Although the diamond anvil cell (DAC) has been used in many forensic science laboratories for the analysis of trace evidence, few applications of this technique for the analysis of controlled substances have been reported. This may be due to both an unfamiliarity on the part of forensic drug chemists with this accessory and the nature and quality of spectra that result from use of a DAC on a dispersive instrument. Along with low energy throughput, which results in relatively high noise levels, strong broad diamond absorptions occur. With the use of a Fourier transform infrared instrument, these do not present a problem and nanogram quantities of materials can be analyzed when the DAC is used with an infrared microscope. Since single crystals can be sampled with the DAC, simple physical separations (involving particle-picking) can be used in certain cases to isolate drugs from particulate mixtures for infrared analysis. This method is especially useful for some "difficult" mixtures and residues, and several examples of such analyses involving samples of forensic science interest are presented.

During a two-month prospective survey in a metropolitan teaching hospital's accident and emergency department, 239 consecutive drug-related attendances (excluding admissions to hospital that were primarily alcohol related) were identified. This represented 2.6% of total attendances. Of the 199 patients who presented to hospital with self-poisoning, a biological specimen was obtained from 158 (79%) for toxicological analysis, thus providing reliable data on the drugs that were involved in the overdoses. The most common drug groups that were identified were barbiturate (51% of cases) and benzodiazepine (49%) agents, alcohol with other drugs (44%), cannabinoids (32%) and opiate analgesic drugs (25%). Quinalbarbitone and amylobarbitone (Tuinal) and oxazepam were the most common "single" preparations. The use of cannabis and alcohol and the use of several drugs concurrently were more common than in previously reported surveys of self-poisoning. Discrepancies between the purported drug consumption and the toxicological results were frequent; complete agreement occurred in only 35% of the cases. The TOXI-LAB system was an adequate method for toxicological analysis. However, for epidemiological studies an additional back-up method is recommended to verify the presence of some drugs such as barbiturate and benzodiazepine agents.

Psychotropic drug use in Saskatchewan during 1977, 1978, 1979 and 1980 was determined. Approximately one in five prescriptions dispensed was for a psychotropic. About 20% of the population received psychotropic drugs in each year but use has declined slightly, especially that of tranquilizers. Psychotropic use increased with the patient's age and nearly two-thirds were women. Considerable caution should be exercised in making comparisons with other drug utilization studies. There may be substantial differences in the drugs selected for study, the categorization of these drugs, and the methodology used to analyze drug use. Also, most studies are based on data that is from a decade old or older. Moreover, most if not all other studies on drug use are based on sample surveys (from different sampling universes), whereas the present study is based on the entire population. Nevertheless, some generalizations may be valid. Since non-formulary drugs are excluded, the findings should be regarded as conservative. Examples of non-formulary drugs considered to be psychotropic include antispasmodic/tranquilizer/sedative combinations (example: Librax, Donnatal), combination hypnotics (example: Tuinal, Mandrax), and some combination analgesics (example: propoxyphene compounds, pentazocine compound, oxycodone compound).

Six case reports are presented to illustrate the problems of abuse of Tuinal (equal parts of sodium quinalbarbitone and sodium amylobarbitone). Over a four-year period in South Australia, Tuinal has risen from causing no deaths to be second only to pentobarbitone as a cause of death. While deaths from pentobarbitone overdosage are largely suicidal, Tuinal deaths are largely accidental, the result of a lack of tolerance in combination with alcohol potentiation.

Although nonaccidental poisoning in childhood is now more often recognised, it is still difficult to establish a diagnosis despite correct investigative procedures. In 1978 we were unable, initially, to establish the cause of intermittent episodes of loss of consciousness in a boy admitted to Sheffield Children's Hospital. Subsequently it was conclusively shown that his mother systematically poisoned him with Tuinal (amylobarbitone and quinalbarbitone) both before admission and while he was being treated in the hospital.

A rare presentation of acute Intermittent Porphyria is described, in which withdrawal of an oral contraceptive (Gynovlar 21) provoked the first acute attack.

A within-subject comparison of the effects on the overnight sleep EEG of 1 tablet of Mandrax (containing methaqualone base 250 mg. and diphenhydramine hydrochloride 25 mg.) and 200 mg. Tuinal (equal parts of quinalbarbitone sodium and amylobarbitone sodium) in 14 normal subjects is reported.Mandrax-induced sleep was not significantly different from natural sleep in the duration of light, moderate, deep and REM phases. Tuinal produced a significant reduction in REM sleep (P < 0.01) compared with natural sleep and with Mandrax-induced sleep.