Forensic medical and toxicological expertise in a case of administrative license revocation: organizational and methodological considerations (a case report)

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INTRODUCTION

False positive results of a chemical toxicological analysis (CTA) are unfortunately quite common [1]. Metabolites of some (including illicit) psychoactive substances (PASs) can be detected after accidentally entering the body in cases that are not related to legal infractions. For example, opium metabolites can be detected after consuming poppy seed buns [2]. Even false positive CTA findings frequently serve as the basis for legal decisions. Furthermore, methodological limitations and the impact of human errors during sampling and laboratory analysis increase the risk of incorrect interpretation of results. This is especially relevant in cases of potential nonmedical use and nonphysiological metabolism of some PASs, including γ-butyrolactone, an organic solvent with various industrial applications. Furthermore, it can be used as a recreational PAS. The pharmacokinetics of γ-butyrolactone are unique in that it undergoes a complete metabolic transformation in the body, rather than retaining its original form. It is eliminated exclusively via the formation of metabolites: 1,4-butanediol or γ-hydroxybutyric acid, also known as 4-hydroxybutanoicacid [3].

Therefore, cases of non-accidental and accidental detection of specific illicit substances in a large sample of examined subjects must be clearly differentiated. The continued use of unreliable CTA findings increases the risk of unlawful decisions with legally significant consequences.

CASE DESCRIPTION

Incident Circumstances

According to an administrative case, citizen G. (31 years old), a driver for a private company, was stopped in his company car by traffic officer P. at 04:25 on April 18, 2021, in the Kirovsky District of St. Petersburg.

Based on Article 27.12 of the Code of the Russian Federation on Administrative Offenses¹, citizen G. was suspended from driving for sobriety testing.

Traffic officer P. issued sobriety testing report 78 АВ No. 024983 of April 18, 2021, indicating that citizen G. showed signs of intoxication (Table 1).

 

Table 1. Data from sobriety testing report 78 АВ No. 024983 of April 18, 2021 (citizen G.)

Assessed criterion	Detected
Alcohol breath	No
Postural instability	Yes
Speech impairment	No
Skin discoloration	No
Inappropriate behavior	Yes

 

Furthermore, the report stated the following: “… was performed at 05:04 using Alcotector PRO 100 combi® (Shenzhen Well Electric Co., Ltd., China), serial number 634499, last calibrated on September 12, 2020, permissible absolute error limit ±0.048 mg/L. Instrument reading 0.000 mg/L. Testing result: intoxication not detected…” A forensic toxicology expert was subsequently provided access to all materials, including the original output listing, which indicated the instrument reading of 0.000 mg/L at 05:04 on April 18, 2021 (Fig. 1).

 

Fig. 1. Results of the study using the technical measuring device “Alcotector PRO 100 combi®” (Shenzhen Well Electric Co., Ltd., China).

 

However, traffic officer P. referred citizen G. to a chemical test and issued a corresponding report (78 20 No. 010952), indicating “probable cause” as the reason. Citizen G., knowing he was not intoxicated, consented to the proposed chemical test.

Specifics of the Chemical Test

According to chemical test report No. 232/6 issued at St. Petersburg State Budgetary Healthcare Institution ХХХ on April 18, 2021, citizen G. was examined by addiction psychiatrist Ch. at 05:20 at the medical examination department (Table 2).

 

Table 2. Data from chemical test report No. 232/6 issued at St. Petersburg State Budgetary Healthcare Institution ХХХ on April 18, 2021 (citizen G.)

Analyzed parameter	Result
Appearance of the examined individual (visible injuries, injection marks)	No visible injuries
Complaints of the examined individual	None
Changes in the mental activity of the examined individual	Euphoric; talkative; oriented to person, place, and time
Schulte test	>1 min
Vegetovascular responses of the examined individual	Pulse 84 bpm, rhythmic
Skin and visible mucosa	Pale
Pupils (constricted, dilated, normal)	Symmetrical, dilated
Pupillary light reflex (brisk, slow)	Slow
Respiratory rate	Normal
Scleras	Injected
Nystagmus	No
Motor activity of the examined individual	Normal motor coordination; no speech or gait impairment
Romberg’s test (stable, unstable)	Stable
Coordination tests	Normal

 

Citizen G. denied the use of alcohol, drugs, or psychoactive substances, which was mentioned in the report.

