INHOUDSOPGAVE
SAMENVATTING FORENSISCHE TOXICOLOGIE .............................................................................. 4
INLEIDING ....................................................................................................................................... 4
Farmacokinetica & farmacodynamica ............................................................................................... 5
Absorptie ...................................................................................................................................... 6
Distributie ................................................................................................................................... 10
metabolisme en excretie = eliminatie ........................................................................................... 13
metabolisme ..................................................................................................................................16
farmacokinetica .......................................................................................................................... 16
drug metabolisme ....................................................................................................................... 16
postmortem redistributie (pmr) ........................................................................................................23
mechanismen ............................................................................................................................. 23
alcoholen – ethanol .........................................................................................................................25
inleiding ...................................................................................................................................... 25
effecten ...................................................................................................................................... 25
kinetiek en metabolisme .............................................................................................................. 27
ethanol in verkeer ........................................................................................................................ 32
ethanol post-mortem .................................................................................................................. 37
overige alcoholen ........................................................................................................................ 38
Sedetiva .........................................................................................................................................40
GHB en precursoren .................................................................................................................... 40
benzodiazepines .............................................................................................................................45
inleiding ...................................................................................................................................... 45
farmacologie ............................................................................................................................... 45
farmacokinetiek .......................................................................................................................... 47
forensische aspecten .................................................................................................................. 48
barbiduraten ...................................................................................................................................49
barbituraten ................................................................................................................................ 49
fenobarbital ................................................................................................................................ 49
Primidone ................................................................................................................................... 50
thiopental ................................................................................................................................... 50
Cocaine ..........................................................................................................................................51
Wat is drugs? .............................................................................................................................. 51
FORENSISCHE TOXICOLOGIE 1
, cocaïne en crack ......................................................................................................................... 53
Opiaten ..........................................................................................................................................57
morfine, heroïne en verwante stoffen ........................................................................................... 58
cannabis ........................................................................................................................................60
situering...................................................................................................................................... 60
achtergrond cannabisgebruik en teelt .......................................................................................... 60
indicatoren druggebruik ............................................................................................................... 63
gebruik (routes) en dosis .............................................................................................................. 65
farmacodynamische aspecten ..................................................................................................... 66
andere cannabinoïden (semisynthetische) ................................................................................... 68
farmacokinetische aspecten........................................................................................................ 73
forensische beschouwingen ........................................................................................................ 76
dissociatieve drugs .........................................................................................................................81
ketamine..................................................................................................................................... 81
ketamine – pink cocaine .............................................................................................................. 88
inhalantia .................................................................................................................................... 88
phencyclidine - PCP ........................................................................................................................91
achtergrond ................................................................................................................................ 91
situering...................................................................................................................................... 92
gebruik........................................................................................................................................ 93
pharmacodynamiek .................................................................................................................... 93
farmacokinetiek .......................................................................................................................... 95
forensische aspecten .................................................................................................................. 96
hallucinogenen ...............................................................................................................................96
voorkomen .................................................................................................................................. 96
LSD gebruik ................................................................................................................................. 96
hallucinogenen in beslagname..................................................................................................... 97
LSD............................................................................................................................................. 97
LSD metabolisme ........................................................................................................................ 98
farmacodynamisch LSD............................................................................................................... 98
LSD – fashbacks .......................................................................................................................... 99
Post-mortem ............................................................................................................................... 99
nieuwe psychoactieve substanties ................................................................................................. 101
inleiding .................................................................................................................................... 101
definitie en geschiedenis NPS .................................................................................................... 102
monitoring en wetgeving ............................................................................................................ 113
FORENSISCHE TOXICOLOGIE 2
, amphetamines.............................................................................................................................. 119
introductie amfetamine ............................................................................................................. 119
amfetamine: gebruik: routes ...................................................................................................... 122
amfetamine: kinetica ................................................................................................................. 124
MDMA: kinetica ......................................................................................................................... 124
amfetamine analogen: farmacodynamica .................................................................................. 125
MDMA: toxische effecten ........................................................................................................... 129
forensische beschouwingen ...................................................................................................... 130
cases – forensiche toxicologie ................................................................................................... 133
deel 1 ........................................................................................................................................... 133
post-mortem ............................................................................................................................. 133
MDMA .......................................................................................................................................... 134
post-mortem ............................................................................................................................. 134
FORENSISCHE TOXICOLOGIE 3
, SAMENVATTING FORENSISCHE TOXICOLOGIE
INLEIDING
- Historisch perspectief
└ Dosis (sola) facit venenum = dosis heeft te maken met wanneer iets giftig wordt,
je kan ook overlijden van te hoge dosissen water
└ Toxisch = als iets vanaf een zeer kleine, lage dosis al schadelijk is
- Gebieden
1. Human performance toxicologie of antemortem toxicologie
= Wanneer iemand intoxicatie heeft overleeft
Þ verkeersongevallen ( alcohol, drugs)
Þ “drug-facilitated” misdrijven, waarbij het slachtoffer wordt geïntoxiceerd
om overval of verkrachting mogelijk te maken
Þ Misdaad onder invloed van drugs
Þ Mislukte poging tot moord of zelfmoord
2. Postmortem toxicologie
= Wanneer iemand intoxicatie niet heeft overleefd of met verdachte toestand
opgenomen
└ Onderzoek van stalen van overleden personen à om zo de wetarts bij te
staan om de oorzaak van overlijden aan te tonen
Þ Analyse (technisch)
Þ Interpretatie (medico-legaal)
└ Scenario’s
Þ Accidenteel (overdosis – oneigenlijk gebruik (kinderen) –
werkgerelateerd – milieu)
Þ Intentioneel ( moord of zelfdoding)
FORENSISCHE TOXICOLOGIE 4
