Violent crime and substance abuse: a medico-legal comparison between deceased users of anabolic androgenic steroids and abusers of illicit drugs

Several case reports and survey studies have indicated that abuse of anabolic androgenic steroids (AAS) often leads to increased aggressiveness and feelings of hostility that may occasionally trigger violent behaviour. Other observations indicate that many users of AAS also abuse alcohol and/or various illegal substances. Since substance abuse is a well-known risk factor for violent behaviour, it could be that violence committed by AAS users might, at least in many cases, actually be caused by abuse of other drugs. In order to examine this possibility further here, the criminal histories (in terms of incidences of convictions) of deceased users of AAS with (AASpos-subst.pos) and without (AASpos-subst.neg) signs of abuse of other illegal substances were compared to the corresponding histories of deceased users of illicit substances testing negatively for AAS (subst.pos-AASneg) at the time of autopsy. The risk of being convicted for a crime against property was significantly higher in the subst.pos-AASneg group than in either the AASpos-subst.neg or AASpos-subst.pos groups (RR=0.048 versus 0.408). At the same time, the risk of being convicted for a crime of violence was at least as high for the two AAS-positive groups as for the AAS-negative group. Furthermore, when compared with the first 3 years after the first criminal conviction, a pronounced increase in the proportion of incidence of violent crimes and a marked reduction in the proportion of incidence of crime against property was observed during the 3-year period immediately preceding death only among the AASpos-subst.neg subjects. In conclusion, the incidence of violent crime among users of AAS without signs of other drug abuse was comparable to the corresponding incidences for drug addicts without AAS use. This observation suggests that the violent criminality observed among AAS users is not confounded in any systematic fashion by abuse of other drugs. The findings also indicate that use of AAS in certain predisposed individuals might cause a high rate of violent crimes, especially if the use of AAS is combined with the use of other illegal substances.     

Prevalence of sexual abuse in organised competitive sport in Australia

Abstract

This article reports the first phase of a three-phase research programme investigating the prevalence and long-term sequelae associated with sexual abuse in a non-psychiatric sample of male and female Australian athletes. A cross-sectional, retrospective design, using a mailed survey, provided a quantitative assessment of sexual abuse prevalence in a national sample of elite athletes and a regional sample of club athletes. Results from the total sample (n = 370) revealed that 31% of female and 21% of male athletes reported experiencing sexual abuse at some time in their lives. Of these, 41% of females, and 29% of males had been sexually abused within the sports environment. It was also found that almost half, 46.4%, of the elite group reporting sexual abuse had been sexually abused by sports personnel. For the club group, this figure was 25.6%. Implications of these results and current initiatives for the prevention of sexual abuse of athletes in Australia are discussed.     

Cause and manner of death among users of anabolic androgenic steroids

Medicolegally investigated deaths among 34 male users of anabolic androgenic steroids (AAS) are described. Nine persons were victims of homicide, 11 had committed suicide, 12 deaths were judged as accidental and 2 as indeterminate. In two cases of accidental poisoning, the levels of pharmaceuticals and illicit drugs were considered too low to be the sole cause of death and AAS was considered part of the lethal polypharmacia. Chronic cardiac changes were observed in 12 cases. In two cases of accidental poisonous deaths, these changes were regarded as contributory cause of death. Homicides, suicides, and poisonings determined accidental or indeterminate in manner were related to impulsive, disinhibited behavior characterized by violent rages, mood swings, and/or uncontrolled drug intake. The observations in the present study indicate an increased risk of violent death from impulsive, aggressive behavior, or depressive symptoms associated with use of AAS. There are also data to support earlier reports of possible lethal cardiovascular complications from use of AAS. Furthermore, a contributing role of AAS in lethal polypharmacia is suggested. Finally, the observations indicate that use of AAS may be the gateway of approach to abuse of other psychotropic drugs.     

