treatment services.
    Sexual Health 10/2015; DOI:10.1071/SH15052 · 1.37 Impact Factor

  • Drugs: Education Prevention and Policy 09/2015; DOI:10.3109/09687637.2015.1081379 · 1.00 Impact Factor
  • Kathleen S Bonnici · Paul I Dargan · David M Wood ·

    British journal of hospital medicine (London, England: 2005) 09/2015; 76(9):C130-C134. DOI:10.12968/hmed.2015.76.9.C130 · 0.38 Impact Factor
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    ABSTRACT: Ethylphenidate is a novel psychoactive substance that is an analogue of methylphenidate. This paper describes its availability, patterns of use, and acute effects. Searches of the scientific and grey literature (publicly accessible Internet resources) were undertaken, using the keywords "Ethylphenidate", "Ethyl phenidate", "Ethyl phenyl(piperidin-2-yl)acetate", and "Nopaine", to identify information on the prevalence and patterns of use, desired effects, and toxicity of ethylphenidate. An Internet snapshot survey was performed on 10 February 2015 to provide information on availability and cost of ethylphenidate. The literature search identified 1 case series of acute recreational ethylphenidate toxicity, 1 case report of ethylphenidate dependence, 1 qualitative analysis of user reports on Internet drug forums, 2 conference abstracts for surveillance studies, 1 report of two cases of ethylphenidate detected in post-mortem analyses, and 198 user reports on Internet discussion forums and social media sites. The Internet snapshot survey found 83 websites selling ethylphenidate, with purchase prices ranging from £28.20 ± 0.63 ( 37.71 ± 0.85) per gram for a 500-mg amount to £2.64 ± 0.57 ( 3.53 ± 0.77) per gram for 1 kg. The published cases and Internet user reports suggest the acute effects of ethylphenidate are similar to other stimulant drugs; the most common route of use was by nasal insufflation. The most common desired effects were euphoria, stimulation, and increased concentration, sociability, and energy levels; the most common unwanted effects included anxiety, palpitations, insomnia, and paranoia. This review of the scientific and grey literature has demonstrated that the acute harms associated with its use are stimulant in nature and that ethylphenidate is widely available to users over the Internet, with significant discounts for bulk purchases.
    European Journal of Clinical Pharmacology 07/2015; 71(10). DOI:10.1007/s00228-015-1906-z · 2.97 Impact Factor
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    ABSTRACT: Risk prediction in paracetamol (acetaminophen, or APAP) poisoning treated with acetylcysteine helps guide initial patient management and disposition. The paracetamol-aminotransferase multiplication product may be a useful and less time-sensitive risk predictor. The aim of this study was to validate this multiplication product in an independent cohort of patients with paracetamol overdose. Using an existing toxicology dataset of poisoned patients from two large inner-city United Kingdom teaching hospitals, we retrospectively identified by electronic search all paracetamol overdoses from February 2005 to March 2013. We assessed the diagnostic accuracy of the multiplication product (serum APAP concentration × alanine transaminase [ALT] activity), especially at the pre-specified cut-off points of 1 500 mg/L × IU/L (10 000 micromol/L × IU/L) and 10 000 mg/L × IU/L (66 000 micromol/L × IU/L). The primary outcome was hepatotoxicity defined by a peak ALT > 1000 IU/L. Of 3823 total paracetamol overdose presentations, there were 2743 acute single, 452 delayed single (> 24 h post overdose), 426 staggered (ingestion over > 1 h), and 202 supratherapeutic ingestions. Altogether, 34 patients developed hepatotoxicity. Among the acute single-ingestion patients, a multiplication product > 10 000 mg/L × IU/L had a sensitivity of 80% (95% confidence interval [CI]: 44%, 96%) and specificity of 99.6% [99.3%, 99.8%], while a product > 1 500 mg/L × IU/L had a sensitivity of 100% [66%, 100%] and specificity of 92% [91%, 93%]. Overall, 16 patients with a multiplication product > 10 000 mg/L × IU/L developed hepatotoxicity (likelihood ratio: 250, 95% CI: 130, 480), and 4 patients with a multiplication product between 1 500 and 10 000 (likelihood ratio: 2.5, 95% CI: 1.0, 6.0). No patient with a product < 1 500 mg/L × IU/L who received acetylcysteine developed hepatotoxicity. Regardless of ingestion type, a product > 10 000 mg/L × IU/L was associated with a very high likelihood, and < 1 500 mg/L × IU/L with a very low likelihood, of developing hepatotoxicity in patients treated with acetylcysteine.
