Forensic Pharmacology

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Forensic Pharmacology Page 5

by B Zedeck


  tability, headache, chills, vomiting, sweating, and painful jerking

  muscle reactions. To avoid these symptoms, people usually will

  do whatever it takes to get more drugs. With opioids, for example,

  where it is necessary to take drugs every few hours, such extreme

  needs may lead to criminal activity to sustain the drug habit.

  Many drugs of abuse make the individual feel excited, aroused,

  and strong. Others result in drowsiness and poor coordination.

  Coupled with these feelings, however, may be an impairment of

  cognitive functions such as judgment, perception, and attentive-

  ness. When these effects are combined, the individual may make

  rash decisions and take risks that otherwise would not be under-

  taken, which can lead to motor vehicle accidents and criminal

  activities such as robbery and homicide.

  Often, when tissue or fluid samples from individuals under the

  influence of drugs are analyzed, more than one drug is present.

  Taking different drugs of abuse at the same time is particularly

  dangerous because of drug interaction. For example, many drugs

  of abuse are central nervous system depressants. While each drug

  may not completely arrest respiration, the combination of drugs

  may. Many drugs of abuse increase blood pressure and, taken in

  combination, might lead to a stroke.

  Injecting drugs of abuse presents special hazards. Transmis-

  sion of the AIDS or hepatitis virus occurs often by using “dirty”

  needles, that is, needles with another user’s blood on them. Also,

  many drugs contain other substances such as adulterants or

  40 Forensic Pharmacology

  diluents. These other substances may not completely dissolve

  when added to water, and injection of tiny particles may clog

  blood vessels. Commonly added agents that may be found during

  analysis of fluids and tissues include caffeine, acetaminophen

  (Tylenol®), and phenobarbital, a sedative.

  In 1970, in response to a rising level of drug abuse, Congress

  enacted the Comprehensive Drug Abuse Prevention and Control

  Act, also known as the Controlled Substances Act (CSA). The

  Drug Enforcement Administration has categorized controlled

  substances (based on the CSA) into five different schedules.3 The

  five schedules are defined as follows:

  Schedule I: Substances with no accepted medicinal use

  in the United States and a high potential for abuse; for

  example, heroin, marijuana, lysergic acid diethylam-

  ide (LSD), mescaline, and psilocybin.

  Schedule II: Substances with a medicinal use but also

  a high potential for psychological or physical depen-

  dence. A written prescription is required for use; for

  example, morphine, cocaine, and oxycodone.

  Schedule III: Substances with less potential for abuse

  than drugs in Schedule I or II; for example, methyl-

  phenidate, amphetamine, secobarbital, and anabolic

  steroids.

  Schedule IV: Substances with low abuse potential;

  for example, some barbiturate compounds, chloral

  hydrate, and benzodiazepine derivatives.

  Schedule V: Substances with limited potential for abuse;

  for example, some codeine preparations for cough,

  and Lomotil® (which contains the opioid diphenoxyl-

  ate) for diarrhea.

  Drug Abuse and Teenager Statistics

  41

  Figure 4.1 The 2004 Monitoring the Future (MTF) survey reveals

  that use of any kind of illicit drug peaked in the early 1980s, decreased

  over the next 10 to 15 years, but then began to increase in the mid-

  1990s.4

  To circumvent restrictions under the CSA, people began to

  synthesize drugs that are chemically and pharmacologically sim-

  ilar to those listed in Schedules I to V. These are termed designer

  drugs. To control the distribution of such chemicals, Congress

  42 Forensic Pharmacology

  amended the CSA in 1986 by passing the Controlled Substance

  Analogue Enforcement Act.

  DRUG USE AND ABUSE IN ADOLESCENTS

  Adolescent substance abuse has been a major health issue for

  many years. Governmental and other agencies survey the use of

  drugs of abuse by teenagers for each drug according to school

  grade, age, gender, and ethnicity. Results obtained from such

  surveys, and from reports of emergency room visits, arrest data,

  and accidents, provide information to monitor trends in abuse

  of illicit and non-illicit dependence-producing substances by

  teenagers (Figure 4.1).

  The extent of drug use in 2003 for different drugs is pre-

  sented in Table 4.1. According to the 2003 National Survey on

  Drug Use and Health (NSDUH), 11.2% of 12- to 17-year-olds

  reported current use of illicit drugs, 30.5% reported use at least

  once during their lifetime, and 21.8% reported use within the

  past year.5

  According to the Drug Abuse Warning Network (DAWN),

  a public health surveillance system, in the second half of 2003,

  there were 627,923 drug-related visits to the emergency rooms

  of hospitals. Of these visits, 141,343 involved alcohol alone or

  alcohol along with other drugs. Of all the alcohol-related visits,

  16,770 were made by 12-to 17-year olds in a ratio of about 2:1,

  males to females.6

  Drug use by teenagers in 2004 appears to have declined,

  though use of inhalants and oxycodone (OxyContin®), a pre-

  scription opioid pain reliever, are on the rise.7 Recent reports

  indicate that a ready source of drugs of abuse for adolescents is

  prescription drugs found in the home medicine cabinet, as well

  as prescription drugs available on the Internet.8

  Drug Abuse and Teenager Statistics 43

  FORENSIC ISSUES

  In cases involving motor vehicles, the defendant generally tries

  to disprove the claim that the concentration of drug found in

  blood could have affected driving performance, or argues that

  a finding of drug in urine only indicates drug use prior to the

  accident but has no value in proving a causal link to impaired

  driving.

