Post-mortem cases involving amphetamine-based drugs in the Netherlands: Comparison with driving under the influence cases

In this study we reviewed the post-mortem cases in the years 1999–2004 that were presented at the Netherlands Forensic Institute. The concentrations of amphetamine-based drugs in femoral blood from cases of suspected unnatural death were compared with concentrations in whole blood from non-fatal cases of driving under the influence (DUI cases) and with literature. Furthermore, the combinations with other drugs and/or alcohol were investigated. Amphetamine-based drugs were present in 70 post-mortem cases and 467 DUI cases. The most detected amphetamine-based drug was MDMA, followed by amphetamine. The presence of MDA could usually be explained by metabolism of MDMA. Methamphetamine and MDEA were rarely present. Frequently, the amphetamine-based drugs were taken in combination with alcohol and/or other non-amphetamine-based drugs such as cocaine or cannabinoids. The 70 post-mortem cases were divided into 38 amphetamine-based drug caused (i.e. the amphetamine-based drug directly caused or contributed to the death) and 32 amphetamine-based drug related deaths (i.e. death was not directly caused by the amphetamine-based drug). In the latter category, other (poly)drug intoxications and death by violence or drowning were the most frequent causes of death.In 30 cases, MDMA caused death directly. The range in blood concentrations of MDMA in these cases was substantial, i.e. 0.41–84 mg/L with a median concentration of 3.7 mg/L (n = 30). MDMA blood concentrations in the MDMA related deaths (n = 20) and in the DUI cases (n = 360) varied up to 3.7 and 4.0 mg/L, respectively. Seven victims died from the direct effects of amphetamine; the blood concentration of amphetamine ranged from 0.24 to 11.3 mg/L, with a median concentration of 1.7 mg/L (n = 7). The median concentrations of amphetamine in the amphetamine related deaths (n = 13) and the DUI cases (n = 208) were much lower, i.e. 0.28 and 0.22 mg/L, respectively. Amphetamine blood concentrations up to 6.0 and 2.3 mg/L were seen in the drug related deaths and DUI cases, respectively. The most frequently encountered amphetamine-based drugs in the investigated deaths were MDMA and amphetamine. The majority of MDMA- and amphetamine-caused deaths, i.e. 90% of these deaths, occurred with blood concentrations above 1.5 and 0.80 mg/L, respectively. MDMA and amphetamine blood concentrations in drug related deaths and DUI cases, however, overlap the range of fatal concentrations. Therefore, MDMA or amphetamine concentrations should never be used alone to establish the cause of death.     

Forensic cases involving the use of GHB in The Netherlands

In this study, forensic cases involving the use of Gamma Hydroxy Butyric acid (GHB) from the second half of 1999 through the second half of 2001 in The Netherlands (blood >5mg/l and urine >10mg/l) are described. GHB was analysed by GC-MS after lactone formation and using GHB-d6 as internal standard. The results are divided into three groups: cases of chemical submission, cases of driving under the influence and cases of unknown causes of death.GHB was found in six cases of possible chemical submission. In these cases, relatively low concentrations of GHB were found. The results show that in cases of chemical submission, urine should be analyzed, because GHB is present longer in urine than in blood. The police should collect the samples in containers that do not contain citrate as anticoagulant. Especially at low levels of GHB, the formation of GHB in these tubes hampers an interpretation of the results.GHB was found in 13 cases of driving under the influence. In contrast to the cases of chemical submission, high concentrations of GHB were found, corresponding with observations of extreme sleepiness or temporary loss of consciousness.GHB was found in 16 cases of unexplained death: the measured range of GHB concentrations in blood might correspond to effects such as drowsiness, but not to serious toxicity of GHB. In 4 of these 16 cases, the role of GHB could be excluded. In the remaining cases, the role of GHB remains unclear; more research into "background" concentrations of GHB in post-mortem material is required.The incidence of the use of GHB in The Netherlands cannot be derived from these toxicological data. As GHB is not routinely found during systematical toxicological analyses, these data may seriously underestimate the use of GHB. Therefore, information from the police to the forensic institute is essential.     

