yellow Card Centre WM Forensic Toxicology Of Drugs

yellow. Card Centre WM Forensic Toxicology Of Drugs That Affect Performance And Behaviour

Drugs That Affect Behaviour: the people yellow. Card Centre WM criminal victim law civil law doctor patient

Drugs That Affect Behaviour: pharmacology yellow. Card Centre WM • drugs affecting neurotransmission • drugs affecting the endocrine system • other exogenous drugs

GABA: major inhibitory neurotransmitter yellow. Card Centre WM • GABA agonists include ethanol benzodiazepine barbiturates ghb GABA receptor

GABA inhibitory effects yellow. Card Centre WM higher centre control Ø disinhibition cerebellum Ø ataxia nystagmus sensory pathways Ø anaesthesia reticular activating sys Ø unconsciousness brain stem Ø respiratory arrest

The dopamine pathway yellow. Card Centre WM • The reward pathway: neural hedonism VTA = ventral tegmental area NIDA©

Classical addictive drugs and other drugs of abuse yellow. Card Centre WM • • opioids ethanol amphetamines cocaine lysergide cannabis gammahydroxybutyrate

Drugs affecting the endocrine system yellow. Card Centre WM • testosterone • insulin • corticosteroids

Other exogenous drugs yellow. Card Centre WM Many predictable agents – anticholinergics, stimulants, hallucinogens Some unexpected drugs, e. g. – infliximab – montelukast – pizotifen – ribavirin – tibolone

Hallucinogens - 1968 yellow. Card Centre WM volatile carbon compounds nutmeg skin of toads night-shade morning glory seeds

What the drug effects mean yellow. Card Centre WM Effect on the perpetrator • drug-induced hallucination • drug-induced aggression • drug-induced disinhibition • drug-induced amnesia • drug-induced confession • drug-induced incompetence

Drug-induced hallucination yellow. Card Centre WM R -v- Lipman [1970] • man took LSD • believed his girlfriend was serpent at the centre of the Earth • attacked her with a sword and killed her

Drug-induced hallucination yellow. Card Centre WM R -v- Lipman [1970] • charged with manslaughter • Guilty • 'voluntary intoxication’

Not drug-induced hallucination R -v- Francis 2000 yellow. Card Centre WM Defendant sexually assaulted boy of 16 Boy was taking tramadol • expert 1: ‘tramadol can cause hallucinations, so boy’s evidence unreliable’ • experts 2, 3: ‘Tramadol for years, no hallucination ever’ • so – expert 1 criticised, appeal dismissed

Drug-induced hallucination? Or religious duty? yellow. Card Centre WM Worshiping with weed R -v- Paul Simon Taylor 2001 • defendant was going into Rasta Temple with 36 g cannabis for ‘act of worship’ • convicted • ‘No statutory defence of religious use in the Misuse of Drugs Act 1971 and prosecution did not infringe the accused's rights under ECHR’

Drug-induced disinhibition yellow. Card Centre WM

Drug-induced disinhibition yellow. Card Centre WM A rich 51 -year-old business man • prolactinoma • Rx bromocriptine, then quinagolide • pursued women and neglected business • after 3 years bankrupt • sued makers of quinagolide • settled out of court

Drug-induced disinhibition R -v- Lee Heard 2007 yellow. Card Centre WM Some crimes can only be committed if the criminal had ‘intent’ {mens rea} • A drunken man rubbed himself lewdly against the leg of a police officer • convicted under Sexual Offences Act 2003: the rubbing was intended at the time, even if he would not have done it sober, or could not remember it

Drug-induced disinhibition yellow. Card Centre WM Know what you are drinking R -v- Allen (Kevin) 1988 • committed sexual assault while drunk • admitted to 4 pints beer + two bottles unknown, ‘tasting of aniseed’ • intoxication not involuntary simply by not knowing precise nature and strength of the alcohol • appeal dismissed

Drug-induced aggression yellow. Card Centre WM Guardian July 27 1991 Drug turned husband into a double killer

Drug-induced aggression: adverse effect yellow. Card Centre WM 44 -year-old depressed man went beserk • hit wife and friend over the head with an iron bar • then tried to cut their heads off with a kitchen knife • drug poisoning + mania from amitriptyline

Steroid suicide yellow. Card Centre WM The down side of drugs Judy Jones reports on a tragic result of taking legally prescribed steroids • asthma • corticosteroids • suicide Guardian 26 th November 1996

Drug-induced aggression: adverse effect yellow. Card Centre WM Arson after diazepam R -v- Hardie 1984 • a man took 5 diazepam tablets ‘to calm his nerves, ’ then set light to his girlfriend’s flat • no evidence that he knew… that this would render a person aggressive or incapable of appreciating risks • appeal allowed

Drug-induced aggression Hypoglycaemia: no bar to conviction for murder yellow. Card Centre WM R -v- Bailey 1983 • • man with IDDM hit a rival lover the head with an iron bar ‘hypo’ if a patient knew there was a risk that failure to take food after insulin could make him aggressive, then he was reckless • ample evidence that he left home armed with an iron bar intent on teaching his rival a lesson • convicted

Anabolic steroids yellow. Card Centre WM ‘Some individuals may experience mental status and behavioral changes with anabolic steroid use, including irritability, aggressiveness, euphoria, depression, mood swings, altered libido, and even psychosis’ Kashkin and Kleber, 1989; Bahrke et al. , 1990; Middleman and Du. Rant, 1996; Clark and Henderson, 2003.