The following equipment was used for the preliminary assessment during the chemical test on April 18, 2021:

• Jupiter® alcotector (ALCOTECTOR, Russia), No. 005896. The first test result (at 05:26) was000 mg/L; the second test (after 15–20 min) was not performed;
• Immunochromatographic urine test using ICA-Multi-Factor test strips (Factor-Med Production, Russia) (at 05:35). The result was positive;
• Gas chromatography–mass spectrometry (GC–MS) as a confirmatory method. According to conclusion No. 005791 issued by clinical pathologist K. at St. Petersburg State Budgetary Healthcare Institution ХХХ: “Confirmatory methods: GC–MS. The chemical toxicological analysis detected (substance): γ-butyrolactone…”

Information on the detection of this substance was included in the chemical test report (No. 232/6 of April 18, 2021) issued at St. Petersburg State Budgetary Healthcare Institution ХХХ, confirming intoxication in citizen G. Notably, conclusion No. 005791 was absent from administrative case files.

Given the detected signs of intoxication (postural instability, inappropriate behavior) and CTA findings, based on Article 28.7 of the Code of the Russian Federation on Administrative Offenses,¹ traffic officer P. initiated an administrative case against citizen G. according to Part 1, Article 12.8 of the Code:¹ Driving while intoxicated, unless such actions constitute a criminal offense. Senior traffic officer N. from the administrative enforcement group issued an administrative offense report based on Article 28.2 of the Code of the Russian Federation on Administrative Offenses.¹ According to the report, citizen G. drove while intoxicated (chemical test report No. 232/6 of April 18, 2021), which is classified as a violation of Item 2.7 of the Traffic Code of the Russian Federation². Part 1, Article 12.8 of the Code of the Russian Federation on Administrative Offenses establishes the accountability for this offense.¹ The actions of citizen G. do not constitute elements of a criminal offense as defined in Article 264.1 of the Criminal Code of the Russian Federation³. The case was submitted to magistrate court at the place of residence of citizen G.

Court Proceedings and Role of the Forensic Toxicology Expert

Three sessions of the court of first instance were held in 2022, with the participation of:

• traffic officer P.;
• clinical pathologist K.; St. Petersburg State Budgetary Healthcare Institution ХХХ;
• independent forensic toxicology expert.

The independent expert was heard in court and clarified the issues that arose. The expert’s conclusion was attached to the case. However, the court did not assess this conclusion and did not provide the expert the opportunity to ask questions to other parties involved.

In particular, the forensic toxicology expert drew the court’s attention to the following circumstances.

• When analyzing report 78 20 No. 013330 of April 18, 2021, on driving suspension issued by traffic officer P., it is impossible to determine which signs (criteria) provided for by Item 6 of the Chemical Test Procedure approved by Order of the Ministry of Health of the Russian Federation No. 933n of December 18, 2015,⁴ were used to make the decision on driving suspension in citizen G.’s case. The required actions were not performed in sections of the protocol where it is necessary to cross out irrelevant reasons (signs/criteria). Moreover, individual signs were underlined, which is not permitted by the established protocol template, and certain signs were later crossed out. As a result, the forensic toxicology expert was unable to reliable assess the condition and behavior of citizen G. at the time of events in question.
• According to report 78 АВ No. 024983 of April 18, 2021, traffic officer P. used Alcotector PRO 100 combi® (Shenzhen Well Electric Co., Ltd., China) for sobriety testing of citizen G. The instrument reading at 05:04 was 0.000 mg/L; therefore, the report stated that intoxication was not detected.
• Furthermore, according to report 78 20 No. 010952 of April 18, 2021, citizen G. was referred to a chemical test based on “probable cause.” However, this reason, along with the absence of specific signs indicated in report 78 20 No. 013330 of April 18, 2021, does not comply with Item 6 of the Chemical Test Procedure⁴ and cannot be considered sufficient for driving suspension and referral to the chemical test.
• Citizen G.’s urine CTA findings obtained by clinical pathologist K. at St. Petersburg State Budgetary Healthcare Institution ХХХ are false positive. According to chemical test report No. 232/6 of April 18, 2021, issued at St. Petersburg State Budgetary Healthcare Institution ХХХ, citizen G. consented for urine sampling for CTA at 05:35. A qualitative preliminary rapid immunochromatographic urine test was then performed using ICA-Multi-Factor test strips (Factor-Med Production, Russia), which detected γ-butyrolactone.
• However, γ-butyrolactone cannot be detected in urine, because it is completely metabolized to γ-hydroxybutyric acid and is therefore never eliminated unchanged.

