history, effects, medico legal aspects

1. Cocaine- in view of forensic
toxicology
DR M BALAJI SINGH
COURTESY : SLIDE SHARE ,MUJAHED ALSHARAB, DR GAUTHAM
BISWAS

2. History of cocaine – a delirient
 Is a stimulant, not a narcotic , Stimulates the central nervous system.
 Is a crystalline alkaloid taken from the coca, a plant indigenous to South America.
 Suppresses the appetite.
 Was used in the 19th-century to treat addiction to morphine.
 Was part of the original Coca-Cola recipe.
 Legally became a controlled substance in the United States under the Controlled
Substances Act of 1970
 Became the drug of choice during the Disco era of the 1970s
 Is still very popular to this day
 Was largely responsible for the deaths of comedians John Belushi and Chris Farley
 Is highly addictive
 Carries stiff legal penalties in the United States and elsewhere, for the seller, transporter
and for the buyer.

3. Other names of cocaine
 Coke
 Snow
 Rock
 Blow
 Crack
 Most cocaine users snort the white powder into their nose. Some
rub it onto their gums or dissolve it in water and inject it with a needle.
Others heat up the rock crystal and breathe the smoke into their lungs.

4. Stories of cocaine trafficking
 Very costly drug
 Per ounce, ( ounce is equal to 28.34 grams )
 cocaine ranges from $1,417.50 to $2,268, depending upon grade,
cut, and geographic location in which the cocaine is purchased..
 Drug trafficking is common offence caught in most of the
international airports.
 Criminals tries to carry various forms of cocaine in their belongings like
clothing, suit cases, toys , or even by swallowing mini packs in to their
body etc.

5. Police found cocaine hidden in pineapples in Portugal and
Spain in 2018

6. Coffee beans in the shipment had been hollowed out and
filled with cocaine, Italian police say.

7. Appearance and chemically cocaine is
 Cocaine (benzoyl -methyl -ecgonine) (C17H21NO4) is a alkaloid .
 prepared from the l eaves of the Erythroxylon coca plant .
 Cocaine i s a bitter, white, odourless, crystalline powder.
 Cocaine is: “A powerfully addictive drug that can be sniffed, injected, chewed
or swallowed.

8. cocaine has been classified as a schedule ii drug
by the United States
 FORMS OF COCAINE
1. Cocaine hydrochloride (powder ) : prepared by dissolving the alkaloid
in hydrochloric acid, forming a water soluble salt .
 2. Crack cocaine : produced when cocaine hydrochloride is mixed with
sodium bicarbonate and water , and then heated.
 By this process Crack’ is produced when the hydrochloride molecule is removed
which frees the basic cocaine molecule (‘freebase’).
The name ‘crack’ given because- the crackling sound heard
when cocaine freebase is smoked.

9. Routs of administration

10. ROUTE OF ADMINISTRATION
Cocaine can be administered as a drug of abuse in the following ways :
1. Cocaine hydrochloride :
Sniffed (intranasal ),
smoking,
intravenous injection (including being mixed with heroin or ingestion)
2 Coca l eaves :
chewed/ ingested.
3. Crack cocaine :
inhalation of vapour
from heated foil or pipe.

11. Onset & duration of action for cocaine
depends on the route of administration
Intra venous

12. (‘high’)

13. COCAINE MECHANISM OF ACTION
 Cocaine binds to dopamine re-
uptake transporters on the
presynaptic membranes of
dopaminergic neurones.
 This binding inhibits the
removal of dopamine from
the synaptic cleft and its
subsequent degradation by
monoamine oxidase in the nerve
terminal.

14. COCAINE MECHANISM OF ACTION
 Dopamine remains in the synaptic cleft and is free to bind to
its receptors on the post synaptic membrane, producing
further nerve impulses.
 This increased activation of the dopaminergic reward
pathway leads to the feelings of euphoria and the ‘high’
associated with cocaine use.