SAMENVATTING FORENSISCHE TOXICOLOGIE .............................................................................. 4
INLEIDING ....................................................................................................................................... 4
Farmacokinetica & farmacodynamica ............................................................................................... 5
Absorptie ...................................................................................................................................... 6
Distributie ................................................................................................................................... 10
metabolisme en excretie = eliminatie ........................................................................................... 13
metabolisme ..................................................................................................................................16
farmacokinetica .......................................................................................................................... 16
drug metabolisme ....................................................................................................................... 16
postmortem redistributie (pmr) ........................................................................................................23
mechanismen ............................................................................................................................. 23
alcoholen – ethanol .........................................................................................................................25
inleiding ...................................................................................................................................... 25
effecten ...................................................................................................................................... 25
kinetiek en metabolisme .............................................................................................................. 27
ethanol in verkeer ........................................................................................................................ 32
ethanol post-mortem .................................................................................................................. 37
overige alcoholen ........................................................................................................................ 38
Sedetiva .........................................................................................................................................40
GHB en precursoren .................................................................................................................... 40
benzodiazepines .............................................................................................................................45
inleiding ...................................................................................................................................... 45
farmacologie ............................................................................................................................... 45
farmacokinetiek .......................................................................................................................... 47
forensische aspecten .................................................................................................................. 48
barbiduraten ...................................................................................................................................49
barbituraten ................................................................................................................................ 49
fenobarbital ................................................................................................................................ 49
Primidone ................................................................................................................................... 50
thiopental ................................................................................................................................... 50
Cocaine ..........................................................................................................................................51
Wat is drugs? .............................................................................................................................. 51
FORENSISCHE TOXICOLOGIE 1
, cocaïne en crack ......................................................................................................................... 53
Opiaten ..........................................................................................................................................57
morfine, heroïne en verwante stoffen ........................................................................................... 58
cannabis ........................................................................................................................................60
situering...................................................................................................................................... 60
achtergrond cannabisgebruik en teelt .......................................................................................... 60
indicatoren druggebruik ............................................................................................................... 63
gebruik (routes) en dosis .............................................................................................................. 65
farmacodynamische aspecten ..................................................................................................... 66
andere cannabinoïden (semisynthetische) ................................................................................... 68
farmacokinetische aspecten........................................................................................................ 73
forensische beschouwingen ........................................................................................................ 76
dissociatieve drugs .........................................................................................................................81
ketamine..................................................................................................................................... 81
ketamine – pink cocaine .............................................................................................................. 88
inhalantia .................................................................................................................................... 88
phencyclidine - PCP ........................................................................................................................91
achtergrond ................................................................................................................................ 91
situering...................................................................................................................................... 92
gebruik........................................................................................................................................ 93
pharmacodynamiek .................................................................................................................... 93
farmacokinetiek .......................................................................................................................... 95
forensische aspecten .................................................................................................................. 96
hallucinogenen ...............................................................................................................................96
voorkomen .................................................................................................................................. 96
LSD gebruik ................................................................................................................................. 96
hallucinogenen in beslagname..................................................................................................... 97
LSD............................................................................................................................................. 97
LSD metabolisme ........................................................................................................................ 98
farmacodynamisch LSD............................................................................................................... 98
LSD – fashbacks .......................................................................................................................... 99
Post-mortem ............................................................................................................................... 99
nieuwe psychoactieve substanties ................................................................................................. 101
inleiding .................................................................................................................................... 101
definitie en geschiedenis NPS .................................................................................................... 102
monitoring en wetgeving ............................................................................................................ 113
FORENSISCHE TOXICOLOGIE 2
, amphetamines.............................................................................................................................. 119
introductie amfetamine ............................................................................................................. 119
amfetamine: gebruik: routes ...................................................................................................... 122
amfetamine: kinetica ................................................................................................................. 124
MDMA: kinetica ......................................................................................................................... 124
amfetamine analogen: farmacodynamica .................................................................................. 125
MDMA: toxische effecten ........................................................................................................... 129
forensische beschouwingen ...................................................................................................... 130
cases – forensiche toxicologie ................................................................................................... 133
deel 1 ........................................................................................................................................... 133
post-mortem ............................................................................................................................. 133
MDMA .......................................................................................................................................... 134
post-mortem ............................................................................................................................. 134
FORENSISCHE TOXICOLOGIE 3
, SAMENVATTING FORENSISCHE TOXICOLOGIE
INLEIDING
- Historisch perspectief
└ Dosis (sola) facit venenum = dosis heeft te maken met wanneer iets giftig wordt,
je kan ook overlijden van te hoge dosissen water
└ Toxisch = als iets vanaf een zeer kleine, lage dosis al schadelijk is
- Gebieden
1. Human performance toxicologie of antemortem toxicologie
= Wanneer iemand intoxicatie heeft overleeft
Þ verkeersongevallen ( alcohol, drugs)
Þ “drug-facilitated” misdrijven, waarbij het slachtoffer wordt geïntoxiceerd
om overval of verkrachting mogelijk te maken
Þ Misdaad onder invloed van drugs
Þ Mislukte poging tot moord of zelfmoord
2. Postmortem toxicologie
= Wanneer iemand intoxicatie niet heeft overleefd of met verdachte toestand
opgenomen
└ Onderzoek van stalen van overleden personen à om zo de wetarts bij te
staan om de oorzaak van overlijden aan te tonen
Þ Analyse (technisch)
Þ Interpretatie (medico-legaal)
└ Scenario’s
Þ Accidenteel (overdosis – oneigenlijk gebruik (kinderen) –
werkgerelateerd – milieu)
Þ Intentioneel ( moord of zelfdoding)
FORENSISCHE TOXICOLOGIE 4
