Evaluating the effectiveness of a court sponsored abuser treatment program

The literature on abuser treatment programs reveals the following problems: (1) the dominance of shelter-related abuser programs, (2) little understanding of the effectiveness of such programs, and (3) low recruitment and high attrition rates in shelter-related programs. This study attempts to deal with some of these difficulties by an evaluation of a court mandated abuser treatment program. The sample used in this study includes a treatment group of 120 court-referred abusers and a control group of 101 nonreferred abusers. The research was designed to deal with problems such as differential participation in the treatment sessions and self-selection bias. Results indicated that the relationship between treatment attendance and recidivism was not linear. Only those defendants who attended 75% of the treatment sessions or more have decreased recidivism; others showed no impact. Some policy implications are also discussed.     

Age assessment of ivory by analysis of 14C and 90Sr to determine whether there is an antique on hand

This report describes the histological changes observed in the heart a young methamphetamine abuser who died of heart failure. Most of the microscopic changes in the heart have previously been described in experimental animals, but never clearly illustrated in man. Gross examination of the heart revealed concentric myocardial hypertrophy (heart weight 470 g versus median predicted weight of 312 g). Areas of old myocardial infarction were also evident, along with enzymatic evidence indicating that a new infarct had occurred. Myocardial remodeling was extensive with perivascular and interstitial fibrosis, cellular vacuolization, and ongoing myocyte destruction with proliferation of fibromyocytes in the intestitum. Of note were the widespread, bizarre looking, distorted, cell nuclei. They were reminiscent of those seen in viral-induced dilated congestive cardiomyopathy. Clinical chemical measurements also showed unequivocal evidence of both evolving infarction and profound heart failure, with a BNP > 5000. This pattern has not previously been reported in humans, probably because forensic pathologists rarely examine the hearts of methamphetamine abusers microscopically. If the pattern observed here is typical for methamphetamine-induced cardiotoxicity, it could well explain increasing reports of heart failure in methamphetamine abusers. It might also be diagnostic for the disorder.     

Detection of methamphetamine and amphetamine in a skeletonized body buried for 5 years

A 28-year-old male methamphetamine abuser, who had been buried for 5 years after being killed by strangulation, was found skeletonized. Methamphetamine and amphetamine in the significantly denatured fatty material of the bone marrow were analyzed by gas chromatography and gas chromatography-mass spectrometry. The confirmation of the chemicals was carried out by chemical ionization (CI) mass chromatography, CI mass spectrometry and CI mass fragmentography. The concentrations of methamphetamine and amphetamine determined by CI mass fragmentography were 1.0 mumol/100 g and 0.1 mumol/100 g, respectively. The method used would seem to be very useful for determination of methamphetamine and amphetamine in marked putrefied biological materials.     

Iliac cancellous bone in drug addicts: a histomorphometric study

Histomorphometry was used to determine structural bone changes in drug addicts. Iliac crest bone biopsies were obtained at autopsy from 28 subjects (21 male, 7 female, aged 18 to 45 years) who had a history of drug abuse and had died due to overdose of illicit drugs. For histomorphometry, undecalcified sections were investigated using the Merz grid. The following histomorphometric indices were measured and calculated: BV/TV, BS/BV, Tb.Th, Tb.N, Tb.Sp, OV/TV, OS/BS, Ob.S/BS, O.Th, ES/BS, Oc.S/BS, and N.Oc/T.A. In 28 controls (24 male, 4 female, aged 17 to 47 years) trabecular bone specimens were investigated in the same way. The parameters in drug addicts did not show any correlation to age, body weight, height or sex differences. Trabecular bone volume and trabecular thickness were slightly but not significantly increased (BV/TV: 23.37 +/- 5.77% (mean, SD), controls 22.23 +/- 5.08%, p = 0.434; Tb.Th: 172.67 +/- 36.83 mcm, controls 169.73 +/- 36.13 mcm, p = 0.764). Only the eroded surface was significantly different to the controls (ES/BS: 8.16 +/- 2.04%, controls 6.96 +/- 2.17%, p = 0.038). We conclude that the incidence of metabolic bone disease in drug addicts is low.     

