FORENSIC TOXICOLOGY ~ Prof. DR. Dr. Johanna Mantu Kandouw, Sp.PA., Sp.

(Nar and Relat. Death) by:

Dr.EzyanATP
The abuse potential of a drug
As that property of a
substance that, by its
physiologic or psychological
effects, or both, increases the
likelihood of an individual
abusing or becoming
dependent on that substance

NAPZA :Drugs or a substance while

entering the body can influence the
CNS, consiousness, mental-emotional
activity, perception, thinking and
behavior
Narcotic
Group I
: Heroin, Cocaine, Ganja
Used only for scientific research, not
for therapy. Potential for severe
addiction
Group II:Morphine, Petidhine Used
for scientific research, last choice for
medical therapy. Potential for severe
addiction
Group III:Codein, Substance
ofnarcotic Used for medical therapy,
scientific research. Potential for mild
addiction

Addict
As a person who is physically
dependent on one or more
psychoactive substances,
whose long-term use has
produced tolerance, who was
lost control over his or her
intake, and who would
manifest withdrawl
phenomena if discontinuance
were to occur
Toxicology Forensic
NAPZA :A. Narcotic
B. Psychoactive /
Psychotropica
C. Adictive
Psychotropica
Group I
:MDMA, Ectacy. LSD,
STP
Used for scientific research,
not for
treatment. Potential for
severe
addiction
Group II :Amphetamine, Fensiclidine
Secobar-Bital Used for treatment, and
research. Potential for severe
addiction
Group III: Phenobarbital,
Flunitrazepam Used for treatment,

Opium
Was brought to china in 1772
by Warren Hasting, the
governor of Bengal
Numbers of patent medicines
containing opium or morphine
Pain could be controlled with
less morphine when injected
addiction
The route of administration :
injection and nasal insufflation
Heroin / morphine availability
and abuse, represent a serious
problem in many countries

scientific research. Potential for

moderate addiction
Group IV : Diazepam, Clobazam,
Bromazepam, Nitrazepam Global
used for medical treatment, scientific
research. Potential for mild addiction

Cocaine
Active alkoloid substance in
Pathophysiology-Cocaine
Clinical Presentation
A. Blockade
Cocaine affects nearly every organ
the coca leaf (1857)
th
th

Directly
blocks
fast
sodium
system. The effects may vary
6 12 century-Incas
depending on the route
channel stabilizing axonal
population in Peru, South
administration
membrane local anaesthetic
America, used cocaine as local
A. Head, ears, nose and throat
effect
anasthesia for ritual
effects
Myocardial fast sodium channels
trephinations (surgery)
Persisten rhinitis, sinusitis
Target Organs : CNS,
type I anti dysrhytmic
Erosions and nasal perforation
B. Interferes
cardiovascular system
Nasal septal collapse, and
Up take of neurotransmitters
As an ingredient in coca-cola
perforations
(epinephrine, or epinephrine and
(20th- century)

Pain, photophobia and decreased

dopamine)
In 1914 : Harrison narcotic ACT
visual acuity (bilateral optic
Function : vaso constrictive agent
labeled cocaine as a narcotic
neuropathy)
US narcotic data 1999 reports :
From nasopharynx in to the
CNS
25 million residents had used
mouth resulting acid capable
cocaine at least once, with 1,5 The most prominent effect : CNS
of dissolving dental mineral,
million people using cocaine in stimulation which occurs in Rostral to
calcium phosphate hydroxycaudal fashion
the past month
apatite from enamel and dentin
Cortex stimulated : excitement
Crack : direct precipitale of
motor activity
free base cocaine that results
Lower motor stimulated : increase Cardiovascular
from alkalinization aquerus
Effect of cocaine :
cocaine hydrochloride
in respiratory rate respiratory
1. Acute coronary syndromes
failure
(myocardial ischemic-infarction)
Vomiting center may also

stimulated

2. Vasoconstriction in coronary
arteries atherosclerotic
3. Stimulation of vagal nuclei
bradycardia
4. Central symphatetic stimulation
Medical Use
Pregnancy and Lactation
Not recommended for standard
Cocaine abuse may injure the
medical care should be limited to
fetus and newborn, infant during
situations in which alternative
pregnancy, at birth, during
agents are contraindicated
lactation, and by passive exposure
Topical anesthesia : (4-110%
to cocaine smoke during infancy
and childhood
solutions)
Pregnant women : who use
Intranasal procedure
cocaine are at increased risk for
Bronchoscopic procedure
maternal and fetal complication.
Ophthalmologic procedure
Teratogenic effect : neonatal
abnormalities
Cocaine : excreated in breast milk
induce cocaine intoxication in
the breast-fed infant apnea and
seizures

Toxic Dose (1)

Maximal safe total dose of
cocaine is 1-3 mg/kg body
weightToxic dose is highly
variable; afffected by
characteristic of :
The user (cardiovascular
disease)
The drugs (concomitant
drug use)
The route of
administration :

Toxic Dose (2)

The potency of smoked cocaine :
60% that of intravenous
cocaine. 50 mg dose of smoked
cocaine ~ 32 mg dose of
intravenous cocaine
Rapidly absorbed through : nasal
mucosa, gastrointestinal mucosa,
pulmonary alveoli
Oral administration : has a lag
phase about 30 minutes
reaches peak cons. 60 minutes
Effect from buccal (Chewing) and
(Smoked, intravenous)
nasal mucosa: due to local
vasocontriction
Smoked cocaine, intravenous cocaine
Fatalities :
heart rate , blood pressure , subjective
Mucous membrane
effect
Cause of death : hyperthermia and
application : 25 mg
agitation
Nasal topical use : 400 gr
Tracheobronchial use : 200 mg
Morphine
Original : extract from plant
The best analgesic
papaverum somniferum
adminstration drug
Narcotic analgesic
Route of :-iv. Injection
Characteristic
-nasal infufflation
CNS effect : Accumulation of
Agonis : morphine, codein,
drugs subtances CNS up
heroin
tight with receptor analgesic
Antagonis : naloxone
effect
Agonis antagonis : nalbufin,
Clinical presentation :
pentazocine
Depands on route of
Heroin : > mis used (abuse)
administration
: Respiratory distress,
Another name : smack, junk,
anorexia, tremor, vomiting, insomnia,
horse, H, Tar, Putaw
panic mental disturbance, sweeting,
Packing : white or chocolate

Heroin
Route of administration
iv. Injection
Subcutan injection
Target organs / system :
CNS, GI. tract,
cardiovascular system
endocrine organ
Side effect
Sudden death
Pulmonary complication
Aids
Infection : tetanus,
vasculitis

powder

fever, increased blood pressure

Amphetamines
Mostly used for treatment of
Pharmacologic effect =
obesity / appetite suppresion
cocaine
All products appear to be
Lethal dose = 0,2 gr
Clinical effect : hallusinogen,
marketed spesifically for abuse
because free from law regulation
raven
neurotraceutical label that the
Herb carries

Renal failure