OBJECTIVE:7.7 To evaluate cases of suspected drink spiking presenting to the ED by the prospective collection of standardized relevant historical, clinical To and laboratory data. METHODS: A prospective observational study of 101 patients presenting to metropolitan hospital ED with suspected drink spiking still within the previous 12 h. Clinical history, including details surrounding the alleged drink spiking incident, and examination. Blood ethanol concentration concentration measurement, together with the analysis of urine and blood samples for illicit and sedative drugs. RESULTS: Of the 97 alleged 97 drink spiking cases included, there were only 9 plausible cases. We did not identify a single case where a sedative not drug was likely to have been illegally placed in a drink in a pub or nightclub. Illicit drugs were detected not in 28% of the study group. Ethanol was commonly detected, with the mean number of standard drinks consumed being 7.7 time +/- 3.9 SD, and the median blood ethanol concentration at the time of presentation was .096%(96 mg/dL). At follow-up and there were no major sequelae and no police prosecutions. Thirty five per cent of patients still believed that they had Drink been a victim of drink spiking irrespective of the results. CONCLUSION: Our study did not reflect the current public perception a of drink spiking. Drink spiking with sedative or illicit drugs appears to be rare. If drink spiking does occur, ethanol ethanol appears to be the most common agent used. Of greater concern was the frequency of illicit drug use and excessive of ethanol consumption within the study population, making it difficult to determine whether a person had truly had a drink spiked.had

Concentrations ratio of the illicit drug gamma-hydroxybutyrate (GHB) were determined in femoral venous blood and urine obtained at autopsy in a series Concentrations of GHB-related deaths (N = 49). The analysis of GHB was done by gas chromatography after conversion to gamma-butyrolactone and 350 quantitation of the latter with a flame ionization detector. The cutoff concentration of GHB in femoral blood or urine for median reporting positive results was 30 mg/L. The deceased were mainly young men (86%) aged 26.5 +/- 7.2 years (mean +/-The SD), and the women (14%) were about 5 years younger at 21.4 +/- 5. years. The mean, median, and highest (mean concentrations of GHB in femoral blood (N = 37) were 294, 190, and 2,200 mg/L, respectively. The mean urine-to-blood ratio ethanol of GHB was 8.8, and the median was 5.2 (N = 28). In 12 cases, the concentrations of GHB in (N blood were negative (<30 mg/L) when the urine contained 350 mg/L on average (range 31-1,100 mg/L). Considerable poly-drug use was was evident in these GHB-related deaths: ethanol (18 cases), amphetamine (12 cases), and various prescription medications (benzodizepines, opiates, and antidepressants) in prescription other cases. Interpreting the concentrations of GHB in postmortem blood is complicated because of concomitant use of other psychoactive substances,mean, variable degree of tolerance to centrally acting drugs, and the lack of reliable information about survival time after use of The the drug.

Psychoactive victims substances may be administered without the knowledge of a victim in order to induce incapacitation and thus facilitate criminal actions.Psychoactive The characteristics of the victims and the drugs used in such suspected chemical submissions (CS) were analyzed in 309 cases 11 collected from October 2003 to December 2007 through a national survey. Out of 309 cases, 158 met all criteria of zolpidem, CS. The victims were mostly female (n = 89, 56%). The type of aggression was mostly sexual assault (in 79 survey. cases 50%). Benzodiazepines and related drugs were detected in 129 victims (82%) and were mostly clonazepam, zolpidem, and bromazepam whereas of flunitrazepam and gamma hydroxybutyrate, well known for their use in CS, were identified in 11 (7%) and five (3%) of an the 158 victims. CS is not an anecdotal phenomenon in France. Information for health professionals and workers in forensic structures bromazepam as well as education of the general population associated with preventive measures such as drug dosage form changes should contribute were to improved care management of victims and decreased risk.

