Unit 5 Drugs, Poisons, and Toxicology

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Unit 5Drugs, Poisons, and Toxicology

• Having sniffed the dead mans lips, I detected a
  slightly sour smell, and I came to the conclusion
  that he had poison forced upon him.
• Sherlock Holmes, in Sir Arthur Conan Doyles
• A Study in Scarlet

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Drug

• Definition
• Natural or synthetic substance designed to affect
  the subject psychologically or physiologically.

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Four Major Drug Classifications

• Hallucinogens
• Stimulants
• Narcotics
• Depressants

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Hallucinogens

• Mostly naturally occuring
• Marijuana
• Active ingredient, tetrahydrocannabinol (THC)
• (1-10)
• Hash (50)
• Cannabis sativa

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Hallucinogens

• LSD (d-lysergic acid diethylamide)
• Derived from alkaloids in fungus
• 25 micrograms
• Microdots, window panes, blotter acid
• Effects
• Visual and auditory hallucinations
• Pychosis, flashbacks, and impaired memory and
  attention span
• Tetrogen causes birth defects

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LSD
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Hallucinogens

• PCP (phencyclidine)
• IV anesthetic 1950s
• Effects
• Insensitivity to pain, super strength, rage,
  memory loss and paranoia
• Mixed (Wobble weed, Angel dust)

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Hallucinogens

• MDMA (methylenedioxymethamphetamine or ectasy)
• Synthetic drug
• Effects
• Stimulates user, hallucinations, psychological
  problems, confusion, depression, addiction,
  severe anxiety, paranoia
• Increased blood pressure and heart rate

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Hallucinogens

• Ketamine (Special K)
• Animal tranquilizer
• Club drug along with MDMA, GHB, GBL, rohypnol,
  LSD, PCP, and methamphetamine
• Effects
• Delirium, amnesia, depression, long term memory
  difficulties

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Stimulants

• Act on central nervous system
• Effects
• Feel better, increase energy, alertness,
  suppressing appetite and fatigue
• Restlessness, anxiety, depression
• Mild Caffeine, Nicotine
• Strong Amphetamines (uppers or bennies),
  methamphetamines (speed or crank)

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Stimulants

• Cocaine
• Alkaloid from leaf of coca plant
• 500 lbs of leaves 1 lb of cocaine powder
• Recrystallized freebase crack
• Highly addictive
• Anxiety, insomnia, weight loss, paranoia, mental
  deterioration

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Narcotics

• Analgesics
• Substances that affect CNS to relieve pain
• Mild OTC drugs like Advil, Tylenol
• Illicit Opium
• Harvested from poppy flowers
• Contains 4-21 morphine
• Heroin (Horse or smack)
• Death, serum hepatitis
• Codeine, methadone, Propoxyphene (Darvon),
  Oxycodon (Percocet), Fentanyl (designer drug,
  China White)

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Narcotics

• Some OTC analgesics can be harmful when
• Taken in excess
• Combined with other medicines
• Combined with alcohol
• Some people are allergic to aspirin
• Throat swells, suffocating them
• Same symptoms occurs with NSAIDS (non steroidal
  anti-inflammatory drugs) (Advil or Motrin)
• Table 1 p. 136

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Narcotics
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Depressants

• Ethyl Alcohol
• Barbituates (Downers)
• Highly additive, withdrawal is difficult
• Phenobarbital, Nembutal, Seconal
• Meprobamate (Miltown), methaqualone (Quaaludes),
  benzodiazepines (tranquilizers such as Librium
  and Valium)

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Identification of Drugs

• PDRPhysicians Desk Reference
• Field Testspresumptive, preliminary, or spot
  tests
• Laboratory Testsconclusive or confirmatory tests

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Presumptive (Spot) Tests vs. Confirmatory Tests

• Spot test
• Chemical reaction occurs when a particular
  substance is added to an unknown
• Color reactions
• Preliminary tests, not conclusive, used in field
• Positive, negative, false positive
• Confirmatory
• Spectrophotometry
• Chromatography (separate mixtures)

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Presumptive Color Tests

• Marquis (MARQ)
• Purple, opium derivatives
• orange-brown, amphetamines
• Dillie-Koppanyi (D-K)
• Violet-blue, barbiturates
• Duquenois-Levine (D-L)
• Purple, marijuana
• Erlich/Van Urk (ERL)
• blue-purple, LSD
• Cobalt thiocyanate/Scott test (CO)
• Blue, cocaine

