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180 Arab Journal of Forensic Sciences and Forensic Medicine 2015; Volume 1 Issue (2), 180-193

Naif Arab University for Security Sciences
Arab Journal of Forensic Sciences and Forensic Medicine
www.nauss.edu.sa
http://ajfsfm.nauss.edu.sa

Hair Analysis as a Diagnostic and Forensic Tool in a Social Support
Original Article

System for Families with Underage Children and Drug Abusing
Parents: Four Year Experience Open Access

Fritz Pragst*, Martin Hastedt, Franziska Krumbiegel and Sieglinde Herre
Institute of Legal Medicine, University Hospital Charité, Turmstraße 21, Building N, 10559 Berlin, Germany

Abstract methadone 9-25%, heroin 7.5-28%, cocaine 46-57%,
Between 2011 and 2014, 388 hair samples from amphetamines and ecstasy 1.6-7.0%, cannabinoids
children (age 1-14 years) and 594 hair samples from 21-49% and benzodiazepines 0-5%. As a rule,
parents/caregivers were analyzed for methadone, concentrations in hair of younger children were
opiates, cocaine, amphetamines, ecstasy, cannabinoids higher than of their elder siblings. In severe cases
and benzodiazepines by LC-MS/MS and GC-MS. and based on the entire information about the case,
Hair testing was preferentially performed for parents/ the children were immediately taken into custody,
caregivers. Children were included in case of positive the family court was appealed, the children were
parents/caregivers results or in urgent cases after a admitted to children's homes or foster families, or the
court decision if the parents/caregivers declined the drug consuming adult was separated from the family
testing. A follow-up hair test was performed after and a withdrawal treatment was initiated. Follow-up
6-months (positive results) or 12-months (negative tests showed an improvement in the situation of the
results). children particularly in severe cases.
Results: The children hair appeared to be a Conclusion: Hair analysis proved to be a very
sensitive indicator of the handling of drugs in their efficient working instrument for social authorities in
environment and often showed a similar or the same the systematic improvement of child-welfare in drug
drug profile as their parents. The annual statistics for abusing environments.
the initial test of children were no drugs 22-33%,
‫حتليل ال�شعر ك�أداة ت�شخي�صية ودليل جنائي يف نظام‬
Key words: Child welfare, Drug abuse, Hair analysis,
‫الرعاية االجتماعية للأ�سر التي لديها �أطفال دون ال�سن‬
Social services, Methadone maintenance ‫ عر�ض‬،‫القانونية و�أولياء �أمور متعاطني للعقاقري واملخدرات‬
‫خربة �أربع �سنوات‬
* Corresponding Author: Fritz Pragst
Email: fritz.pragst@charite.de
‫امل�ستخل�ص‬
1658-6794© 2015 Naif Arab University for Security 1-14 ‫ عينة �شعر لأطفال ترتاوح �أعمارهم بني‬388 ‫لقد مت حتليل‬
Sciences. All Rights Reserved. Peer review under the ‫ عينة �شعر من الوالدين �أو مقدمي الرعاية للأطفال وذلك‬594 ‫ و‬،‫عام ًا‬
responsibility of NAUSS / doi: 10.12816/0017698 ‫ وقد مت فح�ص هذه العينات للك�شف‬.2014 - 2011 ‫خالل الفرتة من‬
،‫عن امليثادون والأفيونات والكوكايني والأمفيتامينات واالك�ستازي‬
Production and hosting by NAUSS
‫ و‬LC-MS/MS ‫والقنبيات والبنزوديازبينات با�ستخدام تقنيتي‬

