Voluntary Intoxication Research Articles

The Formulation of Voluntary Intoxication in Continental Law.

The principle of contemporaneity, which means the actus reus and mens rea must coincide, constitutes the backbone of criminal liability. On the contrary, it is sometimes possible for an offender to commit an offence when she or he does not have the culpability required for the committed offence. The offender can create diminished responsibility through the intake of an intoxicating substance negligently or intentionally, even with the purpose of getting rid of the punishment. To punish such an offender, a legal concept has been developed which is termed as voluntary intoxication in the Anglo-Saxon legal system, while it has been called actiones liberae in causa in the Continental Europe. In this review, actiones liberae in causa, the formulation of voluntary intoxication in the Continental European legal system, will be explained in detail and some suggestions will be made for the application of these two concepts.

Cardiac Arrest Post Voluntary Intoxication with Propafenone

Cardiac Arrest Post Voluntary Intoxication with Propafenone

Ethylene glycol poisoning requiring critical care: Three case reports

Rapid diagnosis and treatment of ethylene glycol poisoning can be challenging and is critical for reducing the morbidity and the mortality of this intoxication. Cases from our center were retrospectively reviewed. From the 12 cases of ethylene glycol poisoning found since 2007, we present here three with significant toxicity and requiring critical care. Case 1 was an accidental intoxication in a 67 year-old male presenting dysarthria and altered level of consciousness. The patient mistakenly drank a bottle of beer containing a blue liquid 15 h before admission. Case 2 was a voluntary intoxication in a 56 year-old male with coma. The patient was found unconscious under a bridge with 9 wine bottles near him. An open bottle of car antifreeze was found at his home. Case 3 was a voluntary intoxication in a 46 year-old female presenting dyspnea. Ingestion amount was around 3 L of antifreeze 2 days before. Ethylene glycol plasma level was measured using liquid chromatography with ultraviolet detection after benzoyl chloride derivatization. At admission, case 1 showed metabolic acidosis (pH = 7.01) with very high serum lactate (> 20 mmol/L, acute renal failure (serum creatinine = 141 μmol/mL) and acute respiratory failure. The patient was transferred to an intensive care unit (ICU) where he was intubated and received renal replacement therapy (RRT). Ethylene glycol plasma level was 614 mg/L. Fomepizole was started 10 hours after admission. The patient was hospitalized for 35 days. Evolution was favorable but marked with an acute coronary syndrome. Cardiac function was recovered afterward. At admission in the ICU, case 2 was in a coma (Glasgow coma scale 3), and presented dyspnea, metabolic acidosis (pH = 6.90) with very high serum lactate (> 20 mmol/L), acute renal failure (serum creatinine = 141 μmol/mL) and hyperkaliemia (6.6 mmol/L). The patient was intubated and received RRT. Ethylene glycol plasma level was 402 mg/L. Fomepizole was started 18 h after admission. The patient was hospitalized for 21 days. Evolution was favorable except for a lower lip pressure ulcer and chronic kidney injury. Follow up at 2 months showed a partial recovery of renal function. Case 3 presented at admission metabolic acidosis (pH = 7.14) with high serum lactate (8.1 mmol/L), acute respiratory failure and acute renal failure (serum creatinine = 114 μmol/L). After transfer to the ICU, the patient was intubated and received RRT. Ethylene glycol plasma level was 607 mg/L. Fomepizole was started about 4 h after admission. The patient was hospitalized for 23 days. Evolution was marked by a ventilator-associated pneumonia but was favorable otherwise. These 3 cases have in common a severe acidosis associated with an acute renal failure and respiratory disorders. High serum lactate has to be interpreted with caution due to analytical interference [1] . Neurological toxicity was characterized for case 1 and 2. The long hospitalization duration (21 to 35 days) reflects the severity of the intoxications. Fomepizole antidote treatment must be started as soon as possible. Ethylene glycol plasma concentration should be obtained to confirm the diagnosis if available. Even though ethylene glycol poisoning is well known, cases are rare but nonetheless can currently be life-threatening. They require fast diagnostic and treatment to avoid morbidity [2] .

