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Safe drugs in drug facilitated crimes and acute intoxications in Northern Italy

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Abstract

Toxicological analyses are often performed in drug-facilitated sexual assaults (DFSA), when the victim shows or reports impaired consciousness and reduced ability. However, in other crimes or fatalities, especially in cases of concurrent natural disease or when another likely cause of death has been established, the involvement of drugs can be overlooked. The aim of this study is to report a series of cases of (i) victims of drug-facilitated crimes (DFC) other than DFSA and (ii) victims of acute intoxications, in which “licit” psychoactive drugs were found in blood samples, with the aim of understanding in which circumstances and to what extent prescription drugs have been used for non-medical purposes in recent Italian casuistry. Circumstantial, autopsy, and toxicological data were collected through a retrospective analysis performed between 2013 and 2017 in the Forensic Toxicology Unit of the University of Bologna. Cases of “DFC other than DFSA” and “Acute Intoxication” in which “psychoactive drugs” or “prescription drugs” or “licit drugs” were found in the blood samples of the victims were included in the study. Nine cases of DFC other than DFSA, and 11 cases of acute intoxication, were identified. Different categories of “licit” psychoactive drugs (e.g. hypnotics, antipsychotics, antidepressants, anticonvulsants) had been used to facilitate diverse types of crime (homicide, robberies, elder abuse, fatal poisoning) or acute intoxication (suicide, attempted suicide, accidental death). The circumstances of these cases, as well as toxicological findings in blood samples and other relevant forensic elements, are reported, summarized and discussed in this paper. The non-medical use of pharmaceuticals has been identified by recent forensic literature and the present study as a significant and growing phenomenon, and its implication in fatalities should be taken into consideration and accurately investigated through appropriate toxicological analysis. Our study presents an overview of the circumstances of non-medical use of prescription drugs, usually considered “safe drugs”, and their involvement in cases of DFC, suicides and accidental intoxication. In order to estimate the real incidence of these medications in DFC and acute intoxication, and thus collect more analytical and contextual data, further studies are needed, along with effective cooperation among police officers, clinicians, forensic pathologists, and toxicologists.

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References

  1. Ronka S, Katainen A. Non-medical use of prescription drugs among illicit drug users: a case study on an online drug forum. Int J Drug Policy. 2017;39:62–8.

    Article  Google Scholar 

  2. McCauley JL, Amstadter AB, Macdonald A, Danielson CK, Ruggiero KJ, Resnick HS, et al. Non-medical use of prescription drugs in a national sample of college women. Addict Behav. 2011;36:690–5.

    Article  Google Scholar 

  3. Kintz P. Toxicological aspects of drug-facilitated crimes. Oxford: Academic Press; 2014.

    Google Scholar 

  4. Anderson LJ, Flynn A, Pilgrim JL. A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: a systematic review. J Forensic Legal Med. 2017;47:46–54.

    Article  Google Scholar 

  5. Xiang P, Shen M, Drummer OH. Review: drug concentrations in hair and their relevance in drug facilitated crimes. J Forensic Legal Med. 2015;36:126–35.

    Article  Google Scholar 

  6. Carson HJ. Classes of drugs and their prevalence in multiple drug intoxication in suicides and accidents. Leg Med (Tokyo). 2008;10:92–5.

    Article  CAS  Google Scholar 

  7. Luchini D, Morabito G, Centini F. Case report of a fatal intoxication by citalopram. Am J Forensic Med Pathol. 2005;26:352–4.

    Article  Google Scholar 

  8. Lahti RA, Vuori E. Fatal drug poisonings: medico-legal reports and mortality statistics. Forensic Sci Int. 2003;136:35–46.

    Article  CAS  Google Scholar 

  9. Druid H, Holmgren P. A compilation of fatal and control concentrations of drugs in postmortem femoral blood. J Forensic Sci. 1997;42:79–87.

    Article  Google Scholar 

  10. Society of Forensic Toxicologists (SOFT), Drug-Facilitated Crimes Committee (DFC) formerly the DFSA Committee. Recommended minimum performance limits for common dfc drugs and metabolites in urine samples. 2017. http://www.soft-tox.org/files/MinPerfLimits_DFC2017.pdf. Accessed 18 Jul 2018.

