by B Zedeck
tability, headache, chills, vomiting, sweating, and painful jerking
muscle reactions. To avoid these symptoms, people usually will
do whatever it takes to get more drugs. With opioids, for example,
where it is necessary to take drugs every few hours, such extreme
needs may lead to criminal activity to sustain the drug habit.
Many drugs of abuse make the individual feel excited, aroused,
and strong. Others result in drowsiness and poor coordination.
Coupled with these feelings, however, may be an impairment of
cognitive functions such as judgment, perception, and attentive-
ness. When these effects are combined, the individual may make
rash decisions and take risks that otherwise would not be under-
taken, which can lead to motor vehicle accidents and criminal
activities such as robbery and homicide.
Often, when tissue or fluid samples from individuals under the
influence of drugs are analyzed, more than one drug is present.
Taking different drugs of abuse at the same time is particularly
dangerous because of drug interaction. For example, many drugs
of abuse are central nervous system depressants. While each drug
may not completely arrest respiration, the combination of drugs
may. Many drugs of abuse increase blood pressure and, taken in
combination, might lead to a stroke.
Injecting drugs of abuse presents special hazards. Transmis-
sion of the AIDS or hepatitis virus occurs often by using “dirty”
needles, that is, needles with another user’s blood on them. Also,
many drugs contain other substances such as adulterants or
40 Forensic Pharmacology
diluents. These other substances may not completely dissolve
when added to water, and injection of tiny particles may clog
blood vessels. Commonly added agents that may be found during
analysis of fluids and tissues include caffeine, acetaminophen
(Tylenol®), and phenobarbital, a sedative.
In 1970, in response to a rising level of drug abuse, Congress
enacted the Comprehensive Drug Abuse Prevention and Control
Act, also known as the Controlled Substances Act (CSA). The
Drug Enforcement Administration has categorized controlled
substances (based on the CSA) into five different schedules.3 The
five schedules are defined as follows:
Schedule I: Substances with no accepted medicinal use
in the United States and a high potential for abuse; for
example, heroin, marijuana, lysergic acid diethylam-
ide (LSD), mescaline, and psilocybin.
Schedule II: Substances with a medicinal use but also
a high potential for psychological or physical depen-
dence. A written prescription is required for use; for
example, morphine, cocaine, and oxycodone.
Schedule III: Substances with less potential for abuse
than drugs in Schedule I or II; for example, methyl-
phenidate, amphetamine, secobarbital, and anabolic
steroids.
Schedule IV: Substances with low abuse potential;
for example, some barbiturate compounds, chloral
hydrate, and benzodiazepine derivatives.
Schedule V: Substances with limited potential for abuse;
for example, some codeine preparations for cough,
and Lomotil® (which contains the opioid diphenoxyl-
ate) for diarrhea.
Drug Abuse and Teenager Statistics
41
Figure 4.1 The 2004 Monitoring the Future (MTF) survey reveals
that use of any kind of illicit drug peaked in the early 1980s, decreased
over the next 10 to 15 years, but then began to increase in the mid-
1990s.4
To circumvent restrictions under the CSA, people began to
synthesize drugs that are chemically and pharmacologically sim-
ilar to those listed in Schedules I to V. These are termed designer
drugs. To control the distribution of such chemicals, Congress
42 Forensic Pharmacology
amended the CSA in 1986 by passing the Controlled Substance
Analogue Enforcement Act.
DRUG USE AND ABUSE IN ADOLESCENTS
Adolescent substance abuse has been a major health issue for
many years. Governmental and other agencies survey the use of
drugs of abuse by teenagers for each drug according to school
grade, age, gender, and ethnicity. Results obtained from such
surveys, and from reports of emergency room visits, arrest data,
and accidents, provide information to monitor trends in abuse
of illicit and non-illicit dependence-producing substances by
teenagers (Figure 4.1).
The extent of drug use in 2003 for different drugs is pre-
sented in Table 4.1. According to the 2003 National Survey on
Drug Use and Health (NSDUH), 11.2% of 12- to 17-year-olds
reported current use of illicit drugs, 30.5% reported use at least
once during their lifetime, and 21.8% reported use within the
past year.5
According to the Drug Abuse Warning Network (DAWN),
a public health surveillance system, in the second half of 2003,
there were 627,923 drug-related visits to the emergency rooms
of hospitals. Of these visits, 141,343 involved alcohol alone or
alcohol along with other drugs. Of all the alcohol-related visits,
16,770 were made by 12-to 17-year olds in a ratio of about 2:1,
males to females.6
Drug use by teenagers in 2004 appears to have declined,
though use of inhalants and oxycodone (OxyContin®), a pre-
scription opioid pain reliever, are on the rise.7 Recent reports
indicate that a ready source of drugs of abuse for adolescents is
prescription drugs found in the home medicine cabinet, as well
as prescription drugs available on the Internet.8
Drug Abuse and Teenager Statistics 43
FORENSIC ISSUES
In cases involving motor vehicles, the defendant generally tries
to disprove the claim that the concentration of drug found in
blood could have affected driving performance, or argues that
a finding of drug in urine only indicates drug use prior to the
accident but has no value in proving a causal link to impaired
driving.