    Clinical Toxicology 07/2015; 53(8):1-8. DOI:10.3109/15563650.2015.1066507 · 3.67 Impact Factor
  • Omar Mukhtar · John Rh Archer · Paul I Dargan · David M Wood ·
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    ABSTRACT: Lipid-emulsion therapy (Intralipid®) has been advocated as a potential treatment for the management of cardio-toxicity arising from lipid-soluble drugs, particularly those acting upon sodium channels. This, on the basis of a number of ex vivo studies and animal models, suggests that partitioning a drug into lipid could alter its pharmacokinetics and result in significant clinical improvements. Its subsequent use in clinical case series has been seen as confirmation of this mechanism of action. While there are undoubtedly instances where lipid emulsion therapy has been associated with a desirable outcome in humans, as described in this case report, clinicians are reminded that they should not attribute causality, on this basis alone. © Royal College of Physicians 2015. All rights reserved.
    Clinical medicine (London, England) 06/2015; 15(3):301-3. DOI:10.7861/clinmedicine.15-3-301 · 1.49 Impact Factor
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    ABSTRACT: The international boundaries to medical education are becoming less marked as new technologies such as multiuser videoconferencing are developed and become more accessible to help bridge the communication gaps. The Global Educational Toxicology Uniting Project (GETUP) is aimed at connecting clinicians in countries with established clinical toxicology services to clinicians in countries without clinical toxicologists around the globe. Centers that manage or consult on toxicology cases were registered through the American College of Medical Toxicology website via Survey Monkey®. Data was analyzed retrospectively from February 2014 to January 2015. Google hangouts® was used as the main conferencing software, but some sites preferred the use of Skype®. Registration data included contact details and toxicology background and qualifications. Thirty sites in 19 different countries in Australasia, Europe, Africa, and America were registered. Twenty-eight (93 %) sites were located in a major urban center, one (3.5 %) site in a major rural center and one (3.5 %) a private practice. Expectations of GETUP included sharing toxicology cases and education (30, 100 % of sites), assistance with toxicology management guidelines (2, 7 %), assistance with providing a toxicology teaching curriculum in languages other than English (2, 7 %), and managing toxicology presentations in resource-poor settings, international collaboration, and toxicovigilance (2 sites, 7 %). Twenty-two conferences were performed during the first 12 months with a mean of 3 cases per conference. GETUP has connected countries and clinical units with and without toxicology services and will provide a platform to improve international collaboration in clinical toxicology.
    Journal of medical toxicology: official journal of the American College of Medical Toxicology 05/2015; 11(3). DOI:10.1007/s13181-015-0479-7
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    ABSTRACT: The aim of this study was to establish a management protocol for body stuffers presenting to the emergency department. This is a retrospective observational case series of patients presenting to the emergency department of a large inner-city hospital as 'body stuffers' during the period between 1 January 2006 and 31 October 2011, irrespective of the type of drug ingested. We reviewed demographic data, ingestion characteristics, clinical progress and outcome. A total of 126 patients were included in the study, with a mean age of 31±8.10 years (range 15-58 years), among whom 106 were male (84%). Drugs ingested were as follows: heroin (n=61, 48%), cocaine (n=58, 46%), other drugs (n=20, 16%) and unknown (n=10, 8%). Of the patients, 23 (18%) ingested more than one drug. At presentation, 96 had features of drug toxicity. The presence of depressant drug toxidrome was more commonly observed among heroin users, but stimulant drug toxidromes were seen across all groups. Of the patients, 12 developed changes in clinical state, with a mean time to development of symptoms of 2 h 50 min±1 h 39 min (range from 1 h 0 min to 5 h 36 min). Abdominal radiography showed the presence of foreign bodies in 8% of the tests performed, and packets were recovered from one patient who underwent gut decontamination. Patients developed new or worsening features of drug toxicity within 6 h of presentation. Toxidromes observed are often not drug/class specific, and treatment including gut decontamination and radiography do not aid in expediting discharge. We propose an observation period of 6 h from the time of admission as the time required if the patient is asymptomatic or there is resolution of presenting signs and symptoms.