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Human ComponentsUsed for Drug Analysis

• Blood
• Urine
• Hair
• Gastric Contents
• Bile

• Liver tissue
• Brain tissue
• Kidney tissue
• Spleen tissue
• Vitreous Humor of the Eye

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Confirmatory Lab Tests

• Spectroscopy
• Infrared (IR)
• Mass Spectroscopy (MS)
• Chromatography
• Paper, Thin layer (TLC), Gas (GC), High pressure
  liquid (HPLC)

PURE SUBSTANCES ONLY!
MIXTURES MUST SEPARATE FIRST!
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Chromatography

• Separating mixtures
• Two phases
• mobile one
• stationary one
• The mixture interacts with the stationary phase
  and separates.

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Types of Chromatography

• Paper
• Thin Layer (TLC)
• Gas (GC)
• High Pressure Liquid (HPLC)
• Column
• Pyrolysis Gas (PGC)
• Liquid (LC)

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Paper Chromatography

• Stationary phasepaper
• Mobile phasea liquid solvent

Capillary action moves the mobile phase through
the stationary phase
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Thin Layer Chromatography

• Stationary phase a thin layer of coating
  (usually alumina or silica) on a sheet of plastic
  or glass
• Mobile phase
• a liquid solvent

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Retention Factor (Rf)
If Rf of unknown matches or is very similar to a
known, they are most likely a match.
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Gas Chromatography

• Phases
• Stationarya solid or a viscous liquid that lines
  a tube or column
• Mobilean inert gas like nitrogen or helium

• Analysis
• Shows a peak that is proportional to the quantity
  of the substance present
• Uses retention time instead of Rf for the
  qualitative analysis

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Uses of Gas Chromatography

• Not considered a confirmation of a controlled
  substance
• Used as a separation tool for
• MS and IR
• Quantitatively measure the concentration of a
  sample
• In a courtroom, there is no real requirement to
  know the concentration of a substance. It does
  not affect guilt or innocence.

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Spectroscopy

• Spectroscopythe interaction of electromagnetic
  radiation with matter.
• Spectrophotometeran instrument used to measure
  and record the absorption spectrum of a chemical
  substance.

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Spectrophotometry

• Components
• A radiation source
• A frequency selector
• A sample holder
• A detector to convert electromagnetic radiation
  into an electrical signal
• A recorder to produce a record of the signal
• Types
• Ultraviolet
• Visible
• Infrared

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IR Spectrophotometry andMass Spectrometry

• Both work well in identifying pure substances.
• Mixtures are difficult to identify in both
  techniques
• Both are compared to a catalog of knowns

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Infrared Spectometry

• Energy causes bonds to bend or stretch.
• Each bond, or group of bonded atoms, has a
  characteristic excitation energy.
• Gives a unique view of the substance like a
  fingerprint
• Fourier Transform Infrared (FTIR) (25,000)

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Mass Spectrometry

• Gas chromatography has one major drawback, it
  does not give a specific identification. Mass
  spectrometry cannot separate mixtures. By
  combining the two (GCMS), constituents of
  mixtures can be specifically identified.

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Mass Spectrometry

• How it works
• Electron beam
• Molecules break apart into many positively
  charged fragments
• Sorted and collected according to their
  mass-to-charge ratio by an oscillating electric
  or a magnetic field.
• Each compound has its own unique fragmentation
  pattern or spectrum.

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Mass Spectra

• Each molecular species has its own unique mass
  spectrum.

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Controlled Substances Act

• Schedule Ihigh potential for abuse no currently
  acceptable medical use in the US a lack of
  accepted safety for use under medical supervision
• Schedule IIhigh potential for abuse a currently
  accepted medical use with severe restrictions
  abuse may lead to severe psychological or
  physical dependence
• Schedule IIIlower potential for abuse than the
  drugs in I or II a currently accepted medical
  use in the US abuse may lead to moderate
  physical dependence or high psychological
  dependence
• Schedule IVlow potential for abuse relative to
  drugs in III a currently accepted medical use in
  the US abuse may lead to limited physical or
  psychological dependence relative to drugs in III
• Schedule Vlow potential for abuse relative to
  drugs in IV currently accepted medical use in
  the US abuse may lead to limited physical or
  psychological dependence relative to drugs in IV

