Toxicological Aspects of Drug-Facilitated Crimes

294 Pages·2014·5.183 MB·English

by  Pascal Kintz (Eds.)

Toxicological Aspects
of Drug-Facilitated
Crimes
Toxicological Aspects
of Drug-Facilitated
Crimes
Edited by
Pascal Kintz PhD
Consultant inForensic and Analytical Toxicology,
X-PertiseConsulting, Oberhausbergen,France
AMSTERDAM(cid:129)BOSTON(cid:129)HEIDELBERG(cid:129)LONDON
NEWYORK(cid:129)OXFORD(cid:129)PARIS(cid:129)SANDIEGO
SANFRANCISCO(cid:129)SINGAPORE(cid:129)SYDNEY(cid:129)TOKYO
AcademicPressisanimprintofElsevier
AcademicPressisanimprintofElsevier
32JamestownRoad,LondonNW17BY,UK
225WymanStreet,Waltham,MA02451,USA
525BStreet,Suite1800,SanDiego,CA92101-4495,USA
Copyright©2014ElsevierInc.Allrightsreserved.
Nopartofthispublicationmaybereproduced,storedinaretrievalsystem
ortransmittedinanyformorbyanymeanselectronic,mechanical,photocopying,
recordingorotherwisewithoutthepriorwrittenpermissionofthepublisher
PermissionsmaybesoughtdirectlyfromElsevier’sScience&TechnologyRights
DepartmentinOxford,UK:phone[phone];fax[phone];
email:[email protected],visittheScienceandTechnology
Bookswebsiteatwww.elsevierdirect.com/rightsforfurtherinformation
Notice
Noresponsibilityisassumedbythepublisherforanyinjuryand/ordamageto
personsorpropertyasamatterofproductsliability,negligenceorotherwise,orfrom
anyuseoroperationofanymethods,products,instructionsorideascontainedinthe
materialherein.Becauseofrapidadvancesinthemedicalsciences,inparticular,
independentverificationofdiagnosesanddrugdosagesshouldbemade.
BritishLibraryCataloguing-in-PublicationData
AcataloguerecordforthisbookisavailablefromtheBritishLibrary
LibraryofCongressCataloging-in-PublicationData
AcatalogrecordforthisbookisavailablefromtheLibraryofCongress
ISBN:978-0-12-416748-3
ForinformationonallAcademicPresspublications
visitourwebsiteatelsevierdirect.com
TypesetbyMPSLimited,Chennai,India
www.adi-mps.com
PrintedandboundinUnitedStatesofAmerica
14 15 16 17 18 10 9 8 7 6 5 4 3 2 1
Preface
In the last few years, considerable information about drug-facilitated crimes
(DFCs) (rape, sexual assault, robbery, sedation of elderly persons) has accu-
mulated. In these situations, the victims are subjected to non-consensual acts
while they are incapacitated through the effects of a drug. This impairs their
ability to resist or to give consent to the act. In a typical scenario, a predator
(rapist, robber) surreptitiously spikes the drink of an unsuspecting person with
ahypnoticdrug.Victims,bothwomenandmen,usuallyreportlossofmemory
during and after the event. For the perpetrator, the ideal substance is one that
is readily available, is easy to administer, rapidly impairs consciousness and
causes anterograde amnesia (i.e. it prevents the recall of events that occurred
whileundertheinfluenceofthedrugbutnotgeneralmemory).
ThemostcommonlyencountereddrugsinallegedDFCsareethanol(alcohol)
andcannabis.Pharmaceuticalsarealsolargelyused,withsedationasacommon
activity.Drugsinvolvedcanbebenzodiazepines(flunitrazepam,lorazepam,etc.),
hypnotics (zopiclone, zolpidem), sedatives, neuroleptics, and some histamine
H1-antagonists or anesthetics (gamma hydroxybutyrate or GHB, ketamine). In
some complicated cases, even clonidine or tetrahydrozoline have been detected.
Due to their low dosage, except for GHB, a surreptitious administration into
beveragessuchascoffee,softdrinks(e.g.Cola)orevenbetteralcoholiccocktails
isrelativelysimple.
Bloodandurinearetheconventionalspecimenstodocumentdrugexposure.