The study of metabolite-to-parent drug ratios of methamphetamine and methylenedioxymethamphetamine in hair

The metabolite-to-parent drug ratios were determined in the hair of 2444 methamphetamine (MA) abusers who had produced MA-positive hair results from 2001 to May 2005 and in the hair of 53 ecstasy abusers who had produced positive methylenedioxymethamphetamine (MDMA) hair results from 2002 to May 2005. For the hair analyses, hair strands were washed, cut into small pieces and extracted for 20 h in 1 mL methanol containing 1% HCl. Drugs in the extract were determined by gas chromatography-mass spectrometry (GC-MS) using selective ion monitoring after derivatization with trifluoroacetic anhydride. The six range groups were divided as follows on the basis of MA concentrations in hair (n = 2389): 0.5-5 ng/mg (n = 950), 5-10 ng/mg (n = 582), 10-20 ng/mg (n = 503), 20-30 ng/mg (n = 160), 30-40 ng/mg (n = 80), more than 40 ng/mg (n = 114) to assess the correlations between MA concentrations and metabolite-to-parent drug ratios. In groups of higher MA concentrations, lower ratios of AP/MA were found, and there was a statistically significant difference among six range groups. Comparisons of age groups (tens, twenties, thirties, forties, fifties, and sixties) and male and female subjects for the ratios of AP/MA showed a statistically significant difference. The detection of metabolites and the parent drug with reasonable ratios was found to be a useful indicator for distinguishing internal drug incorporation from external contamination. In our study, MA users can produce 0.4-116% (mean = 9%) of amphetamine (AP) concentrations in hair, and ecstasy users 1-110% (mean = 12%) of methylenedioxyamphetamine (MDA) in appropriately washed hair samples.     

Predicting the occurrence of stalking in relationships characterized by domestic violence

A high correlation has been found between domestic violence and stalking. However, very few studies have examined what factors predict the occurrence of stalking in relationships characterized by domestic violence. Using in-depth interviews with victims of domestic violence whose cases have gone through the criminal justice system, this article explores this issue. It was found that experiences of stalking by their abusers were very prevalent in this group of domestic violence victims. In terms of predicting stalking, domestic violence victims who were not in a relationship with their abuser, whose abusers had an alcohol or drug problem, who experienced more controlling behaviors by their abusers, and who had experienced prior stalking by their abusers were at the greatest risk of experiencing more severe stalking. Implications for intervention are discussed.     

Forensic toxicologic analysis of methamphetamine and amphetamine optical isomers by high performance liquid chromatography

Optical isomers (d and l) and racemic compounds (dl) of methamphetamine (MAMP) and amphetamine (AMP), and biologic materials including those substances, could be analyzed by high performance liquid chromatography. Examining the temperature for the analysis, 40 degrees C was the optimal condition in the reproducibility of separated MAMP-isomers. The reproducibility at the temperature did not vary significantly. The measured values of optical isomers were 0.116 +/- 0.012, 1.082 +/- 0.070 and 8.984 +/- 0.136 for the mixing ratios (l/d) of 0.111, 1.000, and 9.000, respectively. The detection limit for both d- and l-isomers was 25 ng. The analytic result of hair specimens from two stimulant abusers by the present method indicates that they contained only d-MAMP and d-AMP, which is believed to have the strongest pharmacologic effect among the optical isomers of MAMP. The coefficient of variation in the analysis of five replicate standards, prepared by adding 1,000 ng each of racemate MAMP and AMP to hair, was less than 4%. The measured value against l/d = 1.000 was 1.040 +/- 0.040 in MAMP and 0.980 +/- 0.030 in AMP. The detection limit for both racemate MAMP and AMP accumulated in hair was 250 ng. The analysis of the optical isomers by our method would contribute to identifying the smuggling routes or the illicit method.     

