Forensic Science, Medicine and Pathology

, Volume 14, Issue 4, pp 442–449 | Cite as

Safe drugs in drug facilitated crimes and acute intoxications in Northern Italy

  • Guido PellettiEmail author
  • Marco Garagnani
  • Francesca Rossi
  • Raffaella Roffi
  • Antonio Banchini
  • Susi Pelotti
Original Article


Toxicological analyses are often performed in drug-facilitated sexual assaults (DFSA), when the victim shows or reports impaired consciousness and reduced ability. However, in other crimes or fatalities, especially in cases of concurrent natural disease or when another likely cause of death has been established, the involvement of drugs can be overlooked. The aim of this study is to report a series of cases of (i) victims of drug-facilitated crimes (DFC) other than DFSA and (ii) victims of acute intoxications, in which “licit” psychoactive drugs were found in blood samples, with the aim of understanding in which circumstances and to what extent prescription drugs have been used for non-medical purposes in recent Italian casuistry. Circumstantial, autopsy, and toxicological data were collected through a retrospective analysis performed between 2013 and 2017 in the Forensic Toxicology Unit of the University of Bologna. Cases of “DFC other than DFSA” and “Acute Intoxication” in which “psychoactive drugs” or “prescription drugs” or “licit drugs” were found in the blood samples of the victims were included in the study. Nine cases of DFC other than DFSA, and 11 cases of acute intoxication, were identified. Different categories of “licit” psychoactive drugs (e.g. hypnotics, antipsychotics, antidepressants, anticonvulsants) had been used to facilitate diverse types of crime (homicide, robberies, elder abuse, fatal poisoning) or acute intoxication (suicide, attempted suicide, accidental death). The circumstances of these cases, as well as toxicological findings in blood samples and other relevant forensic elements, are reported, summarized and discussed in this paper. The non-medical use of pharmaceuticals has been identified by recent forensic literature and the present study as a significant and growing phenomenon, and its implication in fatalities should be taken into consideration and accurately investigated through appropriate toxicological analysis. Our study presents an overview of the circumstances of non-medical use of prescription drugs, usually considered “safe drugs”, and their involvement in cases of DFC, suicides and accidental intoxication. In order to estimate the real incidence of these medications in DFC and acute intoxication, and thus collect more analytical and contextual data, further studies are needed, along with effective cooperation among police officers, clinicians, forensic pathologists, and toxicologists.


Drug facilitated crimes Acute intoxications Prescription drugs Safe drugs Northern Italy 



The authors would like to express their thanks to Dr. Thomas Dewis for language editing and corrections and to Dr. Rossella Barone for the assistance in the revision process.


This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The Author(s) declare(s) that there is no conflict of interest.