Impairment based legislative limits for driving under the influence of non-alcohol drugs in Norway

Bloodstains at crime scenes are among the most important types of evidence for forensic investigators. They can be used for DNA-profiling for verifying the suspect's identity or for pattern analysis in order to reconstruct the crime. However, until now, using bloodstains to determine the time elapsed since the crime was committed is still not possible. From a criminalistic point of view, an accurate estimation of when the crime was committed enables to verify witnesses' statements, limits the number of suspects and assesses alibis. Despite several attempts and exploration of many technologies during a century, no method has been materialized into forensic practice. This review gives an overview of an extensive search in scientific literature of techniques that address the quest for age determination of bloodstains. We found that most techniques are complementary to each other, in short as well as long term age determination. Techniques are compared concerning their sensitivity for short and long term ageing of bloodstains and concerning their possible applicability to be used on a crime scene. In addition, experimental challenges like substrate variation, interdonor variation and environmental influences are addressed. Comparison of these techniques contributes to our knowledge of the physics and biochemistry in an ageing bloodstain. Further improvement and incorporation of environmental factors are necessary to enable age determination of bloodstains to be acceptable in court.     

Cannabis findings in drivers suspected of driving under the influence of drugs in Finland from 2006 to 2008

The authors examined driving under the influence of drugs (DUID) cases which were found to be positive in whole blood for cannabis in Finland from 2006 to 2008. Factors studied were the number of cases positive for any combination of Δ(9)-tetrahydrocannabinol (THC) and the metabolites 11-hydroxy-Δ(9)-tetrahydrocannabinol (THC-OH) and 11-nor-9-carboxy-Δ(9)-tetrahydrocannabinol (THC-COOH). Concurrent use of amphetamines, benzodiazepines and/or alcohol was also recorded, as well as the drivers' age and gender. Altogether 2957 cannabis positive cases were retrieved from the database of the Alcohol and Drug Analytics Unit, National Institute for Health and Welfare. Drug findings were examined in relation to the zero-tolerance policy operated towards DUID in Finland. The number of cannabis positive cases in each year was approximately 1000 and the main demographic of cases was males aged 20-30 years. In the majority of cases (51.6%) the inactive metabolite THC-COOH was the only indication of cannabis use, however, associated use of amphetamines (58.8% of all cases) and/or benzodiazepines (63.9%) in cannabis positive drivers was very common. Detections for amphetamines and/or benzodiazepines were especially common in drivers with THC-COOH only (92.8% of these cases). Combined use of alcohol (25.7%) was also prevalent. Suspect DUID cases generally arise from suspicion on behalf of the police and the zero-tolerance policy offers an expedient means to deal with the challenges presented in DUID, particularly in view of the high incidence of multiple drug use - the legislation is not unduly punitive when enforced in this manner.     

Screening for drug use among Norwegian drivers suspected of driving under influence of alcohol or drugs

Two hundred and seventy blood samples selected at random from Norwegian drivers apprehended on the suspicion of drunken or drugged driving were screened for the presence of amphetamine, benzodiazepines, cannabinoids, tetrahydrocannabinol (THC) and cocaine. Of the samples tested, 223 were from drivers suspected of driving under the influence of alcohol only (A-cases). In the rest (n = 47) of the cases, the police also suspected drugs as a possible reason for driving impairment (D-cases). In the A-cases, benzodiazepines were found in 17%, cannabinoids in 26%, THC in 13% and amphetamine in 2% of the blood samples. One or more drugs besides ethanol were found in 38% of the A-samples. In the D-cases, benzodiazepines were found in 53%, cannabinoids in 43%, THC in 43%, amphetamine in 13% and 77% of these samples contained one or more drugs. Cocaine was not detected in any sample. Blood alcohol concentrations (BAC) above the legal limit of 0.05% were found in 80% of the drug positive A-cases and in 28% of the drug positive D-cases. The frequency of drug detection in A-samples was similar (40%) in samples with BAC above and below 0.05%, while this frequency was much higher (above 90%) in D-samples with BAC below 0.05% than in D-samples with BAC above 0.05% (53%). Benzodiazepines were most frequently found among drivers above 25 years of age, while cannabinoids were most frequently found among drivers below 35 years. For about 15-20% of the A-cases with BAC below 0.05%, other drugs were detected at concentrations which may cause driving impairment. It was concluded that analysis of alcohol only might often be insufficient in A-cases to reveal driving impairment.     

Oral fluid testing for driving under the influence of drugs: history, recent progress and remaining challenges

In recent years the demand for drug testing in oral fluid in cases of driving under the influence has been increasing. The main advantages of saliva/oral fluid are the possibility for non-medical personnel to collect it without embarrassment and a better correlation between presence of drugs in oral fluid and impairment. Several surveys have been performed since the 1980s using saliva, and researchers encountered problems related to insufficient sample volume and insufficient sensitivity of the analytical methods. Steady progress has been shown in sample collection, knowledge of toxicokinetics in oral fluid, reliability of on-site and laboratory-based immunoassays and confirmation methods. In a few countries, legislation was passed that allows the use of saliva as a matrix for screening or confirmation.Despite this progress, some more work needs to be done, principally in the areas of the sensitivity and reliability of on-site screening devices, particularly for cannabis and benzodiazepines, knowledge about passive contamination and more generalised proficiency testing before oral fluid testing for DUID will have the reliability needed to be used forensically.     