‫مراقبة لل�شعر بعد �ستة �أ�شهر للحاالت ذات النتائج الإيجابية �أو اثني‬ The children are in a permanent atmosphere of unsteadiness . unemployment. Subjects and Hair Samples Between March 2011 and December 2014. In ‫ كما مت متابعة احلاالت ب�إجراء اختبار‬. Materials and Methods .‫ع�شر �شهرا للحاالت ذات النتائج ال�سلبية‬ and uncertainty.0% ‫واالك�س ـ ــتازي‬ this technique was chosen as the essential diagnostic ‫ كانت الرتاكيز يف عينات �شعر الأطفال الأ�صغر‬،‫ وكقاعدة عامة‬. Pragst et al. subjects of the World Medical Association. Hair analysis proved to be particularly suitable for this ،9-25% ‫ امليثادون‬،‫ من احلاالت‬22-33% ‫عدم وجود خمدرات يف‬ purpose because of the long time window of drug detection ‫ والأمفيتامينات‬،46-57% ‫ والكوكايني‬،7. the social and educational aspects are even length. . this concerns between 30. Shorter hair was investigated in full However. Berlin. children's hair was also tested. more severe. the findings after four years of this ‫ �أو اتخاذ قرار‬،‫بقبول الأطفال يف دور رعاية الأطفال �أو لدى �أ�سرة كفيلة‬ project are reported.‫املتابعة حت�سن �أو�ضاع الأطفال وخا�صة يف احلاالت ال�شديدة‬ 2. In .000 children in Germany [9]. Besides the physical endangerment. children experience material distress. ‫ ومن‬. 388 hair ‫ لقد �أثبت حتليل ال�شعر �أنه �أداة عملية وفعالة جد ًا‬:‫اخلال�صة‬ samples from children (age 1-14 years).‫العقاقري واملخدرات مع نتائج الوالدين �أو مقدمي الرعاية‬ Since this information is often concealed.1. and 572 hair samples . Therefore. by cutting as close as possible danger of poisoning as has been shown by several above the skin. These numbers include .‫�إ�ساءة ا�ستخدام العقاقري واملخدرات‬ from parents/caregivers (age 18-67 years) were analyzed upon the order of the Offices of Social Services at the Senate ،‫ حتليل ال�شعر‬،‫ تعاطي املخدرات‬،‫ رعاية الأطفال‬:‫الكلمات املفتاحية‬ of the Hanseatic City of Bremen. Charité.0-5% tool in a widespread system of regulations which were implemented in the German Hanseatic city of Bremen ،‫ يف احلاالت اخلطرية‬.5-28% ‫والهريوين‬ ranging from several months to years [10. The samples were collected from the vertex posterior region using the hair collection Introduction kit of the Institute of Legal Medicine of the University Children of drug addicted parents are in permanent Hospital.‫ املعاجلة البديلة بامليثادون‬،‫اخلدمات االجتماعية‬ initial tests and control tests. objective test results are required. caused by frequent and drastic drug related ‫ �إن عينات �شعر الأطفال تبدي �إمكانية بكونها م�ؤ�شر‬:‫النتائج‬ mood changes of the parents.GC-MS for the emotional and psychosocial adaptation of the child.000 and 60. ‫ والبنزوديازيبينات‬،21-49% ‫ والقنبيات‬،1. 22 hair samples ‫لل�سلطات االجتماعية يف التح�سني املنهجي لرعاية الأطفال يف بيئات‬ from adolescents (age 15-17 years). Hair sampling parental drug abuse is also a serious developmental risk and analysis were performed either on the basis of a written informed consent or on decision of the local family court. poverty and ethical principles for medical research involving human social discrimination.‫ح�سا�س عن البيئة املحيطة بهم والتي تتعامل مع العقاقري واملخدرات‬ Social help and legal decisions in favor of the children require information about the kind and extent of the parental ‫ويف �أغلب احلاالت �أظهرت هذه العينات نتائج مماثلة لفحو�صات‬ drug abuse and about the exposure of the children to drugs. the proximal segment upto fatal cases involving methadone and other drugs [1-8]. 6 cm was analyzed. ‫�أولياء الأمور �أو مقدمي الرعاية‬ their family setting. Families with illegal drug ‫ �أو‬،‫حالة كون نتائج اختبار �أولياء الأمور �أو مقدمي الرعاية �إيجابية‬ addicted parents often live on the verge of society. For longer hair. maltreatment.11]. This study was conducted according to the Helsinki missed education.000 inhabitants) in 2011. bad housing. In the present paper.‫مقدمي الرعاية للأطفال‬ According to estimations. ‫ ولقد مت �إدارج الأطفال يف االختبار يف‬. Hair Analysis as a Diagnostic and Forensic Tool in a Social Support System for Families with Underage Children and Drug Abusing Parents: Four Year Experience 181 ‫ ومت �إجراء اختبار ال�شعر التف�ضيلي للآباء والأمهات �أو‬. downplayed or ‫الإح�صائيات ال�سنوية التي تناولت االختبارات الأولية للأطفال وجد‬ repressed by the parents.‫�سن ًا �أعلى مقارنة بعينات الأ�شقاء الأكرب �سن ًا‬ (550. The first results of ‫ ومت اتخاذ قرار من قبل حمكمة الأ�سرة‬،‫الأطفال على الفور �إلى الو�صاية‬ this project were presented in a previous publication [12].6-7. malnutrition. The children are threatened by neglect. illness. Besides hair samples from ‫ مت حتويل‬،‫وا�ستناد ًا �إلى املعلومات الكاملة حول مثل هذه الق�ضايا‬ parents. Life is ‫يف احلاالت العاجلة بعد قرار من املحكمة عند رف�ض االختبار من قبل‬ often dominated by drug related crime and prostitution. conflicts and violence. ،‫بف�صل �أو ا�ستبعاد فرد الأ�سرة الكبري واملتعاطي للعقاقري �أو املخدرات‬ ‫ و�أظهرت اختبارات‬،‫وكذلك البدء عند الطفل بربنامج عالج االن�سحاب‬ 2.

