•- Chemical submission can affect victims of all ages not only youngest.•- Toxicological analyzes using appropriate methods are mandatory for diagnosis.•- The name “date-rape drug” is wrongly ...attributed to GHB (less than 4% of our cohort)•- Benzodiazepines deserve this naming due to their highest prevalence each year.
Drug facilitated-crime or chemical submission (DFC/CS) is defined as the concealed or forced administration of psychoactive substances to a victim for criminal purposes. This is a national program set up in the early 2000s in the form of a prospective multicenter survey, the results of which this manuscript presents. Over this 19-year period, 5487 cases were collected, analyzed and classified into 54% of suspected cases, 29% of chemical vulnerability (CV) cases and 17% of proven DFC/CS cases. In the overall data, the most prevalent victims were female (81%), with an average age of 27 years. Sexual assault was the most frequent aggression (77%), followed by theft (14%).
Victims of proven DFC/CS cases were from of all ages including children and elderly. In 934 victims of DFC/CS, 100 various psychoactive substances were detected mostly represented by benzodiazepines and z-drugs (55%), various sedatives including antihistamines (16%) and non-therapeutic substances (16%). Gamma-hydroxybutyric acid (GHB) was found in 4% cases. In CV cases, alcohol (90%) and cannabis (32%) intake were mainly involved
In France, despite prevention messages, DFC/CS has been an epidemic for many years and has been proven by our national study. This national program has the aim to identifying the substances used but unfortunately not the goal to fight against this phenomenon. Since 2009, we observed a new modus operandi of the aggressors who pose as taxi drivers facilitating the reception of the victims leaving nightclubs. We can emphasize that GHB is not the “date rape drug” but rather the benzodiazepine class is.
Methoxphenidine (MXP, 2-MeO-diphenidine) is a dissociative anesthetic drug of the diarylethylamine type, recently introduced for recreational purposes through the online-based sale of new ...psychoactive substances (NPSs). The concentration of MXP in hair has never been reported, either in cases of chemsex use or in fatal cases. A 55-year-old man was found dead at his home the morning after a chemsex party. Toxicological analyses indicated high concentrations of MXP in femoral blood (606 µg/L), cardiac blood (254 µg/L) and hair (13 ng/mg). We also identified 3-methylmethcathinone (3-MMC) in femoral blood (traces) and urine (238 µg/L). The concentrations of all other drugs were consistent with living subjects. This case highlights the risk of MXP poisoning in the context of chemsex and emphasizes the importance of including NPS in postmortem toxicology examinations.
The use of new psychoactive substances derived from ketamine is rarely reported in France. A chronic GHB, 3-MMC, and methoxetamine consumer presented a loss of consciousness in a chemsex context and ...was referred to the intensive care unit with a rapid and favorable outcome. To investigate the chemicals responsible for the intoxication, a comprehensive analysis was conducted on the ten plasma samples collected over a 29.5-hour period, urine obtained upon admission, a 2-cm hair strand sample, and a seized crystal. These analyses were performed using liquid chromatography hyphenated to high resolution tandem mass spectrometry operating in targeted and untargeted modes. Additionally, analyses using gas chromatography coupled to mass spectrometry and nuclear magnetic resonance were conducted to probe the composition of the seized crystal. The molecular network-based approach was employed for data processing in non-targeted analyses. It allowed to confirm a multidrug exposure encompassing GHB, methyl-(aminopropyl)benzofuran (MAPB), (aminopropyl)benzofuran (APB), methylmethcathinone, chloromethcathinone, and a new psychoactive substance belonging to the arylcyclohexylamine family namely deschloro-N-ethyl-ketamine (O-PCE). Molecular network analysis facilitated the annotation of 27 O-PCE metabolites, including phase II compounds not previously reported. Plasma kinetics of O-PCE allowed the estimation of the elimination half-life of ∼5 hours. Kinetics of O-PCE metabolites was additionally characterized, possibly useful as surrogate biomarkers of consumption. We also observed marked alterations in lipid metabolism related to poly consumption of drugs. In conclusion, this case report provides a comprehensive analysis of exposure to O-PCE in a multidrug user including kinetic and metabolism data in human.
•First reported plasma kinetics of O-PCE and its main metabolites in humans.•First identification of plasma O-PCE metabolites in a poisoned patient using a molecular network approach.•Marked alteration in lipid metabolism after O-PCE use.•Multidrug user profile confirmed using hair analysis showing regular synthetic cathinone and recent O-PCE use.