    European Journal of Emergency Medicine 05/2015; Publish Ahead of Print. DOI:10.1097/MEJ.0000000000000277 · 1.58 Impact Factor
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    Clinical Toxicology 04/2015; 53(5):1-2. DOI:10.3109/15563650.2015.1033062 · 3.67 Impact Factor
  • James Glanville · Paul I Dargan · David M Wood ·
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    ABSTRACT: 4-Methyl-5-(4-methylphenyl)-4,5-dihydrooxazol-2-amine (4,4'-dimethylaminorex (4,4'-DMAR)) is a derivative of the controlled substances aminorex and 4-methylaminorex marketed as a potential novel psychoactive substance. This paper brings together the published scientific and 'grey' literature to understand 4,4'-DMAR as a novel psychoactive substance. Searches of the published scientific and 'grey' literature, using the keywords '4-methyl-euphoria', '4-methyl-U4Euh', '4-M-4-MAR', '4,4-dimethylaminorex', '4,4'-DMAR', 'para-methyl-4-aminorex' and 'Serotoni', were undertaken to identify information on the availability, prevalence of use and desired/unwanted effects of 4,4'-DMAR. No studies have reported the prevalence of use of 4,4'-DMAR. Internet snapshot studies in April and May 2014 showed availability of 4,4'-DMAR from one and two Internet suppliers respectively. Price decreased with increasing purchase amounts from €12/g for a 1-g purchase to €2.20/g for a 100-g purchase in April 2014. Internet discussion fora suggest that the desired and unwanted effects of 4,4'-DMAR are similar to those seen with other sympathomimetic drugs such as 3,4-methylenedioxy-methamphetamine and mephedrone, although the duration of unwanted effects and 'comedown' appear to be longer. Unwanted effects were reported at doses of 5-200 mg, which overlaps with the reported doses (10-200 mg) associated with desired effects. 4,4'-DMAR has been detected, along with other drugs, in 27 deaths in Europe; the contribution of the 4,4'-DMAR in these deaths has not been established. Currently, there appears to limited availability of 4,4'-DMAR; therefore, use is likely to be low. Its desired and unwanted effects appear similar to other sympathomimetic recreational drugs such as methylenedioxy-methamphetamine or mephedrone. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    Human Psychopharmacology Clinical and Experimental 03/2015; 30(3). DOI:10.1002/hup.2472 · 2.19 Impact Factor
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    ABSTRACT: Analysis of anonymous pooled urine samples from street urinals has been used to demonstrated time-trends in the detection of classical recreational drugs and novel psychoactive substances (NPS). This study aimed to expand this to undertake a geographical trend analysis of classical recreational drugs/NPS across the UK. Samples of anonymous pooled urine were collected from street urinals that had been in place for one night in April 2014 in nine cities across the UK. Collected samples were then analysed for the presence of recreational drugs, novel psychoactive substances and anabolic steroids using high performance liquid chromatography coupled to high-resolution accurate mass full-scan mass spectrometry (HRAM LCMS) and gas chromatograpy coupled to electron impact ionisation mass spectrometry operating in selected ion monitoring and full scan modes (EI-GCMS) Results: Nine classical recreational drugs, nine NPS and four anabolic steroids were detected across the nine cities; the range of detection was from 1 in Leeds to 14 in London. The most common classical drugs were cocaine (9 cities) and MDMA (8 cities); the most common NPS was 4-methylmethcathinone (5 cities). In addition there was variation in the detection of NPS, with methylhexaneamine detected only in Bristol and London, piperazines (TFMPP and 1-benzylpiperazine) and pentedrone only detected in Birmingham and the cathinone methylone only detected in London. There is variability in the detection of classical recreational drugs, NPS and anabolic steroids across the UK, likely reflecting variation in their use. This technique can be used to supplement drug use surveys to determine geographical and time trends in the use of these substances. This is important to ensure appropriate targeting of drug-related interventions. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    QJM: monthly journal of the Association of Physicians 03/2015; DOI:10.1093/qjmed/hcv058 · 2.50 Impact Factor
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    ABSTRACT: Cannabis is the most commonly used illicit drug in Europe, and is generally regarded as having low acute toxicity. We present the findings of the first 6 months of data collection from the Euro-DEN project on presentations related to cannabis use to further understand the acute toxicity related to the use of cannabis. Data was extracted on clinical features, treatment and outcome from the Euro-DEN minimum dataset for all cases of acute recreational drug toxicity reported 1st October 2013 to 31st March 2014 for all cannabis-related presentations. Of 2198 presentations reported by 14 of the 16 Euro-DEN centres, 356 (16.2 %) involved cannabis either alone or together with other drugs/alcohol. There were 36 that involved lone use of cannabis (1.6 % of all presentations). Of the 35 non-fatal lone cannabis presentations, the most commonly reported features were neuro-behavioural (agitation/aggression 8 (22.9 %), psychosis 7 (20.0 %), anxiety 7 (20.0 %)) and vomiting 6 (17.1 %). Most patients (25, 71.4 %) received no treatment and 30 (85.7 %) were discharged/self-discharged from the ED. There was one fatality amongst these lone-cannabis cases: an 18-year-old male collapsed with an asystolic cardiac arrest whilst smoking cannabis and suffered hypoxic brain injury related to prolonged cardiac arrest. THC was detected in a urine sample taken at ED arrival; no other drugs were detected. Lone acute cannabis toxicity was typically associated with neuro-behavioural symptoms and vomiting. Although uncommon, severe toxicity including cardiovascular toxicity and death may be under-recognised, and it is important that Emergency Physicians are aware of this.