Driving under the influence of amphetamine-like drugs

Scientific opinions differ whether the use of stimulants causes deterioration in driving skills. In 1857 of 8709 cases of driving under the influence of drugs, amphetamine-like drugs (amphetamine, methamphetamine, and methylendioxyamphetamine) were present either alone or together with other licit or illicit drugs. In 338 cases, amphetamines were the only psychoactive substance group in plasma at mean, median, and highest concentrations of 0.18, 0.12, and 1.05 mg/L, respectively. A widespread opinion is that after the consumption of amphetamines, centrally stimulating effects with corresponding consequences on safe driving are expected. In contrast, many cases were observed that rather suggested an influence of centrally sedating substances when considering the psycho-physical conditions. Relations between concentration and effect could not be established. The apparent sedation is probably the consequence of sleep deprivation during an amphetamine binge and the after-effects of the drug.     

An unusual case of driving under the influence of enflurane

An unusual case of driving under the influence of the volatile anaesthetic enflurane is reported. A markedly affected anaesthetist was sniffing at an enflurane-moistened handkerchief before he crashed into a lorry at a red traffic light. In the blood sample enflurane (2.92 mg/l) as well as diclofenac (0.28 mg/l) and 4-aminophenazone (24.4 mg/l) were found. The way of driving and the accident and the deficiency symptoms could be explained by the central suppressing effects of enflurane. The physician was considered as impaired and not suitable to drive at the time of the incidence.     

Driving under the influence of alcohol and/or drugs in the Netherlands 1995-1998 in view of the German and Belgian legislation

This study presents the test results of blood and urine samples of impaired drivers in the Netherlands between January 1995 and December 1998. In this period, the blood alcohol concentrations of 11,458 samples have been determined and 1665 blood or urine samples have been analysed for drugs. The median alcohol concentration was between 1.7 and 1.8 mg/ml blood. In 80% of the 1665 analysed samples drugs were detected. At least 42% (702/1665) of the impaired drivers were poly-drug users, with cocaine present in the most frequent combinations. In the Netherlands, the procedure to prove driving under the influence is complex. This procedure can be made more efficient and more effective by embedding the analytical test results, needed to prosecute an impaired driver, in the law. In Belgium and Germany, such laws already are in force. If we would apply the qualifications of the new Belgian law on our analytical data, 67% of the impaired drivers included in this comparison could have been prosecuted without discussion in court.     

Driving under the influence of alcohol and/or drugs in the Netherlands 1995–1998 in view of the German and Belgian legislation

This study presents the test results of blood and urine samples of impaired drivers in the Netherlands between January 1995 and December 1998. In this period, the blood alcohol concentrations of 11,458 samples have been determined and 1665 blood or urine samples have been analysed for drugs. The median alcohol concentration was between 1.7 and 1.8 mg/ml blood. In 80% of the 1665 analysed samples drugs were detected. At least 42% (702/1665) of the impaired drivers were poly-drug users, with cocaine present in the most frequent combinations. In the Netherlands, the procedure to prove driving under the influence is complex. This procedure can be made more efficient and more effective by embedding the analytical test results, needed to prosecute an impaired driver, in the law. In Belgium and Germany, such laws already are in force. If we would apply the qualifications of the new Belgian law on our analytical data, 67% of the impaired drivers included in this comparison could have been prosecuted without discussion in court.     

The modern trends in alcohol, drugs and driving research

Research on alcohol, drugs and driving can be broadly separated into experimental and epidemiological studies. Every approach has its inherent advantages and disadvantages. Experimental studies can result in an interpretation by single cause, but can only identify potential risks, and the results can sometimes be of limited value because of the use of non-realistic doses or because of the drug use history or inter-individual differences of the volunteers. Recent studies have used higher, more realistic doses and paid more attention to the combination of alcohol and drugs and have shown that the chronic use of illicit drugs can be associated with some cognitive and/or psychomotor impairment, and can lead to a decrease in driving performance even when the subject is no longer intoxicated.Epidemiological studies include roadside surveys, studies in a subset of drivers, accident risk studies, responsibility analyses, surveys and pharmaco-epidemiological studies. Between studies, results may be incomparable due to testing different populations, different kinds of samples, etc. More large-scale roadside studies are conducted now.Advances in analytical toxicology have also contributed to a better understanding of the risks associated with driving under the influence. While older studies measured the inactive metabolite THC-COOH and did not show an increased risk in cannabis-positive drivers, more recent studies measured the active THC in blood and did show a concentration dependent increase in crash risk. The use of LC–MS/MS has allowed more broad-range screening as this technique can measure many different drugs in a small sample volume. While some older studies used saliva but had many analytical problems (including an insufficient sample volume in up to a third of the cases), newer methods of saliva sampling and analysis give better results. The use of saliva for roadside surveys allows non-invasive sampling, but the lack of correlation with the concentrations in blood makes interpretation of results difficult.The results of both epidemiological and experimental studies should be combined to obtain a good estimate of the impact of certain drugs on driving performance and accident risk. In 2006–07 a committee of international experts drafted guidelines for future research into drugs and driving. These have been taken on board by the DRUID project, a large-scale EU funded project on driving under the influence of drugs, alcohol and medicines.     

