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Agressions Sexuelles Et Toxicologie

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Agressions Sexuelles Et Toxicologie Agressions Sexuelles et Toxicologie Service de Toxicologie du Laboratoire de Sciences Judiciaires et de Médecine Légale (LSJML) Présenté par : Anne-Marie Faucher et Pascal Mireault Avec la participation de: Ariane Adam-Poupart Définitions AGRESSION SEXUELLE AVEC SOUMISSION CHIMIQUE: Le terme soumission chimique s’applique lorsqu’une drogue/substance est administrée dans le but d’altérer le comportement d’une victime en la rendant passive, soumise. LES DROGUES DU VIOL : Substance qui invalide un individu pour un certain laps de temps et peut causer une perte de mémoire. Ces drogues augmentent la vulnérabilité d’une personne à une agression sexuelle. Définitions BLACK-OUT: Épisode d’amnésie qui n’est pas accompagné d’une perte de conscience. L’individu expérimentant un black-out peut s’exprimer de façon rationnelle et semble avoir des comportements normaux; toutefois, il est incapable d’enregistrer des informations . Prédisposition variable d’une personne à l’autre. INTOXICATION: Épisode suivant l’administration d’une substance qui résulte en des perturbations graves du comportement. À titre d’exemple, une intoxication à l’alcool peut induire une perte des fonctions motrices, une baisse évidente des réponses aux stimuli, des vomissements, de l’incontinence et peut entraîner un coma. PRINCIPAUX AMNÉSIANTS, SÉDATIFS OU HYPNOTIQUES* Durée Détection Drogue Présentation Dose (mg) d’action Sang Urine Éthanol Liquide (Bière, Vin, etc.) >1ml/Kg Variable Variable Variable GHB (gamma Poudre ou comprimé blanc, >500 mg 15 min- 4 h 8 h 12-48 h hydroxybutyrique) liquide transparent Flunitrazépam 30 min- Comprimé blanc ou bleu 1-2 mg 12 h 48-72 h (Rohypnol) 12 h 30 min- Triazolam (Halcion) Comprimé violet, bleu 0.125 - 0.25 mg 6 h 24 h 6 h Lorazépam (Ativan) Comprimé blanc 0.5 – 2 mg 1-8 h 24 h 72 h 30 min – Alprazolam (Xanax) Comprimé blanc, pêche, lavande 0.25 – 2 mg 24 h 72 h 7h 20 min – Diazépam (Valium) Comprimé jaune, bleu 5 – 10 mg 72 h > 3 jours 7 h Chlordiazépam Capsule jaune/verte, noire/verte, 5 – 25 mg 1 – 8 h 48 h > 3 jours (Librium) blanche/verte * Ce tableau est à titre indicatif et doit être évalué dans le contexte de l’agression. PRINCIPAUX AMNÉSIANTS, SÉDATIFS OU HYPNOTIQUES* Détection Drogue Présentation Dose (mg) Durée d’action Sang Urine Capsule rouge foncé/ Témazépam (Restoril) 15-30 1-8 h 48 h 3 jours clair, rouge foncé/bleu Comprimé jaune pâle, Clonazépam (Rivotril) 0.05-2 1-12 h 48 h > 3 jours blanc Bromazépam Comprimé blanc, rose, 1.5-6 1-8 h 48 h 3 jous (Lectopam) vert-jaune Capsule orange/ivoire, > 3 jours Flurazépam (Dalmane) 15-30 1-6 h 72 h rouge/ivoire Comprimé jaune pâle, > 3 jours Oxazépam (Sérax) 10-30 1-8 h 48 h pêche > 3 jours Nitrazépam (Mogadon) Comprimé blanc 5-10 1-20 h 72 h Diphenhydramine > 3 jours Comprimé, capsule, sirop 50-100 1-7 h 24 h (Nytol, Gravol, etc.) Hydrate de Chloral > 2 jours Capsule verte, sirop 500 1-8 h >12 h (Noctec) > 12 jours Zopiclone (Imovane) Comprimé blanc, bleu 5-7.5 1-8 h >10 h Barbituriques (Amytal, Comprimé, capsule, > 2 jours 15-100 3-12 h >24 h Butisol, Seconal, etc.) liquide * Ce tableau est à titre indicatif et doit être évalué dans le contexte de l’agression. Notions de Toxicologie Les effets d’une drogue et leur durée varient en fonction: • La dose absorbée • La voie d’absorption • L’individu (état psychologique et psychologique) • La présence ou de l’absence d’autres substances • Les circonstances qui entourent la consommation La période de détection d’une drogue et/ou ses métabolites dans les matrices biologiques variera selon: • La drogue et la dose absorbée • La méthode d’analyse • L’individu (sexe, masse corporelle, métabolisme, etc) Survol des principales caractéristiques 1) ALCOOL 2) BENZODIAZÉPINES 3) GHB/GBL (acide hydroxy-4-butanoïque) 4) CANNABIS (THC) 5) AMPHÉTAMINES L’ALCOOL L’alcool est une des substances le plus fréquemment retrouvée dans les dossiers d’agressions sexuelles 21% des cas en 2007 étaient positifs en alcool Alcoolémie (mg%) Effets 50 Désinhibition, jugement altéré 100 Coordination et motricité réduite 150 Trouble d’élocution, perte de mémoire Vomissements, incapacité à rester 250 debout 350 Coma 500 Décès L’ALCOOL Calcul de l’alcoolémie au moment de l’agression: Alcoolémie au = (Délai X élimination ) + Résultat moment de l’agression = (Délai X élimination ) + Résultat Délai = Nombres d’heures entre l’agression et le prélèvement Élimination = Taux d’élimination moyen de l’alcool ( 15 mg % / heure) Résultat = Alcoolémie au moment du prélèvement (rapport toxicologique) L’ALCOOL Mise en situation Une victime indique que l’agression sexuelle a eu lieu vers 23h30 le 21 septembre. Les prélèvements biologiques (sang et urine) ont été effectués le 22 septembre à 04h30. Le rapport de toxicologie indique que