Psychological profile of male and female animal abusers

This study had three purposes: to explore psychological characteristics of animal abusers (criminal thinking styles, empathy, and personality traits), to replicate previously reported results (past illegal actions, bullying behavior), and to examine potential gender differences. The self-reported animal abuser group was 29 college students who reported two or more incidents of animal abuse; controls were 29 college students matched on age and gender. Participants completed self-report measures of criminal thinking, illegal behaviors, bullying, empathy, and the five-factor personality traits. Results indicated animal abusers had more previous criminal behaviors, were more likely to bully, and had the highest scores on the power orientation criminal thinking scale. Abuser by gender interactions were detected; female animal abusers scored significantly higher on several measures of criminal thinking, were found to be more likely to bully, and exhibited lower scores on measures of perspective taking and empathy compared to female controls.     

Alcohol use in male spouse abusers and their female partners

Patterns of alcohol use of 181 maritally violent and maritally nonviolent men and their female partners differed on subscales of the Quantity-Frequency Index. Two abuser groups (43 uncounseled and 46 counseled) drank significantly greater amounts and for different psychological reasons than two nonabuser groups (50 satisfactorily married and 42 discordant). However, group frequency rates did not vary. The abuser groups had experienced and observed significantly more violence during childhood than the nonabuser groups; further, they reported significantly more current life stress. The female partners of the abusers did not differ in global alcohol use; however, they drank substantially more than their counterparts. They were especially prone to drink in response to battering. About one fourth of the abusers and one fifth of their wives drank frequently during abusive episodes. Stressors and depressors most likely precipitated both drinking and battering, with strain, hostility, and alcohol myopia (altered perception) serving as intervening variables. Results clarify contradictory reports concerning the role of alcohol in family violence.     

The influence of sex hormones on the elimination kinetics of ethanol

The goal of the investigation was to research the influence of sex hormones on the elimination kinetics of ethanol. Forty-seven healthy men (average age 25+/-6.1 years) and 61 healthy women (average age 24+/-2.4 years) received 0.79-0.95g of ethanol/kg body weight in the form of an alcohol beverage of their choice. The target concentration for both sexes was a blood alcohol concentration (BAC) of 1.10g/kg. Blood samples for the determination of the ethanol concentration followed in the elimination phase in 10-20min intervals. The sex hormone levels (estradiol, progesterone and testosterone) were determined concomitantly from the serum. In men, the mean testosterone concentration was 5.3+/-1.6ng/ml, the mean estradiol concentration was 34.6+/-13.6pg/ml and the mean progesterone concentration was 0.9+/-0.3ng/ml. In women, the mean estradiol concentration was 47.6+/-52.6pg/ml and the mean testosterone concentration was 0.8+/-0.4ng/ml. Progesterone displayed a so-called dummy effect in women. In the high progesterone group (n=11), the mean concentration was 11.1+/-3.5ng/ml and in the low progesterone group (n=50) the mean was 0.6+/-0.3ng/ml. The mean hourly elimination rate (beta60) was 0.1677+/-0.0311g/kg/h in men. In women, the mean hourly elimination rate was 0.2044+/-0.0414g/kg/h in the high progesterone group and 0.1850+/-0.0276g/kg/h in the low progesterone group (p<0.05). The beta60 for women in the low progesterone group was significantly higher than that of the men, whose progesterone levels fell within a similar range (p>0.01). These results allow one to conclude that the gender differences in the pharmacokinetics of ethanol can partly, but not completely, be explained by progesterone levels.     