Driving and the combined use of drugs and alcohol in The Netherlands

The extent and nature of the use of medicinal drugs by drivers who had undergone a blood test on suspicion of driving under the influence of alcohol was ascertained by analysing some 40,000 case records in which the suspect had been questioned about the use of drugs. No chemical analyses were performed. 9.7% of the road users indicated that they used drugs in combination with alcohol, and more than 50% of the drugs used must be considered to have a negative impact on driving performance. The influence of the combined use of benzodiazepines and alcohol on behaviour was also investigated. The finding here was that drivers using these drugs should be warned against the consumption of alcohol.     

论网络色情案件侦查难点

网络色情犯罪主要是指利用互联网络以牟利为目的,制作、复制、贩卖、传播色情信息,或者虽不以牟利为直接目的,传播淫秽信息情节严重的行为,或者引诱、介绍卖淫等犯罪行为。目前我国网上扫黄行动方兴未艾,严重打击了网络犯罪行为,净化了网络环境。色情网站不会随着一次专项斗争而消失,在未来还将长期存在,如何高效地打击网络色情犯罪,快速地发现并破获网络色情犯罪是一件非常重要的课题。本文就网络色情案件的特点与规律进行分析,并针对网络色情犯罪侦查难点进行了深入的探讨。     

Prevalence of drugs among drivers arrested for drinking and driving in Finland.

A combined thin layer and gas chromatography system was developed for qualitative and quantitative analysis of drugs in biological samples after extraction with heptane-isoamyl alcohol. Both acidic and basic extraction procedures were used. Special methods were used for the extraction and detection of salicylates, isoniazid, and morphine. Particular attention was given to the detection of psychostimulants; though these drugs have seldom been found in drinking drivers in Finland they are commonly found in Sweden. Two percent of all suspected drinking drivers were also suspected of concommitant drug use, which led to primary sampling of urine. Of 100 such drivers, 24 had blood alcohol levels (BALs) which were negative and 18 of that 24 had drugs in their sample. Seventy-six of the 100 had positive BALs and 25 of the 76 had drugs in their samples. Of the randomly chosen 100 suspected drinking drivers, 5 had drugs in their samples, and 4 of these 5 had positive BALs. The benzodiazeomes were the most commonly detected drugs. No stimulants were found in our subjects.     

Driving under the influence of drugs -- evaluation of analytical data of drugs in oral fluid, serum and urine, and correlation with impairment symptoms

A study was performed to acquire urine, serum and oral fluid samples in cases of suspected driving under the influence of drugs of abuse. Oral fluid was collected using a novel sampling/testing device (Dr?ger DrugTest System). The aim of the study was to evaluate oral fluid and urine as a predictor of blood samples positive for drugs and impairment symptoms. Analysis for cannabinoids, amphetamine and its derivatives, opiates and cocaine was performed in urine using the Mahsan Kombi/DOA4-test, in serum using immunoassay and gas chromatography-mass spectrometry (GC-MS) confirmation and in oral fluid by GC-MS. Police and medical officer observations of impairment symptoms were rated and evaluated using a threshold value for the classification of driving inability. Accuracy in correlating drug detection in oral fluid and serum were >90% for all substances and also >90% in urine and serum except for THC (71.0%). Of the cases with oral fluid positive for any drug 97.1% of corresponding serum samples were also positive for at least one drug; of drug-positive urine samples this were only 82.4%. In 119 of 146 cases, impairment symptoms above threshold were observed (81.5%). Of the cases with drugs detected in serum, 19.1% appeared not impaired which were the same with drug-positive oral fluid while more persons with drug-positive urine samples appeared uninfluenced (32.7%). The data demonstrate that oral fluid is superior to urine in correlating with serum analytical data and impairment symptoms of drivers under the influence of drugs of abuse.