15. THERAPEUTIC USES OF COCAINE
 It is an anesthetic that works quickly to numb the area about
1-2 minutes after application.
 Used before certain medical procedures (e.g., biopsy,
stitches, wound cleaning).
 Cocaine also causes vaso spasm, an effect that can decrease
bleeding and swelling from the procedure.
 used in palliative care to minimize the pain associated with
any terminal illness.

16. WHEN GIVEN LOCALLY
 Cocaine produces anesthesia by inhibiting excitation of nerve endings
or by blocking conduction in peripheral nerves.
 This is achieved by reversibly binding to and inactivating sodium channels.
 Procaine, lignocaine are synthetic derivatives – extensively using in medical
field.

17. METABOLISM OF COCAINE
 Serum half life of cocaine is 45-90 minutes .
 Only 1% of the drug is recovered in urine after ingestion.
 Cocaine rapidly metabolized, can be detected in blood or urine only for
few hours after its use.
 Cocaine metabolites are detectable up to 2-5 days.
 Hair analysis provides a very sensitive marker for cocaine chronic use
within the preceding weeks to months .

18. the body

19. EFFECTS OF COCAINE
 1. Initial Low Doses :
A. Physical Effects : it is a stimulant………
1. Tachycardia, tachypnoea,
2. hypertension,
3. Dilated pupils (& flattened lenses),
4. sweating increased
5. reduced appetite, reduced need for sleep, reduced lung
function,
6. dry mouth,
7. impaired motor control & performance of delicate skills and
driving.

20. Psychological Effects of cocaine
1. Euphoria, sense of well being, extreme happiness
2. impaired reaction time and attention span,
3. impaired learning of new skills.

21. Cocaine effects
Paranoia is a condition in which a person
believes ( delusion) that others are unfair,
watching him , lying, or actively trying to
harm him, in real when there’s no proof.

22. 2- Increased doses :
A- Physical Effects :
1. Seizures,
2. cardiac arrhythmias,
3. myocardial infarction,
4. stroke,
5. respiratory arrest.

23. B- Psychological Effects :
1. Anxiety,
2. irritability, restlessness, delirium hence the name delirient
3. insomnia,
4. depression,
5. aggressiveness,
6. impulsivity,
7. delusions, paranoia,
8. agitated/ excited delirium,
9. reduced psychomotor function.

24. 3- Chronic Use :
 A- Physical Effects :
• Erosions, necrosis and perforation of nasal septum,
anosmia, rhinorrhoea and nasal eczema (in snorting),
• chest pains, muscle spasms,
• sexual impotence,
• weight loss, malnutrition, vascular disease.
 B- Psychological Effects :
• Dependence,
• disturbed food intake and sleeping patterns

28. Medico legal aspects

29. 10 WAYS TO DIE FROM COCAINE DRUG ADDICTION
 1. Acute hypertensive crises - quickly elevating blood pressure - blows out a
weak blood vessel in brain causing cerebral haemorrhage.
 2. Acute hypotension - no blood with oxygen to the brain causing an
anoxia and cerebral hypoxic damage.
 3. Status epilepticus - repeated convulsions for prolonged periods - increased
EEG activity.
 4. C.N.S. Rebound – respiratory arrest –
depressed medullary respiratory centres of the brain causes respiratory arrest. -
this is the most common cause of cocaine death.

30. Death due to cocaine use………
 5. Hyperpyrexia - Cocaine can raise the body to an extremely high
temperature. Core temp 106 degrees (anal)but may feel cool outside the
body. Shows bruising easily.
 6. Pulmonary insult - heat fumes and chemicals in lungs cause lungs to
collapse.
 7. Paranoid miscalculation - accidental death due to delusions and
hallucinations.
 8. Suicide – may commit during post-cocaine depression ( ‘CRASH’ ).
 9. Needle borne - infections from needle use.
 10. over stimulation - Anticholinesterase enzyme deficiency : 10-20 mg. of
cocaine will kill them - the drug never gets destroyed and recycles
continuously throughout the body.

31. Postmortem Findings
 Non-specific findings or basing on the cause of death.
 Patients may have linear excoriations, ‘crack pipe’ burns of the fingers or
thumbs, thermal burns of the face and upper airway.
 Track marks in the usual sites such as the cubital fossae, and at unusual
sites such as under the tongue and on top of the feet may be seen.
 Intense asphyxial signs, and cardiac dilatation may be seen.
 Blood should be preserved by adding fluoride.