Drugs and chronic alcohol abuse in drivers

Blood specimens from 210 drivers (179 male and 31 female) apprehended in Luxembourg from autumn 2001 to spring 2002 and requested for the determination of their blood alcohol concentration (BAC) were tested for medicinal drugs, illicit drugs, and chronic alcohol abuse (by quantification of the carbohydrate-deficient transferrin: CDT). These additional analyses were performed anonymously and with permission of state prosecutor. The 22.8% had consumed medicinal drugs, with benzodiazepines and antidepressants (10.9 and 7.6%, respectively) as main psychoactive classes. Cannabis was the most detected illicit drug (9.5%) but only one in three had THC detectable in their blood. Association of two or more psychoactive substances (poly-drug use) was observed in 27.6% of drivers (90.6% of drug consumers). On the basis of CDT values, 29.5% of drivers investigated were assumed to be chronic alcohol abusers. Statistical analysis revealed that chronic alcohol abuse and medicinal psychoactive drugs were associated with significantly higher BAC. Medicinal psychoactive drugs were clearly associated with poly-drug use, and were furthermore detected at supra-therapeutic levels in 34.9%.     

Pulmonary thromboembolism after air travel: Two case reports, the review of literature and forensic implications

Anabolic androgenic steroids (AAS) are the main class of doping agents and their consumption produces adverse effects involving several organs and systems. Three cases of sudden cardiac death (SCD) and one of death due to congestive heart failure of previously healthy athletes who were AAS users are herein reported. Concentric cardiac hypertrophy with focal fibrosis (one case), dilated cardiomyopathy with patchy myocyte death (two cases) and eosinophilic myocarditis (one case) were observed and most probably relate to the final event. Molecular investigation for viral genomes was positive in one case (Ebstein virus). Our data confirm previous findings, showing that the most typical cardiac abnormality in AAS abusers is left ventricular hypertrophy, associated with fibrosis and myocytolysis. An exceptional cardiovascular substrate was represented by the case with drug induced eosinophilic myocarditis. These features are at risk of ventricular arrhythmias as well as congestive heart failure. The cause-effect relationship between AAS abuse and cardiac death can be established only by a rigorous methodology with the use of standardized protocols, including precise morphological studies of all target organs to search for chronic toxic effects. Laboratory investigations should focus on AAS searching on a wide range of biological matrices to demonstrate type, magnitude and time of exposure.     

False confessions: The relative importance of psychological,criminological and substance abuse variables

Abstract

The aim of the study was to investigate the relative importance of psychological, criminological, and substance abuse variables in differentiating between alleged false confessors and other prison inmates. The participants were 509 inmates newly admitted to all Icelandic prisons over a four-year period. Sixty-two (12%) of the inmates claimed to have made a false confession to the police sometime in the past. A discriminant function analysis was used to identify the variables that best discriminated between the alleged false confessors and the other prison inmates. Out of 17 psychological variables and 16 criminological and substance abuse variables, two variables (number of previous imprisonments and the score on the Gough Socialisation Scale) correctly classified 93% of the non-false confessors and 32.3% of the alleged false confessors, with a total classification rate of 82.7%. The findings suggest that among Icelandic prison inmates, antisocial personality characteristics and the extent and severity of criminal behaviour, as judged by number of previous imprisonments, are the best predictors of offenders claiming to have made a false confession to the police. The implication is that among some prison inmates, making a false confession is a part of their criminal life style.     

Practical aspects of roadside tests for administrative traffic offences in Germany

In the context of the European project ROSITA, the Institut of Legal Medicine Homburg/Saar has co-operated with the Saarland traffic police in order to assess different roadside drug tests for their functionality and reliability in traffic controls, and for their analytical force of evidence. In 254 cases within the time period from June 1999 to December 1999, police officers performed a (voluntary) roadside drug testing in saliva/sweat, or urine, to confirm or refute their initial suspicion that a driver had used drugs. Whereas in 45 cases the tests gave negative results (which were confirmed by lab urinalysis), in 209 cases the police officers ordered blood samples after a positive outcome of the tests.In 203 of the 209 positive cases, the results could be confirmed by GC/MS analysis. Regarding the prevalence of used drugs, a single consumption was found in 156 cases (113 cannabis, 38 amphetamines/methamphetamines, three opiates, two cocaine), and a consumption of two drugs was found in 44 cases (34 cannabis+amphetamines/methamphetamines, five cannabis+opiates, three cannabis + cocaine, two cocaine+amphetamines/methamphetamines). In three cases, multi-consumption was found.In six cases, the performed tests gave an incorrect prediction to the police officer at the roadside.The roadside tests gave 97.6% correct assistance to the police officers in the right direction (79.9% correct positive predictions and 17.7% correct negative predictions). As a consequence, the performed tests can be seen as a positive and needful tool for the police to get an immediate response to their initial suspicion and to take the right steps concerning a following legal action.     