First fatal intoxication involving ivabradine

To present a fatal intoxication involving Ivabradine. A 61-year-old woman was admitted to hospital for voluntary intoxication. At admission, the patient presented drowsiness. Few hours later she suffered a cardiac arrest followed by a successful resuscitation but she died 10 hours after admission. Autopsy and reference toxicological analysis were performed. HPLC-DAD, GC-MS and LC-MS/MS screening were performed. Quantification was achieved by LC-MS/MS (TSQ Vantage ThermoFischer ® ), after a double liquid/liquid extraction under alkaline condition [hexane/ethyl acetate (1/1, v/v) followed by Chloroform/Isopropanol (80/20, v/v)]. Chromatographic separation was achieved using a Hypersyl gold PFP column and a classic acetonitrile/formiate2 mM, 0.1% formic acid buffer gradient. IS used was morphine D3. The method was fully validated in whole blood. Calibration curves were linear from 5 to 500 ng/mL. The LOQ was 5 ng/mL and the intra- and inter-assays bias were all acceptable (< 15%). Ivabradine was found and quantified in every matrix. Results are listed in the Table 1 . Due to high concentrations, samples were diluted 1:2 and 1:10. Midazolam, atropine and atracurium metabolite (laudanosine) were identified at therapeutic concentrations. Pregabalin, zopiclone and N-desmethylzopiclone were found at 50 μg/mL (therapeutic range: 2–8 μg/mL), 206 ng/mL (therapeutic range: 10–50 ng/mL) and 400 ng/mL. Midazolam, atropine and atracurium were administered during hospitalization, while ivabradine, zopiclone and pregabalin were part of her chronic treatment. Ivabradine is indicated in the management of stable angina pectoralis and symptomatic chronic heart failure. It selectively and specifically inhibits the pacemaker current I( f ) thereby slowing heart rates with a dose dependent activity. There are few data about therapeutic concentrations; they appear to be around 10 ng/mL, with a Cmax of 22 ng/mL. Three non-fatal Ivabradine intoxications were reported in which peripheral blood concentrations were 119 ng/mL [1] , 375 ng/mL [2] and 525 ng/mL [3] . The concentration in our case is much higher and probably played a major role in the occurrence of the death. We describe here the first case of a fatal intoxication involving Ivabradine; we furthermore provide postmortem concentrations in organs.

Finding the Balance: Intoxication and Consent

Sexual offences in England and Wales have had a dramatic reimagining in the last 15 years, with the Sexual Offences Act 2003 establishing not only the boundaries of the most heinous of offences such as rape, but also defining one of the most important elements; consent. This article seeks to explore the problems that surround establishing if legally valid consent has been given, with particular regard for cases where voluntary intoxication takes centre stage. The problem that often arises is the question on whether or not an intoxicated victim had the capacity to consent, or establishing if she did consent when memory of the event is hazy, possibly from both parties. Using comparative analysis with other jurisdictions and their take on the offence of rape, the author seeks to discover if the current rules are sufficient to fit within twenty-first century western culture. The victim will be referred to as ‘she’, although the law here and all situations discussed are equally applicable to male rape.

Clinical consequences related to a defective elimination of clobazam caused by homozygous mutated CYP2C19 allele

Introduction: Voluntary drug intoxication with benzodiazepines is common and in most cases without consequences. We report an interesting case of voluntary drug intoxication with clobazam (CLB) in a patient with a homozygous mutated CYP2C19 genotype.Case report: A 63-year-old Caucasian man was admitted to an intensive care unit for voluntary drug intoxication with CLB (1200 mg) complicated by prolonged hospitalization (46 days). The levels of CLB and N-desmethylclobazam (NCLB) in plasma were initially 8.3 and 14.8 mg/L. The persistence of a high concentration of NCLB (14.3 mg/L on day 30) suggested a lack of elimination. A homozygous mutated allele of CYP2C19*2 without enzyme activity was discovered. To overcome this phenotype, NCLB metabolism was induced by administering 100 mg of phenobarbital for 10 days, allowing patient improvement.Discussion: NCLB is the major active metabolite of CLB with a longer half-life and much higher steady-state plasma concentrations compared to the parent drug. The half-life elimination of CLB is 18 h that of NCLB is between 40 and 50 h. However, there is considerable inter-individual variation in the metabolism of CLB and of the report NCLB/CLB under the dependence of genotype of CYP2C19. These polymorphisms are not generally well-known by physicians and may lead to severe poisoning.

