Fatal intoxications in the age group 15-34 years in Denmark in 1984 and 1985. A forensic study with special reference to drug addicts

This survey deals with the Danish part of a study on fatal intoxications conducted in the Nordic countries in 1984 and 1985 with special reference to drug addicts. There were 315 cases of fatal intoxications in people 15-34 years of age. These were examined at the Forensic Institutes in Denmark and described with reference to cause of death, sex, age and drug addiction. Of the deceased, 194 were drug addicts according to a specific definition of this term. Women accounted for 28% of all the fatalities investigated in the study and 24% of those in addicts. More than 90% of the deaths were caused by drugs, with ethanol as a contributory factor in approximately 40% of cases. Deaths caused by heroin/morphine predominated, causing 50% of the deaths among drug addicts, but legal drugs, such as dextropropoxyphene, methadone and ketobemidone were also frequent causes of death in this group. In half the cases the concentration of morphine in blood following injection of heroin/morphine was found to be equal to or less than 0.5 mumol/kg, and in only about one-tenth of cases was the blood concentration above 2.0 mumol/kg.     

Fatal poisoning in drug addicts in the Nordic countries in 2007

The frequency of medico-legally examined fatal poisonings in 2007 among drug addicts was investigated in five Nordic countries; Denmark, Finland, Iceland, Norway, and Sweden. The number of deaths, age, sex, place of death, main intoxicant, and other drugs present in blood samples were recorded to obtain national and comparable Nordic data, as well as data to compare with earlier studies in 2002, 1997, and 1991. Norway had the highest incidence of drug addict deaths by poisoning followed by Denmark, with 8.24 and 6.92 per 100,000 inhabitants, respectively. The death rates in Finland (4.02), Iceland (4.56), and Sweden (3.53) were about half that of Norway and Denmark. Compared with earlier studies, the death rates were unchanged in Denmark and Norway, but increased in Finland, Iceland, and Sweden. In all countries, fewer deaths (29-35%) were recorded in the capital area compared with earlier studies. Females accounted for 11-19% of the fatal poisonings. Iceland deviates with a more equal distribution between men and women (40%). Deaths from methadone overdoses increased in all Nordic countries, and methadone was the main intoxicant in Denmark in 2007, accounting for 51% of the poisonings. In Norway and Sweden, heroin/morphine was still the main intoxicant with a frequency of 68% and 48%, respectively. In Iceland, 3 deaths each were due to heroin/morphine and methadone, respectively. Finland differs from other Nordic countries in having a high number of poisonings caused by buprenorphine and very few caused by heroin/morphine. The total number of buprenorphine deaths in Finland doubled from 16 in 2002 to 32 in 2007, where it constituted 25% of deaths. The general toxicological screening program showed widespread multi-drug use in all countries. The median number of drugs per case varied from 3 to 5. The most frequently detected substances were heroin/morphine, methadone, buprenorphine, tramadol, amphetamine, cocaine, tetrahydrocannabinol, benzodiazepines and ethanol.     

Determination of total hemoglobin in forensic blood samples with special reference to carboxyhemoglobin analysis

For the determination of total hemoglobin (Hb) in blood containing elevated carboxyhemoglobin (COHb), a newly developed reagent containing a 100-fold concentration of ferricyanide (20 g/l) and a 2-fold concentration of Sterox SE was compared with a standard reagent (0.2 g/l ferricyanide), the reagent of van Kampen and Zijlstra, using forensic blood samples and experimentally heated blood samples. There were no significant differences between the spectra of hemiglobincyanide (HiCN) solution produced with our reagent and the van Kampen and Zijlstra reagent using experimentally heated blood samples. Although the spectra of HiCN changed gradually with increased heating time and with the passage of time after mixing, the absorbance at 540 nm (A540) did not change until at least 120 min for both the reagents. When forensic blood samples containing elevated COHb were mixed with the van Kampen and Zijlstra reagent, total-Hb concentrations determined 5 min after mixing were 10-20% higher than those determined after 180 min. The overestimates of total Hb determined after 5 min resulted in comparable underestimates of percentage saturation of COHb (COHb%) when COHb% was obtained from the ratio of COHb content, determined by gas chromatogrpahy, to total-Hb concentration in blood. However, there was an extremely good correlation between the values of total Hb in forensic blood samples determined with the van Kampen and Zijlstra reagent after 180 min and those determined with our reagent after 5 min. From the results obtained, our reagent proved to be suitable for the determination of total Hb in forensic science practice.     

Evaluation of sudden death in psychiatric patients with special reference to phenothiazine therapy: forensic pathology

The investigation of sudden unexpected death in psychiatric patients and the ensuing litigation has brought to our attention many unusual features important in the evaluation of such deaths. Certain pathophysiologic mechanisms of death, rarely encountered in routine forensic science practice, may be important in determining the cause of death in psychiatric patients, especially in cases where the autopsy is unrevealing. Of particular concern is a tendency in the current literature to implicate phenothiazines as a cause of death when the death investigation and the autopsies are incomplete. Thus, based on our experience and on a review of the current literature, we have set forth factors that the forensic pathologist should consider when faced with a sudden psychiatric death. A case report illustrates these unique aspects of scene investigation and analysis of terminal events and autopsy findings.     