In many states, it is illegal to drive with any detectable amount
of controlled substance in blood. Other states define “drugged
driving” as driving when the driver is incapable of driving safely
Table 4.1 Percent of 12- to 17- Year-Olds
Reporting Drug Use in 2003
Drug Type
Lifetime
Past Year
Past Month
Any Illicit Drug
30.5%
21.8%
11.2%
Marijuana/hashish
19.6
15.0
7.9
Cocaine
2.6
1.8
0.6
Crack
0.6
0.4
0.1
Heroin
0.3
0.1
0.1
Hallucinogens
5.0
3.1
1.0
LSD
1.6
0.6
0.2
PCP
0.8
0.4
0.1
Ecstasy
2.4
0.4
Inhalants
10.7
4.5
1.3
Methamphetamine
1.3
0.7
0.3
44 Forensic Pharmacology
or is impaired. According to a 2003 NSDUH survey, 10.9 million
people drove under the influence of drugs in the prior year. Of
young adults aged 18 to 25 years, 14.1% drove after using drugs.
Studies of impaired drivers, crash victims, and fatalities revealed
marijuana to be the most prevalent drug used. In the United
States in 2003, there were 2,283 alcohol-related motor vehicle
fatalities among 15- to 20-year-olds.9 In 2004, 12.7% of high
school seniors drove after using marijuana.10
According to the Federal Bureau of Investigation’s Crime in the
United States report, during 2003 there were 137,658 juveniles
arrested by law enforcement agencies for drug abuse violations.
Monitoring Drug Abuse Among Teenagers
There are many different governmental agencies that monitor
their use of alcohol or il icit drugs in the prior year and whether
the use of drugs by teenagers. One of the largest, the National
they drove under the influence of such drugs. Another report,
Institute on Drug Abuse (NIDA), sets scientific standards in
the Drug and Alcohol Services Information System (DASIS),
drug testing, maintains Web sites for teenagers with use-
monitors treatment programs for drug abuse. The Office of
ful information about drug effects, and funds the Monitor-
National Drug Control Policy, under the White House Drug
ing the Future (MTF) program conducted by the University of
Policy program, establishes policies and priorities for the
Michigan. Beginning in 1975, MTF monitored drug use among
United States and provides information concerning drug use
twelfth graders, and in 1991 expanded their studies to include
and effects. Many of the agencies provide reports of the data
eighth and tenth graders. Data collected include usage in the
collected in various formats analyzed by drug, age, gender,
past 30 days, in the past year, and lifetime usage. The Drug
and race. Some of the reports are available on the Internet.
Abuse Warning Network (DAWN), under the supervision of
The National Institute of Justice conducts surveys of drug
the Substance Abuse and Mental Health Services Adminis-
use among arrested individuals under its Arrestee Drug
tration (SAMHSA), monitors drug-related visits to emergency
Abuse Monitoring (ADAM) program. The Centers for Disease
departments and deaths investigated by medical examiners.
Control and Prevention (CDC) monitors ninth to twelfth grad-
One report, the National Survey on Drug Use and Health
ers for behaviors that impose health risks under its Youth Risk
(NSDUH), surveys individuals 12 years or older to determine
Behavior Surveil ance System (YRBSS).
Drug Abuse and Teenager Statistics
45
During fiscal year 2002, the Drug Enforcement Administration
(DEA) arrested 675 persons under the age of 19 involved with
cocaine, marijuana, methamphetamine, or opioids. According
to another study, a median of 59.7% of male juvenile detainees
and 45.9% of female juvenile detainees tested positive for drug
use in 2002.11
SUMMARY
Drugs of abuse can induce physical and psychological depen-
dence and impair cognitive functions. Individuals who use
Monitoring Drug Abuse Among Teenagers
There are many different governmental agencies that monitor
their use of alcohol or il icit drugs in the prior year and whether
the use of drugs by teenagers. One of the largest, the National
they drove under the influence of such drugs. Another report,
Institute on Drug Abuse (NIDA), sets scientific standards in
the Drug and Alcohol Services Information System (DASIS),
drug testing, maintains Web sites for teenagers with use-
monitors treatment programs for drug abuse. The Office of
ful information about drug effects, and funds the Monitor-
National Drug Control Policy, under the White House Drug
ing the Future (MTF) program conducted by the University of
Policy program, establishes policies and priorities for the
Michigan. Beginning in 1975, MTF monitored drug use among
United States and provides information concerning drug use
twelfth graders, and in 1991 expanded their studies to include
and effects. Many of the agencies provide reports of the data
eighth and tenth graders. Data collected include usage in the
collected in various formats analyzed by drug, age, gender,
past 30 days, in the past year, and lifetime usage. The Drug
and race. Some of the reports are available on the Internet.
