Forensic Pharmacology

by B Zedeck

  discoloration of the skin due to methemoglobinemia. The city

  toxicologist and the health department eventually determined

  that salt shakers in a food establishment visited by all of the men

  contained sodium nitrite instead of table salt, sodium chloride.

  Tolerance to inhalants can develop with frequent use, and

  withdrawal symptoms include sleep disturbance, irritability,

  jitteriness, sweating, nausea and vomiting, fast heart rate, and

  hallucinations or delusions. Withdrawal can last one month or

  longer, and the relapse rate is high.

  Inhalants 107

  FORENSIC ISSUES

  In 1962, California enacted the first known law against glue

  sniffing. By 1968, 13 states and 29 counties passed anti-glue

  sniffing legislation prohibiting the inhalation or drinking of

  products such as glue or adhesive cement for the purpose of

  becoming intoxicated or otherwise altering mental functions.

  Although not regulated under the Controlled Substances Act

  (CSA), many state legislatures have attempted to deter youth

  from buying legal products containing inhalants. As reported by

  the National Conference of State Legislatures, by the year 2000,

  38 states had adopted laws preventing the sale and/or distribu-

  tion to minors of various products commonly abused as inhal-

  ants, with penalties of fines or incarceration for offenders.

  In one particular case, a man was stopped for driving while

  intoxicated (DWI). A breathalyzer test revealed a blood alco-

  hol concentration (BAC) of 0.20%. The driver claimed that

  he had consumed only three beers within a four-hour period

  and that the BAC reading was incorrect. He also claimed that

  he had been working all day with furniture refinishing prod-

  ucts containing volatile chemicals such as toluene, xylene,

  acetone, and hexane, and that these chemicals interfered with

  the breath test. Testimony dealt with the effects of these inhal-

  ants on behavior and coordination, and how they may have

  contributed to the defendant’s erratic driving. However, these

  inhalants do not alter a breathalyzer test, and thus the jury was

  convinced that the 0.20% reading indicated that the defendant

  was lying about the number of drinks he had consumed. The

  driver was found guilty of DWI.

  SUMMARY

  Inhalants are volatile substances that produce mind-altering

  effects ranging from euphoria to hallucinations. Effects on brain,

  108 Forensic Pharmacology

  heart, liver, and kidneys are associated with inhalant use, includ-

  ing sudden sniffing death, which can occur within minutes of

  using highly concentrated amounts of an inhalant. Tolerance to

  inhalants can develop with frequent use, and, although with-

  drawal is possible, it occurs infrequently.

  Anabolic-

  Androgenic

  12

  Steroids

  Anabolic-androgenic steroids (AAS) used as drugs of abuse

  include the natural hormone testosterone and its synthetic

  derivatives. Not included in this class of drugs are the female

  steroid hormones, estrogen, and progesterone, and the cortico-

  steroids, such as cortisone and prednisone. More than 150 years

  ago, it was discovered that testes played a role in maintaining

  male characteristics. Testosterone, isolated from bull testes, was

  identified as the active chemical. It soon became evident that

  testosterone not only controlled masculinizing (androgenic)

  properties but could also induce muscle-building (anabolic)

  effects. Since synthetic derivatives of testosterone induce both

  anabolic and androgenic effects, this class of drugs is called

  anabolic-androgenic steroids.

  Recently, two books have drawn attention to the use of ste-

  roids by baseball players, and Congress has held hearings on the

  extent of steroid use in this sport. The current rules provide for

  a 50-game suspension for a first-time steroid user, a 100-game

  suspension for a second-time offender, and a lifetime ban from

  baseball if tested positive for a third time. A NIDA survey taken

  in 2002 indicates that 2.5% of 8th graders, 3.5% of 10th graders,

  109

  110 Forensic Pharmacology

  and 4.0% of 12th graders have used anabolic-androgenic steroids

  at least once.18

  AAS are Schedule III drugs and are referred to as roids

  and juice. Products include Anadrol® (oxymetholone), Oxan-

  drin® (oxandrolone), Dianabol® (methandrostenolone, D-bol,

  D-ball), Winstrol® (stanozolol), Durabolin® (nandrolone),

  Depo®-testosterone (testosterone, Depo-T), and Equipoise®

  (boldenone).

  PHARMACOLOGY OF STEROIDS

  Depending on the AAS, a steroid can be administered either

  orally or by injection (Figure 12.1). Testosterone is inactivated

  Laws, Politics, and Steroids

  The Anabolic Steroid Control Act of 2004 adds steroid pre-

  cursor chemicals to the list of controlled substances under

  the Controlled Substance Act (CSA). One of the AAS that is

  not included on the control ed substance list is dehydroepi-

  androsterone (DHEA). DHEA is metabolized into testosterone

  in the body. This chemical, exempt under federal law, is sold in

  nutrition shops. Senator Orrin G. Hatch of Utah, where many

  dietary substance companies exist, managed to convince

  enough members of Congress to exclude this chemical from

  the list of controlled substances. Although DHEA is available

  to the general public, it is unlikely that sports figures will use

  it, as it is banned by the International Olympic Committee, the

  World Anti-Doping Agency, the National Col egiate Athletic

  Association, the National Football League, the National Bas-

  ketball Association, and minor league basebal .