DISCUSSION

According to Resolution of Plenum of Supreme Court of the Russian Federation No. 20 of June 25, 2019,⁵ the following must be taken into account in cases of traffic violations (and appeals against the decisions in such cases). According to Part 3, Article 26.2 of the Code of the Russian Federation on Administrative Offenses,¹ evidence in administrative cases (administrative offense report, reports of proceedings on administrative offense, sobriety testing report, chemical test report, etc.) cannot be used if obtained in breach of the law.

Therefore, Articles 26.2 and 28.2 of the Code of the Russian Federation on Administrative Offenses¹ suggest that the administrative offense report is the primary service document, confirming that the offense has been committed by the subject of administrative sanctions. A report issued in violation of Article 28.2 of the Code of the Russian Federation on Administrative Offenses¹ cannot be used in administrative proceedings, which results in the reversal of judgment irrespective of evidence of offense.

According to Article 28.2 of the Code of the Russian Federation on Administrative Offenses,¹ which defines the procedure for drawing up a report, the administrative body must follow the established procedure to ensure protection of the subject of administrative sanctions. Furthermore, the Code of the Russian Federation on Administrative Offenses details all stages of liability, excluding the possibility of violent interpretation and preventing violation of the rights of parties involved.

When analyzing the reports issued by traffic officer P., there were no reasonable grounds for driving suspension and referral to the chemical test, according to Article 27.12 of the Code of the Russian Federation on Administrative Offenses.¹ Therefore, all subsequent examinations can be considered legally invalid.

In addition to this legal reasoning, let us consider the detected inconsistencies between the obtained evidence and the typical clinical and laboratory signs of intoxication.

Intoxication in citizen G. was initially suspected based on the signs of intoxication (postural instability and inappropriate behavior) reported by traffic officer P. When questioned in court, traffic officer P. stated that citizen G.’s actions appeared inadequate to him; however, he was unable to specify the signs of inadequacy because he “failed to remember” them.

According to chemical test report No. 232/6 of April 18, 2021, citizen G. consented for urine sampling for CTA at 05:35. An immunochromatographic urine test was performed using ICA-Multi-Factor test strips (Factor-Med Production, Russia), with a positive result. The report does not specify the name of the test used, which is vital, because test strips of this brand can qualitatively detect three, five, six, ten, or twelve addictive substances in urine (ICA-3-Multi-Factor⁶, ICA-5-Multi-Factor⁷, ICA-6-Multi-Factor⁸, ICA-10-Multi-Factor⁹, and ICA-12-Multi-Factor¹⁰, respectively) (Factor-Med Production, Russia). However, none of these tests detect γ-butyrolactone. Therefore, γ-butyrolactone detection in citizen G.’s urine using ICA-Multi-Factor test strips (Factor-Med Production, Russia) is not reliable, because this is simply impossible¹¹.

According to Item 8 of the Rules for Chemical Toxicological Analysis in Medical Examination (Appendix 3 to the Procedure⁴), a CTA of a biological sample (urine) includes two stages:

• “…preliminary immunochemical tests using analyzers that record and quantitatively assess the results…”;
• “…confirmatory tests by gas and/or liquid chromatography–mass spectrometry…”

Item 10 of the Rules states the following: “After the first stage of chemical toxicological analysis, if the biological sample (urine) does not contain addictive substances, psychoactive substances, or medicinal products that impair physical and mental functions, which may lead to adverse consequences of ultrahazardous activities, as well as metabolites and analogs of the specified substances, a conclusion is made that the examined biological sample (urine) does not contain intoxicating agents (substances), and the second stage of chemical toxicological analysis is not performed.”⁴

Furthermore, the body can independently produce small amounts of γ-hydroxybutyric acid. Therefore, to rule out false positive results, Item 8 of the Rules for Chemical Toxicological Analysis in Medical Examination (Appendix 3 to the Procedure⁴) states that both qualitative and quantitative PAS detection is required during the first stage of CTA.