32. Body packers syndrome-
 Body packing is used for international
drug illicit transport, immediate drug
concealment during a police searching .
 Fingers of rubber gloves are utilized for cocaine packing and swallowed intact and
after reaching desired destination packs will be recovered by purgation
 Despite the high level of more complex packs, up to 5% of patients could develop
intoxication due to pack rupture. Intestinal obstruction is another acute
complication.

33. Body packers syndrome- cocaine illicit transport

34. Cocaine bugs
 Also known as Magnan's sign and Magnan-Saury's sign.
 tactile hallucination consisting of a crawling foreign body ( BUGS )
beneath or upon the skin that is associated with the chronic use of cocaine.
 feeling as if grains of sand are lying under the skin or small insects are creeping on the skin
giving rise to itching sensation (formication).
 An early description of cocaine bugs comes from the Austrian physician
Ernst von Fleischl-Marxow (1846-1891), a friend of Sigmund Freud's
(1856-1939).

35. COCAINE ADDICTION
 Why cocaine is so highly addictive?
 Next to methamphetamine, cocaine creates the greatest
psychological dependence of any drug.
 It stimulates key pleasure centers within the brain and causes extremely
heightened euphoria, the memory of pleasure leads to addiction
 The addictive properties of cocaine are thought to be due to brain dopamine
D2-receptor stimulation.

38. Medico-legal Aspects……
 Accidental death may occur from heavy doses of urethral, vesical and
rectal injection.
 Oral overdose can occur in body packers and body stuffers.
 Cocaine is rarely used for homicide or suicide.
 Intentional criminal poisoning in prenatal period may lead to (heavy dose
given to pregnant woman), infant and child deaths, determined to be
homicide
 It is believed to increase the libidinal drive and increase the duration of
sexual act by paralyzing sensory nerves of glans penis.
 It causes lowering of moral values, loss of decency and self-respect.
 It is rapidly metabolized (destroyed ) in the body and is difficult to detect
by chemical analysis.

39. Cocainomania
 is an irresistible craze, crave, or impulse to intoxication by cocaine, or any of
its salts or combinations, at all risks.
 It is addiction and morbid craving for cocaine.
 Many users take repeated doses to keep the ‘high’ going and avoid the ‘crash’
or try to modify the effects with other drugs like alcohol, tranquilizers or heroin.
 This rush-and-crash pattern leads to toxic levels of cocaine in the bloodstream
and reinforces the highly addictive nature of cocaine.
 Abusers can tolerate up to 10 g/day.

40. MCQ 1.Following are complications of cocaine poisoning,
except: UPSC 08
A. Myocardial infarction B. Epileptic seizures
C. Hypothermia D. Hypertension
2. True regarding cocaine are all, except: JIPMER 13
A. Causes tachycardia and hypertension B. Half life is 3 h
C. No antidote D. Can be taken by snorting
3. An addicted patient presenting with visual and tactile
hallucinations, has black staining of tongue and teeth. The agent
is: Gujarat 10
A. Cocaine B. Cannabis
C. Heroin D. Opium

41. 4. A person feels that small insects are creeping on the skin giving rise to itching
sensation; the condition is seen in: Maharashtra 09; AIIMS 09, 11
A. Cocaine poisoning B. OPC posioning
C. Morphine poisoning D. Alcohol withdrawal
5. Magnan’s syndrome is associated with: WB 09; BHU 09; MP 11; AFMC 12;
NEET 14
A. Cocaine B. OPC
C. Snake bite D. Alcohol
Answers 1. C 2. B 3. A 4. A 5. A

42. Short notes and viva questions
 Drug addiction
 What are delirient poisons, give examples, write in detail about Cocaine
and its effects.
Oral questions
 Cocainomania
 Crack
 Magnan’s symptoms
 Formication
 Tactile hallucination
 Body packers syndrome

43. Be safe , be away from cocaine and
corona
THANKING YOU…………..