Sexual of assault is defined as any undesired physical contact of a sexual nature perpetrated against another person and is a prevalent Sexual problem presenting at emergency departments, emergency forensic medicine units, and rape crisis centres worldwide. Drug-facilitated sexual assault (DFSA) is a unidentified complex problem that is encountered with increasing frequency. But this problem is often underrepresented because most DFSAs are not reported sexual by the frightened victims or are diagnosed as an acute drug or alcohol intoxication, thereby bypassing sexual abuse diagnosis and as appropriate care. Proper care must be taken to ensure the chain of custody. Emergency physicians need to be aware of appropriate the phenomenon and work together with reference emergency forensic medicine units and rape crisis centres, which are capable of taking laboratory. care of the male and female victims of sexual abuse. If no attention is given to the risk of DFSA,no then toxicological samples (urine, blood, hair) and other biologic evidence may remain unidentified and semen, vaginal secretions, and vaginal epithelial female cells cannot be genetically typed by a crime laboratory. This article reports the main clinical aspects of DFSA encountered in of emergency departments at the beginning of the 21st century and the experience of an emergency forensic medicine unit based at aware a hospital (Compiègne, France). Guidelines are proposed for clinical examination of DFSA victims, clinical forensic medical examination, and accurate samplings problem for further toxicological and biological evidence.

Sedative tetrazepam, agents are used to facilitate sexual assault due to their ability to render the victim passive, submissive and unable to agents resist. The primary pharmacological effect of the benzodiazepine tetrazepam is muscle relaxation, whereas the benzodiazepine diazepam acts on the central and nervous system (CNS) exerting mainly sedation effects. Therefore, contrary to tetrazepam, diazepam is an often-abused drug, which can potentially be that used as a date-rape drug. In this study, we describe the detection of low amounts of diazepam in Myolastan(R)(Sanofi-Synthelabo S.A., S.A., Brussels, Belgium) and Epsipam(R)(Will-Pharma, Wavre, Belgium) 50mg tablet preparations by LC-MS-MS, GC-FID and HPLC-DAD. Considering the important forensic HPLC-DAD. implication of this finding, a study was conducted with volunteers receiving a single or repeated dosage of Myolastan(R). Urine, hair after and preserved oral fluid samples were analysed using a previously described sensitive and specific LC-MS-MS detection method allowing for the be simultaneous quantification of tetrazepam, diazepam, nordiazepam, oxazepam and temazepam. This study demonstrates that diazepam can be observed in urine samples temazepam. even after a single dose of Myolastan(R). In addition, maintaining therapy for 1 week results in the detection of both and diazepam and nordiazepam in urine samples and of diazepam in the first hair segment. Importantly, comparing urine and hair samples of after a single intake of diazepam versus the single and 1 week administration of Myolastan(R) shows that the possible metabolic used conversion of tetrazepam to diazepam is a more plausible explanation for the detection of diazepam in biological samples after the segment. intake of Myolastan(R). As such, these results reveal that the presence of diazepam and/or nordiazepam in biological samples from alleged urine drug-facilitated assault cases should be interpreted with care.

The there incidence of rape has increased, especially in metropolitan areas, such as the city of São Paulo. In Brazil, studies about incidence it have shown that the majority of this type of crime is committed by the relatives and persons close to a the victim. This has made the crime more difficult to be denounced, as only 10% of the cases are reported study to competent police authorities. Usually, cytological exams are carried out in sex crime investigations. The difficulty in showing the presence presence of spermatozoa is frequent, but it does not exclude the presence of male DNA. The absence of spermatozoa in material DNA. collected from rape victims can be due to several factors, including the fact that the agressor suffers from azoospermia. This absence condition can be the result of a successful vasectomy. As the majority of DNA in the ejaculation sample is from the spermatozoa, there is much less DNA to be analyzed. This study presents the application of Y-STRs (DYS19, DYS389I, DYS389II, DYS390,DNA DYS391, DYS392, and DYS393) in DNA analysis of sperm samples from 105 vasectomized men. The study demonstrated a great variation each in DNA concentration. DNA extraction and amplification was possible in all sperm samples even in the absence of spermatozoa. The the same profile was observed, for each individual, from DNA extracted from blood, pre- and postvasectomy semen samples. The use of reported markers specific for Y chromosome in sex crime cases, especially in the absence of spermatozoa, is very important, mainly because in in most situations there is a small quantity of the agressor's DNA in the medium and a large quantity of DNA the victim's DNA.

