Drugs/Forensic Toxicology

Question 1

Toxicology

Answer 1

Concerned with analysing samples for drugs/poisons and interpreting the significance of the results

Question 2

Forensic

Answer 2

Reports/results are used in courts (Magistrates, Crown, Coroners)

Question 3

What does section 3 of the coroners act 1887 say

Answer 3

The following deaths are reported to the coroner: violent, unnatural or sudden, cause of death unknown

Question 4

Types of cases reported to the coroner

Answer 4

Addicts/drug use
Sudden unexplained/natural 
Hanging 
Overdoses
Road Traffic Collisions 
Train deaths 
Self-inflicted injury 
Fire

Question 5

What samples are used in forensic toxicology

Answer 5

Ante-mortem serum/blood 
Post-mortem blood: heart blood, cavity blood (screening); femoral vein blood (screening and quantitation) 
Urine 
Stomach contents 
Vitreous humour 
Hair 
Liver 
Other - bile, mucous, powders, syringes

Question 6

How is alcohol (+ acetone) tested for

Answer 6

Head-space GC

Question 7

How is the general drug screen done

Answer 7

GC-MS (gas chromatography-mass spectrometry)

Question 8

How is the urine drugs of abuse screen done

Answer 8

GC-MS

Question 9

How is morphine tested for

Answer 9

EIA

Question 10

How is cannabis tested for

Answer 10

GC-MS

Question 11

How are amphetamines tested for

Answer 11

GC-MS

Question 12

How is the hair simultaneous screen and quantitation screen done

Answer 12

GC-MS

Question 13

What are some new psychoactive substances

Answer 13

Modafinil
Ibogaine
Flubromazepam

Question 14

How does heroin overdose occur

Answer 14

Most respiratory depression or aspiration pneumonitis

Question 15

How long after ingesting fatal doses of methadone does death occur

Answer 15

4-6 hours later

Question 16

How heroin taken

Answer 16

IV injected, mix with tobacco, volatilised

Question 17

What is the most fatal route of ingestion of heroin

Answer 17

All routes can cause OD

Question 18

What is a feature of heroin use

Answer 18

Tolerance can develop

Question 19

What is the typical maintenance dose of methadone

Answer 19

Tolerance can develop
5mL can kill a child, 60mL can kill a healthy adult male

Maintenance dose can vary from 5-200mL

Question 20

Can benzodiazepine overdose cause death

Answer 20

Extremely rare to cause death alone

Question 21

What is a common drug found in RTAs

Answer 21

Alcohol

Cannabis

Question 22

What is speedball

Answer 22

Cocaine injected with heroin

Question 23

What are the dangers of cocaine use

Answer 23

Cardiac dysrhythmias
Acute heart failure
Myocardial infarction
Slowly developing damage to the myocardium, ventricular arrhythmias, sudden death

Question 24

What is lethal syndrome of excited delirium

Answer 24

Occurs in regular cocaine users within 24hours of last dose

Question 25

What can prolong the effects of cocaine

Answer 25

Ethanol

Question 26

What does large OD of amphetamine cause

Answer 26

Direct toxic effect on the heart

Question 27

What can amphetamines cause

Answer 27

Hyperthermia, leading to rhabdomyolysis, leading to muscle necrosis and renal failure

Question 28

Designer drug categories

Answer 28

Stimulants Synthetic cannabinoids or 'spice' Synthetic opioids Hallucinogenic compounds

Question 29

What legal drugs can cause lethal overdose

Answer 29

``` Antidepressants Antipsychotics Analgesics Antihypertensives Anticonvulsants Solvents Hypnotics Anxiolytics Antimalarials Beta blockers Anaesthetics ```

Question 30

Sources of drugs

Answer 30

``` Over-the-counter preparations Prescription medication Illegal street drugs Migrant population Bought over internet ```

Question 31

Why can the post-mortem blood not be used to calculate the dose of drug taken

Answer 31

PM redistribution of drugs occurs

Question 32

Why is cocaine overdose difficult to interpret

Answer 32

Degrades in PM blood PM blood concentration and blood concentration at time of death not the same To interpret cocaine levels: witness behaviour, cardiovascular pathology, medicinal/drug use history Addict can tolerate high levels Causes heart problems, death with low levels

Question 33

Why is hair used in toxicology

Answer 33

Blood/serum, drugs typically can be detected for no more than 12 hours Urine, drugs typically detected for 2-3 days Hair is the only specimen can give information about long term drug use Drugs are incorporated into hair from the blood stream during the growth phase Hair growth approx 1cm/month – “tape-recording of drug use”

Question 34

What information can be obtained from hair analysis

Answer 34

Can provide valuable evidence which cannot be provided by any other means Segmental analysis provides pattern of past use Established technique Increasingly used in crime investigation Seldom used in routine Coroner’s Toxicology

Question 35

What drugs can be detected in hair

Answer 35

``` Morphine Cocaine Amphetamine Diazepam Analgesics Anticonvulsants Antiemetics Antihistamines Antidepressants Antipsychotics Local anaesthetic ```

Question 36

Problems with hair analysis

Answer 36

Environmental contamination Absorbed from sweat or sebum coating hair Passive inhalation Cosmetic treatment (Shampoo washing, Perming, dyeing, bleaching) Hair colour

Question 37

What is chemsex

Answer 37

Sex under the influence of drugs (MSM)

Question 38

What drugs are used in chemsex

Answer 38

g-hydroxybutyrate/ g-butyrolactone Methylamphetamine (crystal meth) Mepdedrone

Question 39

Harms associated with chemsex

Answer 39

GHB/GBL have steep dose response curves Mixing with other drugs is dangerous Increased risk of HIV