The local α-hydroxyalprazolam. 2 the case of children. parents and children are scheduled after 6 months in case Between 15 and 30 mg of washed hair pieces were digested of positive results and after 12 months in case of negative with 1 mL of 1N NaOH each containing 10 ng d3-THC. anhydroecgonine parental drug abuse. it was cut into 1–2 mm pieces and 20 mg court. bromazepam. For about 30 families. family court is called in case of insufficient cooperation methylenedioxymethamphetamine (MDMA). Depending Five microliters of the residues were injected for analysis on all available information. 1.O-bis(trimethylsilyl) is to achieve drug abstinence.004 and 0. methylenedioxyamphetamine (MDA). cannabinol (CBN). ecgonine methyl ester. and d3-CBD as internal standards for 20 minutes It must be emphasized that the measures mentioned at 80°C. children and adults were disclosed if the family court or the social workers needed extended interpretation concerning 3. It is based on the German criminal methyl ester. agreement between parents and the local social welfare diazepam. the solvent evaporated.1 ng/mg. d3-CBN. morphine. Analysis of hair samples The social support system for families with drug The hair samples were analyzed for 31 drugs and addicted parents and underage children aims to protect metabolites [6-acetylmorphine (6-AM). CBN 0. A prerequisite (HS-SPME) and GC-MS with N. and cannabidiol (CBD) were determined In less severe cases. in hair by derivative headspace solid phase microextraction which can recieve different kinds of support. of the parents.001 and removal of the child from the family. cannabinol (CBN). and above are not solely based on the hair results but are . 3. network of social and medical institutions and services For basic drugs. A of the parents is investigated. but methamphetamine. children against the abovementioned endangerments of acetylcodeine. impression about the extent of drug exposure. (Δ9-THC)]. 7-aminoflunitrazepam. Structure of the social support system and the role of hair analysis 2.2. cannabidiol code. amphetamine. the mixture of 23 deuterated drugs or metabolites (each 5 ng) hair test of the children is performed in order to get an was used as internal standards. the informed consent was signed by the the residue submitted to HS-SPME-GC-MS in selected ion parents or other caregivers. dihydrocodeine.5 mL. 0. separation of the drug consuming father or mother from the The cannabinoids Δ9-tetrahydrocannabinol (Δ9-THC). measures are taken in severe cases such as the immediate The limits of detection (LOD) were between 0. the German social legislation and on a written (CBD).01 ng/mg [15]. cocaine. New cases with young children become known from were twice incubated for 18 hours with each 0. including the hair results. methadone. benzoylecgonine (BE). methylenedioxyethamphetamine (MDEA).1. the prevention of danger to the child outweighs medical nordiazepam. norcocaine. After determination of the initial status. by LC-QTOF-MS or LC-MS/MS without further cleanup. oxazepam and Δ9-tetrahydrocannabinol secrecy in cases of emergency. federal state government and also includes the family After drying. the hair formate (25:25:50. lorazepam. It consists of a widespread previous papers [15. Confidentiality must be maintained. family. EDDP.005ng/mg and the limits of quantification (LOQ) between court. The samples were anonymized.01 ng/mg. codeine. or initiation of withdrawal treatment. and CBD the code.004 and 0. appeal of the family 0. Results and Discussion the drug distribution between the family members. Both extracts were united and evaporated in a nitrogen stream to a residue of 0. flunitrazepam. heroin. alprazolam. monitoring mode.003 and only the age of the individual was recognizable from and 0.5 mL of maintenance treatment or in case of admitted or suspected a mixture of methanol/acetonitrile/2 mM of ammonium drug use.003 and 0. department for granting the child welfare. The solution was twice extracted with 2 mL iso- octane. v/v/v) under gentle shaking at 37°C.16]. The LOD and LOQ were: THC 0. the children remain in the family. admission into children's homes or by foster families. Follow-up hair tests of trifluoroacetamide (BSTFA) as a derivatization agent [16]. If drugs are detected. cocaethylene. 10 µl BSTFA added. results. 182 Pragst et al. the connections between 0. benzodiazepines and metabolites under the coordination of the social welfare office of the the hair was washed once in water and twice in acetone.01 ng/mg. The methods were fully validated according to The structure of the case management in this support international guidelines [13.14] and were described in detail in system is shown in Fig.

The high portion of new remains a large biological variability of the concentrations. birth of children in such families or changes of residence.Case management in the social support system for families with underage children and drug abusing parents. . can be explained and false negative or false positive results cannot fully be by newly discovered families with drug problems.7% for children and interpretation of hair analysis for drugs in recent years. as shown in Fig.4% to 38. active drug exposure must be assumed. one to five follow-up tests were only performed for the most samples were from individuals between 20 and 40 remaining 19. For these reasons. Despite tremendous progress in performance and from 2011 to 2014 (from 2. There is a steady decrease of the sample number with It can be seen that until now the majority of the children increasing age. 3 shows the distribution of age among the until the end of 2014. and since social support and 3. a consequence of all information available in each there is a steady increase of the portion of follow-up tests case. cases. Children were parents or caregivers who were tested between one and six investigated only above the age of one since it is difficult times is given in Table 1. and the majority of samples were collected and adults (80. there is a large residential fluctuation in this clientele. Generally. A small number of adolescents in cases of younger children to distinguish between in- (age 15 to 17 years) were included in the group of adults utero incorporation into hair and post-natal incorporation. Children and parents/caregivers included in this hair testing require a high degree of cooperation from the study parents.6%.8% for adults). However. The number of tested children and children and adults included in the study. a consequent realization of the project including This is an ongoing project that started in March 2011. even in the fourth year of the project. since at this age. the excluded. 2. all follow-up tests cannot be expected. there from 0% to 35.7 and 20.4%) were tested only once and from toddlers and preschool children. For the adult group. This paper includes 982 hair samples which were collected Fig.2.7% and 79. Hair Analysis as a Diagnostic and Forensic Tool in a Social Support System for Families with Underage Children and Drug Abusing Parents: Four Year Experience 183 child's welfare into to a children's Figure 1 .