The narrow window of detection of GHB, 6 and 10hours in blood and urine,
respectively, is an example of the current limitation of these specimens to
demonstrateexposureafterlatesampling.ForallcompoundsinvolvedinDFC,
thedetectiontimesinbloodandurinedependmainlyonthedoseandsensitivity
ofthemethodused.Prohibitingimmunoassaysandusingonlyhyphenatedtech-
niques, substances can be found in blood from 6hours to 2 days and in urine
from12hoursto5days.Samplingbloodorurinehaslittleimpact48hoursafter
the offense occurred. To address a response to this important caveat, hair was
suggested as a valuable specimen. Hair sampling is a useful complement to
theseanalysestoincreasethewindowofdetectionandtopermitdifferentiation
of a single exposure from chronic use of a drug by segmentation. Moreover,
due to the long delays that are frequently encountered between the event and
thematterbeingreportedtothepolice,haircanoftenbetheonlymatrixcapable
ofprovidingcorroborativeevidenceofacommittedcrime.
This book will compile numerous case reports, as I wanted the authors to
discuss in depth the practical aspects of DFCs and how interpretation was
achieved.
xi
xii Preface
A drug-facilitated offense is not a new phenomenon and has been known
since Homer’s Odyssey: Kirke (or Circe) was a goddess pharmakeia (witch
or sorceress) who lived with her nymph attendants on the mythical island of
Aeaea.Shewasskilledinthe magicofmetamorphosis,thepowerofillusion,
and the dark art of necromancy. When Odysseus landed on her island she
transformed his men into pigs. The drugused was Datura stramonium!
Manyyearslater,in2003,Ipublishedmyfirstpaperaboutchemicalsubmis-
sion(Kintz,P.(2003)Soumissionchimique:quelsproduits,quelspre´le`vements,
quelles analyses? J Me´d Le´g Droit Me´d 45, 158(cid:1)160).Since that time, I know
that the imagination of the perpetrators has no limit, including the chemical
nature of the compound that is administered and the manner to administer it to
thevictim.
Special thanks must go to all the authors who have agreed to write a
chapter to what, I hope, is a worthwhile book. Various opinions, sometimes
controversial, have emerged among the different authors. I find it helpful to
define the areas of agreement among the active investigators and what issues
require further efforts toreacha consensus.
Pascal Kintz
X-Pertise Consulting,France
List of Contributors
Pr. Jean-Claude Alvarez Service de Pharmacologie-Toxicologie, Faculte´ de
Me´decinePIFO,Universite´ VersaillesSaint-Quentin
Jean-Pierre Anger Universite´ de Rennes 1 – Scolarite´ me´decine et pharmacie,
Rennes
Bertrand Brunet Service de Toxicologie et Pharmacocine´tique, Centre Hospitalier
Universitaire,Poitiers
MarjorieChe`ze DirectriceScientifique,LaboratoireToxlab,Paris
MarcDeveaux DirecteurGe´ne´ral,LaboratoireToxlab,Paris
Samira Djezzar Directrice du CEIP Ile de France-Centre, Hoˆpital Fernand Widal,
AssistancePublique-HoˆpitauxdeParis,Paris
Ve´roniqueDumestre-Toulet LaboratoireToxgen,Bordeaux
He´le`ne Eysseric-Gue´rin Responsable toxicologie me´dico-le´gale, Laboratoire de
PharmacologieetToxicologie,CHUdeGrenoble
Jean-Michel Gaulier Service de pharmacologie, toxicologie et pharmacovigilance,
Limoges
Jean-Pierre Goulle´ Departement de pharmacie, Universite´ de Rouen Mont-Saint-
Aignan,Haute-Normandie
Michel Guerbet Departement de pharmacie, Universite´ de Rouen Mont-Saint-
Aignan,Haute-Normandie
GuillaumeHoizey Directeurge´ne´raladjoint,LaboratoireToxlab,Paris
Luc Humbert Laboratoire de Toxicologie & Ge´nopathies, Centre de Biologie
Pathologie,Lille
PascalKintz X-PertiseConsulting,Oberhausbergen
Dr.Anne-SophieLemaire-Hurtel PraticienHospitalier,Laboratoiredepharmacologie-
toxicologie,ServicedePharmacologieClinique,Amiens
Michel Lhermitte Service Toxicologie et Ge´nopathies, Centre de Biologie
PathologieGe´ne´tique,CHRUdeLille
Patrick Mura Service de Toxicologie et Pharmacocine´tique, Centre Hospitalier
Universitaire,Poitiers
A.L.Pelissier Faculte´ deMe´decine,ServicedeMedecineLe´gale,Marseille
GilbertPe´pin Directeurfondateur,LaboratoireToxlab,Paris
Jean-Se´bastienRAUL InstitutdeMe´decineLe´gale,Strasbourg
xiii
xiv ListofContributors
Nathalie Richard Directrice adjointe, Direction des me´dicaments en neurologie,
