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Ahlner, Johan
Publications (10 of 125) Show all publications
Ahlner, J., Holmgren, A. & Jones, A. W. (2016). Demographics and post-mortem toxicology findings in deaths among people arrested multiple times for use of illicit drugs and/or impaired driving. Forensic Science International, 265, 138-143
Open this publication in new window or tab >>Demographics and post-mortem toxicology findings in deaths among people arrested multiple times for use of illicit drugs and/or impaired driving
2016 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 265, p. 138-143Article in journal (Refereed) Published
Abstract [en]

Background: Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem. Methods: This retrospective study (1993-2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma. Results: Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p amp;lt; 0.001). The repeat offenders were predominantly male (90% vs 10%) and mean age of drug poisoning deaths was 5 y younger (mean 35 y) than other causes of death (mean 40 y). Significantly more repeat offenders (46%) died from drug overdose compared with all other forensic autopsies (14%) (p amp;lt; 0.001). Four or more drugs were identified in femoral blood in 44% of deaths from poisoning (drug overdose) compared with 18% of deaths by other causes (p amp;lt; 0.001). The manner of death was considered accidental in 54% of deaths among repeat offenders compared with 28% for other suspicious deaths (p amp;lt; 0.001). The psychoactive substances most commonly identified in autopsy blood from repeat offenders were ethanol, morphine (from heroin), diazepam, amphetamines, cannabis, and various opioids. Conclusions: This study shows that people arrested multiple times for use of illicit drugs and/or impaired driving are more likely to die by accidentally overdosing with drugs. Lives might be saved if repeat offenders were sentenced to treatment and rehabilitation for their drug abuse problem instead of conventional penalties for drug-related crimes. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2016
Keywords
Alcohol; Autopsy; Drug abuse; Poisoning deaths; Repeat offenders; Recidivism
National Category
Forensic Science
Identifiers
urn:nbn:se:liu:diva-130368 (URN)10.1016/j.forsciint.2016.01.036 (DOI)000379695700024 ()26901639 (PubMedID)
Available from: 2016-08-15 Created: 2016-08-05 Last updated: 2017-11-28
Tjäderborn, M., Jönsson, A. K., Zverkova Sandstrom, T., Ahlner, J. & Hägg, S. (2016). Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden. Drug And Alcohol Dependence, 161, 77-85
Open this publication in new window or tab >>Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden
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2016 (English)In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 161, p. 77-85Article in journal (Refereed) Published
Abstract [en]

Aims: To determine the prevalence of non-prescribed drug use among subjects suspected of drug impaired driving with a psychoactive prescription drug, and to identify associated factors. Methods: Subjects investigated for drug-impaired driving in Sweden during 2006-2009 with a confirmed intake of diazepam, flunitrazepam, tramadol, zolpidem or zopiclone were identified using the Swedish Forensic Toxicology Database. Information on dispensed prescription drugs was retrieved from the Swedish Prescribed Drug Register. Non-prescribed use was our outcome, defined as a psychoactive prescription drug intake confirmed by toxicological analysis in a subject by whom it was not dispensed in the 12 months preceding the sampling. Prevalence proportions were calculated for each drug and logistic regression was used to identify associated factors. Results: In total, 2225 subjects were included. The median age (range) was 34 (15-80) years and 1864 (83.8%) subjects were male. Non-prescribed use was found in 1513 subjects (58.7%); for flunitrazepam 103 (76.3%), diazepam 1098 (74.1%), tramadol 192 (40.3%), zopiclone 60 (29.7%), and zolpidem 60 (21.2%) subjects, respectively. Younger age and multiple-substance use were associated with non-prescribed use, whereas ongoing treatment with other psychoactive drugs was negatively associated with non prescribed use. Conclusions: Non-prescribed use of psychoactive prescription drugs was common in subjects suspected of drug-impaired driving and was more frequent for benzodiazepines and tramadol compared to zolpidem and zopiclone. The young and multi-substance users were more likely, whereas subjects with ongoing prescribed treatment with other psychoactive drugs were less likely, to use non-prescribed drugs.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2016
Keywords
Prescription drug diversion; Non-prescribed use; Drug-impaired driving; Drug dispensing; Pharmacoepidemiology
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127559 (URN)10.1016/j.drugalcdep.2016.01.031 (DOI)000373419100011 ()26875672 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland, Sweden [LIO-131751]; Forensic Science Centre, Sweden [CFV 121218]; Linkoping University, Sweden [LIU 2009-01356]