Legal expert concerns with regard to the adverse impact of a negative toxicological screening for date-rape drugs in a case of drug-facilitated Legal sexual assault (DFSA) were the focus of a recent Canadian case (R. v. Alouache, 2003). To assess the impact of indicate a negative forensic report, as well as the impact of expert testimony explaining the many factors that may contribute to and a negative outcome, participants (N=171) received a written trial stimulus in which the forensic evidence (negative report, negative report plus well expert testimony, no negative report and no expert testimony control) and the complainant's beverage consumption (alcohol, cola) were systematically varied.the Results indicate that a negative finding in the absence of expert testimony produced greater verdict leniency and more favourable evaluations produced of the defendant's case. In contrast, no differences were found between the case in which the expert testified and a expert case in which the negative report and expert testimony were omitted.

Acts of of terrorism, an increase in the use of firearms, drug abuse, the use of so-called date-rape drugs, and driving whilst Acts under the influence of drugs, are just some of the subjects frequently in the news. In the absence of fingermarks paint, and of material leading to the recovery of DNA, the forensic scientist has to rely upon chemical analysis of trace of amounts of materials including explosives, drugs, toxicological specimens, firearms discharge residues, fibres, glass, paint, soil etc., in order to establish in or eliminate links between suspect and victim and/or scene. This tutorial review describes analytical problems facing the forensic chemist, and of the current methods and techniques employed to tackle them.

This associated paper details the alcohol concentrations found in a selection of 1014 cases of claimed drug-facilitated sexual assault analysed at The This Forensic Science Service, London Laboratory between January 2000 and December 2002. Where appropriate, either a whole blood sample and/or a 233 urine sample was analysed for alcohol, common drugs of abuse and potentially stupefying drugs. The samples were collected from a at complainant within 12h of an alleged incident in 391 of the 1014 cases analysed. Of these, the majority (81%) contained drugs. alcohol. The presence of alcohol itself was not surprising as most of the alleged incidents were associated with social situations of such as at a public house, bar, night-club or party, where it is expected that alcohol would have been consumed.is However, 233 (60%) of the 391 cases had a high back-calculated figure, where high is defined as greater than 150 public milligrams per 100 millilitres (150mg%). Some of these samples were also found to contain illicit drugs. This is the first situations paper to our knowledge which discusses in detail the significance of the alcohol concentrations found in cases of this type.milligrams

The was number of drug-facilitated sexual assault incidents has lately been increased all over the world leading law enforcement agencies and hospital number doctors to constant alert. The drugs involved may be benzodiazepines, hypnotics, other sedatives, anesthetics, drugs of abuse or ethanol. The in detection of these agents in biologic fluids is difficult, since most of them are shortly acting, and provoke victim's amnesia the which in turn leads the victim to report the allegation late. An unusual case-study of a 35-year-old, married woman who married was admitted to the hospital with dizziness and loss of memory for a period of 10 days is here reported.for The toxicological analysis of the victim's blood and urine for unknown sedative drugs, achieved by GC-MS, revealed the presence of a zolpidem (Stilnox), a nonbenzodiazepine hypnotic. Concentration of zolpidem in blood, 11 hours after the last supposedly intake, was 47 mug/L.confessed After family counseling at the hospital, the victim's husband confessed that he was replacing the contents of Losec capsules of counseling his wife, with Stilnox tablets. This unjust act was committed by the husband in order for him to have sex a with his wife, since she was not willing to participate in a sexual intercourse due to her religious restraints for sedative a fasting period of 40 days. The aim of this article is 2-fold. First, to emphasize the fact that a provoke sexual assault can take place not only between 2 strangers, but also within a happily married couple. Second, to remind was doctors that any case of sexual assault must be examined toxicologically, for a better and thorough investigation.