Methamphetamine in hair and interpretation of forensic findings in a fatal case

Hair analysis for drugs has been developing and is considered a significant tool for distinguishing between recent and long-term drug abuse in forensic and clinical toxicology. Chronic consumption of drugs can gradually induce certain harmful effects on the human organism and can exacerbate some pre-existing diseases. Analysis for drugs in blood or urine in isolation does not provide sufficient information about the history of drug-use by a person and their results cannot be correlated directly with the toxic effects displayed. The chronic abuse of methamphetamine is known to be associated with cardiovascular diseases. During or after autopsy certain types of morphologic alterations are found in the hearts of stimulant addicts. The rapid increase in blood pressure after an intravenous methamphetamine dose can be risky for addicts with arteriosclerosis. However, the anamnestic data about a deceased person may not always be available to explain the pathological findings and to classify the cause of death correctly. The aim of this study was to demonstrate the value of hair analysis for drugs in the context of explaining pathological cardiovascular alterations observed during the autopsy in a case where methamphetamine consumption was involved. In this case, only methamphetamine and metabolites were detected with traces of ephedrine. Ephedrine is the precursor chemical in the illicit synthesis of methamphetamine (known in the Czech Republic as "Pervitin"). The femoral blood level of methamphetamine was 1500 ng/ml. It was documented by a witness that the 31-year-old man died within 1h after an intravenous injection of the drug. The cause of death was established as cerebral edema due to cerebellar bleeding shortly after an intravenous dose of methamphetamine. Findings of methamphetamine in the first three 2-cm hair segments (numbered from the roots) were nearly equal (132+/-9 ng/mg). In the fourth 2-cm segment, it was approximately one-half of previous values. In the remaining, distal 7-cm hair segment sample, the value of methamphetamine was higher and comparable to the third segment. These results provide clear evidence that the man had been a chronic methamphetamine abuser for more than 8 months. This information can help to explain the pathology, the consequence of which could be the bleeding into the cerebellum after the last single methamphetamine dose.     

Articles found in the possession of a methamphetamine abuser

A plastic syringe containing bloody fluid, 2 ampules of 20% glucose, an ampule containing diphenhydramine hydrochloride and calcium bromide, powder in a plastic bag and powder wrapped in paper were among the articles found in the possession of a 42-year-old male methamphetamine abuser, who had been taken to a mental hospital owing to his hallucinations.Examination of the patient revealed several recent needle punctures on the left forearm. The concentration of methamphetamine and its metabolite, amphetamine, in blood collected 1 day following the last intake was 76 nmol/100 g. Analysis of the powder and of the contents of the syringe revealed methamphetamine hydrochloride at a concentration of 99.0–99.5% and 7.4%, respectively. Neither glucose nor diphenhydramine were detected in the contents of the syringe.It would seem that the patient abused methamphetamine hydrochloride by intravenous injection after dissolving it in city water or distilled water.     

Stereoselective analyses of selegiline metabolites: possible urinary markers for selegiline therapy

The stereoselective analysis of selegiline metabolites in human urine and plasma by gas chromatography using the chiral column with the non-chiral reagent was investigated for the differentiation of selegiline therapy from the methamphetamine (MA) abuse. This method gave clear separations of MA and amphetamine (AM) isomers without any artifactual optical-opposite peaks due to the reagent. After the administration of selegiline tablets, desmethylselegiline (DMS), MA and AM were observed as (−)-isomers in the urine and plasma. Within the first 48 h after dosing, approximately 40% of selegiline administered was excreted in urine as these three metabolites. The parent drug, selegiline, was not detected in any urine or plasma samples. On the other hand, MA and AM were observed only as (+)-isomers in the urine of MA abusers. For the distinction of selegiline users from street MA abusers in urinalysis, (−)-DMS, a specific metabolite of selegiline, was not a suitable marker. (−)-DMS rapidly disappeared from urine and was excreted only 1% of the given dose. By the moment analysis with the trapezoidal integration, the mean residence times of (−)-DMS in plasma and urine were 2.7 and 3.8 h, respectively, which were 5–20 times shorter than those of (−)-MA or (−)-AM. The values of AM/MA in the urine increased from 0.24 to 0.67 (r=0.857) along with time after the selegiline administration. This ratio was not a sufficient marker to differentiate selegiline users from MA abusers, although the values of AM/MA in 74% of MA abusers were less than 0.24. The present GC technique improved the chiral analyses of MA and AM. This chiral analysis is the most useful technique to avoid the misinterpretation in the discrimination between clinical selegiline therapy and illicit MA use.     