  In many states, it is illegal to drive with any detectable amount

  of controlled substance in blood. Other states define “drugged

  driving” as driving when the driver is incapable of driving safely

  Table 4.1 Percent of 12- to 17- Year-Olds

  Reporting Drug Use in 2003

  Drug Type

  Lifetime

  Past Year

  Past Month

  Any Illicit Drug

  30.5%

  21.8%

  11.2%

  Marijuana/hashish

  19.6

  15.0

  7.9

  Cocaine

  2.6

  1.8

  0.6

  Crack

  0.6

  0.4

  0.1

  Heroin

  0.3

  0.1

  0.1

  Hallucinogens

  5.0

  3.1

  1.0

  LSD

  1.6

  0.6

  0.2

  PCP

  0.8

  0.4

  0.1

  Ecstasy

  2.4
r />   1.3

  0.4

  Inhalants

  10.7

  4.5

  1.3

  Methamphetamine

  1.3

  0.7

  0.3

  44 Forensic Pharmacology

  or is impaired. According to a 2003 NSDUH survey, 10.9 million

  people drove under the influence of drugs in the prior year. Of

  young adults aged 18 to 25 years, 14.1% drove after using drugs.

  Studies of impaired drivers, crash victims, and fatalities revealed

  marijuana to be the most prevalent drug used. In the United

  States in 2003, there were 2,283 alcohol-related motor vehicle

  fatalities among 15- to 20-year-olds.9 In 2004, 12.7% of high

  school seniors drove after using marijuana.10

  According to the Federal Bureau of Investigation’s Crime in the

  United States report, during 2003 there were 137,658 juveniles

  arrested by law enforcement agencies for drug abuse violations.

  Monitoring Drug Abuse Among Teenagers

  There are many different governmental agencies that monitor

  their use of alcohol or il icit drugs in the prior year and whether

  the use of drugs by teenagers. One of the largest, the National

  they drove under the influence of such drugs. Another report,

  Institute on Drug Abuse (NIDA), sets scientific standards in

  the Drug and Alcohol Services Information System (DASIS),

  drug testing, maintains Web sites for teenagers with use-

  monitors treatment programs for drug abuse. The Office of

  ful information about drug effects, and funds the Monitor-

  National Drug Control Policy, under the White House Drug

  ing the Future (MTF) program conducted by the University of

  Policy program, establishes policies and priorities for the

  Michigan. Beginning in 1975, MTF monitored drug use among

  United States and provides information concerning drug use

  twelfth graders, and in 1991 expanded their studies to include

  and effects. Many of the agencies provide reports of the data

  eighth and tenth graders. Data collected include usage in the

  collected in various formats analyzed by drug, age, gender,

  past 30 days, in the past year, and lifetime usage. The Drug

  and race. Some of the reports are available on the Internet.

  Abuse Warning Network (DAWN), under the supervision of

  The National Institute of Justice conducts surveys of drug

  the Substance Abuse and Mental Health Services Adminis-

  use among arrested individuals under its Arrestee Drug

  tration (SAMHSA), monitors drug-related visits to emergency

  Abuse Monitoring (ADAM) program. The Centers for Disease

  departments and deaths investigated by medical examiners.

  Control and Prevention (CDC) monitors ninth to twelfth grad-

  One report, the National Survey on Drug Use and Health

  ers for behaviors that impose health risks under its Youth Risk

  (NSDUH), surveys individuals 12 years or older to determine

  Behavior Surveil ance System (YRBSS).