Available from: 2016-05-04 Created: 2016-05-03 Last updated: 2017-04-24
Jones, A. W., Holmgren, A. & Ahlner, J. (2015). High prevalence of previous arrests for illicit drug use and/or impaired driving among drivers killed in motor vehicle crashes in Sweden with amphetamine in blood at autopsy. International journal on drug policy, 26(8), 790-793
Open this publication in new window or tab >>High prevalence of previous arrests for illicit drug use and/or impaired driving among drivers killed in motor vehicle crashes in Sweden with amphetamine in blood at autopsy
2015 (English)In: International journal on drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 26, no 8, p. 790-793Article in journal (Refereed) Published
Abstract [en]

Background: Amphetamine, and to a lesser extent the secondary amine methamphetamine, are major recreational drugs of abuse in Sweden. These central stimulant amines are identified in blood from roughly 50% of people arrested for driving under the influence of drugs (DUID). However, much less information is available about the presence of amphetamine in blood of drivers killed in road-traffic crashes.

Methods: This retrospective 10-year study (2001-2010) used a forensic toxicology database (TOXBASE) to retrieve information about road-traffic crashes when the driver had amphetamine and/or methamphetamine in autopsy blood. Forensic toxicology results were available from over 95% of all drivers killed on Swedish roads during this 10-year period.

Results: Amphetamine was present in the blood of 106 drivers (3.9%) either alone or together with other psychoactive substances (e.g. alcohol, cannabis, diazepam, alprazolam, etc.). The vast majority of fatalities were male (95%) with a mean age (+/- standard deviation) of 37 +/- 11.4 years (range 16-67 years). The mean (median) and highest concentrations of amphetamine in femoral blood were 1.36 mg/L (1.0 mg/L) and 6.74 mg/L, respectively. Many of the victims (75%) had been arrested previously for use of illicit drugs or DUID. The median number of previous arrests was 4 (range 0-83) and amphetamine or methamphetamine were among the drugs identified in blood samples from 89% of cases (0-100%).

Conclusion: The high prevalence of repeat DUID offending and/or use of illicit drugs among the drivers killed in road-traffic crashes suggests that an early intervention and treatment for stimulant abuse might have been more beneficial than conventional punishments for such drug-related crimes. (C) 2015 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Abuse; Amphetamine; Driving; Impairment; Recidivism; Traffic fatalities
National Category
Forensic Science
Identifiers
urn:nbn:se:liu:diva-120732 (URN)10.1016/j.drugpo.2015.04.011 (DOI)000358389200012 ()26003926 (PubMedID)
Available from: 2015-08-24 Created: 2015-08-24 Last updated: 2017-12-04
Nilsson, G., Kugelberg, F., Ahlner, J. & Kronstrand, R. (2015). Validation of an LC-MS/MS method for the determination of zopiclone, N-desmethylzopiclone and 2-amino-5-chloropyridine in whole blood and its application to estimate the original zopiclone concentration in stored specimens. International journal of legal medicine (Print), 129(2), 269-277
Open this publication in new window or tab >>Validation of an LC-MS/MS method for the determination of zopiclone, N-desmethylzopiclone and 2-amino-5-chloropyridine in whole blood and its application to estimate the original zopiclone concentration in stored specimens
2015 (English)In: International journal of legal medicine (Print), ISSN 0937-9827, E-ISSN 1437-1596, Vol. 129, no 2, p. 269-277Article in journal (Refereed) Published
Abstract [en]

2-amino-5-chloropyridine (ACP) is a degradation product of zopiclone (ZOP) and may be formed when blood specimens are stored. ZOP instability in blood makes interpretation of concentrations difficult especially in cases of prolonged sample storage. This study investigated how ACP could be used to estimate the original concentration of ZOP in authentic samples. For that purpose, an analytical LC-MS/MS method for the quantitation of ACP, ZOP and the metabolite Ndesmethylzopiclone (NDZOP) in blood was validated. The method was then applied to investigate ACP formation, ZOP and NDZOP degradation in stored ZOP post-dosed authentic whole blood and two mathematical models were used to calculate the original concentration of ZOP. During storage, ACP was formed in amounts equimolar to the ZOP and NDZOP degradation. Results from samples in which ACP had been formed were used to test two models to estimate the original ZOP concentration. The correlation tests of the models showed strong correlations to the original ZOP concentration (r=0.960 and r=0.955) with p<0.01. This study showed that the equimolar degradation of ZOP and NDZOP to ACP could be used to estimate the original concentration of the unstable ZOP.