  1. 1.
    Ronka S, Katainen A. Non-medical use of prescription drugs among illicit drug users: a case study on an online drug forum. Int J Drug Policy. 2017;39:62–8.CrossRefGoogle Scholar
  2. 2.
    McCauley JL, Amstadter AB, Macdonald A, Danielson CK, Ruggiero KJ, Resnick HS, et al. Non-medical use of prescription drugs in a national sample of college women. Addict Behav. 2011;36:690–5.CrossRefGoogle Scholar
  3. 3.
    Kintz P. Toxicological aspects of drug-facilitated crimes. Oxford: Academic Press; 2014.Google Scholar
  4. 4.
    Anderson LJ, Flynn A, Pilgrim JL. A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: a systematic review. J Forensic Legal Med. 2017;47:46–54.CrossRefGoogle Scholar
  5. 5.
    Xiang P, Shen M, Drummer OH. Review: drug concentrations in hair and their relevance in drug facilitated crimes. J Forensic Legal Med. 2015;36:126–35.CrossRefGoogle Scholar
  6. 6.
    Carson HJ. Classes of drugs and their prevalence in multiple drug intoxication in suicides and accidents. Leg Med (Tokyo). 2008;10:92–5.CrossRefGoogle Scholar
  7. 7.
    Luchini D, Morabito G, Centini F. Case report of a fatal intoxication by citalopram. Am J Forensic Med Pathol. 2005;26:352–4.CrossRefGoogle Scholar
  8. 8.
    Lahti RA, Vuori E. Fatal drug poisonings: medico-legal reports and mortality statistics. Forensic Sci Int. 2003;136:35–46.CrossRefGoogle Scholar
  9. 9.
    Druid H, Holmgren P. A compilation of fatal and control concentrations of drugs in postmortem femoral blood. J Forensic Sci. 1997;42:79–87.CrossRefGoogle Scholar
  10. 10.
    Society of Forensic Toxicologists (SOFT), Drug-Facilitated Crimes Committee (DFC) formerly the DFSA Committee. Recommended minimum performance limits for common dfc drugs and metabolites in urine samples. 2017. Accessed 18 Jul 2018.
  11. 11.
    United Nations Office on Drugs and Crime (UNODC). Guidelines for the forensic analysis of drugs facilitating sexual assault and other criminal acts. 2011. Accessed 18 Jul 2018.
  12. 12.
    Moffat AC, Osselton MD, Widdop B, Watts J. Clarke's analysis of drugs and poisons. 4th ed. London: Pharmaceutical press; 2011.Google Scholar
  13. 13.
    Schulz M, Iwersen-Bergmann S, Andresen H, Schmoldt A. Therapeutic and toxic blood concentrations of nearly 1,000 drugs and other xenobiotics. Crit Care. 2012;16:R136.CrossRefGoogle Scholar
  14. 14.
    Schulz M, Schmoldt A. Therapeutic and toxic blood concentrations of more than 800 drugs and other xenobiotics. Pharmazie. 2003;58:447–74.PubMedGoogle Scholar
  15. 15.
    Jonsson AK, Soderberg C, Espnes KA, Ahlner J, Eriksson A, Reis M, et al. Sedative and hypnotic drugs--fatal and non-fatal reference blood concentrations. Forensic Sci Int. 2014;236:138–45.CrossRefGoogle Scholar
  16. 16.
    Sporkert F, Augsburger M, Giroud C, Brossard C, Eap CB, Mangin P. Determination and distribution of clotiapine (Entumine) in human plasma, post-mortem blood and tissue samples from clotiapine-treated patients and from autopsy cases. Forensic Sci Int. 2007;170:193–9.CrossRefGoogle Scholar
  17. 17.
    Vrecko S. Everyday drug diversions: a qualitative study of the illicit exchange and non-medical use of prescription stimulants on a university campus. Soc Sci Med. 2015;131:297–304.CrossRefGoogle Scholar
  18. 18.
    Palazzo C, Fais P, Mazzotti MC, Gaudio RM, Pelletti G, Susi P. A homemade furnace. Influence of occupational skills in a fire-related planned complex suicide. Forensic Sci Med Pathol. 2018;14:109–13.CrossRefGoogle Scholar
  19. 19.
    Dumestre-Toulet V, Eysseric-Guérin H. Case reports in drug-facilitated crimes: from A for Alprazolam to Z for Zopiclone. In: Kintz P, editor. Toxicological aspects of drug-facilitated crimes. Oxford: Academic Press; 2014. p. 223–54.CrossRefGoogle Scholar
  20. 20.
    Kintz P, Evans J, Villain M, Salquebre G, Cirimele V. Hair analysis for diphenhydramine after surreptitious administration to a child. Forensic Sci Int. 2007;173:171–4.CrossRefGoogle Scholar
  21. 21.
    Kintz P, Villain M, Cheze M, Pepin G. Identification of alprazolam in hair in two cases of drug-facilitated incidents. Forensic Sci Int. 2005;153:222–6.CrossRefGoogle Scholar