A brief summary and critique of criminal liability rules for intoxicated conduct

This essay provides an overview of the legal issues relating to intoxication, including the effect of voluntary intoxication in imputing to an offender a required culpable state of mind that he may not actually have had at the time of the offence; the effect of involuntary intoxication in providing a defence by negating a required offence culpability element or by satisfying the conditions of a general excuse; the legal effect of alcoholism or addiction in rendering intoxication involuntary; and the limitation on using alcoholism or addiction in this way if the offender can be judged to be reasonably responsible for creating his own addiction. It notes some of the differences between the US and UK approaches on some issues.

Epidemiology and risk factors of voluntary pesticide poisoning in Morocco (2008-2014).

OBJECTIVESTo determine the epidemiological profile and risk factors of voluntary poisoning by pesticides.METHODSA retrospective analysis was conducted of all cases of voluntary poisoning by pesticides registered at the AntiPoison and Pharmacovigilance Center of Morocco between January 2008 and December 2014.RESULTSDuring the study period, 2,690 cases of acute pesticide poisoning were registered. The region of Rabat-Salé-Zemmour-Zaer accounted for the largest proportion, with 598 cases. The average age of the patients was 24.63±10.29 years. The sex ratio (female-to-male) was 0.45. Adults and teenagers were most affected by this type of poisoning, with 1,667 cases (62.0%) and 806 cases (30.0%), respectively. Suicide attempts accounted for 98.4% of the cases (2,469 cases). Pesticide poisoning occurred more often in urban zones (64.8%). Insecticides were incriminated in 14.0% of cases, with a mortality rate of 4.2%. Among the 1,635 patients for whom the outcomes were known, 154 died, corresponding to a mortality rate of 5.7%.CONCLUSIONSVoluntary intoxication by pesticides presents a real scourge that affects public health, and in this study, we developed an epidemiological profile of this phenomenon. Nevertheless, this study has limitations in that it did not evaluate the impact of the socioeconomic and psychological factors that are important contributors to this type of poisoning.

Jake and Josie Get Drunk and Hook Up: An Exploration of Mutual Intoxication and Sexual Assault

In R. v. Daviault, the Supreme Court of Canada recognized a defence of extreme intoxication to general intent offences, including sexual assault. In the aftermath of Daviault, Parliament swiftly enacted section 33.1 of the Criminal Code. While the lower courts are divided on the constitutionality of section 33.1, its operation precludes a defence of extreme intoxication for some general intent offences. Thus, intoxication can prevent the complainant from giving valid consent, but cannot prevent the accused from forming the necessary intent. How should criminal liability be determined where two individuals become voluntarily intoxicated to the point of incapacity and engage in sex? In theory, the criminal law is committed to the protection of the bodily integrity of all individuals and to the punishment of only the morally blameworthy. However, this article argues that the law’s treatment of mutual voluntary intoxication violates these core principles of our justice system.

Pojam ubrojivosti u kaznenopravnoj teoriji, zakonodavstvu i praksi

Mental capacity is legally defined as an element of culpability. The Criminal Code describes mental incapacity (Article 24), voluntary intoxication (Article 25) and substantially diminished mental capacity (Article 26). This paper firstly deals with the notion of mental incapacity, especially its “biopsychological” and “normative” component. The relationship between judge and psychiatrist in determining mental capacity is also discussed. After this, the concepts of substantially diminished mental capacity and voluntary intoxication are analysed. The final chapter discusses the possibility of imposing security measures on mentally incapable persons. Throughout the paper, judicial decisions related to the mentioned concepts are analysed.