For each sample. Furthermore.3.2.3. Examples are given in section guidelines were used [17-19]. this section is limited to the initial test of all subjects.Numbers of initial and follow-up hair tests of children and parents/caregivers between 2011 and 2014. Drug concentrations in hair of parents and children The numbers and percentages of positive results and All samples were analyzed for the 31 drugs and . 2 Table 1.1. this section. but there were also some adolescents between metabolites as described in section 2.3. 15 and 18 years and some persons up to 67 years old in the a detailed report was written considering all findings. all concentrations above LOQ and the distribution of the drugs between the family members with unambiguous identification of the drug were given.Tested children and parents or caregivers and number of tests between March 2011 and December 2014 Frequency of testing Number of children Number of parents / caregivers 1x 239 358 2x 34 55 3x 13 28 4x 8 9 5x 2 0 6x 0 1 Total number of individuals 296 451 Total number of hair samples 388 594 Figure 2 . 184 Pragst et al. only the key substances (parent compound or For reasons of confidentiality. More details such as gender and links to samples from other family were described previously [12]. years old. The development members were not generally disclosed and were only in the follow-up tests is described in section 3. 3. had to be interpreted to the court or the social workers for No cut-offs recommended by national and international a more profound decision.5. Initial testing results of children 3. further information metabolite) of each drug shall be considered. In environment of the children. 3. In this known to the laboratory regarding about 30 families when child protection project.3.

16 0.4 Amphetamine 14 (4.9 20.3 6.03-0.5 43 48.1 56.6 2. Hair Analysis as a Diagnostic and Forensic Tool in a Social Support System for Families with Underage Children and Drug Abusing Parents: Four Year Experience 185 Table 2. 29 samples for three drugs.48 0.9 0 10.0%) 0.Frequency of hair samples at different ages of the tested children and parents/caregivers.7 15.4 54.1 Benzodiazepines** 12 (4. the ranges. .1 5.6%) 0.056 38.080 24. means and medians of the concentrations of the samples for four drugs and one sample for five drugs.96 1.01-11.1 0.1 0 5.15 0.01-17.6 8.5%) 0. This can be explained by the fact that in the first Figure 3 .7%) 0. Δ9-THC = Δ9-tetrahydrocannabinol ** From the tested benzodiazepines only diazepam and nordazepam were found in children hair.025-5. 19.069 27. 22. 99 samples were positive for one drug. 13 in 2011. (ng/mg) Frequency of positive results.8 0. In 80 children key metabolite of heroin.1 32.6 7 Methamphetamine 0 (0%) 0 0 0 0 0 0 0 MDMA (Ecstasy) 5 (1.7 48.15 0. a percentages for each year are also given. --. (27%). and 6-AM wich exhibited a particularly high frequency 74 samples for two drugs.056 1. with the exception of methadone of 216 children. Out within the four years.5%) 0.34 3.023 4.7%) 0.Illegal drug concentrations found in the initial hair test of 296 children and frequency of positive results between 2011 and 2014.2 7. There was a high frequency There is no clear trend in the percentage of positive results of multiple drug exposure in the remaining children.18 0.1%) 0.5 0 1.27 0. MDE = methylenedioxyethamphetamine. The drugs found in the first test of the 296 children for the whole most frequently detected drugs were cocaine (50%) and time period are shown in Table 2.01-2.5 6-AM (Heroin) 58 (19.6%) and methadone (14.5 33.9 15.3 2.2 No drugs 80 (27%) ---.8 MDE (Ecstasy) 0 (0%) 0 0 0 0 0 0 0 Δ9-THC (Cannabis) 111 (37. Only parent drugs or key metabolites are shown.01-2.7 21. % positive results 2011-2014 2011 2012 2013 2014 Range Mean Median (N=296) (N=122) (N=79) (N=39) (N=56) Methadone 43 (14. the positive Δ9-THC (37. Number of Substance* Concentration.16 0. MDMA = methylenedioxymethamphetamine. ---.68 0.52 0.3 *6-AM = 6-acetylmorphine.8 Cocaine 148 (50.4%). no drugs were found.58 0.043 0.5%) followed by 6-acetylmorphine (6-AM.079 46. Furthermore.012-0.