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Driving under the influence of drugs (DUID) is a worldwide problem with potentially major forensic and life-threatening consequences. Although it is obvious that new psychoactive ...substances (NPS) could lead to impaireddriving, the prevalence of NPS use in a DUID context is unknown as the applied roadside screening tests for drugs of abuse (DOA) are not adapted for NPS detection. This works aims to tested oral fluid (OF) specimens for NPS in French drivers circulating around two music festivals (Artsenik 2017 and Garorock 2017) in order to assess the prevalence of consumption and the kind of used NPS in this particular population. OF samples consisted in dried saliva spots obtained from used Drugwipe-5S® tests (after a positive or negative roadside screening test for DOA). These OF were analyzed using a liquid chromatography coupled with tandem mass spectrometry or high-resolution mass spectrometry method. NPS were detected in 17 out of the 229 OF collected specimens (7.4%). Eleven various NPS were identified (number of identification): 5F-AKB48 (2), MAM2201 (1), JWH122 (1), 4F-PVP (1), 3- or 4-MMC (2), fluoromethamphetamine (1), ketamine (3), MXE (3), methoxyketamine (1), 6-APB (2) and 25C-NBOMe (1). There is an apparent effect of the music festival proximity on the prevalence of NPS in OF from this controlled driver population compared to that of 140 controlled drivers from Northern France analyzed in the same period (7.4% versus 3%). The variety of used NPS appears to be increasing (e.g. large proportion of cyclohexanones). In addition, 5% of drivers initially roadside-tested negative for DOA were in fact driving after NPS use in this specific population. From a forensic perspective, these results confirm the reality of driving after NPS use in French drivers, notably in those driving to or from a music festival.
Abstract
The body of a 61-year-old man was found at his home by his wife, lying on the floor, near the bathroom, around midnight. He was known to be training for bodybuilding, using anabolic ...steroids. Police investigations revealed the presence of two types of tablets at home, one supposed to contain clenbuterol (0.040 mg) and the other stanozolol (10 mg). Testing the tablets revealed different dosages from what was expected, i.e., 0.073 and 11.5 mg/tablet, for clenbuterol and stanozolol, respectively. External body examination and autopsy, which was performed the next day, revealed generalized organ congestion and lack of any traumatic injury (confirmed by radiology). Cardiomegaly, with a heart weighing 692 g, was obvious. Anatomic pathology tests did not reveal evidence of malformations, but atheromatous plaque was identified in the coronaries during complete histology investigations. Femoral blood, urine, bile, gastric contents and two strands of hair (6 cm) were collected for toxicology. These specimens were submitted to standard analyses, but also to a specific LC–MS-MS method for clenbuterol and stanozolol testing. Clenbuterol was identified in all the tissues, including femoral blood (1.1 ng/mL), urine (7.2 ng/mL), bile (2.4 ng/mL), gastric content (3.2 ng/mL) and hair (23 pg/mg). Stanozolol only tested positive in hair (11 pg/mg). All other analyses were negative, including blood alcohol and drugs of abuse. The pathologists concluded to cardiac insufficiency with support of cardiomegaly, in a context involving repetitive abuse of anabolic drugs. This case indicates that more attention should be paid to clenbuterol, a drug widely used as a stimulant by people who want to lose weight, athletes and bodybuilding practitioners.
L’analyse salivaire a un réel intérêt pour les recherches de stupéfiants dans le cadre des dépistages de masse, par exemple dans la « Lutte contre la conduite sous influence de stupéfiants » tel que ...le prévoit le Code de la Route en France mais aussi en médecine du travail, dans le suivi thérapeutique ou les recherches des causes de la mort, en complément éventuel du sang ou des urines. Le recueil de la salive est facile, non invasif, et peut être effectué par un personnel non médical. Des tests de dépistages rapides pour les stupéfiants, utilisables sur le site même du contrôle, sont commercialisés depuis plus de vingt ans et ont considérablement évolué en matière de sensibilité et de spécificité, les rendant plus fiables. La confirmation des tests positifs par des techniques de chromatographie couplées à de la spectrométrie de masse demeurent cependant indispensables. L’interprétation des résultats peut être délicate et doit prendre en compte de nombreux facteurs (variabilité intra et interindividuelle, mode de recueil salivaire, fiabilité des tests, contamination passive…) que doivent maîtriser le toxicologue.
Oral fluid testing is of real interest for monitoring drugs of abuse in driving under influence of drugs (DRUID), workplace drug testing, therapeutic drug monitoring, clinical toxicology and postmortem toxicology, possibly in addition to blood or urine. Collection of saliva is easy, non-invasive, and can be performed by non-medical personnel. For the past 20 years, point-of-collection testing devices and confirmation methods more sensitive and specific are more reliable. However, confirmation of positive tests by chromatographic techniques coupled with mass spectrometry remains essential. Interpreting the results must take into account many factors (intra- and inter-individual variabilitie, method of saliva collection, reliability of tests, passive contamination…) that the toxicologist must keep under control.
Poisoning with volatile substances remains exceptional. Authors report the case of a married couple who were found in a car with a butane gas bottle: the woman was dead and her husband alleged it was ...an unsuccessful suicide pact. A specific research of volatile substances on postmortem samples with headspace gas chromatography–mass spectrometry following a quantitative determination was performed. The n‐butane concentrations detected were composed of 610 μg/L (cardiac blood), 50 μg/kg (brain), 134 μg/kg (lungs), 285 μg/kg (liver), and 4090 μg/kg (heart) and were compatible with the rare lethal concentrations evoked in the literature. The cause of death was determined to be asphyxiation through n‐butane criminal poisoning. Authors recommendation therefore is to take samples immediately and place them in properly sealed containers and hence analyzing the samples as soon as possible after collecting them or storing them under −30°C (−22°F) if analyses cannot be performed immediately.
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