Gender Differences in Child Abuse and Intergenerational Transmission of Crime and Substance Abuse among Israeli Inmates

The aim of this study was to examine the gender differences in various types of childhood abuse and family history of crime, substance abuse, and mental health problems. Our study was conducted among 110 Israeli female and male inmates (50 female and 60 male inmates). The findings indicated a higher rate of multiple types of childhood abuse among the female inmates compared with the male inmates. The findings also revealed that female inmates reported more prevalence of parents’ substance abuse, crime, and family’s mental health problems than the male inmates did. Moreover, the female inmates reported higher rates of emotional, physical, and sexual abuse associated with family history variables compared with the male inmates. Furthermore, the findings indicated that female inmates whose siblings were involved in substance abuse and crime reported higher rates of sexual and emotional abuse compared with the male inmates. We discussed the implications of these findings.     

Clinical applications of hair testing for drugs of abuse--the Canadian experience

During the last 2 decades there has been a substantial increase in illicit drug consumption in North America. It has been repeatedly shown that the personal history of drug use is far from being accurate. Fearing legal consequences and embarrassment of admitted illicit substance use, most users tend to deny or, to under-report illicit drug consumption. These facts have stressed an urgent need for a biological marker which does not lose its sensitivity within a few days after the end of exposure and which may yield a cumulative reflection of long term exposure to illicit drugs. Hair analysis has emerged as such a marker. A variety of illicit and medicinal compounds have been shown to be incorporated into hair including trace metals, barbiturates, amphetamines, opiates, phencyclidine, cocaine, nicotine and cannabis. Hair analysis for drugs of abuse provides long-term information on an individual's drug use; its window of detection is limited only by the length of the hair and typically, ranges from a week to several months. After establishing and validating several hair tests during the last decade, we have analyzed over 1000 hair samples for different drugs of abuse. We used RIA for screening and GC-MS for confirmation of positive results. The aim of this report is to illustrate the diagnostic usefulness of hair testing in different age groups (newborns, children, adults) and circumstances: (criminal cases, athletes, child custody cases, etc.).     

Involvement of Amphetamines in Sudden and Unexpected Death

Abstract:  In the present study, the effects of amphetamine-class drugs were examined in cases reported to the Victorian coroner from 2001 to 2005 to determine if death can occur from the use of amphetamine-class drugs alone. A total of 169 cases were reviewed where a forensic autopsy detected amphetamine(s) in the blood. Pathology, toxicology, and police reports were analyzed in all cases to ascertain the involvement of amphetamine-class drugs in these deaths. In Victoria, methamphetamine (MA) is the principal abused amphetamine-class followed by methylenedioxymethamphetamine (MDMA). There were six cases in which a cerebral hemorrhage caused death and three cases in which serotonin syndrome was established as being caused by the interaction of MDMA and moclobemide. There were 19 cases in which long-term use of amphetamines was associated with heart disease. There were three cases where amphetamine-class drugs alone were regarded as the cause of death, of which two cases exhibited high levels of MDMA and lesser amounts of MA and/or amphetamine. There were no cases in which significant natural disease was absent and death was regarded as caused by the use of MA. There was no correlation between blood concentration of drug and outcome.     

Substance abuse and crime: A local jail assessment

Conclusion The clear picture of multiple arrests and conviction patterns emerged from the study which might indicate long term problems, perhaps with subcultural motivation. Many inmates indicated informally that the pressures to use drugs and alcohol “on the streets” are quite strong, and will be difficult to resist after release. Several of the older inmates who had been heavily addicted before their arrests volunteered to serve as counselors to explain the hazards of drug and alcohol abuse to younger inmates. Unfortunately, a significant number of these inmates also stated that they would probably continue to use drugs upon It would appear that we may expect these relationships to continue in the future, unless some dramatic efforts are made in the enforcement of drug laws, prevention of the gross availability of illegal drugs and legal alcohol, and in the effective rehabilitation of substance abusing offenders. Of particular importance (and difficulty) will be isolating and curbing those social forces which motivate persons to continue using drugs and alcohol in seemingly irrational quantities and combinations, even after arrest and incarceration for substance abuse related behavior.     

