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Forensic Medicine > Drugs > Flashcards

Drugs Flashcards

1
Q

List common drug classes

A 
Opiates - most important 
Depressants 
Benzodiazepines (sedative)
Stimulants 
Hallucinogens 
Cannabis 
Nicotine 
VSA
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2
Q

List common opiates

A 
Morphine 
Heroin 
Methadone 
Dipipanone, Pethidine
Pentazocine, Buprenorphine
Detropropoxyphene, Codeine, DHC

Includes synthetic and semi-synthetic compounds

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3
Q

List common depressants

A

Alcohol
Barbiturates - less common now
Benzodiazepines

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4
Q

List common benzodiazepines

A

Diazepam (valium) - most common
Temazepam
Lorazepam
Many others - typically end in -pam

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5
Q

List common stimulants

A

Amphetamines

Cocaine

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6
Q

List common hallucinogens

A

LSD

Magic mushrooms

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7
Q

Define drug abuse

A

An excessive or improper use of drugs, especially through self-administration for nonmedical purposes

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8
Q

Define drug dependence

A

A physical or psychologic state in which a person displays withdrawal symptoms if drug use is halted suddenly; can lead to addiction.

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9
Q

What is a dependence syndrome

A

A cluster of behavioural, cognitive, and physiological phenomena that may develop after repeated substance use.

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10
Q

List some of the phenomena (features) of dependence syndromes

A

A strong desire to take the drug
Impaired control over its use
Persistent use despite harmful consequences
A higher priority given to drug use than to other activities and obligations
Increased tolerance
A physical withdrawal reaction when drug use is discontinued

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11
Q

Does a dependence syndrome always relate to a single substance

A

No
It can be specific to one
Can apply to a specific class of drug - e.g. all opiates not just one
Or can be dependent on a wider range of drugs despite pharmacological differences

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12
Q

Define drug addiction

A

A chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences
Involves functional changes to the brain which may last a long time after a person has stopped taking drugs
You know you have an issue but continue the behaviour

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13
Q

A drug addiction is considered a brain disorder - true or false

A

True
It involves functional changes to the brain circuits involving reward, stress, and self-control
May persist after stopping

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14
Q

Define drug misuse

A

The taking of a drug which harms or threatens
to harm the physical/mental health or
social well-being of an individual, other
individuals, or society at large or which
is illegal
Includes licit & illicit drugs, prescribed
medications

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15
Q

What is the ICD-10 definition of drug dependence syndrome

A

A cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviors that once had greater value (drug seeking takes over)

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16
Q

According to the ICD 10 what is the central descriptive characteristic of dependence syndrome

A

The desire (often strong, sometimes overpowering) to take the psychoactive drugs (which may or not have been medically prescribed), alcohol, or tobacco

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17
Q

According to the ICD 10 what can happen with a return to substance misuse after abstinence

A

There can be a more rapid reappearance of other features of the syndrome
Past-addicts will fall back into the syndrome quicker
(when compared with nondependent individuals)

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18
Q

What is included in the Misuse of Drugs Act

A

Provides the legal framework for control of drugs according to potential for misuse
Details requirements for prescription, safe custody & record-keeping
Classifies drugs and penalties for supply & possession offences, allowing premises to be used for drug production

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19
Q

List the Class A drugs

A 
Major opiates
Cocaine, crack
LSD
Injectable  amphetamines
Magic mushrooms

Major risk for misuse

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20
Q

What is the sentence for dealing Class As

A

Up to life in prison

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21
Q

What is the sentence for possessing Class As

A

Up to 7 years

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22
Q

What is the sentence for dealing Class Bs

A

Up to 14 years

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23
Q

What is the sentence for possessing Class Bs

A

Up to 5 years

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24
Q

List the Class B drugs

A 
Cannabis 
Oral amphetamines
Ritalin - ADHD drug 
Pholcodeine 
Mephedrone (Bubbles) - less common 
Synth Cannabinoids
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25
Q

List the Class C drugs

A

Tranquilisers (Benzodiazepines)
Some Painkillers (Buprenorphine, Dextropropoxyphene) - strong opiate types
GHB
Ketamine

