Drug Identification and Toxicology Pawson, PVMHS 2015

Student learning objectives: By the end of this chapter you should be able to: Identify the five types of controlled substances Relate signs and symptoms of overdose with a specific class of drugs or toxins Describe the role of various types of toxins in causing death Discuss agents that may be used in bioterrorism Define and describe the goals and practice of toxicology

Labs and activities: The Poisoner’s Handbook Botanical poisons Movie Online activity Botanical poisons Poisonous plants Toxicology report On a person of your choice who died due to drug overdose. Munchausen syndrome by proxy case study Jonestown

Forensic toxicology Helps determine cause and effect relationships between: Exposure to a drug or substance and… Toxic or lethal effects from that exposure People can be exposed to toxic substances: Intentionally: by treating illness or relieving pain Accidentally: by harmful combinations or overdoses Deliberately: by harming or killing others, or by suicide

Types of Poisoning Homicidal poisoning accounts for less than 1% of all homicides Accidental drug overdoses are most common 8,500 per year due to heroin 24,000 per year due to prescription drugs Botanical poisoning & accidental poisoning (household products) – usually children under 6 Drug offenders Make up more than 50% of the federal prison population Make up about 20% of the population in state prisons Food poisoning – 3,000 Americans die each year

Drugs

Controlled Substances Hallucinogens Narcotics Stimulants Anabolic steroids Depressants

Hallucinogens Often derived from plants The effect and intensity of response to these drugs varies from person to person. Affects the user’s perceptions, thinking, self-awareness, and emotions Affects of an overdose often include Increased heart rate Increased blood pressure Panic attacks, anxiety, or psychosis

Hallucinogens

Narcotics Any psychoactive medicine with sleep-inducing, numbing properties. Used in medicine for pain relief. Medicines are habit forming. Vicodin, Lortab, Percocet, OxyContin Heroine, codeine, morphine Derived primarily from opium poppy plants, also from mandrake root.

Narcotics

Stimulants Increases feelings of energy and alertness Suppresses appetite Afterwards, depression often results Overdose affects include high blood pressure, agitation, confusion, seizures Stimulants tend to be highly addictive

Stimulants

Anabolic Steroids A chemical structure similar to testosterone Promote cell and tissue growth increasing bone mass and body muscle. Popular with weightlifters, bodybuilders, and other athletes What are some of the negative side effects? Testicular atrophy, block normal sex hormones disrupting homeostasis, increase aggressive behavior, acne, high-blood pressure, liver disease, stunted bone growth (teens)

Depressants Affects the central nervous system by increasing GABA activity, a neurotransmitter Increased GABA causes drowsiness and slowed brain activity Relieves anxiety and produces sleep Side effects include slurred speech and loss of coordination Mixing depressants with alcohol and other drugs increases potency and health risks Ex: alcohol, barbiturates (fioricet, phenobarb), benzodiazepines (xanax, valium)

Alcohol Most commonly abused drug. Kills more teens than all other drugs combined. 6% of college students are alcohol dependent. In what way are alcohols toxic? What is the effect of alcohol on the central nervous system? What can chronic alcohol abuse cause? Disrupts cell membranes, affecting the ability of your body cells to function. Causes dehydration. Has to be metabolized by the liver and can only be done at a certain rate because enzymes are involved. Blackout, memory loss, blurred vision, slow reaction time, difficulty walking Esophageal cancer, liver cancer, cirrhosis of the liver, arrhythmias, high blood pressure, stroke, pancreatitis

Toxins

Bacterial toxins Tetanus Botulism Causes Lockjaw Produced by the Clostridium tetani bacteria Causes violent muscle spasms Botulism Produced by Clostridium botulinum—botulism Paralyzes muscles Causes irreversible damage to nerve endings Extremely deadly in very small amounts Most poisonous biological substance BOTOX

Bacterial toxins Anthrax Bioterrorism agent Bacillus anthracis, which forms endospores Spreads to humans from infected animals Enters the human body through: Inhalation; causing breathing problems that usually result in death Ingestion; becoming fatal in 25% to 60% of cases Absorption via the skin; leading to death in about 20% of untreated cases Is commonly used as a bioterrorism agent

Pesticides and heavy metals

Pesticides and heavy metals Arsenic Chemical element AS, atomic number 33 Highly toxic, disrupts ATP production Lead Chemical element Pb, atomic number 82 Used in building materials, batteries, bullets and shot Accumulates in the soft tissues and bone Damages nervous system, causes brain disorders Why are children tested for lead levels in their blood? Mercury Chemical element Hg, atomic number 80 Used in thermometers, barometers, fluorescent lights, mercury switches, tooth fillings, cosmetics Damages nervous system, can cause sensory impairment and lack of coordination.

Botanical toxins Ricin A poisonous protein in the castor bean Lethal in extremely small amounts Enters the body in various ways: inhaled as a mist or a powder ingested as food or drink injected into the body Causes death within a few hours Is commonly used as a bioterrorism agent

Botanical toxins Cyanide Strychnine Seeds of apples, apricots, cherries, and peaches Also produced by certain bacteria, fungi, and algae Chemical formula: CN− Strychnine From the strychnine tree (Strychnos nux-vomica) Over the counter herbal supplements called Nux Vomica, are essentially small doses of strychnine! Chemical formula: C21H22N2O2

Botanical toxins

Poisonous plants

Poisonous plants

Poisonous mushrooms

The Poisoner’s Handbook Video Library

Forensic toxicology

Celebrity overdose project Library time to research a celebrity who has died of a drug overdose or alcoholism. Photo Name of celebrity, dates of birth/death What they were known for How they died What were some aspects of their lifestyle that contributed to their death? Did they suffer from any mental illness?

Drug testing Analysis of a biological specimen for the presence of a specific drug or toxin Urine, blood, breath, hair, sweat, saliva If a police officer suspects you’re under the influence, they can order a drug test. A positive drug test may lead to bail not being granted If you are admitted to the hospital and suspected to be under the influence, a drug test will be ordered. An employer may require a drug test before hiring.

Drug testing Alcohol – 12-24 hours in blood, 6-24 hours in urine. Meth – 1-3 days in blood, 3-5 days in urine MDMA – 3-4 days in blood and alcohol Barbiturates – 1-2 days in blood, 1 day in urine Benzo – 6 to 48 hours in blood, 4-6 weeks in urine (chronic use) Cannabis – 2-3 days in blood (2 weeks in heavy users), 7-10 days in urine (30 days in heavy users) The only thing that really works and is undetectable is time & abstinence

DUI & DWI http://www.dmv.org/ma-massachusetts/automotive-law/dui.php 0.08% or higher―Drivers 21 years old or older operating regular passenger vehicles. 0.04% or higher―Drivers operating commercial vehicles. 0.02% or higher―Drivers younger than 21 years old. It's illegal to operate a motor vehicle with an open container of alcohol anywhere in the vehicle, no matter who's holding it. This means you can't drive with an empty liquor bottle in your backseat, nor have a passenger drinking a can of beer.

Munchausen syndrome by proxy Munchausen syndrome by proxy is a mental illness and a form of child abuse. The caretaker of a child, either makes up fake symptoms or causes real symptoms to make it look like the child is sick. Many times, these symptoms appear due to deliberate poisoning by the caretaker. Case studies: http://jimfishertruecrime.blogspot.com/2013/07/marybeth-tinning-worst-munchausen.html http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/48311

Jonestown A total of 909 Americans died in Jonestown, all but two from apparent cyanide poisoning, in an event termed "revolutionary suicide” Video: https://www.youtube.com/watch?v=pwhOBbAmWVU Was it suicide or homicide?