Forensic Pathology - Drug and Suicide

Drug Overdose

the leading cause of accidental death in the US

Ways of Administration

• Smoking (pot)

• Huffing (inhaling volatile) gasoline, toluene,

• Snorting

• Ingesting

• Injecting: veins, under skin

Tolerance

After repeated use of a drug, no longer acts the same way it initially did

Dependence

Neurons only function normally when drug is present

Cocaine

white powder, originates from coca leaves

Crack

salt processed with baking soda and heated to remvoe salt

What does Cocaine causes

euphoria, reduced fatigue, mental alertness, loss of appetite or need to sleep

How can cocaine be detected in your system

Main metabolites BZE can be found in urine up to a week, up to 3 weeks with high doses

Effects of Cocaine

causes elevated blood pressure, hyperthermia, increased heart rate, dilated pupils, chest pain, stroke, seizures, headaches, abdominal pain

PCP

crystalline powder, tablets, capsules

Effect of PCP

creates feeling of detachment, hallucinations, slurred speech, acute anxiety, hostility, paranoia

Cannabis

Smoked dried leaves, flowers, stems, seeds

What does Cannabis cause

shallow breathing, dizziness, dry mouth, dilated pupils, depression, anxiety (detachment from reality)

Effects of Cannabis

effects short term memory, ability to focus and learn and coordination

Medical synthetic cannabinoids

Marinol for nausea associated with chemotherapy, increased appetite in AIDS pt

Medical marijuana currently approved for myriad of conditions

Cancer, Glaucoma, HIV, chronic pain, nausea, cachexia, muscle spasm

K-2

Herbal mixtures, similar effect as marijuana

Benzodiazepines

often abused with opiates, potentiate their effect

Benzodiazepines anti-anxiety agents, attach to the GABA receptor

withdrawal can be fatal

Opium

produced when poppy flower dies in 10-12 day period

Heroin

Derived from morphine alkaloid found in opium, 2-3x times more potent

Heroin is mostly sold as

white or brown powder

How is Heroin administrated

can be smoked, snorted, ingested, injected, suppository

Methadone

can be prescribed for chronic pain patients or for former heroin addicts

Inhalants

Volatile substances which are inhaled to produced mind altering effect

Methamphetamine

comes in clear crystal chunks or shiny blue white rocks “ice”

Prescribed stimulants that are chemically similar to methamphetamine

• Adderall

• Ritalin

• Concerta

Alcohol Abuse

Leads to liver cirrhosis

Drug scene investigation

Check for pills, crack pipes, glassine bags, powdery substances, pill bottles, syringes, cooker spoons, razor blades

Drug Mules

Be aware about practice of snuggling drugs: body packers or mules

External exam

look for injection sites: fresh or scarred track marks

What does external examiners look for

• foam in nares or mouth

• pill fragments in stomach contents

• lung and brain swelling

Suicide

third leading cause of death for ages 15-24

Conditions associated with suicide

• Mental illness

• depression

• alcohol and drug abuse

• terminal illness

• postpartum depression

Mental illness and suicide

• Bipolar disorder

• Major depression

• Schizophrenia

• PTSD

Stressors in Elderly

• Retirement

• Loss of loved one

• Social isolation

• Disability

Self-inflicted injuries

• stabbing and cutting

• firearms and explosives

• jumping from height

• jumping into water

• burning

• suffocation

• hanging

• electrocution

• railroad injuries

• poisoning

Hanging

Self-suspension by rope, scarf, shoelaces, bed-sheets, etc.

knife wounds

favor certain locations (throat, wrists, chest)

Gunshot wound

• Men>Women

• Weapon found at scene

• soot around the wound

• location: temple, neck, mouth, chest

Submersion

Depend on availability of water: river, lake, even bathtub

Jumping from heights

• very important to know circumstances to determine motivation

• Aortic Rupture

• Splenic laceration

• Pelvic fractures

• Spinal injuries

Asphyxiation

• lack of oxygen

• plastic bag suffocation

• homicide (little kids and suicidal)

• rapid

• leaves no physical signs

Carbon Monoxide poisoning

Odorless, tasteless, colorless gas formed by hydrocarbon combustion

How does Carbon Monoxide poisoning happen

Binds to hemoglobin causing impaired oxygen transportation

• organ ischemia

• metabolic derangements

Carbon monoxide poisoning

putting head in gas oven was a common way to commit suicide in the past

Ethylene Glycol

Common household agent, antifreeze

• causes kidney injury and metabolic derangement

Cyanide poisoning

Blocks ATP use in the cell during aerobic metabolism