Notably, report No. 232/6 of April 18, 2021, is issued based on conclusion No. 005791 by clinical pathologist K. (St. Petersburg State Budgetary Healthcare Institution ХХХ), which indicates that γ-butyrolactone was detected in citizen G. by a confirmatory method (GC–MS). However, this is impossible. According to research, this substance begins to be metabolized to γ-hydroxybutyric acid within minutes after entering the body [3]. In theory, it can be converted back to γ-butyrolactone in a laboratory by derivatization with trimethylsilyl derivatives. Notably, this conclusion was absent from administrative case files and therefore was not assessed during court sessions. When questioned in court about the retention period for conclusions according to Form No. 454/u-06 “Chemical Toxicological Analysis Reports,” clinical pathologist K. answered: “We do not keep them for long.” However, Item 9 of Appendix 12 (Guidelines for Filling Out Form No. 454/u-06 “Chemical Toxicological Analysis Reports”) to Order of the Ministry of Health and Social Development of the Russian Federation No. 40 of January 27, 2006,¹² states the following: “The completed Form No. 454/u-06 must be signed by the specialist who conducted the chemical toxicological analysis and certified by seal of the substance abuse clinic/hospital to which the chemical toxicological laboratory belongs, or by stamp of the chemical toxicological laboratory, indicating the full name of the substance abuse clinic/hospital. It must be stored in the archive of the substance abuse clinic/hospital for 5 years, after which it is destroyed.” Unfortunately, the court had no additional questions despite the unexpired 5-year period.

As a result, the court declared that citizen G. was intoxicated, thereby violating Item 2.7 of the Traffic Code of the Russian Federation.² Part 1, Article 12.8 of the Code of the Russian Federation on Administrative Offenses¹ establishes the accountability for this offense in the absence of signs of a criminal offense. By the decision of the magistrate court of March 1, 2022, citizen G. was found guilty of committing an administrative offense under Part 1, Article 12.8 of the Code of the Russian Federation on Administrative Offenses:¹ Driving while intoxicated, unless such actions constitute a criminal offense. A fine of 30,000 rubles was imposed, along with administrative license revocation for 1 year and 8 months.¹³

A session of the court of cassation was held, to which the parties involved were not invited, including the independent forensic toxicology expert, despite the lawyer’s requests. The court of cassation upheld the decision of the court of first instance.¹⁴

Notably, some existing methods for PAS detection need to be aligned with the regulatory framework (or vice versa). It is especially relevant to develop quantification procedures for some PASs in line with Order of the Ministry of Health of the Russian Federation No. 933n of December 18, 2015.⁴ These include γ-butyrolactone, methadone, hallucinogenic mushrooms, etc. [2], as well as other toxicants and drugs (e.g., ethylene glycol, methanol, barbiturates, etc. [4]) mixed with addictive substances in urine and blood samples. The main challenge here is the need to use reference standards of PASs. However, the circulation of some PASs is restricted; therefore, healthcare providers must obtain permits for their use and storage.

The current practice in cases of false positive CTA findings has two-sided negative consequences:

• Unjustified prosecution of individuals who have not used PASs;
• Individuals who actually used PASs may be able to escape responsibility because of inconsistencies in laboratory procedures and regulatory shortcomings.

In the presented case, there are three plausible explanations for the presence of unchanged γ-butyrolactone, rather than its metabolite (γ-hydroxybutyric acid) in urine:

• The substance was introduced into the sample after urine collection;
• A non-conventional method of γ-butyrolactone isolation by derivatization with trimethylsilyl derivatives was used;
• CTA findings were falsified.