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.     

A method for investigating specialised accidents with special reference to diving

This paper describes a format for the investigation of complicated accidents which result in diving deaths. It emphasises the necessity for communication between technical, medical and legal personnel to arrive at a reasoned appreciation of factors leading to an accident. Properly applied this can result in a meaningful accumulation of data, which can be periodically analysed and be used in formulating Regulations for prevention of further accidents.     

Contacts with public services, with special reference to mental health care, preceding a serious crime: a retrospective study of 268 subjects of forensic psychiatric investigations

Between July 1995 and June 1996, 533 subjects underwent forensic psychiatric investigation I Sweden. Odd case numbers (n = 268) were included in the study. Of these 268 people, 50% had been in contact with psychiatric services during the six-month period preceding the crime leading to forensic psychiatric assessment. Contacts with psychiatric services during the six-month period preceding the crime were significantly more common in three categories of individuals than others. These were: women, individuals who were diagnosed as having a psychotic disorder during the forensic psychiatric investigation, and individuals found to suffer from a serious mental disorder as defined in the legislation. Subjects who were found not to suffer from a serious mental disorder and were thus not eligible for special sanctions on medicolegal grounds had significantly less psychiatric contacts before the crime, as did subjects under 20 years of age. However, these two groups still had considerably more psychiatric contacts than the general population. The present results suggest that the patient category studied requires special monitoring and case management in general psychiatry in Sweden. To this end, we call for closer studies of high-risk individuals, particularly of previously violent offenders and potentially violent offenders, and closer studies of their psychiatric contacts. This will provide a basis for the development of adequate programs and guidelines for effective care and treatment within the psychiatric sector.     

Fatal air embolism in diving. A morphologic study

Two cases of barotrauma as a result of excess pulmonary pressure with subsequent air embolism are reported. Both cases involved serious diving safety errors. The morphology of this type of barotrauma is described, with particular reference to the etiology of the phenomena involved. Some specific points regarding the autopsy procedure in connection with such diving accidents are discussed.     

The problem of interviewing drug addicts in custody: A study of interrogative suggestibility and compliance

Abstract

The interrogation of drug addicts in custody presents a problem. The reliability of confessions made either under the influence of drugs or during drug withdrawal may be adversely affected. This study explores the effect of drug use and drug withdrawal on interrogative suggestibility and compliance. These two psychological factors are relevant to erroneous testimony. The interrogative suggestibility and compliance of heroin addicts on an inpatient drug unit were measured on opiates, whilst withdrawing from opiates and drug free. The interrogative suggestibility and compliance of the group of subjects as a whole did not differ significantly in these three conditions. However the results did suggest that a subgroup of vulnerable individuals may have been more suggestible when under the influence of opiates. Further work is needed to clarify these results and to aid professionals assessing fitness for interview and cases of retracted confessions.     

A study of the precursors, intermediates and reaction by-products in the synthesis of 3,4-methylenedioxymethylamphetamine and its application to forensic drug analysis

3,4-Methylenedioxymethylamphetamine (MDMA) was prepared by three synthetic routes. Analytical data from thin-layer chromatography, gas chromatography and gas chromatographymass spectrometry of the precursors (safrole and isosafrole), intermediates (isosafrole glycol, piperonylmethylketone, N-formyl-3,4-methylenedioxymethylamphetamine, N-formyl-3,4-methylenedioxyamphetamine and 1-(3,4-methylenedioxyphenyl)-2-bromopropane), reaction by-products and the product MDMA were obtained. Further analyses of MDMA using other techniques including ¹H- and ¹³C-nuclear magnetic resonance spectroscopy, X-ray diffraction, infrared spectroscopy, ultraviolet spectroscopy and high performance liquid chromatography were also carried out. The results were then used as reference data for the identification of MDMA in case samples and also to establish the route of synthesis of illicity prepared MDMA by the study of trace impurities.     

酒精相关违法行为的犯罪学特点分析

目的探讨法医精神病学鉴定中两种酒精相关违法行为的犯罪学特征。方法采用自行编制的法医精神病学鉴定案例登记表,对符合本研究纳入标准的90名被鉴定人分为普通醉酒(63例)和慢性酒精中毒(27例)两组,采用统计描述和对照研究的方法进行分析。结果普通醉酒组54.0%的案前有诱发事件,慢性酒精中毒组案前有诱发事件的为22.2%;58.7%普通醉酒组作案是临时确定的作案动机,55.6%慢性酒精中毒组无明显的作案动机;66.6%普通醉酒组是临时确定的作案目标,51.8%慢性酒精中毒组无明确的作案目标。普通醉酒组19.0%对作案时间做出了选择,慢性酒精中毒组织有3.7%选择了作案时间;普通醉酒组61.9%的案后有一定的反侦查手段,慢性酒精中毒组则是有59.3%案后停留现场。普通醉酒组98.4%被评为有刑事责任能力,慢性酒精中毒组仅3.7%被评为有刑事责任能力。结论普通醉酒组案前有诱发事件和作案动机的要高于慢性酒精中毒组,慢性酒精中毒组在案中和案后更多地缺乏自我保护意识。普通醉酒组更多地被评为有刑事责任能力,慢性酒精中毒组则多被评为部分刑事责任能力或无刑事责任能力。     