  11. United Nations Office on Drugs and Crime (UNODC). Guidelines for the forensic analysis of drugs facilitating sexual assault and other criminal acts. 2011. https://www.unodc.org/documents/scientific/forensic_analys_of_drugs_facilitating_sexual_assault_and_other_criminal_acts.pdf. Accessed 18 Jul 2018.

  12. Moffat AC, Osselton MD, Widdop B, Watts J. Clarke's analysis of drugs and poisons. 4th ed. London: Pharmaceutical press; 2011.

    Google Scholar 

  13. Schulz M, Iwersen-Bergmann S, Andresen H, Schmoldt A. Therapeutic and toxic blood concentrations of nearly 1,000 drugs and other xenobiotics. Crit Care. 2012;16:R136.

    Article  Google Scholar 

  14. Schulz M, Schmoldt A. Therapeutic and toxic blood concentrations of more than 800 drugs and other xenobiotics. Pharmazie. 2003;58:447–74.

    CAS  PubMed  Google Scholar 

  15. Jonsson AK, Soderberg C, Espnes KA, Ahlner J, Eriksson A, Reis M, et al. Sedative and hypnotic drugs--fatal and non-fatal reference blood concentrations. Forensic Sci Int. 2014;236:138–45.

    Article  CAS  Google Scholar 

  16. Sporkert F, Augsburger M, Giroud C, Brossard C, Eap CB, Mangin P. Determination and distribution of clotiapine (Entumine) in human plasma, post-mortem blood and tissue samples from clotiapine-treated patients and from autopsy cases. Forensic Sci Int. 2007;170:193–9.

    Article  CAS  Google Scholar 

  17. Vrecko S. Everyday drug diversions: a qualitative study of the illicit exchange and non-medical use of prescription stimulants on a university campus. Soc Sci Med. 2015;131:297–304.

    Article  Google Scholar 

  18. Palazzo C, Fais P, Mazzotti MC, Gaudio RM, Pelletti G, Susi P. A homemade furnace. Influence of occupational skills in a fire-related planned complex suicide. Forensic Sci Med Pathol. 2018;14:109–13.

    Article  Google Scholar 

  19. Dumestre-Toulet V, Eysseric-Guérin H. Case reports in drug-facilitated crimes: from A for Alprazolam to Z for Zopiclone. In: Kintz P, editor. Toxicological aspects of drug-facilitated crimes. Oxford: Academic Press; 2014. p. 223–54.

    Chapter  Google Scholar 

  20. Kintz P, Evans J, Villain M, Salquebre G, Cirimele V. Hair analysis for diphenhydramine after surreptitious administration to a child. Forensic Sci Int. 2007;173:171–4.

    Article  CAS  Google Scholar 

  21. Kintz P, Villain M, Cheze M, Pepin G. Identification of alprazolam in hair in two cases of drug-facilitated incidents. Forensic Sci Int. 2005;153:222–6.

    Article  CAS  Google Scholar 

  22. Hindmarch I, ElSohly M, Gambles J, Salamone S. Forensic urinalysis of drug use in cases of alleged sexual assault. J Clin Forensic Med. 2001;8:197–205.

    Article  CAS  Google Scholar 

  23. Hall J, Goodall EA, Moore T. Alleged drug facilitated sexual assault (DFSA) in Northern Ireland from 1999 to 2005. A study of blood alcohol levels. J Clin Forensic Med. 2008;15:497–504.

    Google Scholar 

  24. Boussairi A, Dupeyron JP, Hernandez B, Delaitre D, Beugnet L, Espinoza P, et al. Urine benzodiazepines screening of involuntarily drugged and robbed or raped patients. J Toxicol Clin Toxicol. 1996;34:721–4.

    Article  CAS  Google Scholar 

  25. Mehling LM, Johansen SS, Wang X, Doberentz E, Madea B, Hess C. Drug facilitated sexual assault with lethal outcome: GHB intoxication in a six-year-old girl. Forensic Sci Int. 2016;259:e25–31.

    Article  CAS  Google Scholar 

  26. McBrierty D, Wilkinson A, Tormey W. A review of drug-facilitated sexual assault evidence: an Irish perspective. J Forensic Legal Med. 2013;20:189–97.