Abuse Warning Network (DAWN), under the supervision of
The National Institute of Justice conducts surveys of drug
the Substance Abuse and Mental Health Services Adminis-
use among arrested individuals under its Arrestee Drug
tration (SAMHSA), monitors drug-related visits to emergency
Abuse Monitoring (ADAM) program. The Centers for Disease
departments and deaths investigated by medical examiners.
Control and Prevention (CDC) monitors ninth to twelfth grad-
One report, the National Survey on Drug Use and Health
ers for behaviors that impose health risks under its Youth Risk
(NSDUH), surveys individuals 12 years or older to determine
Behavior Surveil ance System (YRBSS).
46 Forensic Pharmacology
drugs may make rash decisions or take risks that can result in
violence and accidents. The use of drugs of abuse by teenagers is
well documented. Many governmental agencies monitor the use
of drugs, the presence of drugs in accidents, and the number of
drug-related emergency department admissions. Recent surveys
indicate that while overall drug use by adolescents decreased in
the period from the 1980s to mid-1990s, it began to rise after
that. Even with a decrease in drug use, a significant number
of young adults use or have used drugs and have driven while
under the influence of drugs.
Cannabinoids
5
Cannabinoids are isolated from the plant Cannabis sativa,
which was initially found in Central Asia. Marijuana refers to
any part of the cannabis plant that can induce psychotomimetic
effects, a loss of contact with reality. Marijuana induces a wide
spectrum of behavioral effects and has been classified as a stim-
ulant, sedative, or hallucinogen. Marijuana is the most widely
used illicit drug in the United States. There are more than 200
slang terms for marijuana, including bhang, blunt, bud, dope,
gangster, grass, herb, jive, joint, Mary Jane, pot, reefer, roach,
rope, skunk, Thai stick, weed, and zig zag man. Marijuana has
also been used in combination with codeine cough syrup or
with embalming fluid.
Cannabinoids have been used for over 4,000 years as a seda-
tive, a remedy for relief of pain, epilepsy, and asthma, and in
religious cer
emonies. The Spanish brought Cannabis sativa to
the Americas, and Mexican laborers introduced the drug into
the southern portion of the United States around 1910. The
plant has been used for its fiber (called hemp) content for over
2,000 years. Early American settlers grew the plant for its hemp
47
48 Forensic Pharmacology
content, and the Marijuana Tax Act of 1937 banned cultivation,
possession, and distribution of hemp plants except for making
cord and twine.
Marijuana contains 421 different chemicals, including 61 can-
nabinoids. The potency is based on the percentage of the active
ingredient delta-9-tetrahydrocannabinol (THC) per dry weight
(Figure 5.1). Preparations from leaves and flowers contain about
3% THC, sinsemilla (the unpollinated seedless female plant)
contains about 5% THC, hashish (resin from the flower tops of
female plants) contains approximately 10% THC, and hashish
oil, a viscous product obtained by extracting the resin with sol-
vent, may contain as much as 20% THC. The word hashish comes
from the Arabic word meaning “grass.” Street names for hashish
include charas, gangster, ganja, hash, and hemp. In 1965, Israeli
Figure 5.1 THC, also known as delta-9-tetrahydrocannabinol, is the
main psychoactive chemical in the cannabis plant. Its chemical formula
is C21H30O2.
Cannabinoids
49
Medical Marijuana Usage
in California
On November 5, 1996, the people of California passed
Proposition 215 (The California Compassionate Use Act of
1996, CA Health and Safety Code Section 11362.5) by 56%
of the vote. It provides that if recommended by a physi-
cian, a primary caregiver (an individual designated as being
responsible for the housing, health, or safety of the patient)
who obtains and uses marijuana for medical purposes is not
subject to criminal prosecution or sanction. The proposition
also removes state-level criminal penalties on the use, pos-
session, and cultivation of marijuana by patients who pos-