Disposition of quetiapine in biological specimens from postmortem cases

Quetiapine is a new atypical antipsychotic that was approved in 1997 by the U.S. Food and Drug Administration for the treatment of schizophrenia. It possesses a high affinity for 5-HT2 receptors and a low affinity for D1 and D2 dopamine receptors. Because quetiapine has only been released recently to the U.S. market, little information exists regarding therapeutic, toxic, and lethal concentrations. This study reports the detection of quetiapine in 13 postmortem cases. Following a basic liquid-liquid extraction, quetiapine was identified and quantitated by capillary gas chromatography with nitrogen phosphorus detection. Confirmation was accomplished by full scan electron impact gas chromatography/mass spectrometry. Heart blood quetiapine concentrations ranged from 0.07 to 18.37 mg/L (N = 12, mean +/- SD = 3.42 +/- 5.67, median 0.62) and femoral blood concentrations ranged from 0.06 to 19.25 mg/L (N = 10. mean +/- SD = 3.89 +/- 6.12, median 0.81). The average heart blood/femoral blood ratio was 1.31 (range 0.55 to 2.57, N = 10). Urine, bile, and gastric contents were assayed in all cases in which they were submitted. In three cases, the cause of death was determined to be quetiapine toxicity. In these cases heart blood concentrations ranged from 0.72 to 18.37 mg/L (N = 3). These data may provide a basis for establishing levels associated with quetiapine toxicity as well as therapeutic concentrations in postmortem specimens.     

Methamphetamine-related fatalities in forensic autopsy during 5 years in the southern half of Osaka city and surrounding areas

To outline the recent features of methamphetamine-related fatalities from the medico-legal point of view, a retrospective investigation of forensic autopsy cases involving methamphetamine during a 5-year period (1994-1998) in the southern half of Osaka city and surrounding areas (about 1.57 million population) was undertaken. Among 646 autopsy cases, methamphetamine was detected in 15 victims (nine males, six females; 16-71 years of age; most frequently in males in their thirties). Primary scenes of fatal events were concentrated in the middle of the city. About half of them were transferred from emergency medical centers (survival time, up to 30 h). The cause and manner of death were: methamphetamine poisoning (n=4), homicide (n=4), accidental falls and aspiration from drug abuse (n=4), fire death (n=1), myocardial infarction (n=1), and cerebral hemorrhage (n=1) under drug influence. Usually injection scars and fresh puncture sites were found. Blood methamphetamine concentrations were 2.29-17.05 micromol/dl in the fatal poisoning, 0. 44-3.80 micromol/dl in deaths from other extrinsic causes (trauma), and 1.35-2.17 micromol/dl in cardio- and cerebrovascular strokes. Common complications were cardiomyopathy, cerebral perivasculitis and liver cirrhosis/interstitial hepatitis. Fatal and nonfatal methamphetamine poisonings are separately dealt with by the administrative medical examiner's office and in emergency medical centers. Tightly cooperative approaches of clinical and medico-legal experts are required for the effective social and medical management of drug abuse.     

