Medicine - drugs and alcohol

Question 1

Medicolegal aspects of drugs and alcohol

Answer 1

o Acute poisoning
o Establishing cause of death/damage
o Chronic damage
o Establishing cause of death/damage
o Effects on behaviour
o Driving, anti-social behaviour
o Abused and illicit substances
o Road traffic acts

Question 2

Acute drug poisoning (5 points)

Answer 2

o Common cause of suicide
o Common cause of accidental death (drug misuse)
o Very rate cause of homicide
o Rarely leaves specific post-mortem findings
o Have to do ‘tests’

Question 3

Fatal acute poisoning

Answer 3

o 2019 – 4393 drug poisoning deaths in E and W
o 2/3rds male
o 2/3rds drug misuse; 1/3rd suicide
o Usually multiple drugs
o Often alcohol too
o 50% involve opiates (2160 cases)
o 13% cocaine
o 10% antidepressant
o 4% each paracetamol and benzodiazepines
o Then amphetamines, ecstasy and anti-psychotics

Question 4

Mechanisms of death in a cute poisoning

Answer 4

o Drugs which reduce brain activity
 Opiates, antipsychotics, benzodiazepines, alcohol, antidepressants
 Loss of protective reflexes, respiratory depression
o Drugs which increase brain activity
 Cocaine, amphetamines, ecstasy
 Cardiac arrythmias, heart attacks, strokes, seizures, hyperthermia
o Paracetamol
 Liver damage
 Happens slowly usually without realising until next day
 Can get antidote if present early before liver failure
o Aspirin
 Gastric irritation – bleeding
o Corrosives
 Destroy organs

Question 5

Findings in acute poisoning deaths

Answer 5

o Respiratory depression
 Vomit in airway, pulmonary congestion, evidence of coma
o Increased brain activity
 Stroke, heart attack, but often nothing (cardiac arrythmia)
o Individual findings
o Needle Marks
o None of these findings are specific so need to do tests
 Samples – blood, urine, others
 Results often open to interpretation
* Tolerance
* Huge overlap between therapeutic and fatal levels
 Not reliable as results in life
* Post mortem redistribution – many drugs
* Post mortem production – alcohol
* Post mortem destruction – cocaine, insulin

Question 6

Alcohol (intro)

Answer 6

o CNS depressant
o Rapidly absorbed from stomach
o as is a small molecule (30-40 minutes)
o Detoxified by liver
o 15mg/100ml/hr
o Can back calculate to see level of alcohol when they were driving

Question 7

Medicoloegal issues of alcohol

Answer 7

o Cause of death
 Acute poisoning
 Chronic damage
o Effects on behaviour
 Aggression
 Falls, other accidents
o Drink driving
 Back calculation

Question 8

Chronic alcoholism

Answer 8

o Neglect and malnutrition
 Lack of eating nutritious diet and underweight
o Liver Damage
 Fatty liver
 Sorosis of liver – liver cells rapidly divide (irreversible)
o CNS damage
o Heart damage
 large, inflamed heart

Question 9

Chronic drug damage - heroin (opiates)

Answer 9

o Hepatitis, HIV
o Bacterial complications of IV injection – needle sharing or bacteria causing sepsis
o Usually don’t know dose or what it has been diluted with
o Post mortem findings
 Usually needle marks on skin – in rows over blood vessel
 Fibrosis of cutaneous veins - May see blocked up blood vessels on skin
 Neglect possibly
 Pulmonary oedema and congestion
 Toxicology – results from laboratory as to what drugs are present

Question 10

Chronic damage - hallucinogens

Answer 10

o Taken orally
o Cause of death
 Accidents
 Hypothermia (make user highly active)

Question 11

Chronic damage - cocaine

Answer 11

o High blood pressure – starts to speed up heart which causes damage (heart inflames to counteract blood pressure
o Accelerated heart disease
o Lung disease
o CNS disease

Question 12

Chronic damage - substance abuse

Answer 12

o 100 deaths/year
o Age group 12-19
o Tippex, glue, petrol – have effect on brain if inhaled
o Method of abuse
 Plastic bag
 Handkerchief
 Direct
o Effects
 Intoxication
* Euphoria disinhibition
* Hallucinations
 Acute
* Cardiac arrest, suffocation accidents
 Chronic
* Damage to organs e.g. liver

Question 13

chronic damage - cannabis

Answer 13

o Has not killed anybody? – could cause mental health problems
o Synthetic cannabinoids have killed

Question 14

Medicolegal issues of drugs of abuse

Answer 14

o Post mortem findings non-specific
o Laboratory test needed
o Samples taken
o Continuity
o Technique used
o Interpretation of results
o Individual variation
 Tolerance
 No such thing as a necessarily fatal level
o Post mortem results unreliable – redistribution
o Back calculation