DRUG IDENTIFICATION & SYMPTOMOLOGY

1. First Responders Training SeminarD’Arcy Smith BSc, MSc(Pharm)Toxicology Services SectionForensic Laboratory - Halifax902-426-8827 ext.284darcy.smith@rcmp-grc.gc.ca

2. DRUG IDENTIFICATION & SYMPTOMOLOGY

3. Definition of a Drug • Substance that when taken into the living organism, may modify one or more of its functions. • Compound which, when taken into the body, cause an effect, whether that effect is harmful or beneficial.

4. Drug Recognition Evaluation and Classification Catagories • based upon signs & symptoms produced • 7 catagories • CNS Depressants - alcohol + CABANA • Inhalants - volatiles, aerosols, aneasthetic gases • Dissociative aneasthetics - PCP, ketamine, DXM • Cannabis • CNS Stimulants - methamphetamine, cocaine • Hallucinogens - LSD, X, peyote, psylocibin • Narcotic analgesics - heroin, oxy, dilaudid, etc.

5. Ingestion oral - pills / tablets (Ecstasy, prescription drugs, LSD…) intravenous - heroin, cocaine, methamphetamine… smoked - cannabis, heroin, cocaine, PCP, methamphetamine… intranasal - cocaine, meth, crushed pills… transdermal - LSD, PCP, fentanyl…

6. Speed ofEffect vs. Mode of Ingestion Brain 1.Intranasal/Oral2. Intravenous3. Smoking 3 Lungs (L) (R) Heart 2 Veins Arteries Capillaries 1

7. Distribution of Drugs • Drugs are distributed throughout the body by blood. • Drugs are distributed to places called receptors. • Receptors are usually in the brain and are responsible for drug effects.

12. Sites of Drug Action

13. Elimination of Drugs • Effects of drugs are stopped by eliminating them from the body, usually in the urine. • Drugs are also metabolized or changed chemically, by the liver before they are eliminated.

14. CANNABIS

16. Cannabis Classification • Cannabis sativa - usually tall, 5’-20’ (THC) • Cannabis indica - smaller, 4’ or less, very bushy (THC + hemp) • Cannabis ruderalis - 1’-2’, tall, sparsely branched (cross-breeding) • Plants of all 3 varieties are interfertile; therefore, they are considered to be one species

17. CannabisThe Plant • Leaves are compound with 5-11 leaflets pointed at the end with serrated edges. • Both male and female plants produce resin, but the female produces more. • Cannabis propagation: • Seeds (sexual) • Cloning (asexual)

18. CannabisSinsemillia - “Without Seeds” • A technique used to increase the quantity of resin produced by plants • Male plants are removed from the growing area to prevent fertilization of the female plants and subsequent seed production • This causes the female plants to continue flowering and increases resin production

19. Time Course of Effectssmoked • Effects start within 30 sec. • Effects rapidly increase in the 1 st. 10 minutes • Peak effects within 10-30 minutes. • last 2 - 4 hours after smoking • significant, but not dramatic dose dependent • drug use history • light, moderate or heavy user • users can titrate dose by varying smoking technique

20. CANNABIS: PSYCHOLOGICAL EFFECT: SHORT TERM General feeling of well being, relaxation and drowsiness, emotional disinhibition and garrulousness. Wide spectrum of sensory and perceptual distortion:distortion of of time, distance and body images. ↑ in the 5 senses, auditory and visual acuity. Spontaneous laughter. Impairment of recent memory and concentration with mild confusion and disorientation. Attention span is reduced and users ability to process information is impaired

21. CANNABIS EFFECTS : PSYCHOLOGICALSHORT TERM LOW DOSE Mild cognitive and motor impairment. Balance and stability when standing may be impaired. Impaired ability to perform complex tasks. adverse effects as: fearfulness and anxiety, mild paranoia.

22. CANNABIS EFFECTS: PHYSICAL HEART EFFECTS: ↑ in peripheral blood flow rapid ↓ in blood flow when moving from lying or sitting position to standing. IRRITATION TO LUNGS: EYES: Red with Rebound dilation and lack of convergence. ↑ appetite , dryness of mouth and throat. OTHERS: Hangover, changes in libido, headache, slight changes in body temperature. Decrease in muscle strength and hand steadiness with tremors.

23. Effects of Marijuana • DESIRABLE • euphoria and relaxation • heightened perceptions • perceptual distortions • visual • sound • time distortions • time passes more slowly

24. Effects of Marijuana • ADVERSE • acute anxiety • restlessness • sense of loss of control • fragmented thought processes • panic reactions • suspicious and paranoid • acute toxic confusion and mood disturbances • depression • marijuana psychosis • delusions • hallucinations

25. Acute Cognitive Effects • Impaired short term memory, attention, organisation / information processing, integration of complex information • user lost in reverie, fantasy - difficult to sustain goal directed mental activity • motor skill, reaction time, coordination affected • perceptual distortions (time and distance) • naïve users - anxiety, panic (↑ H.R, ↑ B.P )

26. Chronic Effects • Cannabis psychotic disorder • - heavy cannabis use can produce an acute toxic state • confusion, delusions, hallucinations, • anxiety, agitation, paranoia, panic • - evidence cannabis may precipitate latent psychosis in vulnerable individuals • amotivational syndrome - diminished drive, lessened ambition, decreased motivation