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26
Q

What is the sentence for dealing Class Cs

A

Up to 14 years

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27
Q

What is the sentence for possessing Class Cs

A

Up to 2 years

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28
Q

What does the misuse of drugs regulations 2001 define

A

Defines who may produce, possess, supply,

prescribe & administer certain drugs

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29
Q

Describe schedule 1 drugs (as per the misuse of drugs regulations 2001)

A

These are prohibited without a home office license
Don’t really have a medicinal use
Includes LSD, cannabis, opium, ecstasy

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30
Q

Describe schedule 2 drugs (as per the misuse of drugs regulations 2001)

A

These drugs require controlled prescribing, custody and registers
Includes heroin, methadone, cocaine and amphetamines’

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31
Q

Describe schedule 3 drugs (as per the misuse of drugs regulations 2001)

A

Includes barbiturates and pentazocine

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32
Q

Describe schedule 4 drugs

A

Includes benzodiazepines

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33
Q

Describe schedule 5 drugs (as per the misuse of drugs regulations 2001)

A

These are medications which contain a small amount of controlled substance such as co-codamol
May be available over the counter or on prescription

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34
Q

What is covered by the Medicine Act 1968

A

Controls the production & supply of drugs

Includes the general sales list (over the counter), pharmacy medicine and prescription only

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35
Q

Which effects do all drugs of dependence have in common

A

An initial pleasurable effect
A rebound unpleasant effect on stopping

They potentiate each other and lead to a vicious cycle

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36
Q

Drug dependence usually starts off as psychological - true or false

A

True

In early stages the desire to take it is greater than the physical need

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37
Q

How does dug dependence cause neuro-adaption

A

The nerve cells become used to the presence of the drug and alter their excitability in response

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38
Q

What effect do stimulant drugs have on nerve cells and neuro-adaptability

A

The nerve fibres adapt to become less excitable (due to persistent stimulation)
When the drug is removed the person crashes

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39
Q

What effect do depressant drugs have on nerve cells and neuro-adaptability

A

In the presence of the drug a stronger signal is needed to trigger the nerve
If the drug is taken away the nerves become grossly overexcited (new higher level without the damping effect of drug)

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40
Q

Describe tolerance

A

With persistent use the body becomes more used to the drug
More and more is required to get the same clinical effect
This is why addicts can take very high doses

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41
Q

What is meant by physical drug dependence

A

This is when the person will experience withdrawal symptoms on stopping the drug
The body is so used to the presence of the drug that it cant cope without it

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42
Q

Where is withdrawal a big issue

A

In custody
Addicts who are kept in will have an interruption to their usual drug use which can send them into withdrawal
The police etc. should be on the lookout for this

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43
Q

Which type of drug has mainly replaced barbiturates in drug abuse

A

Benzodiazepines

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44
Q

In addiction the drug overtakes the other key survival needs - true or false

A

True
The drug stimulates the reward centers and provide all the ‘pleasure’ the person needs
No longer seek normal rewards like friendship, achievement, sex, food etc

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45
Q

Which country has the highest rate of drug use (per head)

A

Scotland

3x higher than rest of UK

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46
Q

What is the most common drug used in Scotland

A

Cocaine

4% of Scots use it

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47
Q

Drug abusers are more likely to die than the general population - true or false

A

True

found to be 12x more likely (in 2010)

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48
Q

Drug deaths increasing in Scotland - true or false

A

True

Significant rise since 2015

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49
Q

Which city has the worst drug death rate in Scotland

A

Dundee

Worst place in Scotland (and therefore UK and Europe)

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50
Q

Which group accounts for the greatest proportion of drug death

A

Seems to be due to older uses (50s-60s)

Used to be young people (novices)

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51
Q

Which single drug is responsible for the greatest number of drug deaths in

A

Heroin

But poly drug use is also very common

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52
Q

Describe the typical demographic of drug death victims

A

Mostly white males from deprived areas
75% unemployed, 75% single
50% living alone
33% had children

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53
Q

Which other health/addiction/social problems are commonly seen in those who die from drug use

A

40% also had alcohol problems
40% psychiatric problems
33% in contact with drug treatment service
Recent negative life events, previous suicide attempts or self harm
History of sexual abuse - more common in women
10% are Hep C positive
5% with liver disease