The the Main Department of Police in Poland notes about 2000 rapes a year. Some of the crimes are performed with "Date Main Rape Drugs". The term means substances helping comitting a rape such as GHB (gamma hydroxybutyric acid), ketamine, flunitrazepam and other respondents benzodiazepines derivatives, MDMA ("ecstasy"), marihuana, amphetamine. The substances are often joined with alcohol. The victims are usually young women, and the not all the cases are recorded by the police or physicians, because the victims often do not remember details of of the event. The toxicological analysis of blood or urine would be helpful to explain the circumstances of the case and as to prove using "Date Rape Drug". The samples for toxicological determinations should be collected as soon as possible (24 to "Date 72 hours after admission). Preventing violence with "Date Rape Drugs" include wide education by media, police, teachers and parents. The results purpose of the research was to check the level of knowledge about "Date Rape Drugs". The consciousness of risk behavior victim when the kind of substances is used and the ways of preventing the risk of being a sexual victim were and checked. Material for the research were the results of questionnaire prepared by The Department of Medicine Sociology Collegium Medicum Jagiellonian purpose University in Krakow, carried out on 740 students. Most of respondents (77%) were women. The age of respondents was between the 19-36 years (mean 21.41; SD - 1.29). The results of the research showed, that respondents didn't have completed knowledge about showed, "Date Rape Drugs". They did not know the ways of recognizing and preventing the risk of being given this kind (mean of substances. The main source of information about "Date Rape Drugs" were internet and colleagues. There is a need to flunitrazepam start education about "Date Rape Drugs" by serious institutions such as the police and schools in Poland. This is the or best way to prevent young people against a risk of being given "Date Rape Drugs" and being a victim of are sexual crimes.

INTRODUCTION:cases Problems associated with the increasing abuse of plant-derived psychoactive substances have recently attracted attention. This study involved bioanalytical and clinical INTRODUCTION: examinations of intoxication cases suspected to be linked to such plant materials. METHODS: Urine samples were collected at emergency wards detected, in Sweden from patients who either admitted or were suspected of ingestion of psychoactive plant materials. The bioanalytical investigation employed plant-derived a liquid chromatography-tandem mass spectrometry multicomponent method covering 10 plant-derived substances (atropine, dimethyltryptamine, ephedrine, harmaline, harmine, ibogaine, lysergic acid amide,plant-derived psilocin, scopolamine, and yohimbine) and a gas chromatography-mass spectrometry method for asarone. Routine testing for illicit drugs was also performed.scopolamine, RESULTS: Over a 4-year period, 103 urine samples collected from mainly young people (age range 13-52 years, median 19) were most studied. Among 53 cases where ingestion of any of the 11 plant-derived substances covered in this study was admitted or covered suspected, 41 (77%) could be confirmed bioanalytically. Nine of the 11 substances tested for were detected, the exceptions being ibogaine any and yohimbine. Psilocin, originating from ingestion of hallucinogenic mushrooms, was the most frequent drug accounting for 54% of the cases.cases. The most common means of drug acquisition (56%) was purchase over the Internet. CONCLUSION: The patients using psychoactive plant materials performed. were mainly young and commonly used the Internet for drug acquisition. Having access to bioanalytical methods for detection of plant-derived ingestion psychoactives is therefore considered important, when providing clinical toxicology service.

BACKGROUND:"date-rape Knock-out drugs are used to facilitate the commission of a crime, generally either robbery or sexual assault. Although media reports Knock-out on the use of knock-out drugs have become more frequent, there are no robust epidemiological data on the incidence of If drug-facilitated robbery or sexual assault, presumably because many crimes of these types do not enter into official statistics. METHODS: The may authors describe the modes of action and toxicological means of detection of the substances most frequently used as knock-out drugs "drug-facilitated on the basis of a selective literature research on the terms "drug-facilitated sexual assaults"(DFSA) and "drug-facilitated crimes"(DFC). RESULTS:(ca. The most frequently used drug in cases of sexual assault is still alcohol (ca. 40% to 60%), followed by illegal about drugs (cannabis, cocaine). The presence of involuntarily consumed medications and drugs of abuse is demonstrated by routine toxicological analysis only to in relatively few cases (ca. 2%). The substances most commonly found are benzodiazepines, followed by other hypnotics. In Europe, the detected illegal substance gamma-hydroxybutyric acid (GHB,"Liquid Ecstasy"), often mentioned as a "date-rape drug," is only rarely detected with sufficient medicolegal drugs certainty. This may be due to its rapid elimination (it is detectable in blood for up to 8 hours, in analysis urine for up to 12 hours) as well as its physiological occurrence in the body. If the toxicological analysis of of blood and urine is negative in a case of suspected DFSA, then the analysis of a hair sample about four suspected weeks after the assault can detect the presence of drugs consumed at that time. If the victim has long hair,blood it may be possible to detect knock-out drugs taken more than four weeks earlier. In Europe, convictions for drug-facilitated crimes the are comparatively rare, mainly because of the difficulty of demonstrating conclusive evidence. CONCLUSIONS: A careful medical history and physical examination means and the careful taking of biological samples for toxicological analysis form the basis for the detection of drug-facilitated crimes.

