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Saint-Sauveur-en-Rue, France

Pelissier-Alicot A.-L.,Aix - Marseille University | Sastre C.,Aix - Marseille University | Baillif-Couniou V.,Aix - Marseille University | Gaulier J.-M.,Limoges University Hospital Center | And 6 more authors.
International Journal of Legal Medicine | Year: 2010

The success of high-dose buprenorphine (HDB) as substitution therapy for major opioid dependence is related to its partial agonist effect on opioid receptors, which in theory makes it very safe to use. However, numerous deaths directly attributable to buprenorphine have been described in the literature. These deaths are generally related to misuse of HDB with intravenous administration and/or concomitant use of benzodiazepines, and they usually occur in patients on HDB substitution therapy for opioid dependence. We present three deaths attributed to HDB which arose from uncommon mechanisms and led to unusual forensic situations. The first death was that of a patient admitted to hospital after simultaneous prescription of HDB, clonazepam, oxazepam, and cyamemazine. The second death followed forcible administration of a very low dose of HDB to a patient with post-hepatitis C cirrhosis and heart failure. The third death was subsequent to an HDB overdose, probably with suicidal intent, in a young woman who had not been prescribed the drug as opiate substitute. Such deaths raise the question of the mechanisms involved and draw attention to the resulting unusual forensic situations. © Springer-Verlag 2010. Source

Sastre C.,Jean Moulin University Lyon 3 | Baillif-Couniou V.,Jean Moulin University Lyon 3 | Kintz P.,X Pertise Consulting | Cirimele V.,Laboratoire ChemTox | And 5 more authors.
Journal of Forensic Sciences | Year: 2013

Hydrogen sulfide (H2S) poisonings are classically reported in occupational settings. We describe an unusual domestic case of fatal acute poisoning by H2S inhalation. A mother and her infant daughter were found dead in the kitchen of their home. The emergency medical team described a strong smell of rotten eggs, suggesting acute H2S poisoning. Autopsies revealed only multiorgan congestion. H2S was measured in blood and lung tissue samples by gas chromatography/mass spectrometry. Body fluids were negative, but H2S was found in the lungs of both the mother and the child at concentrations of 1.46 and 1.92 mg/kg, respectively, concentrations described in the literature as potentially lethal. Expert surveys of the premises suggested a complex mechanism involving both defective maintenance of the pipes and drains of the building and faulty assembly of the sink siphon, which led to stagnation of waste water and formation of a pocket of H2S. © 2012 American Academy of Forensic Sciences. Source

Agius R.,Labor Krone | Kintz P.,Laboratoire ChemTox
Drug Testing and Analysis | Year: 2010

Drug and alcohol abuse is a concern for many European companies, especially those having safety-critical jobs. It is not uncommon for European companies to establish a drug policy with little or no provision for drug testing. The European Union (EU) has launched a number of initiatives in its fight against drugs. There is, however, no specific EU legislation and no generally accepted guidelines. Since the outcome of workplace drug testing (WDT) can have serious consequences for the employee, it is of utmost importance that WDT be performed in a defined quality standard and in a legally secured way. In order to fulfil this, the European Workplace Drug Testing Society (EWDTS) has formulated WDT guidelines in order to ensure that the entire drug testing process is of high quality, accredited, and legally defensible, hence giving accurate and reliable information about employee drug use while respecting the privacy of the employee. The aim of this paper is to present the recently formulated guidelines for workplace drug testing in hair. Copyright © 2010 John Wiley & Sons, Ltd. Source

Chatterton C.,7007 116 Street NW | Turner K.,Laboratoire ChemTox | Klinger N.,Laboratoire ChemTox | Etter M.,Laboratoire ChemTox | And 2 more authors.
Journal of Forensic Sciences | Year: 2014

Three separate cases of child administration of prescription drugs are described. Following liquid-liquid extraction, high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was used to identify and quantify methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenyl-1-pyrrolidine (EDDP), tramadol, amitriptyline, and nortriptyline in children's hair. The children's age ranged from 14 months to 7 years; in all three cases, the drug in question was detected in more than one section of hair. Methadone was detected in the concentration range of 0.65-0.99 and 0.04-0.4 ng/mg; tramadol was detected in the concentration range of 1.5-2.2 ng/mg; amitriptyline and nortriptyline were detected in the concentration range of 0.18-1.06 and 0.38-2.0 ng/mg, respectively. In each case, the children's parents admitted to or were found guilty of drug administration to the child. These cases demonstrate the added value of hair testing and emphasize the importance of using hair samples to complement conventional analyses. © 2013 American Academy of Forensic Sciences. Source

Kintz P.,Laboratoire ChemTox | Evans J.,Roar Forensics Ltd | Villain M.,Laboratoire ChemTox | Cirimele V.,Laboratoire ChemTox
Forensic Science International | Year: 2010

Methadone is not licensed for use in children though it can be employed for the management of neonatal opiate withdrawal syndrome. During the last 2 years, our laboratory has been asked to test for methadone and EDDP, its major metabolite, in hair from children that were admitted to hospital unconscious and where methadone had already been identified in a body fluid (4 cases) or where the children were deceased and evidence of methadone overdosage having already been established (2 cases). In all of these cases, segmental analysis revealed approximately the same amount of drug along the hair lock. As a consequence, contamination was considered as an issue and interpretation of the results was a challenge that deserves particular attention. After decontamination with dichloromethane and segmentation the hair was cut into small pieces, incubated overnight at 40 °C, liquid-liquid extracted and analysed with LC-MS/MS, using 2 transitions per compound. The LOQ for both methadone and EDDP was 10 pg/mg. In the first series involving children admitted to hospital, the following results were obtained:•case 1: 4 × 1 cm section, methadone at 0.05-0.08 ng/mg, no EDDP detected,•case 2: 4 × 1 cm section, methadone at 0.13-0.15 ng/mg, EDDP at 0.02 ng/mg,•case 3: 3 × 1.5 cm section, methadone at 0.07-0.09 ng/mg, EDDP at 0.01-0.03 ng/mg,•case 4: 6 × 2 cm section, methadone at 0.06-0.13 ng/mg, EDDP at 0.02-0.03 ng/mg. The following concentrations were obtained from the children who had died following a methadone overdose:•case 5: 2 × 2 cm section, methadone at 0.53-0.58 ng/mg, no EDDP detected,•case 6: 4 × 1 cm section, methadone at 0.44-0.77 ng/mg, EDDP at 0.04-0.06 ng/mg. The first observation is that all these concentrations are low by comparison with those observed in adults on methadone maintenance therapy. However, the more surprising observation is the relative homogenous concentrations along the hair locks in each specific case. This raises concerns around the possibility that contamination could have occurred prior to sampling and makes it hard to reach a conclusion regarding the possibility of repeated methadone exposure in the months prior the incidents. In these cases it was impossible to conclude that the children were deliberately administered methadone. The results of the analysis of hair could indicate that they were in an environment where methadone was being used and where the drug was not being handled and stored with appropriate care. The homogenous concentrations found on segmental analyses could be indicative of external contamination that may have arisen not only from direct contamination with the drug but also via contamination with body fluids at the post mortem or from sweat produced close to the time of the incident. In view of these results we concluded that a single determination should not be used firmly to discriminate long-term exposure to a drug. © 2009 Elsevier Ireland Ltd. All rights reserved. Source

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