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54
Q

Where do most drug deaths occur

A

75% deaths occurred at home
66% someone in vicinity
Many also have ambulances attending and resus attempts

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55
Q

Why do people take drugs

A

Enjoyment - either social or as an escape
Due to their environment - more common in deprived areas, associated with gangs
Natural curiosity
As a defence mechanism - stress etc
Natural rebellion - young people trying it out
Cost - VFM per hour of effect: drugs cheaper than alcohol

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56
Q

List some preparations of cannabis

A

Leaves and flowers can be turned into a herbal preparation (grind them)
Rolled into cigarettes’ - joints
Smoked through a bong
Put into food

Resin - hash
Oils - solvent extraction from resin (more concentrated)

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57
Q

Where does cannabis come from

A

Herbal cannabis comes from dried leaves, flowers of the cannabis plant

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58
Q

What is the active compound in cannabis

A

TetraHydroCannabinol (THC)

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59
Q

Describe the appearance of cannabis resin

A

Hard, breakable substance
Can be bitten into - used to break up
Dark in colour

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60
Q

Cannabis resin is a good bite substrate - true or false

A

True

Very good at holding the shape of the teeth - get good casts

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61
Q

List the positive acute psychological effects of cannabis

A

Talkative, hilarity, well-being, confidence
Appreciation of sound & colour
Time slows

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62
Q

List the negative acute psychological effects of cannabis

A 
Nausea
Hunger (the munchies)
Poor concentration
Impaired driving
Anxiety, agitation, paranoia
Cannabis psychosis
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63
Q

Most drugs can be linked to severe psychological problems - true or false

A

TRUE

Uncertain whether this is due to personal susceptibility or whether the drug alone triggers this

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64
Q

List the acute physical effects of cannabis

A 
Dry mouth
Dilated pupils
Red eyes
Tachycardia
Hypertension
Postural hypotension

Often not specific enough for police to prove

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65
Q

List some of the chronic effects of cannabis use

A

Psychosis - schizophrenia
Amotivational syndrome - only care about smoking
Reduced sperm count in men
Reduced fertility in women

Bronchitis & emphysema
? Lung cancer
This is due to the lack of filters in joint - more hydrocarbons

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66
Q

List signs of cannabis withdrawal

A 
Irritability - opposite to usual drug effect 
Mood change
Restlessness
Loss of appetite
weight loss
Insomnia
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67
Q

How do withdrawal symptoms relate to the type of drug

A

If the drug is a stimulant then withdrawal will have a depressant effect

Opposite is true for depressant drugs (withdrawal is excitation)

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68
Q

Which drug has the street name Valium

A

Diazepam

Most common Benzo

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69
Q

How was temazepam prepared

A

Jellies - fluid filled capsules
Banned because you could easily draw the fluid for injection

Now get in in tablets

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70
Q

Describe benzodiazepines

A

They are sedatives and anxiolytics (tranquillizers)
Very commonly abused
Can have both psychological and physical dependence

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71
Q

List the acute psychological effects of benzodiazepines

A

Relief of anxiety, relaxation - positive
Impaired memory
Paradoxical aggression
Uncharacteristic criminal behaviour
Uncontrollable emotions
‘Hangover’ - feel groggy the day after taking them

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72
Q

The effects of benzodiazepines are potentiated by alcohol - true or false

A

True

Effects become stronger if taken with alcohol

73
Q

List the acute physical effects of benzodiazepines

A 
Dizziness
Sedation
Incoordination
Sexual dysfunction 
Weight gain
Hypotension & coma with high dose (brain stem depression)
74
Q

OD from benzos alone is rare - true or false

A

It can cause death through brain stem depression but usually another substance is involved in death

75
Q

List the chronic effects of benzodiazepines

A

Chronic intoxication
Tolerance
Psychological & physical dependence

76
Q

How long does it take for benzo withdrawal to set in

A

2-3 days

77
Q

List features of benzo withdrawal

A 
Anxiety, insomnia 
Sweating, headache
Tremor, nausea 
Disordered perceptions - hallucination
Hypersensitivity to stimuli 
Psychosis 
Convulsions - can be dangerous, due to over excitability of brain
78
Q