le taux d’alcoolémie est de 70 mg %. Quelle est l’alcoolémie au moment de l’agression? Alcoolémie au moment de l’agression = (Délai X Élimination) + Résultat Alcoolémie au moment de l’agression = ( X 15 ) + Alcoolémie au moment de l’agression = ( 5 X 15 ) + 70 Alcoolémie au moment de l’agression = 145 mg % LES BENZODIAZÉPINES Qu’est-ce qu’une Benzodiazépine? • Famille de substances prescrites pour le traitement de l’anxiété, de la nervosité, de l’insomnie ou de l’épilepsie •Substances sédatives les plus prescrites à travers le monde •Fréquemment impliquées lors agressions sexuelles avec soumission chimique Effets indésirables: •Incoordination des mouvements, étourdissements, vertiges, somnolence •Peut causer des black-out • Augmentation des effets avec l’alcool LES BENZODIAZÉPINES LSJML (2005-2007) • Benzodiazépines retrouvées dans •Alprazolam (Xanax®) environ 11 % des dossiers analysés. •Bromazépam (Lectopam®) •Chlordiazépoxide (Librium®) • En 2006: 2 cas de soumission chimique confirmée à l’aide de •Clobazam (Frisium®) Benzodiazépines •Clonazépam (Rivotril®) •Diazépam (Valium®) • En 2007: ATIVAN impliqué •Flurazépam (Dalmane ®) dans un cas de soumission chimique et un dossier de vol •Lorazépam (Ativan®) suite à l’administration de •Midazolam (Versed®) substance soporifique. •Nitrazolam (Mogadon®) •Oxazépam (Serax®) •Témazépam (Restoril®) •Triazolam (Halcion®) GHB (Acide hydroxy-4-butanoïque) Qu’est-ce que le GHB? • Substance endogène chez les mammifères (faible concentration). • Substance qui peut être synthétisée à partir du GBL (solvant industriel) Utilisation: • Médicale: Anesthésiant, étude sur le sommeil, cure de désintoxication, narcolepsie, etc. Il n’y a aucune utilisation médicale du GHB au Canada. • Récréationnelle: Culturisme (stimule l’hormone de croissance dans le but d’accroître la masse musculaire et pour augmenter le métabolisme des graisses), Rave, etc. • Sa vente est illégale. GHB (Acide gamma hydrobutyrique) Quels sont ses effets? • Similaires à ceux de l’alcool (euphorie, relaxation, ivresse, somnolence, inconscience, coma, etc) • Amnésie possible mais non systématique Délai de détection: • Sang < 8 heures • Urine : 12 à 48 heures La détection est-elle possible en laboratoire? Le GHB a été détecté uniquement dans des cas de consommation volontaire • 9 cas d’agression sexuelles (dont un cas avec délai de 20 heures) • 9 cas de conduite avec facultés affaiblies • 5 cas autres (vol, décès, etc..) • 12 pièces (exhibit) CANNABIS Qu’est-ce que le Cannabis? • Marijuana (fleurs et feuilles) et Haschich (résine) sont des extraits du chanvre (cannabis sativa, india). • Le THC (tétrahydrocannabinol) est le principal agent psychoactif • Substance illégale la plus consommée au Canada • Est la substance la plus fréquemment retrouvée dans les agressions sexuelles en 2007 Utilisation: • Médicale: stimule l’appétit (SIDA), antiémétique (cancer), analgésique (migraine, etc) et relaxant musculaire (sclérose en plaques). Au Canada, 3 médicaments sont dérivés du cannabis : Marinol®, Sativex® et Cesamet ®. • Récréationnelle : pour ses effets euphorisants et relaxants CANNABIS Quels sont ses effets indésirables? • Altération de la perception du temps et de la vision; somnolence, confusion, trouble de la coordination des mouvements, anxiété et psychose, réactions de panique, hallucination. • Amplification des effets lorsque consommé avec de l’alcool. Délai de détection • Chez l’usager chronique: Détection des métabolites de THC plusieurs semaines après l’arrêt de la consommation • Exposition à la fumée secondaire : Peut induire des résultats positifs à des tests urinaires (inférieurs au seuil de dépistage) AMPHÉTAMINES Qu’est-ce que les amphétamines? • Ce sont des stimulants du système nerveux central, • Les plus connus sont : Amphétamine,MDMA, Méthamphétamine, Pseudoéphédrine, Méthylphénidate • Consommation est en croissance exponentielle depuis les 10 dernières années, • Fréquemment retrouvés dans les milieux biologiques des victimes d’agressions sexuelles Utilisation: 1) Médicale: Traitement de l’hyperactivité chez les enfants,de la narcolepsie,de l’obésité,de la congestion nasale, etc. Les applications médicales ont été interrompues en raison de la dépendance rapide et dangereuse observée chez les patients 2) Récréationnelle: Pour ses effets euphorisants; disparition de la fatigue; accroissement de la vivacité et du sentiment de bien-être, émotion de puissance et de supériorité. AMPHÉTAMINES Quels sont ses effets indésirables? • Perte d’appétit, insomnie, nausées, déshydratation, problème de coordination, maux de tête, contractions musculaires involontaires. Psychose, fatigue, dysphorie, irritabilité, hallucinations Syndrome de sevrage (crash) Délai de détection • Est généralement détectable pendant 2 à 4 jours suivant la consommation en fonction du type, de la quantité et de la période de consommation. .
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