Voluntary Intoxication and the Charter: Revisiting the Constitutionality of Section 33.1 of the Criminal Code

Voluntary Intoxication and the Charter: Revisiting the Constitutionality of Section 33.1 of the Criminal Code

Thermoregulatory and Cardiovascular Consequences of a Transient Thyrotoxicosis and Recovery in Male Mice

Thyroid hormones play a major role in body homeostasis, regulating energy expenditure and cardiovascular function. Given that obese people or athletes might consider rapid weight loss as beneficial, voluntary intoxication with T4 preparations is a growing cause for thyrotoxicosis. However, the long-lasting effects of transient thyrotoxicosis are poorly understood. Here we examined metabolic, thermoregulatory, and cardiovascular function upon induction and recovery from a 2-week thyrotoxicosis in male C57BL/6J mice. Our results showed that T4 treatment caused tachycardia, decreased hepatic glycogen stores, and higher body temperature as expected; however, we did not observe an increase in brown fat thermogenesis or decreased tail heat loss, suggesting that these tissues do not contribute to the hyperthermia induced by thyroid hormone. Most interestingly, when the T4 treatment was ended, a pronounced bradycardia was observed in the animals, which was likely caused by a rapid decline of T3 even below baseline levels. On the molecular level, this was accompanied by an overexpression of cardiac phospholamban and Serca2a mRNA, supporting the hypothesis that the heart depends more on T3 than T4. Our findings therefore demonstrate that a transient thyrotoxicosis can have pathological effects that even persist beyond the recovery of serum T4 levels, and in particular the observed bradycardia could be of clinical relevance when treating hyperthyroid patients.

Complex Suicide: Unusual Combination

There are a great number of complex suicides in the literature. It is so interesting to expand the list and to publish more cases of complex suicide which are examined by forensic worldwide. It’s interesting to know the maximum of method that can be used by suicidal individuals. We present a case of a complex suicide of a young woman by using ingestion of paraphenylene Diamine associated with self-strangulation by a link. Self-strangulation is probably used to accelerate death or to reduce pain caused by the first method. Forensic autopsy and further tests confirmed the voluntary intoxication by PPD and showed signs of strangulation by a loose link. The circumstances of the facts and the judicial inquiry were in favor of self-strangulation without the intervention of another person. This case illustrates an example of complex suicide. To our knowledge, it is the first case of complex suicide involving intoxication PPD and self-strangulation.

Non Lethal Self-injurious Behaviour in Trieste Between 2000-2007.

Introduction The suicidal behaviours constitute a significant problem in terms of public health, thus a major goal of the WHO is to reduce these behaviours. In the '80s suicide rates and suicide attempts in the Trieste were the highest in Italy, comparable with those of Central Europe. Since the '90s a project was launched to prevent suicidal behaviour and suicide rates and non-lethal self-harm gestures have plummeted. Objectives We study the sociodemographic variables of this phenomenon. Aims The aim of our study is to monitor the performance of non-lethal self-harm over time and identify evidences to implement prevention strategies Methods We conducted retrospective study in the period 01.01.2000- 31.12.2007. We analyzed the records of hospital emergency rooms in Trieste, screened according to the keywords that indicate the diagnosis of access “self-harm” and “voluntary intoxication”. Socio-demographic variables were stratified by age and gender. Outcome variables were evaluated. Data were compared with those of a study conducted from 1993 to 1990. Results The study showed a mean of 85/100,000 inhabitants. The methods most frequently used were drug intoxication and cutting. There was a reduction in hospitalisations rates and an increased number of appointments in the Mental Health Department by the subjects with a suicide attempt history. Conclusions The rates of non-lethal self-harm in the period considered decreased compared to the '80s, while the average age of those who commit the act increased. These data can be used to enhance the primary and secondary prevention strategies.