Place, publisher, year, edition, pages
Springer, 2015
Keywords
Degradation; Forensic toxicology; 2-amino-5-chloropyridine; Zopiclone; LC-MS/MS
National Category
Medical and Health Sciences Forensic Science
Identifiers
urn:nbn:se:liu:diva-105820 (URN)10.1007/s00414-014-1049-2 (DOI)000350032800007 ()25069820 (PubMedID)
Note

The article title of this article was in Manuscript: LC-MS/MS determination of 2-amino-5-chloropyridine to estimate the original zopiclone concentration in stored whole blood.

Available from: 2014-04-08 Created: 2014-04-08 Last updated: 2017-12-05Bibliographically approved
Hedlund, J., Ahlner, J., Kristiansson, M. & Sturup, J. (2014). A population-based study on toxicological findings in Swedish homicide victims and offenders from 2007 to 2009. Forensic Science International, 244, 25-29
Open this publication in new window or tab >>A population-based study on toxicological findings in Swedish homicide victims and offenders from 2007 to 2009
2014 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 244, p. 25-29Article in journal (Refereed) Published
Abstract [en]

Background and objectives: Previous research on the toxicology of homicide has shown that about half of offenders and victims have psychoactive substances in their blood. The purpose of this study was to examine this topic in a Swedish setting. Methods: Toxicological data were sought in a database for all victims (n = 273) and perpetrators (n = 257) of homicide in Sweden from 2007 to 2009. Sufficient tests were identified for 97.1% of all victims (n = 265) and 46.7% of all offenders (n = 120). Additional information was obtained from court records and police reports. Results: A majority of individuals involved in homicides displayed positive toxicology (57.0% of victims and 62.5% of offenders). The most commonly detected substances, in both victims and offenders, were ethanol (44.9% vs. 40.8%) and benzodiazepines (8.3% vs. 19.2%). The difference between offenders and victims concerning benzodiazepines was statistically significant (OR 2.6; p = 0.002). Perpetrators of homicide-suicide had a lower prevalence of positive toxicology (30.8%) than other homicide offenders (66.4%; p = 0.04) and victims in unsolved cases more often exhibited positive drug toxicology compared to victims in solved cases (36.1% vs. 8.3%; p less than 0.001). Conclusions: The results of the study support the notion that substance abuse is firmly linked to committing homicide and to becoming a victim thereof.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Homicide; Toxicology; Substance abuse
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113020 (URN)10.1016/j.forsciint.2014.07.015 (DOI)000345017000016 ()25151217 (PubMedID)
Available from: 2015-01-12 Created: 2015-01-08 Last updated: 2017-12-05
Hedlund, J., Ahlner, J., Kristiansson, M. & Sturup, J. (2014). Correction: A population-based study on toxicological findings in Swedish homicide victims and offenders from 2007 to 2009 (vol 244, pg 25, 2014). Forensic Science International, 245, 161-161
Open this publication in new window or tab >>Correction: A population-based study on toxicological findings in Swedish homicide victims and offenders from 2007 to 2009 (vol 244, pg 25, 2014)
2014 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 245, p. 161-161Article in journal (Other academic) Published
Abstract [en]

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Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113181 (URN)10.1016/j.forsciint.2014.10.031 (DOI)000345628100035 ()
Available from: 2015-01-13 Created: 2015-01-12 Last updated: 2017-12-05
Bastami, S., Gupta, A., Zackrisson, A. L., Ahlner, J., Osman, A. & Uppugunduri, S. (2014). Influence of UGT2B7, OPRM1 and ABCB1 gene polymorphisms on morphine use. Basic & Clinical Pharmacology & Toxicology, 115(5), 423-431
Open this publication in new window or tab >>Influence of UGT2B7, OPRM1 and ABCB1 gene polymorphisms on morphine use
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2014 (English)In: Basic & Clinical Pharmacology & Toxicology, ISSN 1742-7835, E-ISSN 1742-7843, Vol. 115, no 5, p. 423-431Article in journal (Refereed) Published
Abstract [en]

Therapeutic modulation of pain with morphine and other opioids is associated with significant variation in, both, effects and adverse effects in individual patients. Many factors including gene polymorphisms have been shown to contribute to the interindividual variability in the response to opioids. The aim of this study was to investigate the significance of UGT2B7, OPRM1 and ABCB1 polymorphisms for interindividual variability in morphine induced analgesia in patients undergoing hysterectomy. The frequency of these polymorphisms was also investigated in forensic autopsy cases as morphine is also a very commonly abused drug

Blood samples were collected from 40 patients following abdominal hysterectomy, 24 hours after initiation of analgesia through a PCA pump. Samples were genotyped and analysed for morphine and its metabolites. We also genotyped approximately 200 autopsy cases found positive for morphine in routine forensic analysis.

