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Drugfacilitated Sexual Crime by Use of Ketamine and Diazepam by A

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Drugfacilitated Sexual Crime by Use of Ketamine and Diazepam by A Drug Testing Correspondence case report and Analysis Received: 30 January 2013 Revised: 19 July 2013 Accepted: 22 August 2013 Published online in Wiley Online Library (www.drugtestinganalysis.com) DOI 10.1002/dta.1554 Drug-facilitated sexual crime by use of ketamine and diazepam by a gynaecologist Sarah M. R. Wille,*† Vincent Di Fazio† and Nele Samyn Introduction as contraception. On the day of the alleged incident, she was alone in his office. During the procedure she felt enormous pain due to Drug facilitated crimes (DFCs) can be defined as criminal acts carried an injection in the fold of her elbow. She lost consciousness for a out by means of administering a substance to a person with the while and when she regained it, she felt a second injection from intention of impairing behaviour, perceptions, or decision-making which she collapsed again. When she awoke she noticed that the capacity. It also extends to taking advantage of an impaired person gynaecologist was touching her intimately. The doctor was very after voluntary intake of an incapacitating substance. Crimes include nervous when he noticed that she was awake. She started robbery, money extortion, and maltreatment of the elderly, children, vomiting and only after he had cleaned up the office did he let or mentally ill patients.[1] Rape or other types of sexual assault are her contact her boyfriend. While the doctor insisted that she referred to as drug facilitated sexual assault (DFSA). In DFSA cases, stayed for observation, the couple left the medical centre about the victim is subjected to a sexual act without legal consent as a an hour after the young woman had entered. The next morning, result of the pharmacological effects of alcohol and/or drug(s). the victim went to the police to press charges for sexual assault. A large number of psychoactive substances have the potential to Physical examination of the victim by a medical doctor revealed alter the victim’s state of mind, alcohol being the number one the presence of two injection marks in her arm fold. Blood and candidate because of its widespread use.[2] Illicit drugs, psychoactive urine samples for genetic and toxicological analysis were collected prescription drugs and even over-the-counter medicines are also between 9:30 PM and 11:15 PM, while the alleged assault was es- likely candidates, either consumed alone or in combination with alcohol. timated to have occurred between 4:00 PM and 5:00 PM the day The resulting pharmacological effects may include relaxation, before. The evidence for genetic analysis was stored without fur- euphoria, and lack of inhibition on the one hand and drowsiness, loss ther analysis since the declarations of the victim did not indicate of motor function, unconsciousness, and amnesia on the other hand. that sexual contact had occurred. No medication or drug use oc- Information on the frequency of DFC cases is scarce but there has curred in the week before the sampling according to the victim. been a significant increase in reports worldwide. However, several factors complicate the registration of the actual number of DFSA cases. Governmental statistics show a general underreporting of Materials and methods sexualassaultcrimes.Theimpactthatcentralnervoussystem depressant drugs have on memory and consciousness might lead Sexual aggression set (SAS) to a situation where the victim is not able to remember what has The SAS used in this case has been developed by our institute to actually happened and chooses not to report the incident. If the inci- harmonize the approach in cases of sexual assault, to provide a dent is reported, police officers often assume that the victim was rapid and standardized evidence collection, and to provide tools simply drunk rather than drugged. If an investigation is initiated, for professional support for the victim. Sets are distributed to the delay between the collection of biological evidence and the pathologists or medical doctors working in a hospital that have alleged assault can be between several hours and more than a day. signed a protocol of collaboration with the local judicial authority. This case report describes a DFSA case in a medical setting: a They contain material for the medical doctor for sampling (24 gynaecologist was suspected of assaulting a young patient after ‘steps’), manuals for the police officer and the health professional, drug administration. In the presented case, the time delay between a medical report and questionnaire and material (e.g. disposable the alleged assault and the sampling was 30 h. Evidence collection clothing), and information for the victim. Each SAS has a unique via a standardized sampling kit and the choice of sample in such ID number that is used by the police in their report; all 24 ‘steps’ cases is discussed. The analytical strategy is described with regard are sub-numbered and no name is mentioned