  22. 22.
    Hindmarch I, ElSohly M, Gambles J, Salamone S. Forensic urinalysis of drug use in cases of alleged sexual assault. J Clin Forensic Med. 2001;8:197–205.CrossRefGoogle Scholar
  23. 23.
    Hall J, Goodall EA, Moore T. Alleged drug facilitated sexual assault (DFSA) in Northern Ireland from 1999 to 2005. A study of blood alcohol levels. J Clin Forensic Med. 2008;15:497–504.Google Scholar
  24. 24.
    Boussairi A, Dupeyron JP, Hernandez B, Delaitre D, Beugnet L, Espinoza P, et al. Urine benzodiazepines screening of involuntarily drugged and robbed or raped patients. J Toxicol Clin Toxicol. 1996;34:721–4.CrossRefGoogle Scholar
  25. 25.
    Mehling LM, Johansen SS, Wang X, Doberentz E, Madea B, Hess C. Drug facilitated sexual assault with lethal outcome: GHB intoxication in a six-year-old girl. Forensic Sci Int. 2016;259:e25–31.CrossRefGoogle Scholar
  26. 26.
    McBrierty D, Wilkinson A, Tormey W. A review of drug-facilitated sexual assault evidence: an Irish perspective. J Forensic Legal Med. 2013;20:189–97.CrossRefGoogle Scholar
  27. 27.
    Collins KA, Presnell SE. Elder homicide: a 20-year study. Am J Forensic Med Pathol. 2006;27:183–7.CrossRefGoogle Scholar
  28. 28.
    Ehrlich E, Riesselmann B, Tsokos M. A series of hospital homicides. Leg Med (Tokyo). 2009;11(Suppl 1):S100–2.CrossRefGoogle Scholar
  29. 29.
    Aitken G, Murphy B, Pilgrim J, Bugeja L, Ranson D, Ibrahim JE. Frequency of forensic toxicological analysis in external cause deaths among nursing home residents: an analysis of trends. Forensic Sci Med Pathol. 2017;13:52–7.CrossRefGoogle Scholar
  30. 30.
    Ramadan AS, Wenanu O, Cock AD, Maes V, Lheureux P, Mols P. Chemical submission to commit robbery: a series of involuntary intoxications with flunitrazepam in Asian travellers in Brussels. J Forensic Legal Med. 2013;20:918–21.CrossRefGoogle Scholar
  31. 31.
    Pilgrim JL, Gerostamoulos D, Drummer OH. Deaths involving contraindicated and inappropriate combinations of serotonergic drugs. Int J Legal Med. 2011;125:803–15.CrossRefGoogle Scholar
  32. 32.
    Karjalainen K, Lintonen T, Hakkarainen P. Illicit drug use is increasing among non-medical users of prescription drugs-results from population-based surveys 2002-2014. Drug Alcohol Depend. 2017;178:430–4.CrossRefGoogle Scholar
  33. 33.
    Solarino B, Riesselmann B, Buschmann CT, Tsokos M. Multidrug poisoning involving nicotine and tramadol. Forensic Sci Int. 2010;194:e17–9.CrossRefGoogle Scholar
  34. 34.
    Singh SP, Kaur S, Singh D, Aggarwal A. Lorazepam: a weapon of offence. J Clin Diagn Res. 2015;9:Hd01–2.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Grzybowski S. The black market in prescription drugs. Lancet. 2004;364(Suppl 1):s28–9.CrossRefGoogle Scholar
  36. 36.
    Byard RW, Kenneally M. Body pushing, prescription drugs and hospital admission. Forensic Sci Med Pathol. 2017;13:359–61.CrossRefGoogle Scholar
  37. 37.
    LeBeau MA. Guidance for improved detection of drugs used to facilitate crimes. Ther Drug Monit. 2008;30:229–33.CrossRefGoogle Scholar
  38. 38.
    Acikkol M, Mercan S, Karadayi S. Simultaneous determination of benzodiazepines and ketamine from alcoholic and nonalcoholic beverages by GC-MS in drug facilitated crimes. Chromatographia. 2009;70:1295.CrossRefGoogle Scholar
  39. 39.
    Lusthof KJ, Bosman IJ, Kubat B, Vincenten-van Maanen MJ. Toxicological results in a fatal and two non-fatal cases of scopolamine-facilitated robberies. Forensic Sci Int. 2017;274:79–82.CrossRefGoogle Scholar
  40. 40.
    Shbair MK, Lhermitte M. Drug-facilitated crimes: definitions, prevalence, difficulties and recommendations. A review. Ann Pharm Fr. 2010;68:136–47.CrossRefGoogle Scholar
  41. 41.
    Pilgrim JL, Drummer OH. The toxicology and comorbidities of fatal cases involving quetiapine. Forensic Sci Med Pathol. 2013;9:170–6.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Medical and Surgical Sciences, Unit of Legal MedicineUniversity of BolognaBolognaItaly
  2. 2.Department of Medicine and Surgery (DiMec)University of ParmaParmaItaly

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