oxazepam (12x).3 11.9 9.09 0.5 7. mean concentrations and median concentrations of methadone. cocaine and THC in the initial hair test of children in the age groups 1-3 years (N=120). flunitrazepam (2x) and lorazepam (1x). 6-acetylmorphine (6-AM).8%) 0. ng/mg Frequency of positive results.1%) 0.3%) 0.49 0.1 47.1 *6-AM = 6-acetylmorphine.15 7.7%) 0. Number Substance* of positive Concentration.01-36. 19.5 Methamphetamine 1 (0.1 4.0 6-AM (Heroin) 59 (13.48 6.1 44.2 9.3 No drugs 127 (28.1 3.0 MDE (Ecstasy) 3 (0.0 0.5 9.99 0. % results 2011 2012 2013 2014 2011-2014 Range Mean Median (N=122) (N=79) (N=39) (N=56) Methadone 57 (12.28 24.5 27.0 Δ9-THC (Cannabis) 196 (43.47 0.02 0.90 0.024-25.4 4.39 0.3 10.7 0.21 45.0 38.8 30. ---.36 0.02-20.49 26.24 52.4 6.33 0.24 6.1 Amphetamine 35 (7. 2 Table 3. ---.6 Benzodiazepines** 31 (6.4 13.2%) 0.5%) 0.5 1.2%) ---.4 6.0 MDMA (Ecstasy) 22 (4. MDE = methylenedioxyethamphetamine.0 0. Only parent drugs or key metabolites are shown. Δ9-THC = Δ9-tetrahydrocannabinol ** From the tested benzodiazepines found in parents / caregivers hair: diazepam (19x).Illegal drug concentrations found in the initial hair test of parents or caregivers and frequency of positive results between 2011 and 2014.0 8.01-1.3 4.8 37.6%) 0.8 12.Percentage of positive results. .8 45.01-8.02 0.6 0.20 3.63 0.0 Cocaine 200 (44.02-18.8 2.9%) 0.5 0.13 8.1 4.13-1.4 43.9%) 0.01-11.7 7. 186 Pragst et al. MDMA = methylenedioxymethamphetamine.3 32.0 0. nordazepam (16x). 4-6 years (N=82) and 7-14 years (N=94).2 1. Figure 4 .02 0.26 0.

27 Norcocaine pos.36 (THC) Cannabinol (CBN) 0.d.d. 0. n.57 0. n. Hair Analysis as a Diagnostic and Forensic Tool in a Social Support System for Families with Underage Children and Drug Abusing Parents: Four Year Experience 187 year of the project. n. n.d.036 0. Cocaethylene n. n.2.09 0.d. results and almost always the highest mean and median Table 4.7 0. cocaine and Δ9-THC.05 0. 6-Acetylmorphine 5. n. different drugs are very similar to those of the children.063 0. n. 0. However.d. n.d. 0. n.43 n.d. n. 1. There is a clear effect were preferentially included.d. n. n. n. n. 0.021 0.d. heroin (22 times). n. amphetamine with the drug consuming parents and their environment (11 times) and twice MDMA.46 n. n.012 0.d. 55 cases for 1 drug.d. n.d. n. less new cases of children with parents in methadone and on the drug concentrations as shown in Fig.25 n. n. and that in the following of children’s age on the frequency of positive results years.d. cocaine and cannabinoid results*. 0. n.d.94 n.d.d. 0. n. n.037 n.d.68 0. = detected but not quantified. 0.21 n. n. pos.d.d. n. n.d. n.d. n. 0. n. Cocaine 1.. n. 0.42 0.21 n.06 0.d. n.d. years 34 5 1 29 2 35 7 34 13 7 Methadone 12.16 15.24 n. n.d. Initial testing results of parents or caregivers put contaminated objects into their mouth and also have a The results of the initial hair test of 451 parents or higher respiratory rate than older children or adults. heroin. This is in agreement with previous findings and cases for three drugs.d.6 0. pos.085 0. methadone.2.d. n. pos. 0. n. Morphine 1. = not detected.59 pos. Codeine 0.d.63 0. Heroin pos.Concentrations in hair (ng/mg) of families with positive methadone. n.d.d.14 n. pos.d.36 Cannabidiol (CBD) 0.d. 0.08 0. 68 of the In 127 samples (28. n.d.d.21].d.d.04 n.2%) no drug was detected. n.07 0. pos.24 1. whereas elder children spend more time outdoors or at school [20.19 n.d.04 n. EDDP 0.d.31 0. pos. cocaine (35 times).d.8 0.d.d. n. small children tend to 3.d.39 0.d.d.d.05 n.073 12.d.d. n.d.87 n. n.d.65 n.d.d. n.d. n.35 n. which caregivers are given in Table 3.3.03 Ecgonine methyl ester n. According to the criteria given in section 3.d.d. Δ9-Tetrahydrocannabinol 1.d. n.39 1. n.d. n.d.53 n.d.d.d.d.024 0. n.29 41. there were .60 0.d.023 1. n. 8 cases for two drugs and 5 7-14 years.d.d. n. 4 for maintenance treatment were observed.d.d.4. The frequencies of the increases inhalation of smoke and dust.014 pos.54 1. These results included methadone (13 can be explained by the closer contact of younger children times). n. 6-AM. n.d. 0. Toddlers aged The concentrations vary strongly with the majority 1-3 years always displayed the highest portion of positive below the usual values of regular drug users.d. * Only drugs or metabolites with positive results are shown. From the 296 initially tested children (23%) presented very serious remaining 324 samples with positive results.d.006 n.d. concentrations followed by the age groups 4-6 years and results. Benzoylecgonine 0. n. 0.06 1.d.d.18 0. n.05 n. indoors.d. children from parents in methadone there are several samples with concentrations typical maintenance programs who frequently co-abuse heroin for occasional or regular abuse. 0.0 1.d.11 0.d. n. Family 1 Family 2 Family 3 Family 4 Family member Mother Child 1 Child 2 Mother Child Mother Child Mother Child 1 Child 2 Age. Furthermore.82 0. n.