This case highlights existing issues in clinical pathology. In particular, unreliable detection methods are frequently associated with insufficient training of clinical pathologists [5], as well as a mechanistic approach to analysis. However, forensic medicine has accumulated a sufficient number of cases that can be used in the future to create evidence-based algorithms and criteria for interpreting analysis results [6–9].

CONCLUSION

The presented case highlights how unreliable laboratory analysis methods and incorrect interpretation of results can lead to inaccuracies in determining PASs in biological samples. Such false positive results have major implications for patients’ social and professional rights. In our case, the unlawful conclusion based on CTA findings effectively deprived the individual of their ability to continue working, which is unacceptable.

To minimize this risk, effective procedures for determining PASs in urine and blood samples are required, including γ-butyrolactone, methadone, hallucinogenic mushrooms, ethylene glycol, methanol, and barbiturates. Furthermore, standardized algorithms for interpreting laboratory findings are necessary, taking into account both the pharmacokinetics of analyzed substances and potential routes of sample contamination. Without such approaches, there is a high risk of judicial decisions based on unreliable conclusions, resulting in legal stigmatization of citizens.

ADDITIONAL INFORMATION

Author contributions: S.V. Kuznetsov: conceptualization, data curation, writing—original draft, writing—review & editing; Yu.A. Molin: writing—review & editing; V.L. Reiniuk: conceptualization, writing—review & editing; A.G. Sinenchenko: investigation, writing—review & editing; O.L. Balabanova, A.M. Antonova: data curation; Ch.B. Batotsyrenov, E.O. Demidova, P.N. Varioshkin, D.A. Pshennikova, N.Yu. Sukhonos, A.G. Lodiagin: investigation. All the authors approved the version of the manuscript to be published and agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ethics approval: Not applicable.

Consent for publication: Informed consent for publication could not be obtained from Mr. G. due to the authors’ inability to establish contact (contact details such as phone number and email address could not be retrieved). All data presented are anonymized, and no photographs are published.

Funding sources: No funding.

Disclosure of interests: The authors have no relationships, activities, or interests for the last three years related to for-profit or not-for-profit third parties whose interests may be affected by the content of the article.

Statement of originality: No previously published materials (text, figures, or data) were used in this work.

Data availability statement: The editorial policy regarding data sharing does not apply to this work.

Generative AI: No generative artificial intelligence technologies were used to prepare this article.

Provenance and peer-review: This article was submitted unsolicited and reviewed following the standard procedure. The peer review process involved two external reviewers.

 

¹ Code of the Russian Federation on Administrative Offenses No. 195-FZ of December 30, 2001. Available at: https://base.garant.ru/12125267/ Accessed on: December 12, 2024.

² Decree of the Government of the Russian Federation No. 1090 of October 23, 1993, On the Traffic Code. Available at: https://www.consultant.ru/document/cons_doc_LAW_2709/. Accessed on: December 12, 2024.

³ Criminal Code of the Russian Federation No. 63-FZ of June 13, 1996. Available at: https://base.garant.ru/10108000/. Accessed on: December 12, 2024.

⁴ Order of the Ministry of Health of the Russian Federation No. 933n of December 18, 2015, On the Chemical Test Procedure. Available at: https://base.garant.ru/71350220/. Accessed on: December 12, 2024.

⁵ Resolution of Plenum of Supreme Court of the Russian Federation No. 20 of June 25, 2019, On certain issues arising in judicial practice during administrative case hearings, provided for in Chapter 12 of the Code of the Russian Federation on Administrative Offenses. Available at: https://www.consultant.ru/document/cons_doc_LAW_327611/. Accessed on: December 12, 2024.

⁶ For detecting morphine, marijuana, amphetamine.

⁷ For detecting the above substances, as well as methamphetamine and cocaine.

⁸ For detecting the above substances, as well as benzodiazepine.

⁹ For detecting the above substances, as well as barbiturates, methadone, ecstasy, tricyclic antidepressants.

¹⁰ For detecting the above substances, as well as phencyclidine and ketamine.