Racial identification from the midfacial skeleton with special reference to American Indians and whites

Successful approaches to race determination of unidentified human remains have been developed by anatomists and physical anthropologists, but few quantitative methods are available for distinguishing American Indian crania from those of whites. The leading method in use today is particularly ineffective in its placement of American Indian skulls from the western regions of the United States. Recent development and testing of a new metric method suggests a much more effective technique. The method involves six breadth and projection measurements of the midfacial skeleton, the calculation of three indices, and a simple direct reading of results. The method has the additional advantage of use in the autopsy room with minimal dissection of soft tissue required. Based upon a less extensive test of East Asian and Arctic Mongoloid crania, the method appears to be even more effective in separating them from the sharp featured whites. Larger samples of American blacks and Polynesians are presently under study and these also appear to separate quite readily from whites using the same or similar sectioning values.     

Offender characteristics in lethal violence with special reference to antisocial and autistic personality traits

The objective of the study is to assess the relationships between personality traits, lifetime psychosocial functioning, and crime scene behavior. Thirty-five male offenders referred for forensic psychiatric assessment in Sweden (1996-2001) and assigned a main diagnosis of either antisocial personality disorder (APD) or autism spectrum disorder (AUT) were retrospectively studied. APD were subcategorized into impulsive (APDi) and controlled (APDc). Those in the AUT group were less intoxicated at the time of the crime and did not often use knives or guns compared to the APD group. Males in the APDi group were older and had a higher proportion of abuse of alcohol and drugs in biological parents, physical abuse during childhood, psychiatric contacts, and suicide attempts compared to the APDc group. In the APDi group, knives were used in the homicide compared to the use of guns in the APDc group. The results suggest differences in psychosocial functioning and crime scene characteristics related to personality traits.     

A statistical approach to drug sampling: a case study.

In many countries it is left to the discretion of the court to accept or reject conclusions based on sampling procedures as applied to the total drug exhibit. As an alternative to this subjective approach, a statistical basis is presented using binomial and hypergeometric distributions to determine a lower limit for the proportion of units in a population which contains a drug, at a given confidence level. A method for calculating the total weight of a drug present in a population within a given confidence interval is also presented. In the event of no failures (all units sampled contain a drug), a sample size of six or seven units is generally sufficient to state that a proportion of at least 0.70 of the population contains a drug at a confidence level of at least 90%. When failures do occur in the sample, point estimation is used as the basis for selecting the appropriate sample size.     

Drug abuse in western Denmark during the eighties. II. Fatal poisonings among drug abusers.

Cases of fatal poisoning among drug addicts (n = 246) and abusers of medical drugs (n = 138) are discussed on the basis of the availability of illicit and medical drugs during the eighties. Propoxyphene was frequently the cause of death among both drug addicts and abusers of medical drugs. Deaths caused by analgesics and psychoactive drugs, mainly barbiturates and antidepressants, predominated among abusers of medical drugs. During the late eighties the number of deaths caused by barbiturates and propoxyphene declined as a result of changes in the distribution regulations for both drugs. Heroin/morphine accounted for only one-third of the poisonings in drug addicts. No trends concerning the prevalence of deaths caused by these drugs were observed throughout the decade. The number of deaths caused by the synthetic opiates methadone and ketobemidone, however, increased during the late eighties, probably due to an increased availability of these drugs in the illicit drug market. Alcohol was detected in half of all the poisoning cases and benzodiazepines in one-third.     

Examples for use of the STR systems in stain assessment with special reference to Y chromosome systems

The authors describe 3 cases where Y-chromosomal systems were used for typing the biological traces. In the first case, a murder, for the major amount of cell material found on a dish towel (and analysed two years after the crime) female persons were excluded for the system amelogenin and Y-chromosomal systems. A brother of the victim could not be excluded for autosomal STR-systems. Upon confrontation with the results of the DNA-analysis (among other things), this brother confessed the murder of his sister some days later. He was found guilty by the court. In the second case described, a rape of two girls, many traces were analysed parallely with Y-chromosomal and autosomal PCR-systems. The objects where male DNA matching the suspect were found (a paper tissue, a sweat shirt and the knickers of the girls), also showed small amounts of alleles matching with the suspect for autosomal systems, while the major part in these systems was from the girls. The suspect was sentenced to many years imprisonment. In the third case, a possible rape of a young woman, a stained microscope slide of a vaginal swab had to be examined. Microscopically a few sperm heads could be seen in a surplus of leucocytes. The male proportion could be analysed only in the Y-chromosomal systems, not in the autosomal ones. For the frequency calculation of the Y-chromosomal allele combination the haplotype data bank of the Institute for Legal Medicine of the Humboldt university in Berlin was indispensable.