Interpretation for parents or caregivers assessment of the domestic drug situation. a short description of the caregivers (14. There were 39 parents or caregivers (8. information the criteria given in section 3. 7 samples positive for five drugs lower than those in the hair of their consuming parents. Between them. and limitations in demonstrated for several examples in the previous paper interpretation of hair results have been comprehensively about the project [12] and is shown in Table 4 for four described in the literature [11]. the mother) displays negative or very low results. In case of the parents further families (mothers with one or two children). two drugs.4. The situation is and upper range (above 75 percentile). The corresponding approximate concentration ranges for The concentrations of the 13-year-old child were clearly the drugs are given in Table 5. principles. 97 samples positive for very well mirrored by the hair results of the children. 188 Pragst et al.. This is caused by the than of their elder sisters or brothers. but environment of the children who was not tested. AM) occurred 22 times. there must and the data were not available for this study. From the family examples as a whole. it can be frequent use are.1. On using including characterization of the hair sample. the frequency of methadone and of 6-AM was much higher the concentrations in hair of younger children are higher in 2011 than in the following years. a differentiation of the exposure/ of family 2.g. or even higher than in the hair of their parents.g.4.3. addicted concluded that the drug situation of the parents is often to the drug and are a serious risk to the child's welfare. This is also clearly the detection and concentrations of metabolites. The values similar in families 2 and 3 with the exception of cannabis described by Tsanaclis and Wicks for a large population and the additional detection of cocaethylene as a proof appeared to be very helpful for this purpose [22]. Parents with regular and lower the mother. and ecstasy (MDMA or MDE) 4 times.5%) occurred most frequently followed by the concentration in children’s hair was in the same range 6-AM (13. the mother was possible between active drug consumption and external on methadone maintenance treatment but continued to contamination of the hair. cocaine and cannabis. If the tested parent fact that from 2012 parents in maintenance treatment (but (e. The reflected in the hair sample of the one year old child with concentrations were compared with the whole database of one to two orders of magnitude lower concentrations. This is mainly based on abuse heroin. The the corresponding drug and were assigned to the lower range concentrations are even lower in the hair of the five year (below 25 percentile). In case of follow-up testing. medium range (25 to 75 percentile) old child. cocaine 22 times. In this of co-consumption of cocaine and alcohol by the mother child protection project. be another drug consuming person (e.3%) and However. a table of the measured concentration drugs in the range of regular and frequent use (56 times and interpretation. the concentrations in children’s hair are much positive for four drugs. where Δ9-THC (43. there are also examples. 42 samples positive for three drugs. The comparison of hair results between children and parents within a family is often very helpful for the 3. according to the hair findings. In the same way. the change one drug and 9 times two drugs). Interpretation of hair results [22]. In or caregivers. a further 65 parents or about hair cosmetics used. seven year-old child in the same order as of the mother. it had to be distinguished as far as family 1. for Δ9-THC.4%) displayed concentrations of illegal hard analytical method.g. Only cocaine and cannabis were detected consumption into experimental. e. Comparison of concentrations within families case.4. The . and one sample positive for six drugs.1%) and methadone (12. heroin (6. The interpretation is different for adults and children. 22 samples Usually. the means and medians are clearly higher than the children and are in the typical ranges as described in in the literature 3. not their children) were mainly tested in another laboratory despite clearly positive findings for the children.6%). amphetamine 4 It is very important that any decision taken by the social times. offices does not solely depend on the hair report but must be based on entire body of evidence known in a specific 3. 2 155 samples positive for one drug. in comparison to all previous tests was also interpreted. As a rule.6%) with A detailed report was written for each tested sample methadone in the range of maintenance treatment. Cocaine (44. with a high degree of probability.3. and cannabis was not detected. occasional (<25 percentile) in family 4 with the THC and CBN concentration of the and regular / frequently (≥25 percentile) was performed. the father) in the The concentrations also vary strongly in this group. This was Physiological basis.1.