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Examples of Controlled Substances and Their
Schedule Placement

• Schedule Iheroin (diacetylmorphine), LSD,
  marijuana, ecstasy (MDMA)
• Schedule IIcocaine, morphine, amphetamines
  (including methamphetamines), PCP, Ritalin
• Schedule IIIintermediate acting barbiturates,
  anabolic steroids, ketamine
• Schedule IVother stimulants and depressants
  including Valium, Xanan, Librium, phenobarbital,
  Darvon
• Schedule Vcodeine found in low doses in cough
  medicines

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ToxicologyPoisons and Alcohol

• All substances are poisons. There is none which
  is not. The right dose differentiates a poison
  and remedy.
• Paracelsus (1495-1541). Swiss physician and
  chemist

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The Poison is in the Dosage.

• Arsenic
• Botulin, Clostridium botulinum
• Hormesis
• Substances that kill in high doses may actually
  be beneficial in low doses

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Toxicology

• Definitionthe study of the adverse effects of
  chemicals or physical agents on living organisms.
• Types
• Environmentalair, water, soil
• Consumerfoods, cosmetics, drugs
• Medical, clinical, forensic

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Forensic Toxicology

• Postmortemmedical examiner or coroner
• Criminalmotor vehicle accidents (MVA)
• Workplacedrug testing
• Sportshuman and animal
• Environmentindustrial, catastrophic, terrorism

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Toxicology

• Toxic substances may
• Be a cause of death
• Contribute to death
• Cause impairment
• Explain behavior

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Historical Perspective of Poisoners

• Olympiasa famous Greek poisoner
• Locustapersonal poisoner of Emperor Nero
• Lucretia Borgiafather was Pope Alexander VI
• Madame Giulia Toffanacommitted over 600
  successful poisonings, including two Popes.
• Hieronyma Sparaformed a society to teach women
  how to murder their husbands
• Madame de Brinvilliers and Catherine
  DeshayesFrench poisoners.
• AND many others through modern times.

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The Severity of the Problem

• If all those buried in our cemeteries who were
  poisoned could raise their hands, we would
  probably be shocked by the numbers.
• John Harris Trestrail, Criminal Poisoning

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People of Historical Significance

• Mathieu Orfila
• father of forensic toxicology
• Traite des Poisons
• James Marsh
• Arsenic test

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Aspects of Toxicity

• Dosage
• The chemical or physical form of the substance
• How it enters the body
• Body weight and condition of the victim,
  including age and sex
• The time period of exposure
• Small amounts over time, tolerance
• Large amounts over time, chronic exposure
• Large one time dose, acute toxicity
• The presence of other chemicals in the body or in
  the dose
• Synergism, increases effects
• Antagonism, decreases effects
• Chelating agent, takes up poison

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Lethal Dose

• Test on animals, only way to standardize
• LD50refers to the dose of a substance that kills
  half the test population, usually within four
  hours
• Expressed in milligrams of substance per kilogram
  of body weight

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Toxicity Classes
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Some Lethal Dose Values
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Federal Regulatory Agencies

• Food and Drug Administration (FDA)
• Environmental Protection Agency (EPA)
• Consumer Product Safety Commission
• Department of Transportation (DOT)
• Occupational Safety and Health Administration
  (OSHA)

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Symptoms of Various Typesof Poisoning

• Type of Poison Symptom/Evidence
• Caustic Poison (lye) Characteristic burns around
  the lips and mouth of the
  victim
• Carbon Monoxide Red or pink patches on the chest
  and thighs,
  unusually bright red lividity
• Sulfuric acid Black vomit
• Hydrochloric acid Greenish-brown vomit
• Nitric acid Yellow vomit
• Phosphorous Coffee brown vomit. Onion or garlic
  odor
• Cyanide Burnt almond odor
• Arsenic, Mercury Pronounced diarrhea
• Methyl (wood) or Nausea and vomiting,
  unconsciousness,
• Isopropyl (rubbing) alcohol possibly blindness

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To Prove a Case

• Prove a crime was committed
• Motive
• Intent
• Access to poison
• Access to victim
• Death was caused by poison
• Death was homicidal