Patients homozygous for UGT2B7 802C needed significantly lower dose of morphine for pain relief. The same trend was observed for patients homozygous for ABCB1 1236T and 3435T, as well as to OPRM1 118A. Dose of morphine in patients included in this study was significantly related to variation in UGT2B7 T802C. Age was significantly related to both dose and concentration of morphine in blood.

Regression analysis showed that 30% of differences in variation in morphine dose could be explained by SNPs in these genes. The genotype distribution was similar between the forensic cases and the patients. However, the mean concentration of morphine was higher in forensic cases compared to patients.

We conclude that gene polymorphisms contribute significantly to the variation in morphine levels observed in individual patients.

Place, publisher, year, edition, pages
Wiley, 2014
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-96791 (URN)10.1111/bcpt.12248 (DOI)000344015300008 ()24703092 (PubMedID)
Available from: 2013-08-27 Created: 2013-08-27 Last updated: 2017-12-06Bibliographically approved
Ahlner, J., Holmgren, A. & Jones, A. W. (2014). Prevalence of alcohol and other drugs and the concentrations in blood of drivers killed in road traffic crashes in Sweden. Scandinavian Journal of Public Health, 42(2), 177-183
Open this publication in new window or tab >>Prevalence of alcohol and other drugs and the concentrations in blood of drivers killed in road traffic crashes in Sweden
2014 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 2, p. 177-183Article in journal (Refereed) Published
Abstract [en]

Background: Drunk or drug-impaired drivers represent a major public health and societal problem worldwide. Because over 95% of drivers killed on the roads in Sweden are autopsied, reliable information is available about the use of alcohol and/or other drug before the crash. Methods: This retrospective 4-year study (2008-2011) used a forensic toxicology database (TOXBASE) to evaluate the concentrations of alcohol and other drugs in blood samples from drivers killed in road-traffic crashes. Results: The mean age of all victims (N = 895) was 48 +/- 20 years, and the majority were male (86%). In 504 drivers (56%), the results of toxicological analysis were negative and these victims were older; mean age (+/- SD) 47 +/- 20 years, than alcohol positive cases (35 +/- 14 years) and illicit drug users (34 +/- 15 years). In 21% of fatalities, blood-alcohol concentration (BAC) was above the statutory limit for driving (0.2 g/L), although the median BAC was appreciably higher (1.72 g/L). Illicit drugs (mainly amphetamine and cannabis) were identified in similar to 7% of victims, either alone (2.5%), together with alcohol (1.8%) or a prescription drug (2%). The psychoactive prescription drugs identified were mainly benzodiazepines, z-hypnotics and tramadol, which were found in the blood of 7.6% of crash victims. Conclusions: The high median BAC in fatally-injured drivers speaks strongly towards alcohol-induced impairment as being responsible for the crash. Compared with alcohol, the prevalence of illicit and psychoactive prescription drugs was fairly low despite a dramatic increase in the number of drug-impaired drivers arrested by the police after a zero-tolerance law was introduced in 1999.

Place, publisher, year, edition, pages
SAGE Publications (UK and US), 2014
Keywords
Alcohol; driving; drugs; impairment; traffic fatalities
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-105752 (URN)10.1177/1403494813510792 (DOI)000331371600009 ()
Available from: 2014-04-07 Created: 2014-04-04 Last updated: 2017-12-05
Nilsson, G., Kugelberg, F., Ahlner, J. & Kronstrand, R. (2014). Quantitative Analysis of Zopiclone, N-desmethylzopiclone, Zopiclone N-oxide and 2-Amino-5-chloropyridine in Urine Using LC-MS-MS. Journal of Analytical Toxicology, 38(6), 327-334
Open this publication in new window or tab >>Quantitative Analysis of Zopiclone, N-desmethylzopiclone, Zopiclone N-oxide and 2-Amino-5-chloropyridine in Urine Using LC-MS-MS
2014 (English)In: Journal of Analytical Toxicology, ISSN 0146-4760, E-ISSN 1945-2403, Vol. 38, no 6, p. 327-334Article in journal (Refereed) Published
Abstract [en]