  Anabolic-Androgenic Steroids 111

  in the liver and has little effect if taken orally. Synthetic com-

  pounds, which are less readily metabolized, can be given by

  mouth, but are usually given in oil by intramuscular injection

  and are absorbed slowly. AAS can be detected in urine within

  four to six hours after use and, depending on the AAS, for weeks

  or months thereafter.

  Unlike most drugs discussed in prior chapters, use of AAS

  does not result in euphoria. People use these agents for long

  periods of time to improve their physical appearance and ath-

  letic performance. A metabolite of testosterone, dihydrotestos-

  terone, acts in the cell nucleus to synthesize RNA and protein

  molecules that result in more efficient use of nitrogen to build

  muscle tissue. Individuals using AAS, however, are in dan-

  ger of developing a physical and psychological dependence.

  Withdrawal results in depressive mood, fatigue, restlessness,

  anorexia, insomnia, decreased libido, musculoskeletal pain,

  and suicidal tendencies.

  Adverse reactions that can occur while taking AAS include

  liver toxicity, suicide, delirium, aggression (called “roid rage”),

  mood swings, psychosis, premature baldness, and acne. Steroids

  can interfere with endocrine function. For males, there is
the

  possibility of benign prostatic hypertrophy, testicular atrophy,

  sterility, enlargement of breast tissue, and closure of the bone

  epiphysis, resulting in shortened growth. For females, the con-

  cerns include shrinking of breast size, clitoral hypertrophy,

  hirsutism (facial and body hair), and deepened voice. AAS have

  been used medically to treat osteoporosis, anemia, breast cancer,

  and other diseases.

  FORENSIC ISSUES

  In one particular case, a man attacked another with a bat.

  The man who was attacked took the bat and used it to hit

  the attacker, who later died. At the murder trial, the defense

  112 Forensic Pharmacology

  Figure 12.1 Anabolic-androgenic steroids, such as Depo®-

  Testosterone, are often injected directly into muscle tissue. In teens,

  steroid use can slow or halt bone growth and damage the heart,

  kidneys, and liver.

  Anabolic-Androgenic Steroids 113

  wanted to introduce evidence that the deceased used large

  amounts of AAS, and autopsy results showed that the deceased

  had an enlarged heart consistent with his steroid use. Such use

  of AAS by the attacker would have made for a strong argument

  that rage played a role and that the defendant had no choice but

  to defend himself. The defense, however, was barred because

  of legal technicalities from introducing this evidence and tes-

  timony. Without the evidence of AAS use, the defendant was

  found guilty of manslaughter.

  SUMMARY

  Anabolic-androgenic steroids (AAS), which are analogs of the

  male hormone testosterone, are used among athletes and body-

  builders. AAS alter the hormonal systems of males and females,

  and induce many adverse effects. In addition to the sex-related

  changes, violent behavior and psychological dependence can

  also occur. The use of AAS in professional sports as well as in

  high school sports has aroused considerable attention.

  The Future

  of Forensic

  13 Pharmacology

  In the first chapters of this book, we discussed the fields of

  pharmacology and toxicology, how these sciences are applied

  to the legal system, the role of the forensic scientist, and some

  of the analytical tools used to detect the presence of chemi-

  cals in bodily fluids and tissues. Drugs of abuse were chosen

  to illustrate practical applications of forensic pharmacology,

  since these drugs are often involved in legal matters. In order

  to establish a causal link between exposure to a chemical and

  an eventual outcome, the forensic scientist must understand

  the pharmacokinetics, pharmacodynamics, and effects of

  each chemical under study. Only then can one draw an accu-

  rate conclusion as to causality. Each of the eight drug chap-

  ters provided actual cases to illustrate how such information

  played a role in the resolution of the case. It is now of interest

  to look ahead and envision the role of forensic pharmacology

  in the future.

  New chemicals are synthesized constantly. Also, many

  pharmacologically active chemicals continue to be found

  in plant life and sea life, and it can be expected that these

  114

  The Future of Forensic Pharmacology 115

  resources will continue to provide new material. Some of the

  newly discovered chemicals will have antianxiety properties

  or be used to treat pain, and such drugs, acting in the central

  nervous system (CNS), may lead to drug abuse. In addition

  to new chemicals, people are constantly modifying existing

  drugs of abuse and synthesizing new drugs for recreational

  purposes. Consequently, either to maintain the habit of tak-

  ing these drugs or because of their effects on behavior, coor-

  dination, and judgment, users may engage in criminal activity

  or cause injury to themselves or others. The forensic scientist

  needs to be knowledgeable of new legal and illegal drugs and

  of their pharmacological and toxicological effects.