List some of the street names for amphetamines

A

uppers, ‘A’, speed, whizz, sulph, cranks, wake-up, hearts

79
Q

List some of the street names for dextroamphetamines

A

dex, dexy, dexies

80
Q

Which drug is also known as ICE or crystal meth

A

Methamphetamine

81
Q

What is the full name of MDMA

A

3,4, Methylenedioxymethamphetamine

82
Q

List street names of Methylenedioxyamphetamine

A

MDA

EVE - partner drug to ADAM (MDMA)

83
Q

List other names for MDMA

A

ADAM
ecstasy
E’s
doves

84
Q

What are the medical uses of amphetamines

A

Narcolepsy
Some areas of psychiatry

No longer used really

85
Q

What type of drug are amphetamines

A

Synthetic stimulants

86
Q

How are amphetamines taken

A

Orally
Usually as tablets or powder
Can be taken, snorted, smoked or injected

Associated with rave culture

87
Q

List the acute psychological effects of amphetamines

A 
Increase in adrenaline
Euphoria, calm, peace and friendliness
Heightened awareness & concentration
Increased energy (dancing) 
Irritability, restlessness
Irrational behaviour, confusion 
Hallucinations, delusions, paranoia 
Psychosis
88
Q

List the acute physical effects of amphetamines’

A 
Due to effect of adrenaline again 
Tachycardia, hypertension, tachypnoea 
Loss of appetite
Dilated pupils, brisk reflexes
Dry mouth, blurred vision, dizziness 
Sweating, flushing or pallor
Teeth-grinding, repetitive actions 
Pyrexia, Dehydration - dangerous
89
Q

Why is a lot of water usually handed out at raves

A

Amphetamine use is common in rave culture

These have dehydration and pyrexia as side effects so water is used to counteract it

90
Q

List acute adverse effects of amphetamine use

A

Arrhythmias - adrenaline effect goes to far
Stroke (ICH, SAH) - due to increased BP
Hyperpyrexia
DIC - clotting deficiency caused by pyrexia/dehydration
Acute paranoid psychosis

91
Q

List chronic adverse effects of amphetamine use

A 
Aggression, fatigue & insomnia
Anorexia, malnutrition & weight loss
Diarrhoea & vomiting 
Heart muscle damage (cardiomyopathy) - pumping hard/fast for too long
Chronic paranoid psychosis
Depression, schizophreni
92
Q

List other names for mephedrone

A

Bubbles”
Plant Food - sold as this
Miaow miaow

93
Q

What is mephedrone derived from

A

Cathinone found in Khat plant which is found in E. Africa and Arabia
Traditionally the leaves were chewed to relieve fatigue (mild euphoria and stimulant)

94
Q

What is the chemical name of mephedrone

A

4-Methyl Meth Cathinone (MMCAT)

95
Q

How is mephedrone manufactured and sold in the UK

A

Mephedrone is typically synthetic in the UK

Sold on the internet as plant food

96
Q

How is mephedrone taken

A

Crystalline powder which is taken orally or snorted (painful)
Taken as tablets
It is a stimulant

97
Q

When was mephedrone made illegal in the UK

A 
April 2010 
Lots of derivatives produced which were shut down 
Made a class B
98
Q

Describe what happens when you take mephedrone

A

Initial euphoria and energy rush as it is a stimulant (similar to E and coke)
Has a very unpleasant comedown (crash) with sleep disturbance
Associated with severe paranoia and depression as well as many suicides

99
Q

List some of the physical effects of mephedrone

A 
Tachycardia, Hypertension
Insomnia, Anorexia
Chewing/grinding teeth (bruxism)
Nystagmus
Blue & cold extremities (vasoconstriction)
Pains in the chest, throat and nose
Nosebleeds when snorted
Tolerance & Dependence
100
Q

What is cocaine derived from

A

Coca leaves which are found in South America

101
Q

How is crack cocaine made

A

Heating and chemical alteration of the cocaine powder (e.g. mixed with baking powder)
It crystallizes into crack crystals