on these items. to the choice of methods, uncertainty measurement, and limita- Immediately after use, the set is sealed by the police officer and tions of the methods which are important during interpretation sent to the laboratory as soon as possible, preferably within 24 h. of the analytical results. Finally, interpretation of this specificcase, but also interpretation issues of DFSA cases in general, is discussed. * Correspondence to: Sarah Wille, National Institute of Criminalistics and Crim- inology, Laboratory of Toxicology, Vilvoordsesteenweg 100, 1120 Brussels, Case history Belgium. E-mail: [email protected] † These authors contributed equally to this work A young woman of 29 was searching for a gynaecologist via the Internet. After about five consultations at that gynaecologist’s National Institute of Criminalistics and Criminology, Laboratory of Toxicology, practice, she asked the physician to place an intra-uterine device Vilvoordsesteenweg 100, 1120 Brussels, Belgium Drug Test. Analysis (2013) Copyright © 2013 John Wiley & Sons, Ltd. Drug Testing and Analysis S. M. R. Wille, V. Di Fazio and N. Samyn In addition to evidence seals for genetic analysis, a urine per min. Total run time was 28.5 min for one run. The Automated sample and two 5-ml blood tubes with sodium fluoride and Mass Spectrometry Deconvolution and Identification System potassium oxalate as anticoagulant are provided for toxicologi- (AMDIS) permitted the search in different published mass spectral cal analysis. The questionnaire contains information on the date libraries (MPW, Wiley-VCH, 2011; NIST 05, Agilent Technologies, and time of collection, the date and time of the alleged assault, 2008; RTL 01.00, Agilent Technologies; DD2011, Wiley-VCH, 2011) the date and time of the last consented sexual relations, and together with a ‘home made’ library. One ml of blood sample was the use of alcohol, drugs and medication in the week before also screened using an HPLC-DAD method as published by Herzler the assault. et al.[3] using a UV library of 2682 compounds. The chromatographic system consisted of a reversed-phase Lichrospher-RP8ec column (5 μM, 250 x 4.0 mm) in a HP 1100 Series (Agilent Technologies, Santa Screening techniques Clara, CA, USA) HPLC-DAD. Two different chromatographic screening techniques for urine or blood were applied: a gas chromatography–mass spectrometric Target techniques (GC-MS) method and a high performance liquid chromatography (HPLC) method combined with a diode-array detector (DAD) (Agilent The methods used for target quantification in urine and blood are Technologies, Santa Clara, CA, USA). The sample preparation step of described in the literature.[4–12] The applied method to detect the GC-MS screening comprised an enzymatic hydrolysis of 2 ml of benzodiazepines and their metabolites as well as several hypnotics urine using β-glucuronidase obtained from Helix pomatia (Sigma in blood and urine is described by our research group.[7] However, Aldrich, St Louis, MO, USA) or 500 μl of whole blood and a liquid- the HPLC method was transferred to a UPLC method. Twenty tree liquid extraction (LLE) using Toxitube A (Varian, Palo Alto, CA, USA). compounds were detected using an Acquity UPLC coupled to a An internal standard (IS) prazepam (400 ng/ml, LGC Standards, Quattro premier XE Mass spectrometer (Waters, Milford, MA, USA). Teddington, UK) and an external standard SKF-525 (proadifen, Sigma An LLE using chlorobutane after alkalization of the sample was Aldrich, St Louis, MO, USA) were used. The organic phase was applied for 250 μl of blood and 200 μl of hydrolyzed urine using evaporated and reconstituted in 50 μl of anhydric ethylacetate. β-glucuronidase (Helix pomatia, Sigma Aldrich, St Louis, MO, USA). One μl was injected in splitless mode onto the 6890 GC- 5973N MS The limit of quantification (LLOQ) of diazepam, nordiazepam and from Agilent Technologies (Santa Clara, CA, USA). After injection, temazepam were 10 ng/ml and 1 ng/ml in urine and blood, respec- the organic phase was acetylated using acetic anhydride and pyri- tively. The uncertainty measurement (U) was determined to be 10%. dine and injected again. Chromatographic separation occurred on Ketamine and its metabolites were quantified in urine and blood a DB-5MS (0.2 μm, 30 m x 0.250 mm) column (Agilent according to the method published by Ramirez-Fernandezetal.[11] Technologies, Santa Clara, CA, USA) and the temperature program An SPE using Oasis MCX cadriges (Waters, Milford, MA, USA) was was as follows: 100 °C (1 min) to 325°Cwithanincreaseof10°C applied to extract 500 μl of sample after acidification. A Sunfire Figure 1. Multiple Reaction Monitoring chromatograms of diazepam (28 ng/ml), nordiazepam (8 ng/ml) and temazepam (2 ng/ml) in the blood sam- ple. Deuterated analogues (d-5) were used as IS at a concentration of 80 ng/ml. wileyonlinelibrary.com/journal/dta Copyright © 2013 John Wiley & Sons, Ltd. Drug Test. Analysis (2013) Drug Testing Drug facilitated sexual crime by use of ketamine and diazepam by a gynaecologist and Analysis Figure 1.
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