psychiatrie,antalgie,rhumatologie,pneumologie,ORL,opthtalmologie,stupe´fiants;
ANSM,SaintDenis
Elodie Saussereau Laboratoire de pharmacocine´tique et de toxicologie cliniques,
Groupehospitalier,LeHarvre
Christian Staub Centre Universitaire Romand de Medecine Legale (CURML), Unite
deToxicologieetChimieForensiques,Geneve
Aline Staub Spo¨rri Official Food Control Authority and Veterinary Affairs of
Geneva,Geneva
Chapter 1
The History of Drug-Facilitated
Crimes in France
Gilbert Pe´pin
During the month of June 1982, three identical incidents were reported to
the Poison Control Center of Marseille, France. They involved young girls,
victims of sexual assault, who had experienced amnesia and were found by
the roadside in the Aix countryside. During police questioning, they said
they had been hitchhiking. One of them reported having flashbacks, describ-
ing one in which she sees a vehicle stop and the driver offer her a can of
soda which she partially drinks and then throws into the street. Informed
of the facts, the police find a can by the roadside. The toxicological analysis
of the content revealed the presence of triazolam. The man in the vehicle is
found shortly after and confessed that he would pierce a hole in the bottom
of the can, then introduce a crushed triazolam tablet, seal it with a patch, and
offer his victims the undamaged can. These first cases observed in France
were reported in September 1983 by Poyen, Arditti and Jouglard during the
21st Annual Conference of French Poison Control Centers.1 The term “drug-
induced submission” was proposed by the authors at that time. This term
was later replaced with “chemical submission.” The crimes committed in
this way were called “drug facilitated crimes” (DFCs) and included “drug
facilitated sexual assaults” (DFSAs). In his presentation, Poyen stated that
the well-known amnesiac effects of benzodiazepine tranquilizers cause those
who have ingested them unknowingly to be easily swayed, losing all capac-
ity to judge and resist. At that time, he also spoke about children “beaten”
with drugs and stated that the populations at risk were young women, the
elderly and adolescents who were “robbed of their dignity as well as their
money.”
A second publicized case dates from May 15, 1993, when a hostage-taker
in a kindergarten in Neuilly, France, was killed by security forces. At the
s
request of the police, a doctor prepared a cup of coffee with Gamma-OH
ToxicologicalAspectsofDrug-FacilitatedCrimes.DOI:http://dx.doi.org/10.1016/B978-0-12-416748-3.00001-3
©2014ElsevierInc.Allrightsreserved. 1
2 ToxicologicalAspectsofDrug-FacilitatedCrimes
s
and Hypnovel . The nurse who gave the coffee to the kidnapper stated that
the man in question began to drink it and then spat it out, clearly suspicious
of such an action. In order to prove to the public that the hostage-taker had
not been killed while out of commission, toxicological tests were conducted
to verify the absence of incapacitating substances in the criminal’s blood.
The analyses showed a physiological concentration of gammahydroxybutyric
acid (GHB) (,2µg/mL) and the absence of midazolam (,0.1ng/mL). In
other words, there was clear evidence of an attempt at “legal” drug-induced
submission by slipping midazolam into a cup of coffee. Nevertheless, given
that the person ingested just one sip and then spat it out could not be consid-
ered murder. The person in question was not under the influence when he
was killedby police gunfire.
In 1994, Bismuth2 published clinical case studies of drug-induced
submission,whichatthattimealreadydemonstratedtheimportanceofdetec-
tion techniques. Indeed, the immunochemical methods used by hospital
emergency services gave negative results even when prior analyses (shown
by a highly indicative chart) by gas chromatography/mass-spectrometry (GC-
MS) revealed the presence of triazolam. The first case was that of a 45-year-
s
old man robbed after Halcion was slipped into his coffee. The second was
that of a man whose wife regularly administered sodium bromide to limit his
sexual inclinations—it was a car accident that brought this story to light, but
the husband didnot wish to press charges.