    Journal of medical toxicology: official journal of the American College of Medical Toxicology 02/2015; DOI:10.1007/s13181-014-0460-x
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    ABSTRACT: Introduction: The 25X-NBOMe series are N-2-methoxybenzyl analogues of the respective 2C-X substituted phenethylamine and include 25B-N(BOMe)2, 25B-NBOMe, 25C-NBOMe, 25D-NBOMe, 25E-NBOMe, 25G-NBOMe, 25H-NBOMe, 25I-NBOMe, 25N-NBOMe and 25iP-NBOMe. There are reports of their use as novel psychoactive substances and associated acute toxicity from Europe, the United States and elsewhere over the last five years. This review will discuss the epidemiology of use and pattern of acute toxicity associated with use of these compounds. Methods: A PubMed search was performed using the search terms 'NBOMe', '25B-N(BOMe)2', '25B-NBOMe', '25C-NBOMe', '25D-NBOMe', '25E-NBOMe', '25G-NBOMe', '25H-NBOMe', '25I-NBOMe', '25N-NBOMe' and '25iP-NBOMe' covering the years 1966-2014. In addition, abstracts from the 2010-2014 congresses of the European Association of Poisons Centres and Clinical Toxicologists and the 2010-2013 North American Congress of Clinical Toxicology were reviewed using these search terms. Further information was obtained from the European Information System and Database on New Drugs co-ordinated by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). PREVALENCE OF USE: There are no national or international surveys collecting data on the prevalence of use of NBOMe drugs. The only information on prevalence of use is from two sub-population surveys of individuals who frequent nightclubs. Of 22,289 respondents of the 2013 Global Drugs Survey, 582 (2.6%) had previously used an NBOMe; the most commonly used NBOMe was 25I-NBOMe (442 respondents, 2.0% of whole cohort and 75.9% of those who had used an NBOMe). In a survey of 397 clubbers in London nightclubs in 2013, 11.8% had heard of the NBOMe drugs (compared with 96.0% for mephedrone), and 4.8% had ever used an NBOMe (compared with 76.6% for mephedrone). ACUTE TOXICITY: There were 29 published cases in the literature of acute toxicity associated with the use of an NBOMe: 25I-NBOMe - 23 cases; 25B-NBOMe - 3 cases; 25C-NBOMe - 3 cases. Commonly reported features include tachycardia (96.6%), hypertension (62.0%), agitation/aggression (48.2%), seizures (37.9%) and hyperthermia (27.6%). Five patients were reported to have developed acute kidney injury. There were an additional 25 reports of acute toxicity related to the use of 25I-NBOMe reported to the EMCDDA. The pattern of toxicity in these cases is similar to that seen in the published cases. NBOMe-related deaths. 25I-NBOMe has been detected in eight fatalities; in one of these, 25C-NBOMe was also detected. The role of the NBOMe drugs in these deaths has not been determined in all cases. Conclusions: Currently, there is evidence suggesting limited use of the NBOMe class of drugs as novel psychoactive substances compared with that of classical recreational drugs and other novel psychoactive substances such as mephedrone.