    Article  Google Scholar 

  27. Collins KA, Presnell SE. Elder homicide: a 20-year study. Am J Forensic Med Pathol. 2006;27:183–7.

    Article  Google Scholar 

  28. Ehrlich E, Riesselmann B, Tsokos M. A series of hospital homicides. Leg Med (Tokyo). 2009;11(Suppl 1):S100–2.

    Article  Google Scholar 

  29. Aitken G, Murphy B, Pilgrim J, Bugeja L, Ranson D, Ibrahim JE. Frequency of forensic toxicological analysis in external cause deaths among nursing home residents: an analysis of trends. Forensic Sci Med Pathol. 2017;13:52–7.

    Article  Google Scholar 

  30. Ramadan AS, Wenanu O, Cock AD, Maes V, Lheureux P, Mols P. Chemical submission to commit robbery: a series of involuntary intoxications with flunitrazepam in Asian travellers in Brussels. J Forensic Legal Med. 2013;20:918–21.

    Article  Google Scholar 

  31. Pilgrim JL, Gerostamoulos D, Drummer OH. Deaths involving contraindicated and inappropriate combinations of serotonergic drugs. Int J Legal Med. 2011;125:803–15.

    Article  Google Scholar 

  32. Karjalainen K, Lintonen T, Hakkarainen P. Illicit drug use is increasing among non-medical users of prescription drugs-results from population-based surveys 2002-2014. Drug Alcohol Depend. 2017;178:430–4.

    Article  Google Scholar 

  33. Solarino B, Riesselmann B, Buschmann CT, Tsokos M. Multidrug poisoning involving nicotine and tramadol. Forensic Sci Int. 2010;194:e17–9.

    Article  CAS  Google Scholar 

  34. Singh SP, Kaur S, Singh D, Aggarwal A. Lorazepam: a weapon of offence. J Clin Diagn Res. 2015;9:Hd01–2.

    PubMed  PubMed Central  Google Scholar 

  35. Grzybowski S. The black market in prescription drugs. Lancet. 2004;364(Suppl 1):s28–9.

    Article  Google Scholar 

  36. Byard RW, Kenneally M. Body pushing, prescription drugs and hospital admission. Forensic Sci Med Pathol. 2017;13:359–61.

    Article  Google Scholar 

  37. LeBeau MA. Guidance for improved detection of drugs used to facilitate crimes. Ther Drug Monit. 2008;30:229–33.

    Article  CAS  Google Scholar 

  38. Acikkol M, Mercan S, Karadayi S. Simultaneous determination of benzodiazepines and ketamine from alcoholic and nonalcoholic beverages by GC-MS in drug facilitated crimes. Chromatographia. 2009;70:1295.

    Article  CAS  Google Scholar 

  39. Lusthof KJ, Bosman IJ, Kubat B, Vincenten-van Maanen MJ. Toxicological results in a fatal and two non-fatal cases of scopolamine-facilitated robberies. Forensic Sci Int. 2017;274:79–82.

    Article  CAS  Google Scholar 

  40. Shbair MK, Lhermitte M. Drug-facilitated crimes: definitions, prevalence, difficulties and recommendations. A review. Ann Pharm Fr. 2010;68:136–47.

    Article  CAS  Google Scholar 

  41. Pilgrim JL, Drummer OH. The toxicology and comorbidities of fatal cases involving quetiapine. Forensic Sci Med Pathol. 2013;9:170–6.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors would like to express their thanks to Dr. Thomas Dewis for language editing and corrections and to Dr. Rossella Barone for the assistance in the revision process.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy

    Guido Pelletti, Marco Garagnani, Francesca Rossi, Raffaella Roffi & Susi Pelotti

  2. Department of Medicine and Surgery (DiMec), University of Parma, Via A. Gramsci 14, 43126, Parma, Italy

    Antonio Banchini

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  1. Guido Pelletti
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  2. Marco Garagnani
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  3. Francesca Rossi
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Correspondence to Guido Pelletti.

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Pelletti, G., Garagnani, M., Rossi, F. et al. Safe drugs in drug facilitated crimes and acute intoxications in Northern Italy. Forensic Sci Med Pathol 14, 442–449 (2018). https://doi.org/10.1007/s12024-018-0010-y

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