Lárez A.( l ), Henríquez E.{2), Bol años A.1*', Valles A.0 ), Carrasquel J.( l ), Cheng B.m, Colina J.( 1 ) (1) Universidad Central de Venezuela
(2) Ministerio de Justicia, Venezuela (3) Universidad de Carabobo, Venezuela
(under the whole responsability of the authors)
The present study is based in the quali-quantitative investigation of cocaine in urine and pubis hair of 6 masculine patients under ambulatory treatment in the José Félix Rivas Foundation of the Aragua State, using for it, in the case of the urine sample, the Inmunoassay technique of Polarized Fluorescence, and in the sample of pubic hair, that of Ultraviolet Spectrophotometry (U.V.) and that of Gas Chromatography, integrated with the Mass Spectrometry (CG-MS) technique. The results were negative for the urine and positive for the pubic hair, in the spectrum and value of the Ultraviolet absorbance to the wave longitude of 233 nm. referred to a standard of cocaine of 20 p.p.m.. and with the time of retention and structural spectrum provided by the Gas Chromatography and Mass Spectrometry, corroborated equally with the Standard one signal. The quantitative investigation, was executed with the Ultraviolet Spectrophotometry technique, being expressed the values in range between 11,71 and 45.92 p.p.m. /100 mg in pubic hair with standard deviation between 0.78 and 2.03.
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Forensic cases involving the use of GHB in the Netherlands
Lusthof K.J., Smink B.E., Bosnian I.J.Netherlands' Forensic Institute, Dept. Toxicology, P.O.Box 3110, 2280 GC, Rijswijk, The Netherlands GHB (Gamma Hydroxy Butyric Acid) is a compound, that has gained increasing popularity as a drug of abuse. Next to its euphoric effects, it is also used by body builders to increase muscle mass; it is also said to increase sexual pleasure. Historically, GHB was used as an anaesthetic and as a treatment for narcolep-sy and alcoholism. The central depressant activity of GHB is probably narcolep-synergistic with that of other cen-tral depressant drugs, such as alcohol, opiates, methadone and benzodiazepines. Many cases have been published in the literature on hospitalization and even death after the use of GHB. The analysis of GHB after exogenous intake or administration can be difficult. GHB levels in blood or urine may be low when the time interval between administration en sampling is longer than 6, resp. 12 hours. This is caused by a short half-life and extensive metabolism. Another problem is the apparent formation of GHB in blood tubes containing citrate solution, as well as in post mortem material. Finally, GHB levels in blank urine may be up to 10 mg/L or more, due to endogenous production. The specificity of the analysis may be a problem due to the low molecular mass of GHB. As GHB is not routinely found in systematical toxicolo-gical analyses, a specific analysis, usually involving lactone formation or derivatization, is required. As a result, many cases involving GHB may be missed by hospitals and forensic institutes.
From the second half of 1999 through the first half of 2001, the department of Toxicology from the Netherlands* Forensic Institute found 30 biological samples positive on GHB (blood positive or urine > 3 mg/1). Analysis of GHB was initiated because of specific information from the police, or when the suspect was drowsy and medication was not found.
In many more cases, only non-biological samples were presented to our lab (bottles, ampoules, tablets, etc). The toxicological results of the biological samples were as follows:
In cases of an unknown cause of death (n=12), GHB concentrations in post mortem blood ranged from 6-40 mg/1. Three other cases were body builders, who died unexpectedly. In three cases, a contribution of GHB to the death could be excluded. The range of 6-40 mg/1 covers effects like drowsiness, but not serious toxicity of GHB. The contribution of GHB to the death of the victims remains unclear.
In cases of driving under the influence of alcohol and/or drugs (n=9), GHB concentrations in blood (n=7) ranged from 22-194 mg/1 and in urine (n=2) from 100-732 mg/1. High concentrations of GHB correspon-ded with observations of extreme sleepiness or temporary loss of conscience. Indications for the use of GHB were generally obtained after questioning the driver, or by the presence of bottles in the car. In cases of supposed chemical submission (n=9), 4 urine samples contained very low GHB concentrations, around 4 mg/1. After considering the circumstances and the analytical results, two cases were concluded to invol-ve drugging by using GHB; concentrations in blood were 13 and 251 mg/I. In three cases of violent death with possible drugging, GHB concentrations in post mortem blood ranged from 10-29 mg/1. The role of GHB in these cases remains unclear.