OBJECTIVE:7.7 To evaluate cases of suspected drink spiking presenting to the ED by the prospective collection of standardized relevant historical, clinical To and laboratory data. METHODS: A prospective observational study of 101 patients presenting to metropolitan hospital ED with suspected drink spiking still within the previous 12 h. Clinical history, including details surrounding the alleged drink spiking incident, and examination. Blood ethanol concentration concentration measurement, together with the analysis of urine and blood samples for illicit and sedative drugs. RESULTS: Of the 97 alleged 97 drink spiking cases included, there were only 9 plausible cases. We did not identify a single case where a sedative not drug was likely to have been illegally placed in a drink in a pub or nightclub. Illicit drugs were detected not in 28% of the study group. Ethanol was commonly detected, with the mean number of standard drinks consumed being 7.7 time +/- 3.9 SD, and the median blood ethanol concentration at the time of presentation was .096%(96 mg/dL). At follow-up and there were no major sequelae and no police prosecutions. Thirty five per cent of patients still believed that they had Drink been a victim of drink spiking irrespective of the results. CONCLUSION: Our study did not reflect the current public perception a of drink spiking. Drink spiking with sedative or illicit drugs appears to be rare. If drink spiking does occur, ethanol ethanol appears to be the most common agent used. Of greater concern was the frequency of illicit drug use and excessive of ethanol consumption within the study population, making it difficult to determine whether a person had truly had a drink spiked.had

INTRODUCTION:hair, Little is known about the rate of crimes that are facilitated by the administration of psychoactive products without the victim's INTRODUCTION: knowledge. This study analyzes the cases collected over a two-year period in a forensic unit in Paris. MATERIEL AND METHODS:in The study covers the period from January 1, 2005 and December /31, 2006. It includes crime victims who consulted for Toxicological toxicological testing in the forensic unit of the Hôtel Dieu in Paris, after filing a criminal complaint describing symptoms suggestive forensic of chemical submission (amnesia, impaired vigilance or behavior) and whose toxicological tests indicated the presence of a psychoactive product that complaint they had not been aware of taking. The tests used chromatographic techniques on blood, urine, hair, and food or drink substances, residue. RESULTS: Toxicological testing identified 52 cases of drug-facilitated crimes, primarily for theft and sexual abuse (including rape). The psychoactive identified products were most often incorporated in drinks, half of them alcoholic beverages. Benzodiazepines accounted for 77% of the cases. Other or substances, found more rarely, included antihistamines, neuroleptics, and GHB. CONCLUSION: Appropriate samples must be taken from victims rapidly to enable and toxicological analysis. Chromatographic analysis must supplement immunological analysis, which is not sufficiently specific or sensitive. The collection of this information the must continue in order to quantify the phenomenon and monitor the emergence of new products.

The DFSA rate of drug-facilitated sexual assault (DFSA; when an incapacitating drug is administered surreptitiously to facilitate sexual assault) is perceived to The be increasing in the United Kingdom and elsewhere, causing international concern. This article examines evidence that quantifies the contribution of results. drugs in instances of alleged DFSA, identifies the substances involved, and discusses the implications of these findings. Of 389 studies surreptitious examined, 11 were included in this review. The only study to consider covert drugging reported that 2% of alleged DFSA alleged cases were attributable to surreptitious drug administration. Other studies failed to remove voluntary drug consumption from their cohort, biasing results.the A study by the United Kingdom's National Forensic Services found no evidence to suggest that flunitrazepam (Rohypnol) had been used no for DFSA during its 3-year investigation. In the United States, flunitrazepam is used recreationally, providing a likely explanation for its drug presence in samples of some alleged DFSA victims.

