The hazard caused by driving under the influence of drugs (DUID) is determined by the time of consumption, dose and biological effects of a substance, as well as by synergistic drug interactions after multi-drug use. The aim of this work was to investigate the prevalence and pattern of psychoactive substance use of suspected DUID drivers and to present the advantages and disadvantages of the system currently used for determination of impairment in Hungary. Blood and urine samples, collected between 2016 and 2018, were taken from 2369 drivers with a positivity rate of 95% for at least one substance. Classical illicit drugs were detected in 76-87%, prescription medications in 9-15%, stimulant New Psychoactive Substances (sNPS) in 3-8%, and synthetic cannabinoids (SCs) in 20-22% of the positive samples. The most frequent substances according to substance groups were: classical illicit drugs: cannabis (n = 1240), amphetamine and methamphetamine (AM/MA) (n = 753), MDMA (n = 196), and cocaine (n = 180), medicines: alprazolam (n = 188) and clonazepam (n = 83), sNPS: N-ethyl-hexedrone (n = 115), SCs: 5 F-MDMB-PINACA (n = 267), AMB-FUBINACA (n = 92) and ADB-FUBINACA (n = 90). The median age of classical illicit drugs users was 29 years, prescription medicine users were 33 years old, sNPS users were 28 years, and SC users were 26 years old. Compared to the previous two years, we found pronounced changes in the ratio of sNPS (14% decrease) and SC users (10% increase), and in the pattern of NPS consumption. The ratio of multi-drug use varied between 38% and 50%. 69% of drivers tested positive were deemed impaired. Impairment was determined according to impairment limits (80-82%), multi-drug use (12-13%), and the result of medical investigation when a single active substance with no set impairment limit was detected in the blood (6-8%). The results of medical investigations may be uncertain due to the long time delay between arrest and clinical examination and to the structure of medical investigations created for determination of alcoholic impairment. In conclusion, a revision of the current medical investigation protocol is warranted to standardize clinical symptom scores that better correlate with driving impairment.

New Psychoactive Substances (NPS) impose a new challenge on the legal and health care system, yet, there is little information available about how new substances spread based on hospitalization of ...

Concerning a concrete case the author analyses the process of death detection that occurs out-of-hospitals in approximately 50,000 cases per year in Hungary, focusing the declaration of the fact and the type (natural/unnatural) of death. Author presents obligatory tasks of the primary care physician, the importance of the death examination, subtypes of unnatural death, and the role of the physician in the legal procedure performed by the police. The decision making process and its control mechanisms are also presented proving that there is no case in which only one person is entitled to make final decisions. Strength and weakness of the Hungarian legislation are enlightened to argue for the traditional death detection by the primary care physician. The most important conclusion is that the final case summary (“cadaveric epicrisis”) made by the primary care doctor would be useful in out-of-hospital death cases for the purpose of quality insurance, health policy planning and malpractice claims raised later. Orv. Hetil., 2011, 152, 1808–1812.

70% of the death cases in Hungary occur in hospitals, so there is an extraordinary importance of the correct detection of the death, the medical cause of death and the management of the postmortem process. This article presents the obligations of physicians of clinical wards step-by-step, and the insufficiencies and faults experienced several times leading to complaints and pleas from the relatives. Beyond the legal background the specific needs of medical ethics and communication are also presented. Some elements of the final case-summary (epicrisis of the dead), as the complete and complex case-history are described in details. Author suggests a few points of view for renewing the hospital manuals and creating local professional protocols covering the activities of the clinical wards as well as the pathology and administrative units of the hospital, which protocols may act also as quality assurance and lawsuit prevention instruments. The examples of deficient practice are taken from medical experts’ experiences and from Hungarian case-law. Orv. Hetil., 2012, 153, 184–190.

In the Hungarian law, non-burial interventions on cadavers are regulated only by the health law and, therefore, other scientific examinations are theoretically not allowed. Only the international ethical code of museums is used in certain cases. Numerous cultures consider this practice as the mutilation of the cadaver. Beyond this and the criminal forms of mutilation, the medical interventions (trial and training) are also appropriate to hurt the dignity of the dead. As a counterweight, the consent of the patient or his/her relatives is needed for post-mortem interventions. This study presents the Hungarian legislation in which the deceased is a ‘patient’, and the special enforcement of patients’ rights takes place in relation to the body. The relatives have many rights concerning autopsy, and the anatomy institutes are also regulated. The presumption of opting-out is used for organ harvesting; objection is accepted only from the patient. Medical data of the deceased are strictly protected, but there are no obstacles to the interests of the relatives. The graduate and postgraduate education pays only small attention to these issues, and the legislation is not in line with the present expectations and possibilities, so that it would be advisable to reconsider the full spectrum of the problem. Orv. Hetil., 2012, 153, 330–338.