  Drug Abuse and Teenager Statistics

  45

  During fiscal year 2002, the Drug Enforcement Administration

  (DEA) arrested 675 persons under the age of 19 involved with

  cocaine, marijuana, methamphetamine, or opioids. According

  to another study, a median of 59.7% of male juvenile detainees

  and 45.9% of female juvenile detainees tested positive for drug

  use in 2002.11

  SUMMARY

  Drugs of abuse can induce physical and psychological depen-

  dence and impair cognitive functions. Individuals who use

  Monitoring Drug Abuse Among Teenagers

  There are many different governmental agencies that monitor

  their use of alcohol or il icit drugs in the prior year and whether

  the use of drugs by teenagers. One of the largest, the National

  they drove under the influence of such drugs. Another report,

  Institute on Drug Abuse (NIDA), sets scientific standards in

  the Drug and Alcohol Services Information System (DASIS),

  drug testing, maintains Web sites for teenagers with use-

  monitors treatment programs for drug abuse. The Office of

  ful information about drug effects, and funds the Monitor-

  National Drug Control Policy, under the White House Drug

  ing the Future (MTF) program conducted by the University of

  Policy program, establishes policies and priorities for the

  Michigan. Beginning in 1975, MTF monitored drug use among

  United States and provides information concerning drug use

  twelfth graders, and in 1991 expanded their studies to include

  and effects. Many of the agencies provide reports of the data

  eighth and tenth graders. Data collected include usage in the

  collected in various formats analyzed by drug, age, gender,

  past 30 days, in the past year, and lifetime usage. The Drug

  and race. Some of the reports are available on the Internet.

  Abuse Warning Network (DAWN), under the supervision of

  The National Institute of Justice conducts surveys of drug

  the Substance Abuse and Mental Health Services Adminis-

  use among arrested individuals under its Arrestee Drug

  tration (SAMHSA), monitors drug-related visits to emergency

  Abuse Monitoring (ADAM) program. The Centers for Disease

  departments and deaths investigated by medical examiners.

  Control and Prevention (CDC) monitors ninth to twelfth grad-

  One report, the National Survey on Drug Use and Health

  ers for behaviors that impose health risks under its Youth Risk

  (NSDUH), surveys individuals 12 years or older to determine

  Behavior Surveil ance System (YRBSS).

  46 Forensic Pharmacology

  drugs may make rash decisions or take risks that can result in

  violence and accidents. The use of drugs of abuse by teenagers is

  well documented. Many governmental agencies monitor the use

  of drugs, the presence of drugs in accidents, and the number of

  drug-related emergency department admissions. Recent surveys

  indicate that while overall drug use by adolescents decreased in

  the period from the 1980s to mid-1990s, it began to rise after

  that. Even with a decrease in drug use, a significant number

  of young adults use or have used drugs and have driven while

  under the influence of drugs.

  Cannabinoids

  5

  Cannabinoids are isolated from the plant Cannabis sativa,

  which was initially found in Central Asia. Marijuana refers to

  any part of the cannabis plant that can induce psychotomimetic

  effects, a loss of contact with reality. Marijuana induces a wide

  spectrum of behavioral effects and has been classified as a stim-

  ulant, sedative, or hallucinogen. Marijuana is the most widely

  used illicit drug in the United States. There are more than 200

  slang terms for marijuana, including bhang, blunt, bud, dope,

  gangster, grass, herb, jive, joint, Mary Jane, pot, reefer, roach,

  rope, skunk, Thai stick, weed, and zig zag man. Marijuana has

  also been used in combination with codeine cough syrup or

  with embalming fluid.

  Cannabinoids have been used for over 4,000 years as a seda-

  tive, a remedy for relief of pain, epilepsy, and asthma, and in

  religious cer
emonies. The Spanish brought Cannabis sativa to

  the Americas, and Mexican laborers introduced the drug into

  the southern portion of the United States around 1910. The

  plant has been used for its fiber (called hemp) content for over

  2,000 years. Early American settlers grew the plant for its hemp

  47

  48 Forensic Pharmacology

  content, and the Marijuana Tax Act of 1937 banned cultivation,

  possession, and distribution of hemp plants except for making

  cord and twine.

  Marijuana contains 421 different chemicals, including 61 can-

  nabinoids. The potency is based on the percentage of the active

  ingredient delta-9-tetrahydrocannabinol (THC) per dry weight

  (Figure 5.1). Preparations from leaves and flowers contain about

  3% THC, sinsemilla (the unpollinated seedless female plant)

  contains about 5% THC, hashish (resin from the flower tops of

  female plants) contains approximately 10% THC, and hashish

  oil, a viscous product obtained by extracting the resin with sol-

  vent, may contain as much as 20% THC. The word hashish comes

  from the Arabic word meaning “grass.” Street names for hashish

  include charas, gangster, ganja, hash, and hemp. In 1965, Israeli

  Figure 5.1 THC, also known as delta-9-tetrahydrocannabinol, is the

  main psychoactive chemical in the cannabis plant. Its chemical formula

  is C21H30O2.

  Cannabinoids

  49

  Medical Marijuana Usage

  in California

  On November 5, 1996, the people of California passed

  Proposition 215 (The California Compassionate Use Act of

  1996, CA Health and Safety Code Section 11362.5) by 56%

  of the vote. It provides that if recommended by a physi-

  cian, a primary caregiver (an individual designated as being

  responsible for the housing, health, or safety of the patient)

  who obtains and uses marijuana for medical purposes is not

  subject to criminal prosecution or sanction. The proposition

  also removes state-level criminal penalties on the use, pos-

  session, and cultivation of marijuana by patients who pos-

 

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