Pathology, Toxicogenetics, and Criminalistics of Drug Abuse

210 Pages·2007·4.58 MB·English

by  MD

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Half Title Page
Pathology,
Toxicogenetics,
and
Criminalistics
of
Drug Abuse
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Title Page
Pathology,
Toxicogenetics,
and
Criminalistics
of
Drug Abuse
Edited by
Steven B. Karch, MD, FFFLM
Consultant Pathologist and Toxicologist
Berkeley, California
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
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CRC Press
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Contents
Chapter 1 The Criminalistics of Controlled Substances............................................................1
Joseph P. Bono, M.A.
Chapter 2 Overview of Pathology of Drug Abuse: Scene of Death and the Autopsy............71
Charles V. Wetli, M.D.
Chapter 3 Heart Disease...........................................................................................................79
Renu Virmani, M.D., F.A.C.C., Allen P. Burke, M.D., and Andrew Farb, M.D.
Chapter 4 Vascular Effects of Substance Abuse......................................................................97
Frank D. Kolodgie, Ph.D., Allen P. Burke, M.D., Jagat Narula, M.D., Ph.D.,
Florabel G. Mullick, M.D., and Renu Virmani, M.D., F.A.C.C.
Chapter 5 Myocardial Alterations in Drug Abusers...............................................................115
Steven B. Karch, M.D., FFFLM
Chapter 6 Valvular Heart Disease...........................................................................................123
Michael D. Bell, M.D.
Chapter 7 Lung Disease..........................................................................................................129
Michael D. Bell, M.D.
Chapter 8 Disorders of the Central Nervous System.............................................................137
Michael D. Bell, M.D.
Chapter 9 Toxicogenetics in Drug Abuse: Pharmacogenomics for Toxicology....................153
Robert M. White, Sr., Ph.D. and Steven H.Y. Wong, Ph.D.
Chapter 10 Toxicogenetics in Drug Abuse: Heritable Channelopathies and Myopathies......165
Kathryn A. Glatter, M.D., Jonica Calkins, M.D., and Sanjay J. Ayirookuzhi, M.D.
Index..............................................................................................................................................185
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Preface
In a very broad sense, the criminalistics and pathology of drug abuse are determined by the
particular drugs abused, the ways those drugs are used and administered, their toxic effects, and
the behavioral modifications they produce. This volume begins with a basic overview of the
identification and analysis of physical evidence derived from drugs and drug users. The discussion
continues with an examination of pathological changes resulting from the pharmacologic effects
of various drugs that are abused and from the ways that these drugs are administered: in short, a
review of the changes one would likely encounter at the autopsy table. Much of this book focuses
on emerging concepts and newly discovered phenomena, with an emphasis on death scene inves-
tigation, evaluation of the drug abuse victim (living or deceased), and cardiovascular pathology. In
many instances, the authors have relied on their own academic and investigative experiences to
provide a practical approach to evaluating these drug abuse victims.
Much of what is known about the pathology of drug abuse has been derived from thorough
and carefully performed autopsies. Much of this book deals with the autopsy and will be of particular
interest to pathologists; however, far from this being an academic exercise, it is hoped that the
reader will discern applications to clinical situations. This, in fact, has been accomplished over the
years as clinicians have come to better appreciate the pathophysiology of diseases resulting from
drug abuse.
The final two chapters explore exciting new methods and advances in molecular biology and
DNA technology that now make it possible to explain instances of sudden death that previously
were unexplained. Emerging evidence suggests that the underlying cause of death in many is
genetic, and that heart and liver abnormalities may play a role. The problem is that death from a
wide variety of genetic defects leaves no histological markers. The ability to identify these “invisible
diseases” with postmortem genetic testing has become a reality far more quickly than anyone had
ever imagined. It may not yet be “standard of care” to test for cardiac channelopathies or P450
polymorphisms, but it will be in the not-too-distant future.
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The Editor
Steven B. Karch, M.D., FFFLM, received his under-
graduate degree from Brown University. He attended grad-
uate school in anatomy and cell biology at Stanford Univer-
sity. He received his medical degree from Tulane University
School of Medicine. Dr. Karch did postgraduate training in
neuropathology at the Royal London Hospital and in cardiac
pathology at Stanford University. For many years he was a
consultant cardiac pathologist to San Francisco’s Chief Med-
ical Examiner.
In the U.K., Dr. Karch served as a consultant to the
Crown and helped prepare the cases against serial murderer
Dr. Harold Shipman, who was subsequently convicted of
murdering 248 of his patients. He has testified on drug
abuse–related matters in courts around the world. He has a special interest in cases of alleged
euthanasia, and in episodes where mothers are accused of murdering their children by the trans-
ference of drugs, either in utero or by breast feeding.
Dr. Karch is the author of nearly 100 papers and book chapters, most of which are concerned
with the effects of drug abuse on the heart. He has published seven books. He is currently completing
the fourth edition of Pathology of Drug Abuse, a widely used textbook. He is also working on a
popular history of Napoleon and his doctors.
Dr. Karch is forensic science editor for Humana Press, and he serves on the editorial boards
of the Journal of Cardiovascular Toxicology, the Journal of Clinical Forensic Medicine (London),
Forensic Science, Medicine and Pathology, and Clarke’s Analysis of Drugs and Poisons.
Dr. Karch was elected a fellow of the Faculty of Legal and Forensic Medicine, Royal College
of Physicians (London) in 2006. He is also a fellow of the American Academy of Forensic Sciences,
the Society of Forensic Toxicologists (SOFT), the National Association of Medical Examiners
(NAME), the Royal Society of Medicine in London, and the Forensic Science Society of the U.K.
He is a member of The International Association of Forensic Toxicologists (TIAFT).