Drugged driving in the Nordic countries--a comparative study between five countries

The purpose of this study was to compare whether the high incidence of drugged driving in Norway was different to that in the other Nordic countries. All blood samples received by Nordic forensic institutes during one week in 1996, from drivers suspected by the police of driving under the influence (Denmark: n = 255, Finland: n = 270, Iceland: n = 40, Sweden: n = 86, Norway: n = 149), were analysed for alcohol and drugs (benzodiazepines, cannabinoids, amphetamines, cocaine, opiates and a number of antidepressant drugs) independent of the primary suspicion, and using the same analytical cut-off levels at the different institutes. The primary suspicion was directed towards drugs in more than 40% of the Norwegian cases, drugs were detected in more than 70% of these samples. In only 0-3% of the cases from Denmark, Finland and Iceland, were drugs suspected, while the corresponding frequency for Sweden was 17%. However, evidential breath analyses were used for about three-quarters of the Swedish drivers suspected to be influenced by alcohol. Blood alcohol concentrations (BAC's) below the legal limits were found in 32, 18 and 2% of the Norwegian, Icelandic and Finnish cases, respectively (BAC < 0.05%), in 10% of the Danish cases (BAC < 0.08%) and in 20% of the Swedish cases (BAC < 0.02%). Drugs were most frequently found in the Norwegian and Swedish cases with no alcohol (80-83%). Similar frequencies of drugs in samples with BAC's above the legal limits (19-22%), were obtained for all countries. Benzodiazepines, tetrahydrocannabinol and amphetamine represented the most commonly detected drugs. Our results show that differences between Norway and other Nordic countries with regard to drugs and driving, are connected to the selection criteria made by the police and with more focus on drugged driving in Norway.     

Police attitudes toward domestic violence offenders

Police attitudes are important in facilitating a sense of safety and comfort in women seeking justice-system support for protection from partner violence. This study examined police attitudes toward sanctions and treatment for domestic violence offenders compared with other violent and nonviolent offenders. In addition, police attitudes toward domestic violence offenders who do and do not use substances were examined. Officers from one city police department (n = 315) participated in a survey. Results indicate there is a trend toward attitudes that treatment, rather than sanctions, was more appropriate for domestic violence offenders. In addition, officers rated the use of sanctions higher for domestic violence offenders who abuse alcohol or drugs compared with domestic violence offenders who did not abuse alcohol or drugs. Understanding police attitudes toward domestic violence offenders may have implications for police training and victim services in facilitating the use of the justice system in protecting women from partner violence.     

Drug users’ Satisfaction with Drug Control by the Police in China

Illicit use of drugs has received tremendous public attention in China in recent years, but little is known about the effectiveness of drug control practices, especially those adopted by the police. This study examines the effectiveness of drug control as perceived by drug users. The study uses surveys from 100 drug users who have voluntarily participated in nongovernmental treatment in Kunming. Results show that, inconsistent with prior research on campaign style policing, the majority of respondents were satisfied with the police in drug control. In addition, drug users’ evaluations of the police were significantly correlated with their age, marital status, perceptions of collective efficacy, and evaluations of their prior contacts with the police. Limitations of the research and future directions are also discussed.     

Substance Use and Abused Women's Utilization of the Police

There is extensive research that addresses the role of police in responding to domestic violence calls. However, there has been relatively little attention to the factors that impel women to call the police during an incident of abuse. This paper investigates the role of alcohol and drugs in influencing women's utilization of the police for misdemeanor-level incidents of abuse, and is based on interview data from 419 abused women. Results indicate that women are significantly more likely to call the police when male partners use both alcohol and drugs, and when they are frequently drunk. Offender drunkenness, rather than the quantity or frequency of alcohol consumption, has a significant escalation effect on police utilization by victims of abuse.     