In 1997, Bismuth published eight cases of what she denounced as
psychological manipulation.3 The products in question were Halcions (tria-
s s
zolam),Rohypnol (flunitrazepam) and Temesta (lorazepam).
In 1997, Pe´pin and coworkers also cited the case of a 50-year-old man
who died of hypothermia. He was found in a doorway without a jacket on a
very cold winter night. The evening before, in a nearby bar, he had con-
sumed a beer in the company of another man. The investigation revealed
that the victim’s credit card was used after his death. The toxicological anal-
ysis showed the presence in the victim’s urine of midazolam (15ng/mL)
which was administered by the SAMU (mobile emergency unit). A concen-
tration of 13pg/mL of 7-aminoflunitrazepam was also noted. The perpetra-
tor, who was subsequently arrested, admitted to having added a tablet of
s
Rohypnol to his victim’s beer. This was his fortieth victim over the last 10
years. He said he was living off the proceeds of his crimes, but this was the
first case of death among his “clients.” However, this case was not published
until 2001.4 It was the first French case involving repeated chemical-induced
submission for the purpose ofstealing creditcards.
Given the increasing number of cases concerning drug-induced submis-
sion through the use of hypnotics or tranquilizers, the head of the Agence du
Me´dicament (French health authority) decided to set up a multidisciplinary
exploratory committee within the agency. It would be chaired by Professor
Lagierand would meet from May to July 1997. The group published areport
entitled “Thoughts on the Criminal Use of Psychoactive Substances”.5
Chapter | 1 TheHistoryofDrug-FacilitatedCrimesinFrance 3
Pharmacists, analysts, judicial experts (among others: Ghysel of the Police
Laboratories; Kintz of the Socie´te´ Franc¸aise de Toxicologie Analytique,
SFTA; and Pe´pin of the Compagnie Nationale des Biologistes et Analystes
Experts, CNBAE), representatives from the three medical orders (doctors,
pharmacists, dentists), representatives from the Direction Ge´ne´rale de la
Sante´ (DGS), as well as clinicians (among them Mallaret, Diamant-Berger,
Bismuth and Jouglard) participated in this group. Officials from the Agence
du Me´dicament, including Alexandre, Gatignol, Guiton, Andrieu and Castot,
alsoattended.
The group wanted to make concrete proposals, including facilitating the
dissemination of information and cooperation between the different profes-
sionals involved, to ensure that cases were diagnosed under the best possible
conditions and in a timely manner. Its aim was to preventthe criminal use of
these products or, at the very least, to make such crimes as difficult as possi-
ble. The group also emphasized the need for medical and medico-legal care
of the victims, and from the outset insisted that the toxicological analyses by
immunochemistry routinely performed in hospital emergency rooms were
inadequate and insufficient for the detection of the products in question, con-
sidering their short half-life and low therapeutic concentration. The report
insisted that the medical profession was generally unaware of this problem,
and did not take into account the medico-legal aspect of drug-induced sub-
mission, and therefore legal errors were made resulting in the release of the
perpetrators.
In 1998, Ghysel, Pe´pin and Kintz6 specified the nature of the products
involved,how thesamplesshouldbetakenfromthevictims,howtopreserve
the samples, and which toxicology tests should be performed with the proper
equipment in order to expose drug-induced submission, which they then
called “chemical submission.” Dr. Samira Djezzar also set up in 1998 con-
sultations in Paris for victims of drug-induced submission who did not wish
to press charges. These victims could either go directly to his office during
his shift at the Fernand Widal Hospital, or they could be sent to him by the
Hoˆtel Dieu Hospital emergencyservice.
The following year, Djezzar and Dally published an article7 concerning
the seizure of 4kg of GHB manufactured illegally in a Paris laboratory. The
press then highlighted the misuse of this synthetic molecule in the United
States, where it was nicknamed the “date-rape drug,” and how it was being
administered without the victims’ knowledge due to its euphoric effects.
However, no cases of the possible misuse of GHB had been reported in
France inthe scientific journalsat that time.
In 2000, Questel et al. characterized chemical-induced submission as a
major public health issue.8 The authors reviewed a number of cases previ-
ously reported over a 4-year period in the Urgences Me´dico Judiciaires
(UMJ) at Hoˆtel Dieu Hospital in Paris. Only 82 of the 128 cases of alleged
chemical-induced submission were used in their study. Clinical cases showed
four predominant symptoms: amnesia or partial memory loss, impaired