    Clinical Toxicology 02/2015; 53(2):85-92. DOI:10.3109/15563650.2015.1004179 · 3.67 Impact Factor
  • Hwee Min D Lee · John R H Archer · Paul I Dargan · David M Wood ·
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    ABSTRACT: Background. Intravenous lipid emulsion (ILE) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are being used together or in close succession in the management of circulatory failure secondary to cardiotoxic drug poisoning. There have been reports of mechanical problems, including fat emulsion agglutination, clogging, increased blood clot formation and even cracking of parts of the machine, in patients concurrently receiving VA-ECMO and ILE as part of parenteral nutrition. Objective. To ascertain the adverse effects associated with the combined use of ILE and ECMO in the poisoned patient. Methods. PubMed and OVID (1966 to 9 June 2014) and EMBASE (1947 to 9 June 2014) were searched to identify publications relating to studies and/or case reports where ILE had been used at the same time when VA-ECMO was used - 7 were identified. In addition, the abstracts published between 2006 and 2013 inclusive of those from the North American Congress of Clinical Toxicology and the congresses of the European Association of Poisons Centres and Clinical Toxicologists were searched to identify additional cases and 2 were found. Finally all cases posted on lipidrescue.org were reviewed to determine if they related to the use of ILE with VA-ECMO and no new cases were identified. In vitro study. An in vitro study involving the continuous infusion of 20% ILE at 3 mL/h for 24 h demonstrated layering (separation of intact fat emulsion from blood) and agglutination (clumping resulting in little or no flow of fat emulsion through the circuit) in all circuits within 30 min of starting the fat emulsion infusion. Clinical studies. An observational study based in 42 centres that regularly used 'fat emulsion' during VA-ECMO treatment reported cracking of stopcocks (the valve which restricts flow in the VA-ECMO tubing) (n = 10, 23.8%); fat emulsion agglutination (n = 11, 26.2%); clogging and associated malfunction of the membrane oxygenator (n = 2, 4.8%); and increased blood clot formation in the circuits (n = 2, 4.8%). In a prospective observational study of 9 neonates on VA-ECMO receiving intravenous nutrition, layering and agglutination were seen in four sets of VA-ECMO tubing and blood clots were found in seven circuits. Nine case reports were identified where ILE was used with VA-ECMO for the management of circulatory failure/instability secondary to cardiotoxic drug poisoning. In two of these case reports, the authors specifically stated that ILE did not cause any mechanical complications with the VA-ECMO; the other seven reports made no comment as to whether there were any complications or not. Conclusions. There is in vitro and clinical evidence that the combined use of ILE and extracorporeal membrane oxygenation may be associated with fat deposition in the VA-ECMO circuits and increased blood clot formation. Clinicians managing poisoned patients with both of these novel treatment modalities should be aware of these potential complications.
    Clinical Toxicology 01/2015; 53(3):1-6. DOI:10.3109/15563650.2015.1004582 · 3.67 Impact Factor

  • Drug Testing and Analysis 01/2015; 7(5). DOI:10.1002/dta.1764 · 2.51 Impact Factor
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    ABSTRACT: Gamma-hydroxybutyric acid (GHB) is a well-known illicit club and date-rape drug. Dried blood spot (DBS) sampling is a promising alternative for classical venous sampling in cases of (suspected) GHB intoxication since it allows rapid sampling, which is of interest for the extensively metabolized GHB. However, there is limited data if -and how- capillary DBS concentrations correlate with venous concentrations. We conducted a comparative study in 50 patients with suspected GHB intoxication, to determine and to correlate GHB concentrations in venous DBS (vDBS) and capillary DBS (cDBS). This is the first study that evaluates in a large cohort the correlation between capillary and venous concentrations of an illicit drug in real-life samples. Of the 50 paired samples, 7 were excluded: the vDBS concentration was below the LLOQ of 2 µg/mL in 3 cases and 4 samples were excluded after visual inspection of the DBS. Bland-Altman analysis revealed a mean % difference of -2.8% between cDBS and vDBS concentrations, with the zero value included in the 95% confidence interval of the mean difference in GHB concentration. A paired sample t-test confirmed this observation (p = 0.17). Also the requirement for incurred sample reproducibility was fulfilled: for more than two-thirds of the samples the concentrations obtained in cDBS and those in vDBS were within 20% of their mean. Since equivalent concentrations were observed in cDBS and vDBS, blood obtained by fingerprick can be considered a valid alternative for venous blood for GHB determination. Copyright © 2015 John Wiley & Sons, Ltd.
    Drug Testing and Analysis 01/2015; 7(4). DOI:10.1002/dta.1760 · 2.51 Impact Factor

Publication Stats

2k Citations
403.52 Total Impact Points


  • 2011-2015
    • King's College London
      Londinium, England, United Kingdom
  • 2007-2015
    • Guy's and St Thomas' NHS Foundation Trust
      • Department of Clinical Toxicology
      Londinium, England, United Kingdom
    • St. George's University
      گرینیدا، میسیسیپی, Mississippi, United States
  • 2013
    • Lancaster University
      • Department of Applied Social Science
      Lancaster, England, United Kingdom
  • 2011-2013
    • ICL
      Londinium, England, United Kingdom
  • 2010-2011
    • Public Health England
      Londinium, England, United Kingdom
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2009
    • East London NHS Foundation Trust
      Londinium, England, United Kingdom
  • 2008
    • University of London
      Londinium, England, United Kingdom
  • 2004-2008
    • St George's, University of London
      • Medical School
      Londinium, England, United Kingdom