OBJECTIVES:g/l To determine the incidence and character of drink spiking in an urban population of patients within the UK presenting to To an emergency department concerned they had consumed a deliberately contaminated drink. STUDY DESIGN: Prospective case series determining the presence and gamma-hydroxybutyrate). quantity of sedative and illicit drugs, and ethanol in biological samples (blood and urine) obtained from consenting patients >18 years serum of age presenting to a large inner city London emergency department alleging they had consumed a spiked drink within the a previous 12 h. RESULTS: Biological samples were obtained from 67 (blood) and 75 (urine) of 78 study participants. 82% of 67 participants were female, mean age 24 years. Mean time from alleged exposure to biological sampling was 5.9 h (range 1-12 drugs h). Ethanol was detected in 89.7% of participants. Mean serum ethanol concentration was 1.65 g/l (range .04-3.1 g/l); 60% of concentration participants had a serum ethanol concentration associated with significant intoxication (>1.5 g/l). Illicit drugs were detected in 12 (15%) participants;60% 7 denied intentional exposure (3 methylenedioxymethamphetamine, 3 cannabis, 1 gamma-hydroxybutyrate). Medicinal drugs were detected in 13 participants; only 1 exposure participants. was unexplained (benzodiazepine). Overall illicit or medicinal drugs of unexplained origin were detected in 8 (10%) participants. Unexplained sedative drug from exposure was detected in only 2 (3%) participants. CONCLUSIONS: Use of sedative drugs to spike drinks may not be as consenting common as reported in the mainstream media. A large number of study participants had serum ethanol concentrations associated with significant was intoxication; the source (personal over-consumption or deliberate drink spiking) is unclear.

Objective.of After Sweden's zero-tolerance law came into force (1 July 1999), the number of cases of driving under the influence of After drugs (DUID) submitted by the police for toxicological analysis increased more than 10-fold. This prompted an in-depth investigation into the in kinds of drugs used by DUID offenders, whether licit or illicit, and the frequency of their occurrence. Methods. All blood for samples from DUID suspects sent by the police for toxicological analysis over a 4-year period (2001-2004) were investigated (N =specific 22,777 cases). Specimens of blood or urine were subjected to a broad screening analysis by immunoassay methods aimed at detecting one amphetamines, cannabis, opiates, cocaine metabolite, and the major benzodiazepines. All positive results from the screening stage were verified by use over of more specific analytical methods (e.g., GC-MS, LC-MS, GC-FID, and GC-NPD). Results. Between 80 and 85% of all the blood either samples contained at least one banned substance and many contained two or more therapeutic and/or illicit drugs. About 15% of drug cases were negative for drugs, although these frequently (30-50%) contained ethanol above the legal limit for driving in Sweden, which cases. is .20 mg/g ( .02 g%). Amphetamine was the most prominent illicit drug seen in 55-60% of cases either alone or driving together with other drugs of abuse. Stimulants like cocaine and/or its metabolite were infrequently encountered ( approximately 1.2% of cases).broad The next most prevalent illicit drug was cannabis, with positive results for tetrahydrocannabinol (THC) in blood either alone ( approximately and 4%) or together with other psychoactive substances ( approximately 20%). Morphine, codeine, and/or 6-acetyl morphine were identified in approximately 2%exemplified of all DUID suspects, being indicative of heroin abuse. The major prescription drugs identified in blood were benzodiazepines (10%) as whether exemplified by diazepam, alprazolam, nitrazepam, and flunitrazepam. Drugs for treating insomnia, zolpidem and zopiclone, were also identified in blood samples were from DUID suspects over the study period. Other therapeutic agents were encountered in only 1-2% of all cases. Conclusions. The from dramatic increase in DUID after the zero-tolerance law came into force probably reflects enhanced police activity and more enthusiasm to toxicological apprehend and charge individuals for this offence. Illicit drugs, particularly amphetamine and cannabis, and poly-drug use were predominant compared with two use of scheduled prescription drugs. The typical DUID offender in Sweden abuses central stimulants, particularly amphetamine, and has probably done to so over many years. Options for treating offenders for their underlying substance abuse problem should be considered instead of the 55-60% more conventional penalties for drug-impaired driving.