Young Self-injourious Behaviour in Young People of Trieste: a Study From 2000 to 2007

Introduction The rate of non fatal self-injurious behaviour in young people has increase in recent years. Non fatal self-injurious behaviour such as cutting oneself and abuse of substance is often performed without suicidal intent to cope with emotional distress although it is well known to have a close association with future suicidal behaviour. Objectives Evaluating people under 29's suicidal behaviours' rates. Aims Monitoring developments in not lethal self injurious behaviour in the population of adolescents and young adults in Trieste to identify strategies that will guide the prevention of suicidal behaviour in this age group. Methods Retrospective study based on verbal access to emergency, extracts under the headings “self-harm” and “poisoning” during period 2000-2007. We considered as variables the calculation of rates for the age groups 15-19 and 20-29 years, mode of self-injurious act coded according to the parameters of the ICD-10. Results The average rate for the age group 15-19 years was found to be 0.5 cases per 100,000 inhabitants, while for ages 20-29 was found to be 1.3 cases per 100,000 inhabitants. There wasn't a significant difference between the two genders. The methods most frequently adopted were found to be voluntary intoxication and cutting. Conclusions To counter the fragility and risk of self-harm and suicide in adolescents and young adults, our Local Health Company launched in 2014 a dedicated website. The site provides information on the types of conditions that may affect the target population and the self-destructive behaviors.

Diagnosis of Coma through Social Media Announcement

We report a case of a voluntary intoxication where preliminary announcement on social media permitted to know the exact nature of the products and medications taken by the patient.

Case Report of Ivabradine Intoxication

Ivabradine is a drug used for the treatment of angina and chronic heart failure in cases of intolerance or insufficiency of response to beta-blocker treatment. A 47-year-old man was admitted to the emergency department of the hospital for a voluntary intoxication with 280 mg of ivabradine: he presented drowsiness and a mild sinusal bradycardia (50 bpm) associated with a well-tolerated low blood pressure at 100/50 mmHg. No complication was noted and he was discharged from the hospital on Day 3. A method for ivabradine assay in serum was obtained using liquid chromatography coupled with a mass spectrometry detection method. After a deproteinization step using QuECHERS salts and acetonitrile, a chromatographic separation was performed using a 5-µm 50 × 2.1 mm Xterra® column (Waters, France). Detection was performed using an LTQ linear ion-trap mass spectrometer equipped with an electrospray ionization source used in a positive ionization mode (ThermoFisher Scientific, San Jose CA, USA) and a detection in full MS(2) scan. The limit of quantification of ivabradine was 10 µg/L, and the method was linear up to 1000 µg/L. The ivabradine concentration in the patient's serum was 375 µg/L. This concentration value was >30 times those measured after therapeutic doses intakes. Nevertheless, the bradycardia was no more severe than the one observed with therapeutic dosage. In conclusion, this case tends to show an absence of correlation between blood concentration and severity of the troubles in cases of overdosage.

The 'Too Intoxicated' Defense Measuring All Criminal Defendants by the Same Judicial Standard

In select jurisdictions, a criminal defendant who voluntarily becomes intoxicated before the commission of a crime may negate an element of the offense and receive a modified jury instruction, including charges of lesser included offenses. These modified instructions alleviate the severity of the defendant’s actions and essentially pardon his criminal conduct. This standard is unacceptable; a system of government that tolerates this type of behavior promotes criminal conduct by embracing voluntary intoxication as an acceptable defense. This message opposes the morals and beliefs upheld by our society and as such, the voluntary intoxication defense should be abolished. Eliminating the intoxication defense would reinforce the standards of fairness and justice supported by our community; it would increase judicial uniformity in the courts, improve judicial efficiency of legal resources, simplify confusing jury instructions and yield numerous societal benefits. Because of its volitional nature, intoxication should be measured by the same judicial standard as that of sobriety, regardless of the mental state of the defendant during the commission of a crime. For these reasons, voluntary intoxication should not be an available defense to excuse or mitigate the criminal behavior of a guilty defendant.

A Comparative Study on Sentences of Judge and Jury in Voluntary Intoxication Defence Cases in Korea

A Comparative Study on Sentences of Judge and Jury in Voluntary Intoxication Defence Cases in Korea

Loss of Control and the ‘Normal’ Person: The Relevance of Self-Induced Intoxication

Discusses the case of R v Asmelash [2013] EWCA Crim 157, which confirms that, for the purposes of the defence of loss of control, voluntary intoxication on the part of the defendant is to be disregarded when the jury is considering whether a 'normal' person would have reacted as the defendant did.