  Pharmacokinetic and pharmacodynamic studies lead to a

  greater understanding of chemical interactions at the molecu-

  lar level and may identify specific receptors for drug activity.

  With more specific knowledge of how a drug works, it may

  become easier to more accurately establish what effects are

  actually caused by a particular drug. Thus, studies in these

  two areas of pharmacology will always be necessary.

  As discussed earlier, forensic pharmacology and toxicol-

  ogy are not limited to the study of drugs of abuse or poisons.

  These fields of science also have a growing role in the legal

  system to help resolve civil issues related to chemical exposure

  and cancer causation, medical malpractice as a result of drug

  interactions, and product liability issues.

  CHALLENGES FOR THE FUTURE

  To identify the presence of new drugs, forensic scientists

  will always need to develop new analytical techniques. In

  addition, analytical techniques with greater specificity and

  sensitivity will continue to be developed for existing drugs.

  116 Forensic Pharmacology

  Reporting false-positive results may send an innocent person

  to prison, so everything possible must be done to avoid such

  an outcome. Assays with enhanced sensitivity to detect both

  parent compound and metabolites will allow for detection

  of drugs over longer periods of time and for more accurate

  determination of when an individual was first exposed to a

  chemical.

  Today, everyone is aware of terrorist activity. A well-known

  terrorist attack involving chemicals occurred in 1995 with the

  release of the nerve gas sarin in the subway systems of Tokyo,

  resulting in the death of 12 people and injury of many more.

  Should chemicals again be used for terrorist activity, foren-

  sic pharmacologists and toxicologists may be called upon

  to analyze bodily samples in order to identify the chemical,

  determine its mechanism of action, and propose antidotes

  and preventive measures.

  Forensic science is an exciting and rewarding field of work. A

  forensic scientist is at times a scientific detective and at times a

  teacher, instructing the judge, attorney, and jury, and helping

  to promote justice. Enrollment in forensic science programs

  will continue to increase as new programs are established at

  colleges and forensic science courses are introduced at the

  high school level. As more industries, sports organizations,

  and agencies involved with supervision of children monitor

  their personnel for drug abuse, additional forensic scientists

  and laboratory facilities will be needed.

  To assure that the best technology is available and that

  personnel are qualified, forensic science laboratories should

  undergo accreditation processes with periodic proficiency

  testing. This will assure some uniformity in procedure among

  different laboratories, and provide assurance that samples are

  analyzed correctly and data are interpreted accurately.

  The Future of Forensic Pharmacology
117

  Thus, much work lies ahead. As the field of forensic science

  advances, forensic pharmacologists and toxicologists will

  continue to be integral players in bringing truth to our system

  of justice.

  14

  Solve the Cases!

  The following hypothetical scenarios are intended to test your

  knowledge of the pharmacology of drugs of abuse and of the

  procedures used to resolve cases. The answers are provided at

  the end of the chapter.

  Case a. ImpaIred drIvIng?

  A police officer stops a car that is driving fast and erratically on

  a major highway. The driver stumbles slightly when stepping out

  of the car. The officer, a trained drug recognition expert (DRE),

  notices that the driver’s eyes are bloodshot and the pupils are

  dilated. The officer sees an empty beer bottle but does not detect

  any unusual odor or see any signs of drugs. The DRE performs

  a roadside breath test, which reveals a BAC of 0.02%, and field

  sobriety tests, which the driver fails.

  What do you suspect caused the erratic driving, and what

  additional tests would you suggest be performed?

  Case B. Team rIvalry?

  Before a big football game, the coach of Team A called in the

  squad for a pep talk and breakfast of juice, bagels, and donuts. As

  118

  Solve the Cases! 119

  the teams took the field, the two opposing quarterbacks wished

  each other good luck with a Gatorade toast. Fifteen minutes into

  the game, the Team A quarterback began acting aggressive, anx-

  ious, and hyperactive, and then passed out. Doctors rushed onto

  the field and found the quarterback had slightly elevated blood

  pressure, heart rate, and respiration, and was sweating and sali-

  vating. The quarterback was revived, but stared into space and

  was nonresponsive. In the locker room, suspecting an overdose

  of drugs, a urine sample was collected. The results were positive

  for morphine and one other drug.

  How do you explain the presence of morphine? Does the

  presence of morphine agree with the signs and symptoms exhib-

  ited by the quarterback? What other drug do you suspect was

  found?

  Case C. goT away wITh IT?

  Following a motor vehicle accident, the driver accused of caus-

  ing the accident was taken to a hospital, where a urine sample

  was obtained. A screening test revealed the presence of benzodi-