A simple LC-MS/MS method was validated to allow determination of zopiclone (ZOP), Ndesmethylzopiclone (NDZOP), zopiclone N-oxide (ZOPNO) and 2-amino-5 chloropyridine (ACP) in urine at concentrations up to 3000 ng/mL within 3.5 min. This method was used for quantitative analysis of the analytes in authentic urine samples obtained 10 h after oral administration of zopiclone (Imovane®) and in aliquots of the same urine samples after different storage conditions. Additionally, pH of each studied urine sample was measured over time. The results showed that formation of ACP occurred at elevated pH and/or temperature by degradation of ZOP, NDZOP and ZOPNO. This method was also applied to samples obtained from two female victims of drug-facilitated assault. One sample had been exposed to long-term storage conditions at different temperatures and at pH>8.2, which resulted in high concentrations of ACP. The other sample, which was exposed to pH <6.5, showed no formation of ACP. ACP is formed both from ZOP and from its metabolites NDZOP and ZOPNO depending on the pH of the urine, time of storage and/or the temperature conditions. For correct interpretation in forensic cases ZOP, its major metabolites and ACP should be analyzed. When ACP is identified in urine the concentrations of ZOP, NDZOP and ZOPNO should be interpreted with great caution.

Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy F, 2014
Keywords
Degradation; Forensic toxicology; Zopiclone; LC-MS-MS
National Category
Clinical Medicine Pharmacology and Toxicology
Identifiers
urn:nbn:se:liu:diva-105819 (URN)10.1093/jat/bku042 (DOI)000340069000004 ()
Available from: 2014-04-08 Created: 2014-04-08 Last updated: 2018-01-11Bibliographically approved
Jönsson, A. K., Soderberg, C., Arne Espnes, K., Ahlner, J., Eriksson, A., Reis, M. & Druid, H. (2014). Sedative and hypnotic drugs-Fatal and non-fatal reference blood concentrations. Forensic Science International, 236, 138-145
Open this publication in new window or tab >>Sedative and hypnotic drugs-Fatal and non-fatal reference blood concentrations
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2014 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 236, p. 138-145Article in journal (Refereed) Published
Abstract [en]

In postmortem investigations of fatal intoxications it is often challenging to determine which drug/s caused the death. To improve the interpretation of postmortem blood concentrations of sedative and hypnotic drugs and/or clonazepam, all medico-legal autopsies in Sweden - where these drugs had been detected in femoral vein blood during 1992-2006 - were identified in the databases of the National Board of Forensic Medicine. For each drug, concentrations in postmortem control cases - where the cause of death was not intoxication and where incapacitation by drugs could be excluded - were compiled as well as the levels found in living subjects; drugged driving cases and therapeutic drug monitoring cases. Subsequently, fatal intoxications were assessed with regards to the primary substances contributing to death, and blood levels were compiled for single and multiple drug intoxications. The postmortem femoral blood levels are reported for 16 sedative and hypnotic drugs, based on findings in 3560 autopsy cases. The cases were classified as single substance intoxications (N = 498), multiple substance intoxications (N = 1555) and postmortem controls (N = 1507). Each autopsy case could be represented more than once in the group of multiple intoxications and among the postmortem controls if more than one of the included substances were detected. The concentration ranges for all groups are provided. Overlap in concentrations between fatal intoxications and reference groups was seen for most substances. However, the concentrations found in single and multiple intoxications were significantly higher than concentrations found in postmortem controls for all substances except alprazolam and triazolam. Concentrations observed among drugged drivers were similar to the concentrations observed among the therapeutic drug monitoring cases. Flunitrazepam was the substance with the highest number of single intoxications, when related to sales. In summary, this study provides reference drug concentrations primarily to be used for improving interpretation of postmortem drug levels in obscure cases, but which also may assist in drug safety work and in pharmacovigilance efforts.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Postmortem; Intoxication; Poisoning; Forensic toxicology; Toxicity; Benzodiazepines
National Category
Forensic Science
Identifiers
urn:nbn:se:liu:diva-105408 (URN)10.1016/j.forsciint.2014.01.005 (DOI)000331198500023 ()
Available from: 2014-03-21 Created: 2014-03-21 Last updated: 2017-12-05
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