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Forensic Autopsy

• Look for
• Irritated tissues
• Characteristic odors
• Mees linessingle transverse white bands on
  nails.
• Order toxicological screens
• Postmortem concentrations should be done at the
  scene for comparison
• No realistic calculation of dose can be made from
  a single measurement

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Human Specimens for Analysis

• Blood
• Urine
• Vitreous Humor of Eyes
• Bile
• Gastric contents

• Liver tissue
• Brain tissue
• Kidney tissue
• Hair/nails

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AlcoholEthyl Alcohol (C2H5OH)

• Most abused drug in America
• About 40 of all traffic deaths are
  alcohol-related
• Toxicaffecting the central nervous system,
  especially the brain
• Colorless liquid, generally diluted in water
• Acts as a depressant
• Alcohol appears in blood within minutes of
  consumption 30-90 minutes for full absorption
• Detoxificationabout 90 in the liver
• About 5 is excreted unchanged in breath,
  perspiration and urine

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Rate of Absorption

• Depends on
• amount of alcohol consumed
• the alcohol content of the beverage
• time taken to consume it
• quantity and type of food present in the stomach
• physiology of the consumer

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BACBlood Alcohol Content

• Expressed as percent weight per volume of blood
• Legal limits in all states is 0.08
• 0.08 grams of pure alcohol for every 100 mL of
  blood
• Parameters influencing BAC
• Body weight
• Alcoholic content
• Number of beverages consumed
• Time between consumption

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BAC

• Burn off rate of 0.015 per hour but can vary
• Male
• BAC male 0.071 x (oz) x ( alcohol)
• body weight
• Female
• BAC female 0.085 x (oz) x ( alcohol)
• body weight

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Example

• What would be the approximate BAC of a 185 lb man
  who has consumed three shots (1.5 oz each) of
  Jack Daniels (80 proof 40 alcohol) in an hour?
• 0.71 x 4.5 x 40 0.07
• 185
• If he had just one more shot, would he be over
  the legal limit? If not, how many shots would it
  take?

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Henrys Law

• When a volatile chemical (alcohol) is dissolved
  in a liquid (blood) and is brought to equilibrium
  with air (breath), there is a fixed ratio between
  the concentration of the volatile compound in the
  air and its concentration in the liquid this
  ratio is constant for a given temperature.
• THEREFORE, the concentration of alcohol in breath
  is proportional to that in the blood.
• Ratio of alcohol in the blood to alcohol in the
  alveolar air is approximately 2100 to 1.
• In other words 1 ml of blood will contain nearly
  the same amount of alcohol as 2100 ml of breath.

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Field Tests

• Preliminary testsused to determine the degree of
  suspects physical impairment and whether or not
  another test is justified.
• Psychophysical tests3 Basic Tests
• Horizontal gaze nystagmus (HGN) follow a pen or
  small flashlight, tracking left to right with
  ones eyes. In general, wavering at 45 degrees
  indicates 0.10 BAC.
• Nine Step walk and turn (WAT) comprehend and
  execute two or more simple instructions at one
  time.
• One-leg stand (OLS) maintain balance, comprehend
  and execute two or more simple instructions at
  one time.

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The Breathalyzer

• More practical in the field
• Collects and measures alcohol content of alveolar
  breath
• Breath sample mixes with 3 ml of 0.025 K2Cr2O7
  in sulfuric acid and water
• 2K2Cr2O7 3C 2H5OH 8H 2SO4 ? 2Cr2(SO4)3
  2K2SO4 3CH3COOH 11 H2O
• orange green
• Oxidation-Reduction reaction
• Potassium dichromate is yellow, as concentration
  decreases its light absorption diminishes so the
  breathalyzer indirectly measures alcohol
  concentration by measuring light absorption of
  potassium dichromate before and after the
  reaction with alcohol

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Generalizations

• During absorption, the concentration of alcohol
  in arterial blood will be higher than in venous
  blood.
• Breath tests reflect alcohol concentration in the
  pulmonary artery.
• The breathalyzer also can react with acetone (as
  found with diabetics), acetaldehyde, methanol,
  isopropyl alcohol, and paraldehyde, but these are
  toxic and their presence means the person is in
  serious medical condition.
• Breathalyzers now use an infrared light
  absorption device with a digital read-out. Prints
  out a card for a permanent record.