27. Chronic Effects • Cognitive : • - heavy daily use - pronounced impairment • - remains to be seen whether impairment can be reversed through abstinence • Dependence syndrome: • - daily use over prolonged period leads to tolerance / withdrawal symptoms

28. Cannabis Withdrawal • Symptoms: • irritability • restlessness • sleep disturbances • tremors • decreased appetite

29. COMBINED EFFECT OFTHC AND ALCOHOL THE EFFECTS ARE OVERLAID, RESULTINGIN AN INCREASED STATE OF INTOXICATION. ALCOHOL MORE ADVERSELY AFFECTS : • JUDGEMENT • MOTOR COORDINATION THC HAS A MORE DIRECT EFFECT ON TIME AND SPACE PERCEPTION THC AND ALCOHOL BOTH AFFECT DIVIDEDATTENTION TASKS.

30. MARIJUANA USAGECLASSIFICATION OF USAGE INFREQUENT USER -ONCE OR TWICE A MONTH MODERATE USER -ONCE OR TWICE A WEEK FREQUENT USER -SIX-SEVEN TIMES A WEEK -Daily usage.

31. Residual Effects of Marijuana • may last 24 hrs • complex performance tasks involving machinery - airplanes, cars, boats • due to limited capacity of working memory • cognitive activities requiring conscious thought • divided attention • focused attention • short term memory retention • reasoning

32. CANNABIS GENERAL INDICATORS Red, Possibly Dilated Eyes, with Rebound Dilation Sluggish Intoxicated Laughter Impaired Recent memory. Lack of Convergence Eye lid tremors Increased appetite Relaxed Inhibitions Tremors Dry Mouth and Throat Odor of marihuana, debris in mouth Disorientation Decreased Muscle Strength Impaired perception of time/distance

33. CNS Stimulants • Drugs that stimulate or increase the activity of the CNS • Mood elevation • Increased alertness • Increased energy • Suppressed appetite • Sleep suppression

34. Methamphetamine

35. Amphetamines • first manufactured in 1927 • popular 1930 to 1960 • widely used in W.W.II • popularity decreased late 1960’s

36. Types of Amphetamines • Amphetamine: • coloured hearts (peaches, roses, hearts, bennies) • round white double scored tablets (bennies, cartwheels) • capsules (L.A. turnabouts, co-pilots) • Dextroamphetamine • orange heart shaped tablets (oranges, dexies)

37. Types of Amphetamines • Methamphetamine • in bulk, light brown powder • Methylphenidate (Ritalin) • blue, scored, 10 mg tablets • ADHD • Diethylpropion (Tenuate) • light blue or green tablets, 20 mg • white capsules, 75 mg • Appetite suppressant

38. d-Methamphetamine • Speed/Crank • purity > 90% • confusion in names • powdered methamphetamine called crystal • east coast USA “ICE” refers to 4-methylaminorex (U4EUH)

39. d-Methamphetamine • Also known as: • quartz • ice cream • batu • yaamaa • yaba (Southeast/East Asia - Thailand) • hiroppon (Korea) • shabu (Japan)

40. “ICE” Appearance clear-opaque, shiny rhombic crystals vary in size 0.25 to 1 inch Origin: Taiwan South Korea Phillippines First US lab: Sacramento similar to making rock candy from sugar recrystallized from a heated supersaturated solution in a refrigerator may take up to two months to crystallize d-Methamphetamine

41. ephedrine pseudoephedrine alcohol toluene ether sulfuric acid methanol lithium trichloroethane anhydrous ammonia sodium hydroxide cold/allergy medicine cold/allergy medicine rubbing alcohol brake cleaner engine cleaner drain cleaner gas additive camera batteries gun scrubber farm fertilizer lye Chemicals and sources for synthesis

42. Chemicals and sources for synthesis • red phosphorous • iodine • sodium metal • hydrochloric gas • matches • veterinary products • can be made from lye • HCl + H2SO4 • table or rock salt • kerosene/gasoline acetone • muriatic acid cat litter camp fuel • paint thinner

43. pinkish tint - red pseudoephedrine pills • bluish tint - camper fuel • greenish tint - green gun scrubber • - cutting agents - baking soda, lactose, epsom salts, quinine, mannitol, procaine, ether, insecticides, MSG, photo developer, strychnine

45. d-Methamphetamine • Methods of Use: • intravenous • oral • smoking

46. Methamphetamine

47. d-MethamphetamineDisadvantages • high psychological tolerance • high physical tolerance • must increase dose • amphetamine psychosis

48. AmphetaminesPhysical Effects Effects of methamphetamine are similar to those of cocaine but its onset is somewhat slower and the effect duration is longer Effects can last 4-12 hours. • pupils dilate • increased blood pressure • increased heart rate • inability to sleep • sweating, body odour • dry mouth, lips, nose • muscle twitches • tremors • fever • irregular heart beats

49. AmphetaminesPsychological Effects • feel stronger • increased confidence • increased alertness • increased sexual feelings • increased restlessness • increased talkativeness • increased irritability • fear, apprehension • distrust of people • hallucinations • psychosis

50. The Meth AbuserProfile • exhibits tremors of the hands • constantly licks lips • very thin • increased perspiration • usually wears long sleeves • bad teeth (malnutrition, calcium leaching) • bruxism (grinding of the teeth)