102
Q

Cocaine abuse is associated with crime - true or false

A

True
Associated with gun use
the drug itself makes people aggressive

103
Q

The initial high from cocaine is very intense and pleasurable - true or false

A

True
The first time is supposedly very good
However, people then chase this initial high which is hard to recreate - leads to addiction

104
Q

Cocaine is naturally occurring - true or false

A

True

It comes from the coca plant

105
Q

How is cocaine taken

A

Snorted
Smoked (crack)
Rubbed on
Injected

106
Q

How are coca leaves converted to cocaine

A

The leaves are turned into a paste and then a powder

This manufacturing process is illegal

107
Q

Describe crack cocaine

A

More pure form of cocaine and gives a cleaner hit

108
Q

List the acute psychological effects of cocaine

A

Euphoria, well-being - intense
Formication - feeling insects under skin
Irritability & confusion
Hallucinations, paranoia, depression

109
Q

List the acute physical effects of cocaine

A

Tachycardia, hypertension, tachypnoea
Dilated pupils,
Increased mental excitement
Hyperpyrexia

110
Q

List chronic effects of cocaine

A 
Chest pains, muscle spasm
Weight loss
Perforated nasal septum - snorting 
“Crack keratitis” of the eyes.  
Erosion of tooth enamel
‘Crack callus’ of the fingers - from lighting up 
Male impotence
Female orgasm problems
111
Q

How does cocaine use lead to a perforated nasal septum

A

Occurs when the drug is snorted
It anaesthetizes the septum at first but then starts to erode it
Eventually the blood vessels are affected and you get tissue degeneration
Septum may disappear

112
Q

List signs of cocaine withdrawal

A 
Intense psychological craving
Irritability, depression
Muscle pains & tremor
Hunger
Exhaustion & prolonged sleep - even up to 2 days!

Reflex excitability due to removal of stimulant

113
Q

How can cocaine be tested for

A 
Cocaine and its metabolites are detectable in:
Blood
Urine
Nasal swabs
Hair
Saliva

Easily detected

114
Q

How can cocaine affect the heart

A

Premature Atherosclerosis
Coronary artery thrombosis
MI
Heart muscle damage - stimulant effect stresses the muscle fibres
- Acute contraction band necrosis due to catecholamine stress
Chronic scarring - cardiomyopathy
Fatal arrhythmia - common cause of death before the chronic damage

115
Q

How can cocaine affect the brain

A

Can cause brain haemorrhage - intracerebral or SA
Can cause brain infarction via arterial spasm

Kills through stroke

116
Q

What is LSD

A

A synthetic hallucinogenic drug

117
Q

What is LSD

A

It is semi -synthetic hallucinogenic drug

118
Q

In which decade was LSD popular

A

In the 60s
Less common now
Those who took it back then may suffer flashbacks years later

119
Q

What is the chemical name for LSD

A

LySergic acid Diethylamide

120
Q

What is LSD derived from

A

Derived from lysergic acid, found in ergot fungus which grows on rye grains

121
Q

What is LSD derived from

A

Derived from lysergic acid, found in ergot fungus which grows on rye grains
Further processing gives final product - semi-synthetic

122
Q

What was LSD originally used for

A

Initially synthesised in 1938 and had some psychiatric use

123
Q

How long does LSD take to take effect

A

Effects within 1 h, peak 4 h, lasts 12 h.

124
Q

Is LSD a drug of dependence

A

Not really compared to others

Can build tolerance but few dependent on it

125
Q

List the acute psychological effects of LSD

A 
Effects vary widely - good & bad trips
Bad trips can be terrifying 
Depend on to mood & environment
Hallucinations - visual & auditory
Distorted perception of time, distance & speed - common to think you can fly 
Mood swings, paranoia & violence
126
Q

List the acute physical effects of LSD

A 
Hypertension, tachycardia 
Dilated pupils
Tremor & incoordination 
Flushing & nausea
Pyrexia
127
Q

List some of the chronic effects of LSD use

A 
Tolerance develops but not dependence
Abortion in pregnant women
Anxiety & psychosis
Later flashbacks - may be triggered by another stimulus
Can occur years later
128
Q

Why was methadone introduce

A

It is a synthetic opiate that aims to replace heroin and reduce addiction
However, people become addicted to this

129
Q

What are opiates derived from

A

The opium poppy

This grows in SE and SW Asia

130
Q

What is opium a mixture of

A

Alkaloids
Morphine makes up 10%
other compounds include noscapine, papaverine, codeine and thebaine (seen as contaminants in heroin)

131
Q

How is the opium poppy processed to make opium

A

Unripe seed capsule is scored
Milky extract emerges
Dries to brown gummy residue - this is opium

132
Q

Opium has been used in medicine for centuries - true or false

A

True
Used for many ailments - particularly pain relief
Even coughs and toothache!