poisoning cases known in which the mothers tried to calm It is also important to distinguish between systemic their children by administration of a methadone overdose incorporation of the drug in hair after oral intake or [5.1 0. criteria for most common adverse effects of methadone.7 ≥0.1 0. it can generally be assumed that in cases of high which could be incorporated from the sweat of the mother concentrations the degree of risk was more severe than if into the hair of the child [12]. .7 * Methadone maintenance treatment frequency of such cases in the initial and follow-up tests is outside of the body but only enzymatically within the described in section 3.1 to 1. this period can be up to 6 months longer.0 >2. was assessed. Frequent contamination of the room in absence of the child hydrolytic” metabolites were used as criteria for a systemic or frequent touching of the child’s hair with contaminated incorporation since they are not formed by hydrolysis hands after preparing and smoking cannabis joints in another place can be sufficient for a positive result [24].0* 6-Acetylmorphine (Heroin) <0. means in every case that there was a handling of the It can also not totally be excluded that a non-hydrolytic drug in the environment of the child. between systemic and external incorporation was possible for amphetamine. Hair Analysis as a Diagnostic and Forensic Tool in a Social Support System for Families with Underage Children and Drug Abusing Parents: Four Year Experience 189 Table 5. A positive result by the detection of the THC-COOH [12]. Interpretation for children's hair results deposition of Δ9-THC can be assumed.1 0.0 MDMA (Ecstasy) < 0. from heroin.02 to 0.5.5. However.1 to ≤2. case of heroin.Interpretation of drug concentrations in hair (ng/mg) of parents / caregivers.4.0 Cocaine <0. no distinction growing hair. mainly external 3. “serious exposure” drug occurred by intentional administration or accidentally and “very serious exposure” and are given in Table 6.02 0.23]. frequently contamination Methadone <0. This concerns EDDP from methadone. the length of hair above the hair 6-acetylmorphine. More details for children's That means a proximal hair segment of 6 cm represents hair were previously described [12]. Heavy sweating is one of the only traces of the drug were found. the concentration ratio of morphine and As the minimum period.1 to 2.1 to ≤1. which can both be formed by hydrolysis root is equal to the number of months before sampling. smoke or contaminated hands or surfaces. also an estimation of the time period from cocaine and MDA from MDMA or MDE. this project. There are lethal and survived follow-up tests is discussed in section 3.2 0. This means there is metabolite is transferred from the consuming parent to always a risk to the child as described in the introduction. In presence of the child cannot unambiguously be answered. in some There are several aspects to consider in the cases systemic uptake by inhalation of smoke was probable interpretation of children's hair results.0 >1. norcocaine Finally. Due to the absence 6 months before sampling.2 to 2.0 >2. In the represented by the hair sample was given in the expertise.1 0. body. Therefore. the hair of the child.0 >2.0 >1.0 Δ9-THC <0. assessment of the drug concentrations were chosen in this The important question whether a systemic intake of the project in the categories “detected”.2. The cannot be answered by hair analysis but is a question of frequency of very serious exposure cases in the initial and criminological investigation. Caused by telogen and slow of a suitable non-hydrolytic metabolite.0 Amphetamine <0. Such cases were probable for EDDP. the detection and concentrations of “non. the question whether in the case of a positive inhalation by the child and external deposition into hair result the handling or consumption of the drug occurred in from dust. Also. However. In the case of cannabis. Concentration range Traces Lower range Medium and upper range Experimental or Exposure or consumption Occasional Regular.

1 ≥ 0.05 . no EDDP Methadone <0. Eight months later. Systemic drug intake was probable from the detection of EDDP and 3. (1) no drugs in initial and follow-up tests.1 + norcocaine Cocaine no norcocaine no norcocaine ≥0. The situation worsened during the testing period.5. Obviously.5.10 to 0.05 . It can be seen from the four The statistic evaluation of the cases was separately graphs that a favorable development (negative in all tests performed for so-called hard drugs (heroin.1 ≥ 0. the results from the initial and three up to the age of one year.49.05 < 0. the initial test and the last follow-up test. only a small cocaine value The success of measures and support provided by the remained. the range (criteria in Table 5) was compared accordingly. drug use.0.1 MDMA (Ecstasy) <0. However. the number of very methadone maintenance treatment and all four hair tests serious cases according to Table 6 was compared between showed an occasional but steady abuse of heroin (6-AM).5. the 15 month old child exhibited very first approximation the same chronological interpretation as high concentrations of methadone. 6-acetylmorphine and for adults was applied (growth rate ≈1cm/month).0. it can be seen from from the comparison of initial and follow-up hair results the third and fourth test two years later that again heroin Table 6. For adults. this concerns mainly the perinatal period As examples.5. by increased exposure or new exposure to additional The mother in Table 7 from another family was on drugs. In the initial test.05 0. the cases were subdivided into groups: from 17 to 12 cases for the parents. According to the outcome of initial in the initial test to 5 in the last follow-up test. results are shown in Figure 5. or improvement) dominates over worsening or unchanged amphetamine and ecstasy) and for cannabinoids. 2 There are also differences between adults and children with was evaluated for the 57 children and 93 adults for whom respect to the hair growth rate and presence of telogen hair follow-up tests were performed. new abuse of cocaine became evident in number of cases in the medium and upper concentration test 4 with a relatively high concentration. Obviously.1 ≥0. the measures of the social tests. Development from initial to follow-up tests norcocaine. However. it falls only and follow-up tests. [11.1 <0. for children. Furthermore.1.25. (2) improvement It follows from the comparison in Fig.26].1 Δ9-THC <0.05 0.0.1 . Whereas in the case of children the number medium and upper concentration ranges was due to of severe cases (only with hard drugs) decreases from 21 maintenance treatment. this favorable outcome is more Methadone was only considered as a “hard drug” for pronounced for children and for hard drugs than for parents children since its presence in the hair of adults in the and cannabis. in a 7. cocaine and a positive diazepam result.1 ≥ 0.Interpretation of drug concentrations (ng/mg) in hair of children Degree of exposure Detected Serious Very serious ≥0.10.1 ng/mg + EDDP 6-Acetylmorphine (Heroin) < 0. 5 that the efforts by strong decrease of concentrations or negative results. 0. 190 Pragst et al. Since in this project only samples follow-up tests for a child and a mother are shown in Table from children above the age of one year were included. cocaine.1 ---- * Methadone maintenance treatment and cocaine were handled in the surroundings of the child. no EDDP ≥0. ≥0. the In addition to that. no EDDP 0. Therefore. no norcocaine Amphetamine <0. to minimize the drug exposure of the children were more . which could be explained to be older residues social offices are evident from the results of the follow-up in telogen hair. the development of the cases as it appears authorities were successful. (3) no essential change of drug exposure and (4) worsening and that diazepam was administered. However.