Patterns of Crime and Substance Abuse among Israeli Ex-Addict Female Inmates

The current study examined the relationship between drug addiction and crime involvement among Israeli female prisoners, and further examined the differential contribution of early onset of drug, sexual abuse and poly drug use, to predict involvement in offenses against person. Fifty-four ex-addict female inmates participated in this study. Research findings indicated that a majority began using drugs prior to their involvement in crime and most were convicted of drug-related crimes. In addition, almost half had a history of sexual abuse. Female inmates who were sexually abused were characterized by an early onset of drug and poly drug use. A relationship was observed between poly drug use and offenses against person. Also, the duration of drug abstinence corresponded to a lower sense of coherence and higher level of trait anxiety among female inmates. The implications of these findings for substance abuse treatment are discussed. Gila Chen, PhD, is a lecturer in the Criminology Department at Ashkelon Academic College and Bar-Ilan University. Her academic interests include youth at risk, female offenders, self-help groups, and drug addiction.     

Flunitrazepam: an evaluation of use, abuse and toxicity.

The benzodiazepine flunitrazepam is extensively prescribed to patients with insomnia in many countries, but has also become popular among alcohol- and drug abusers. Several reports indicate that it is used as a date rape drug and suggest that it may precipitate violent behavior. Furthermore, flunitrazepam is involved in many fatal intoxications in Sweden. This study was designed and conducted to explore the negative consequences of flunitrazepam abuse in Sweden, and to assess the trends in its use and abuse. The occurrence of flunitrazepam in cases referred to the Department of Forensic Chemistry in Link?ping, Sweden 1992-1998, was investigated in detail. The detections were studied separately for different groups; medicolegal death investigations, drug abuse cases, driving under influence cases, and other medicolegal cases. These data were further compared with the sales, and seizures by the Swedish Customs and the Swedish Police. During 1992-1998, 641 fatalities occurred, where the cause of death was attributed to intoxication with flunitrazepam solely (130) or in combination with other drugs, or concomitant conditions (511). In 78% of all driving under influence cases, where flunitrazepam was detected, the analyses also disclosed the presence of illicit drugs. A similar association was seen in drug abuse cases. The seizures reported by the Swedish Customs revealed a substantial and increasing illegal trade. Cases, where flunitrazepam seemingly induced violent behavior were identified, and one of these is described in some detail. It is concluded that the abuse pattern and the toxicity of flunitrazepam should be kept in mind by forensic investigators and that this panorama also should be considered when decisions about the registration and classification of flunitrazepam are made in different countries.     

A validated method for the analysis of cannabinoids in post-mortem blood using liquid-liquid extraction and two-dimensional gas chromatography-mass spectrometry

Phenazepam is a long-acting benzodiazepine that, unlike other benzodiazepines, is currently not scheduled as a narcotic in Finland, most other European countries or the USA. It is used as an anxiolytic, sedative-hypnotic and anti-epileptic, mainly in Russia. In Finland, as well as in some other countries, an increase in the unauthorized use of phenazepam has been observed in recent years. In the one year period between July 1, 2010 and June 30, 2011 the prevalence of phenazepam in Finland was assessed among drivers apprehended for driving under the influence of drugs (DUID), in medico-legal autopsy cases and in police confiscations of illicit drugs. In DUID cases an LC-MS/MS method preceded by solid phase extraction was used for the determination of phenazepam. In the post-mortem investigations the sample preparation consisted of liquid-liquid extraction followed by derivatization and the determination was carried out by GC-MS. The police confiscations were analysed by GC-MS. There were 141 positive phenazepam cases among apprehended drivers, representing approximately 3.5% of all confirmed drug cases (n=4007) in this time period. The median (range) phenazepam blood concentration in DUID cases was 0.061 mg/L (0.004-3.600 mg/L). The median phenazepam concentration in cases with no concomitant stimulant use was significantly higher than the overall median concentration. Phenazepam was found in 17 medico-legal autopsy cases and the median (range) blood concentration was 0.048 mg/L (0.007-1.600 mg/L). Phenazepam was not considered by the medico-legal team to be the sole cause of death in any of the cases, the majority of them being accidental opiod overdoses. There were 26 seizures of phenazepam by the Police in the time period studied, some of the batches consisted of a mixture of phenazepam and stimulant designer drugs. The data show that phenazepam abuse is a widespread phenomenon in Finland. A typical user was a male multi-drug user in his 30s. The concentration range of phenazepam among apprehended drivers and medico-legal autopsy cases was wide and the drug was usually found along with other psychoactive drugs. Therefore, although it seems likely that phenazepam contributed to impairment of driving in some DUID cases, the extent of its effect remains unclear and further studies are needed to define the concentrations causing impairment and toxicity.