133
Q

When was morphine first converted to heroin

A

In 1874

Produced via acetylation (adds acetyl groups, if 2 are added its heroin)

134
Q

What is diamorphine

A

Heroin

Morphine with 2 acetyl groups added

135
Q

What is heroin broken down to in the body

A

First to 6-monoacetylmprohine (in a few minutes) and then morphine (takes 5-25 mins) - caused by loss of acetyl groups
Addition of other structures converts morphine to morphine-3-glucuronide (inactive) and morphine-6-glucoronide (active)

136
Q

List the medical uses of opiates

A

Pain relief (analgesia)
Cough suppressants
Anti-diarrhoeal drugs

137
Q

List different preparations of heroin

A

White powder

Brown powder

138
Q

How is heroin taken

A

Injected - most common
Smoked -chasing the dragon (smoking on foil)
Sniffed

139
Q

Which paraphernalia is associated with IV heroin use

A

Burnt spoon - may see blood or residue on it

Lemon juice - dissolves the heroin better tan water

140
Q

Which safety measures are now provided to IV heroin users

A

Needle exchanges - clean needles
Sachets of citric acid
Naloxone

141
Q

List the acute psychological effects of opiate abuse

A

Rush of euphoria
Contentment - head rolls back, instant relief
Relief of anxiety
Inability to concentrate

142
Q

List the acute physical effects of opiate abuse

A

Constricted pupils
Nausea & vomiting
Suppression of cough reflex - can lead to aspiration
Decreased heart and breathing rate - act on breathing centers
Unconsciousness, respiratory arrest and death
Fatal reaction to impurities

143
Q

How can heroin overdose be reversed

A

Naloxone (Narcan) administration

It reverses the effects of heroin very quickly

144
Q

Foam at the mouth seen in opiate abusers is a sign of what

A

Terminal heart failure

seen in death from respiratory failure and cardiac arrest

145
Q

List the chronic effects of opiate abuse

A 
Tolerance - need to take more and more 
Physical & psychological dependence
Constipation
Loss of libido
Complications of IV injection
146
Q

How long does it take withdrawal to set in if opiates are stopped cold turkey

A

Commences after 8-15 h
Peaks at 36-48 h
Subsides over 5-10 days

147
Q

What withdrawal symptoms are seen if opiates are stopped cold turkey

A 
Clinical effects opposite of intoxication
Craving  
Anxiety, restlessness, irritability
Alternate sweating and shivering
Generalised aches & weakness
Cramps in back, legs and abdomen
Insomnia
148
Q

What physical signs of withdrawal are seen if opiates are stopped cold turkey

A 
Dilated pupils
Watering eyes (lacrimation), yawning
Tachycardia, hypertension
Cold clammy skin with goose flesh 
Loudly audible bowel sounds
Nausea, vomiting & diarrhoea

Shows they are really withdrawing - cant be faked like symptoms

149
Q

Addicts may fake the symptoms of withdrawal - true or false

A

True
They often know the symptoms well but may fake them to get more opiates from medical providers
Physical signs will be absent if faking

150
Q

How can withdrawal be confirmed

A

There is a clinical withdrawal scale
Looks at factors such as HR, RR, pupils, pain, tremor, mental state, sweating etc.
Determines how much medication they will get - methadone

151
Q

What determines the dose of methadone given to someone withdrawal

A

The severity of symptoms as determined by the clinical withdrawal scale
e.g. mild = 10mg
Severe = 20mg