In conclusion, the data show that GHB is used in the Netherlands in traffic and in cases of chemical sub-mission. However, the incidence cannot be concluded from the toxicological data, as this seriously unde-restimates the use of GHB. The role of GHB in fatal cases remains unclear; more research into "back-ground" concentrations of GHB in post mortem material is required. In cases of chemical submission, urine should be analyzed, because GHB is longer present in urine than in blood. The police should be informed that the urine sample should be collected in a vessel that does not contain a citrate solution.
Annales de Toxicologie Analytique, vol. XIV, n° 3, 2002
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Medicolegal problems in Germany related to the substitution with methadone
Musshoff F . Laehenmeier D.W, Madea B.Institute of Legal Medicine, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
In Germany methadone substitution of heroine abusers has arisen during the last years and resulted in various medicolegal problems, mainly concerning methadone-related fatalities, or the prescription of methadone and criminal prosecution concerning physicians, as well as the problem of driving under the influence of methadone.
A substantial number of patients died within days of entering a methadone maintenance program.
Otherwise, after a relaxing of regulations concerning the so-called take-home prescription rules an increa-se of methadone available on the black market was obincrea-served. In some areas there are more methadone-related fatalities than to heroine abuse, and mainly persons who are not patients in an official maintenan-ce program were involved.
In Germany the prescription of narcotic agents which are used for substitution is legal according to the acknowledged rules of medical art and the guidelines of the law. Any unauthorised prescription to patients, with the risk of uncontrolled or unsupervised intake or handing over are treated as circumstantial eviden-ce that one is dealing not with a legal prescription but a punishable act of gaining. There are a lot of cases against physicians who were sentenced for offences against prescription rules concerning methadone, for some part in coincidence with physical injury. Some examples are given.
With the rising numbers of methadone-substituted drug users more persons who take part in motorized traffic under the influence of methadone were found. In the years 1997 to June 2001, in the Bonn area we found methadone in the blood of road users in 125 cases. In only five cases methadone was the only intoxi-cating agent, in most of the cases one up to five additional drugs were found. The most common of these were benzodiazepines (in 60 % of the cases), followed by morphine (40 %), alcohol (37 %), cannabinoids (31 %), cocaine (30 %), anti-depressants (4 %), and amphetamines (1 %). In more than 70 % of the cases, substitution was performed under the supervision of a physician. The question arises to what extent the guidelines for the test of fitness to obtain a driver's licence are being followed. This suggests that the per-mission may be given after a successful methadone substitution of at least one year. Additional drug abuse must be excluded. Self-responsibility, therapeutic compliance as well as exclusion of personality disorders have to be proved.
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Simultaneous screening and quantitation of 39 drugs in blood by GC-MS
Mykkanen S.. Gunnar T., Ariniemi K., Lillsunde P.National Public Health Institute, Laboratory of Substance Abuse. Mannerheimintie 166, FIN-00300 Helsinki, Finland
A rapid GC-MS method is presented for the simultaneous screening and quantitation of 39 different drugs in blood.
The method includes e.g. benzodiazepines, opiates, cannabinoids and tricyclic antidepressants. The sample treatment involved liquid-liquid extraction followed by silylation as a derivatization technique.
Screening and quantitation were performed by Agilent Network GC-MS 6890/5973 with HP 35 % PH ME siloxane column in SIM mode.
Apart from large variety of different kind of substances and low detection limits, the method showed in validation tests good reliability at the relevant concentrations. The linearity varied between 2- 20000 ng/ml depending on the typical concentration levels found in blood. The limits of quantitation were 2-2000 ng/ml. The intra-assay relative standard deviations were 2,3 - 22,2 % and the inaccuracy 0,04- 44,7 % on cutt-off levels.
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