¹¹ Posted on Telegram on December 9, 2024 [accessed on: December 9, 2024]. In: Bureau of Biomedical Expertise [Internet]. 2024–. Available at: https://t.me/bmbex/493?

¹² Order of the Ministry of Health and Social Development of the Russian Federation No. 40 of January 27, 2006, On chemical toxicological analysis for detecting alcohol, addictive substances, psychoactive substances, and other toxic substances in the human body. Available at: https://base.garant.ru/12145258/. Accessed on: December 12, 2024.

¹³ Judicial decisions of the Russian Federation. Decision of the Volkhov City Court of the Leningrad Region of July 7, 2022, in administrative case No. 516/2022. Available at: https://судебныерешения.рф/68634872. Accessed on: December 13, 2024.

¹⁴ Judicial decisions of the Russian Federation. Third General Court of Cassation ruling No. 16-5221/2022 of September 19, 2022. Available at: https://судебныерешения.рф/69450260. Accessed on: December 13, 2024.

About the authors

Semyon V. Kuznetsov

Institution Golikov Research Clinical Center of Toxicology; Saint-Petersburg State Pediatric Medical University

Author for correspondence.
Email: Nachsml@mail.ru
ORCID iD: 0000-0002-3132-8522
SPIN-code: 5122-0242

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Yuri A. Molin

North-Western State Medical University named after I.I. Mechnikov

Email: juri.molin@yandex.ru
ORCID iD: 0000-0002-4343-4656
SPIN-code: 7439-0540

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Vladimir L. Reiniuk

Institution Golikov Research Clinical Center of Toxicology

Email: institute@toxicology.ru
ORCID iD: 0000-0002-4472-6546
SPIN-code: 5828-0337

MD, Dr. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg

Andrej G. Sinenchenko

Saint-Petersburg Institute of emergency care named after I.I. Dzhanelidze

Email: andreysin2013@yandex.ru
ORCID iD: 0000-0003-2815-3108
SPIN-code: 6059-1125

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg

Olga L. Balabanova

Saint-Petersburg Institute of emergency care named after I.I. Dzhanelidze

Email: o.l.ya@mail.ru
ORCID iD: 0000-0002-8636-9858
SPIN-code: 6286-3797

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg

Anna M. Antonova

Institution Golikov Research Clinical Center of Toxicology; Saint-Petersburg Institute of emergency care named after I.I. Dzhanelidze

Email: ama-spb@yandex.ru
ORCID iD: 0009-0004-2690-5200
SPIN-code: 1576-7890

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg; Saint Petersburg

Chimit B. Batotsyrenov

Institution Golikov Research Clinical Center of Toxicology

Email: steelfire282@gmail.com
ORCID iD: 0000-0002-2693-6283
SPIN-code: 9446-5175

MD

Russian Federation, Saint Petersburg

Ekaterina O. Demidova

Institution Golikov Research Clinical Center of Toxicology

Email: bedskaya.667@yandex.ru
ORCID iD: 0009-0003-0820-8471
SPIN-code: 1618-1510

MD

Russian Federation, Saint Petersburg

Pavel N. Varioshkin

Institution Golikov Research Clinical Center of Toxicology

Email: zonner17@list.ru
ORCID iD: 0009-0000-3863-3602
SPIN-code: 6563-9541

MD

Russian Federation, Saint Petersburg

Darya A. Pshennikova

Institution Golikov Research Clinical Center of Toxicology; Saint-Petersburg Institute of emergency care named after I.I. Dzhanelidze

Email: dneoberdina@yandex.ru
ORCID iD: 0009-0004-2531-410X
SPIN-code: 3810-1510

MD

Russian Federation, Saint Petersburg; Saint Petersburg

Nickodim Yu. Sukhonos

Kirov Military Medical Academy

Email: Kazisuv1@yandex.ru
ORCID iD: 0009-0001-6036-4581
Russian Federation, Saint Petersburg

Georgy A. Lodiagin

Almazov National Medical Research Center

Email: glodyagin@mail.ru
ORCID iD: 0009-0007-6310-4797
SPIN-code: 4886-8890
Russian Federation, Saint Petersburg

References

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