152
Q

What is the maximum dose of methadone that can be given in the first 24 hours

A

40mg

153
Q

Where would you look for needle punctures in a suspected IV user

A

Crook of elbow
Along the line of a vein
Groin

154
Q

Which skin signs may be seen in IV drug users

A

Needle puncture marks
Associated bruising (seen on skin and also overlying the vein when incised)
Marks from the ligature
Sinuses with chronic use - funneling of skin, puckered and scarred

155
Q

Describe the pattern of effect and use in heroin

A

Take a hit and get the euphoric high
Levels start to fall and they become straight (most time in this phase)
Then start to withdraw and usually take another shot

156
Q

Describe the pattern of effect and use in methadone

A

Single dose lasts 24h
Keeps them straight but does not give the euphoria or high
Avoids both high and withdrawal

157
Q

What is the half life of heroin

A

Very short - only about 3-6 minutes

158
Q

when testing for heroin use which compounds are you actually looking for in the blood

A

Usually 6MAM as heroin breaks down too quickly to be picked up

159
Q

If heroin is detected in the blood what does it suggest

A

That they died almost instantly - hasn’t had time to be broken down

160
Q

Tolerance to heroin is lost quickly - true or false

A

True
Both gained and lost quickly
Therefore if use is interrupted (e.g. prison) and they go back to their old dose it can result in fatal overdose

161
Q

Morphine levels are lower in death than in life - true or false

A

False

Levels of morphine are no different to those in living addicts

162
Q

Describe the cocktail effect

A

When multiple drugs are taken at the same time
One can potentiate the other
Or if all drugs have the same effect it can be very intense - e.g. multiple depressants increase risk of respiratory depression

163
Q

Why might someone inject an oral pharmaceutical

A

They may actually enjoy the act of injecting - social event, part of their process
May not have a great effect but some still enjoy it

164
Q

How can oral pharmaceuticals be used for injection

A

Tablet crushed, dissolved & injected
Gelatinous capsule content extracted by a needle
Can just inject methadone liquid

165
Q

What effect can tablet fillers have if oral pharmaceuticals are injected

A

Can get into the bloodstream alongside drugs

Filtered out by lung and liver where they can cause damage and inflammation - granulomas

166
Q

List common tablet fillers

A

Starch
Cellulose
Talc
Cotton - drug strained through as some fibres get in

167
Q

Which infections are common in IV drug users

A 
Septicaemia
Acute endocarditis
Anthrax - cases seen in contaminated heroin batch 
Skin Abscesses
Necrotising fasciitis
Hepatitis B, C
HIV
Opportunistic infections
168
Q

List some systemic complications of IV drug use

A

Heart: enlargement, endocarditis
Lung: scarring, FB granulomas
Liver: granulomas
Brain: blood vessels, neurones all damaged

169
Q

How do lung granulomas appear on microscopy

A

Foreign material present

Birefringent in polarized light

170
Q

The toxic effects of a drug are usually dose dependent - true or false

A

True

171
Q

The collateral side effects of a drug are usually dose dependent - true or false

A

False

172
Q

List general adverse effects of drugs

A

Dose dependent Toxic effects
Dose independent collateral side effects
Idiosynchratic reaction
Allergic reaction to impurities
Hazards related to route of administration
Chronic effects (heart, lungs, liver, brain)

173
Q

How can you tell is a PM drug level has been fatal

A

You can’t!
Massive intra-individual variation - depends on tolerance
Also have to consider the cocktail effect and the PM redistribution of the drug

174
Q

How can PM redistribution affect drug level analysis

A

May produce an artefactual elevation of measured drug conc

175
Q

How do drugs redistribute after death

A

Passive diffusion of drug from a site of high conc. (“reservoir”) into neighboring blood vessels
Central blood vessels are most vulnerable

176
Q

Which vessels are most affected by PM drug redistribution

A

Central vessels such as heart, aorta, pulmonary vessels and the IVC

177
Q

Drugs present in the stomach at death will be redistributed where

A

Will contaminate the heart blood

178
Q

Drugs present in the liver at death will be redistributed where

A

Abdominal vessels

179
Q

Where should samples for drug testing be taken from to reduce the chance of contamination from redistribution

A

Peripheral vessels such as the femoral vein

Forensic Medicine (13 decks)

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