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Forensic implications of cocaine

Forensic implications of cocaine

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Published by: forensicmed on Feb 18, 2008
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The Forensic Implications of Cocaine – Richard Jones
The Forensic Implications of Cocaine
 
The Forensic Implications of Cocaine – Richard Jones
Introduction
Cocaine use in the UK is on the increase, particularly in London and the South East, and ismirroring the situation in the US. Cocaine is often thought of as a ‘safe’ drug, but more andmore evidence is becoming available suggesting that this is not the case. This report aimsto consider the forensic aspects of cocaine abuse, from the point of view of the ForensicMedical Examiner (FME) in terms of clinical signs and symptoms; the Forensic Psychiatristin terms of the psychiatric effects of cocaine intoxication and chronic abuse (with adiscussion of the phenomenon of ‘excited delirium’) and the forensic pathologist in termsof investigating the death of a suspected cocaine abuser, including findings at the sceneof death and at autopsy. A description is also given of the basic pharmacology of cocaineand it’s most important metabolites (including cocaethylene), the analysis of samplestaken for forensic investigation and the epidemiology of cocaine abuse.
Cocaine and ‘Crack’ Cocaine
Cocaine (benzoylmethylecgonine, C
17
H
21
NO
4
) is an alkaloid prepared from the leaves of the
Erythroxylon coca
plant, which grows mainly in South Africa, and to a lesser extent in Africa, theFar East and India.For centuries, the large Indian population of Peru have chewed coca leaves, and they have beenfound in the tombs of their ancestors dating back to 600 AD.Coca leaves were first used in medicine in 1596, but it was not until the mid 1800’s that cocainewas extracted. Freud reported the effects of cocaine in 1884, and it was subsequently utilised inophthalmology and dentistry as a local anaesthetic. (Cregler et al (1986) pp.1495-6).Cocaine hydrochloride is prepared by dissolving the alkaloid in hydrochloric acid, forming a water soluble salt. It is sold illicitly as a white powder, or as crystals or granules. (See fig 1. illustratingthe coca leaves and cocaine hydrochloride).
Fig 1. Coca Leaves and Cocaine Hydrochloride powder 
Street names include
‘coke’, ‘charlie’, ‘nose-candy’, ‘snow’ and ‘wash’ 
. This form of cocainecan be ‘freebased’, prior to smoking, in which it is dissolved in ether or ammonia. The ‘freebase’remains after the volatile substance has evaporated. Although this form of cocaine was popular inthe late 1970s, a further refinement of this process became more prominent in the US during the1980s, in which
‘crack’ 
cocaine was produced.Crack cocaine is produced when cocaine hydrochloride is mixed with sodium bicarbonate (bakingsoda) and water, and then heated. On cooling, ‘rocks’ are precipitated, and these are smoked incrack pipes, or are heated on foil with the vapour inhaled. Crack is an extremely ‘pure’ form of analready ‘pure’ substance (in comparison with other drugs of abuse such as amphetamines). Fig 2.Illustrates ‘rocks’ of crack cocaine.
 
The Forensic Implications of Cocaine – Richard Jones
Fig. 2. ‘Rocks’ of Crack Cocaine
Cocaine can be administered as a drug of abuse in the following ways,
Cocaine hydrochloride
– snorting (intranasal), smoking, intravenous (including beingmixed with heroin (‘speedball’ or ‘snowball’)), ingestion, application to genitalia
Crack cocaine
– inhalation of vapour from heated foil or pipe
Coca leaves
– chewed/ ingestedIn the UK, cocaine is classified as a Class A controlled drug, by virtue of Schedule 2 of the
Misuse of Drugs Act 1971
(as amended by the
Misuse of Drugs Regulations 1985 
). It is acriminal offence to ‘unlawfully possess’ (with or without intent to supply), to import or export thedrug, or produce it, and the police have extensive ‘stop and search’ powers to enforce theseoffences.Cocaine addicts are required to be notified by doctors to the Chief Medical Officer under Regulation 3 of the
Misuse of Drugs (Notification of and supply to Addicts) Regulations1973
, and Regulation 4 prevents doctors from prescribing cocaine unless they are licensed to doso by the Home Secretary. However, this does not apply to those treating organic disease or injury.
Epidemiology
Epidemiological data of drug misuse in the UK is not freely available in the same way that it is inthe US because there is no ‘National Drugs Survey’ or ‘National Household Drugs Survey’.However, data have been collated by the Health Education Authority (1995), and as part of the 2yearly British Crime Survey (most recently in 1998). The Four Cities Study (1992), and the YouthLifestyle Survey (1993) also provided useful data on drug misuse in the populations covered bythe study. (BMA 1997 pp,13-27, Institute for the Study of Drug Dependence, British Crime Survey1998).The following points of note can be extracted from the data,
32% of the adult population is thought to have used a drug at some point in their life (11%in the last year, 6% in the last month)
49% of under 30s report having used a drug (16% within the last month)
the highest adult prevalence is in the 16-19 year age group – 31% using drugs on aregular basis
drug use peaks at the end of the teens
male users outstrip female users by 2:1
unskilled workers abuse drugs more than other social classes, and chose moredangerous routes of administration

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