Determination of sex from femora

The determination of sex from bones or bone fragments considerably contributes to identifying unknown bodies or skeletal remains. Due to temporal change and regional differences anthropometric standards have to be constantly renewed. The present study provides measurements of femoral dimensions in a contemporary German population and analyses sexual dimorphism by discriminant analysis. Maximum length (male: 46.4+/-2.4 cm, female: 43.4+/-2.4 cm), maximum midshaft diameter (male: 3.1+/-0.2 cm, female: 2.8+/-0.2 cm), condylar width (male: 8.4+/-1.0 cm, female: 7.7+/-0.5 cm), vertical head diameter (male: 4.9+/-0.3 cm, female: 4.4+/-0.3 cm), head circumference (male: 15.7+/-0.8 cm, female: 13.8+/-1.0 cm) and transverse head diameter (male: 4.9+/-0.3 cm, female: 4.3+/-0.3 cm) were measured in 170 femora, 100 from male (age: 16-92 years, mean: 60.8 years; body height: 153-190 cm, mean: 171 cm) and 70 from female (age: 20-96 years, mean: 72 years; body height: 146-175 cm, mean: 161 cm) individuals. In the discriminant analysis (leave-one-out-method) 67.7% of cases could be grouped correctly with the maximum length alone, 72.4% with the maximum midshaft diameter, 81.4% with the condylar width, 86.8% with the vertical head diameter, 87.7% with the head circumference and 89.6% with the transverse head diameter. The stepwise procedure with all head measurements showed that the results for the transverse head diameter could not be improved. With all measurements subjected to stepwise procedure 91.7% of cases could be classified correctly combining midshaft diameter and head circumference (D=3.012xmidshaft diameter in cm+0.780xhead circumference in cm 20.569).     

Focal neurological complications of handcuff application

The application of handcuffs may result in compression neuropathies at the wrist. The frequency of these complications is unknown. Twelve of 190 (6.3%) consecutive subjects kept in police custody presented distal neurological symptoms possibly related to handcuff application. The duration of handcuffing was significantly longer in patients with neurological symptoms than in patients without neurological symptoms (mean +/- SD: 3.7+/-5.2 h vs. 1.8+/-2.6 h, P = 0.02). A long duration of handcuff application and, possibly, the existence of somnolence or acute alcohol intoxication could be predisposing factors to handcuff neuropathy. A prospective study of clinical and electrophysiological detection and follow up is needed.     

Japanese Sexual Offenders: A Descriptive Study

Young adult male offenders in Japanese correctional institutions were questioned confidentially about their history of sexual abuse. The self‐reported information showed that when the sexual abuse went undetected, the relationships between abuser and victim were closer, and more victims were reported to be under the influence of substances. At the same time, the nature of the sexual abuse was even more serious among self‐reported‐only (undetected) offenders in terms of direct sexual acts. In terms of unhealthy sexual preference and childhood sexual victimization, sexual abusers reported higher level of problems comparing to nonsexual abusers. Self‐reported‐only sexual abusers identified even more problems than officially identified sexual offenders. The results suggest that when we focus only on the characteristics shown by officially identified sexual offenders, we may overlook important risk and need factors that should be addressed in psychotherapy for preventing future reoffending.     

Enantiomeric separation of amphetamine by high-performance liquid chromatography using chiral crown ether-coated reversed-phase packing: application to forensic analysis

d-Amphetamine and l-amphetamine were clearly separated by HPLC analysis using a chiral crown ether column (CROWNPACK CR(+)). As little as 0.1% d-amphetamine in bulk methamphetamine could be determined. The enantiomeric form of the by-product in a drug sample may be helpful in evaluating the possibility of illicit synthesis. When the isomeric composition of amphetamine present in urine from a methamphetamine abuser was examined, only d-amphetamine was detected as a metabolite. The present method was also applied to the enantiomeric separation of norephedrine.     

甲基苯丙胺对映异构体两种衍生化方法的比较分析

目的建立甲基苯丙胺毒品的对映异构体分析的优化方法。方法按文献方法用（S）-（＋）-a-甲氧基-a-（三氟甲基）苯基乙酰氯（MTPACl）对甲基苯丙胺直接衍生化和在碱性条件下用有机溶剂萃取后再用MTPACl衍生化（对文献方法优化）,分别对其衍生物采用全扫描形式进行GC-MS分析,比较其结果。结果优化方法的检测限低,峰型好,副反应少。文献方法的检测限是0.1ng,优化方法的检测限是0.001 6ng。结论优化方法用于甲基苯丙胺的对映体特征分析,结果更准确,实用性更强。