Drug-induced aggression: anabolic steroids yellow. Card Centre WM Klotz et al, 2006 • 241 anabolic steroid positive • 1199 anabolic steroid negative • RR of carrying a weapon x 2, but • RR of violent crime x 1 and • the wrong study…

Drug-induced aggression? yellow. Card Centre WM Sgt Colin Murray, Royal Engineers • 22 years of blameless service • two pints of beer in Nairobi nightclub • bit a stranger on the nose • Court martial • Pleaded guilty, but …

Drug-induced aggression? yellow. Card Centre WM • • completely out of character taking mefloquine as an antimalarial having nightmares, neuropsychiatric troubles and aggression recognized ADRs to mefloquine • so: ‘? involuntary intoxication’ • Appeal upheld

Drug-induced aggression? yellow. Card Centre WM Murder under the influence R -v- Catling (2006) • • • man took alcohol + paroxetine put daughter and bag in car, ransacked house stabbed sleeping ex-girlfriend to death drove to police Court accepted that paroxetine could cause violence • BUT clearly premeditated, so appeal dismissed

Drug-induced amnesia yellow. Card Centre WM I really can’t remember, officer • 29 -year-old took heroin + 30 x 20 mg temazepam • tried to rob 2 garages, a store, and a fish -and-chip shop • can’t remember the next day • entirely consistent with effects of temazepam • convicted

Zolpidem, amnesia, and unconsciousness yellow. Card Centre WM Take it off shelves Call for Stilnox ban after leg lost in incident

Drug-induced confession yellow. Card Centre WM

Drug-induced confession yellow. Card Centre WM Thiopental (Pentothal®)1948 Raymond Cens • tried as Nazi collaborator • “aphasic and amnesia after stroke” • given thiopental and answered questions coherently • ‘memory unimpaired, aphasia feigned’… • Cens sues psychiatrists for assault and breach of confidentiality • Cens censured

Hypos, death, and pardon R -v- G yellow. Card Centre WM Mr M IDDM • many hypos; car accident 3/12 before • fatal car accident while hypo • convicted Mrs G IDDM for > 40 years • hypo while driving > killed another driver • never previously had serious hypo • hypo couldn’t have been expected • acquitted

Not just the customers … Independent 4 th Sept 1998 yellow. Card Centre WM Doctors’ drinking ‘out of control’

Testing for benzodiazepine inebriation Bramness, Skurtveit, Mørland yellow. Card Centre WM • Norwegian tests for impairment • 818 drivers +ve for benzodiazepines • ‘Standardized field sobriety test’ • Romberg’s, eye tests, and general look correlate with benzo concentration • 2– 3 times worse in those with highest concentrations

Drugs and the victim yellow. Card Centre WM State of mind making the victim do what you want unconsciousness helplessness – physical or mental amnesia making the ‘victim’ imagine a crime

Making the victim do what you want: helplessness yellow. Card Centre WM

Percent amnesic after diazepam-D or flunitazepam-F % amnesic yellow. Card Centre WM D 20 F 1 D 10 F 0. 5 0 D 5 5’ 20’ 40’ 60’ Time from 90’ dose

Making the victim do what you want: unconsciousness yellow. Card Centre WM

Making the victim do what you want: unconsciousness yellow. Card Centre WM GP took his assistant with him • ‘smell my aftershave’ • rape • facial burn • evidence • conviction

How to give chloroform yellow. Card Centre WM

yellow. Card Centre WM Rape doctor gets 10 years

The victim: helpless yellow. Card Centre WM R -v- Khan; Khan

Not murder, but ? manslaughter by omission yellow. Card Centre WM Khan & Khan gave LB heroin • LB took heroin • the heroin killed her • she would have survived if treated… • Khan & Khan charged with murder • no clear intention, so manslaughter • convicted, but

Not according to English law yellow. Card Centre WM ‘Stephen's Digest of the Criminal Law (3 rd edition 1887): • "A sees B drowning and is able to save him by holding out his hand. • A abstains from doing so in order that B may be drowned, and B is drowned. • A has committed no offence. ” • Pardoned on appeal

The victim: helpless yellow. Card Centre WM Chaotic 25 -year-old drug user and shoplifter • briefly arrested, then left by police in field • body found a month later • toxicology: dextroproxyphene, morphine, and procyclidine; • police charged with manslaughter • opinion: possibly relevant, but not certainly • verdict: not guilty

Making the ‘victim’ imagine a crime yellow. Card Centre WM A 70 -year-old man given midazolam for GI endoscopy • Shortly afterwards: ‘sexually assaulted by two nurses’ • One hour later: remembers nothing

Conclusion yellow. Card Centre WM • Many drugs – ethanol – benzodiazepines – opioids • Many forensic problems – adverse effects, toxic effects – perpetrator, victim – crime, damages • Many more problems to come

yellow. Card Centre WM