n. n.d. n. n.d.14 Heroin Pos.017 n.24 0.88 41.47 n. 0.d.033 0.d.0 EDDP (Methadone- 0. n. Diazepam 0.d. 2014 Methadone 14.d.076 0. n.d.d.d.d.d.32 0.04 Cocaine n.d.19 0. 0. 0.d.078 n. born in October 2010 Test No.d.03 0. Benzoylecgonine 0. n.d.089 0. n.28 0.09 Norcocaine Pos.d. n. 2014 Aug. 1 2 3 4 Date of testing Feb.d. n.54 Norcocaine n. n.31 0. 0.39 Metabolite) Morphine 0.d. n.42 Benzoylecgonine n. 1. EDDP 0. n. 0.21 6-Acetylmorphine 0.d.d.096 0.30 n. 12. born in May 1979 Test No. Cocaethylene n.32 0.d.d.d. n.02 Codeine n. n. 0.d.d. 2012 May 2014 Dec.d. Acetylcodeine 0. 2011 Mar.017 0.31 Heroin n. n.27 n. 2012 Feb.02 Mother. n.46 n. n.d.d. Codeine 0. n.d.d.d. n.28 0.d.d. 0.22 0. Hair Analysis as a Diagnostic and Forensic Tool in a Social Support System for Families with Underage Children and Drug Abusing Parents: Four Year Experience 191 Table 7. n.d.d.d.d.52 0. n.d. .d.d.07 0.52 Pos.2 14.d.41 n.21 Acetylcodeine 0.d. n. 2012 Oct. n.07 Ecgonine methyl ester n. n.28 0.01 Cocaine 2. n. = not detected.d. n.83 9. 1 2 3 4 Date of testing Dec. Analyzed hair segment upto 6 cm. n. Child. 0.04 Ecgonine methyl ester n. n. 2014 Methadone 0.Two examples from different families of the results (ng/mg) of the initial and three follow-up hair tests. n.d. Morphine 0.03 6-Acetylmorphine 3.06 0. n.01 0.34 0.d.d.28 0.

Additional investigation of children’s hair gives evidence about the degree of their exposure to these drugs. Drug concentrations parents. the interpretation should be performed by experienced 4. or separation of the the systematic improvement of child-welfare in a drug drug consuming father or mother from the family should abusing environment. 2 Figure 5 . hair analysis proved to be a very the removal of the child from the family and admission into efficient working instrument for social authorities in children's homes or by foster families.Change of hair test results from initial test to last follow-up test of 93 parents or caregivers and 57 children. 192 Pragst et al. successful than to overcome the drug addiction of the schematic interpretation of hair results. Because of the long time window never be based solely on the hair analysis result but must and the high performance of applied chromatographic and include all other sources of information. specificity. Therefore. hair testing of parents be ensured by the principles of this social support system reveals their use of illegal drugs with high sensitivity and as described in section 3. Consequences such as continuous project. The lower improvement concerning cannabis in in hair can arise from different ways of incorporation. 1. and are decreased to a ongoing debate about its legalization. different degree by hair care and hair cosmetics. it must be cautioned against the uncritical and . as is obvious in the many other individual parameters. Conclusions hair analysts who know the pitfalls and the up-to-date After the experience of four years with this literature of drug analysis in hair. This appeared to mass spectrometric techniques. children as well as parents can be explained by the general depend strongly on variable physiology of hair growth and more moderate opinion about this drug.1 and in Fig. However.

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