**7. Addendum**

#### **7.1. Principal drugs of abuse**

#### *7.1.1. Nicotine*

Alakloid from *Nicotiana tabacum*; found in cigarettes, cigars, and smokeless tobacco (snuff, spit tobacco, chew); it can be smoked, snorted, chewed

#### **Acute Effects** - Increased blood pressure and heart rate

**Health Risks** - Chronic lung disease; cardiovascular disease; stroke; cancers of the mouth, pharynx, larynx, esophagus, stomach, pancreas, cervix, kidney, bladder, and acute myeloid leukemia; adverse pregnancy outcomes; addiction

#### *7.1.2. Ethanol*

Alcohol, ethyl alchol, produced by sugar fermentation; found in liquor, beer, and wine; orally ingested (swallowed)

**Acute Effects** - In low doses, euphoria, mild stimulation, relaxation, lowered inhibitions; in higher doses, drowsiness, slurred speech, nausea, emotional volatility, loss of coordination, visual distortions, impaired memory, sexual dysfunction, loss of consciousness

**Health Risks** - Increased risk of injuries, violence, fetal damage (in pregnant women); depression; neurologic deficits; hypertension; liver and heart disease; addiction; fatal over‐ dose.

#### *7.1.3. Tetraydrocannabinol*

Active principle of *Cannabis*; found in marijuana or hashish or hash oil or hemp; smoked or swallowed.

Scheduled drug.

Obligation in the above-mentioned areas is complex because of «pre-analytical» and «analyt‐ ical» variables. Among the pre-analytical variables are: quantity of dose ingested, frequency and means of ingestion, interval between intake and sample taking, the sample collection

Among the analytical variables are: elevated number of analytes, large variety of chemical structures, of volatility, functional groups, hydrophilic/lipophilic ratios, values of pKa or pKb; wide ranges of concentration in liquids and biological tissues, dependent on dose intake; the way the specimens are stored; the possible lack of pharmacokinetic and pharmacodynamic studies; the diversity of biological matrices and potential analytical interferences produced by

The complexity of those variables ensures that *every analysis may be given as an individual case*

With the diffusion of environmental toxins and the clandestine drug market, the forensic toxicology laboratory is also committed to the analysis of non-biological material. In this context, Forensic Toxicology can provide to institutions and society information and aware‐ ness on the appearance of new drugs; identification of the major channels of drug distribution in the local and national black market; identification of the means adopted by traffickers to bypass systems of control; information on substances used in the cutting or treatment of the

With the main objective of providing scientifically based *evidence*, the complexity of all the above outlined roles of forensic toxicology entails the need for the adoption of quality

Alakloid from *Nicotiana tabacum*; found in cigarettes, cigars, and smokeless tobacco (snuff, spit

**Health Risks** - Chronic lung disease; cardiovascular disease; stroke; cancers of the mouth, pharynx, larynx, esophagus, stomach, pancreas, cervix, kidney, bladder, and acute myeloid

Alcohol, ethyl alchol, produced by sugar fermentation; found in liquor, beer, and wine; orally

assurance systems, ascertainement methodologies and evaluation criteriologies.

procedure, the interval between sample taking and analysis.

*for which there are no rules applicable to all xenobiotics and all situations*.

exogenous, endogenic and putrefactive substances.

96 Toxicology Studies - Cells, Drugs and Environment

drug; suggestions for timely legislative adaptations.

tobacco, chew); it can be smoked, snorted, chewed

leukemia; adverse pregnancy outcomes; addiction

**Acute Effects** - Increased blood pressure and heart rate

**7. Addendum**

*7.1.1. Nicotine*

*7.1.2. Ethanol*

ingested (swallowed)

**7.1. Principal drugs of abuse**

**Acute Effects –** Euphoria; relaxation; slowed reaction time; distorted sensory perception; impaired balance and coordination; increased heart rate and appetite; impaired learning, memory; anxiety; panic attacks; psychosis

**Health Risks** - Cough, frequent respiratory infections; possible mental health decline; addiction

#### **7.2. Opioids**

Alkaloids from Papaverum Somniferum; found in opium (Morphine, Codeine) or derived from opium by chemical synthesis (Heroin) or chemically synthesized (Naloxone, Oxycodone, Oxymorphone etc); Heroin (diacetylmorphine) can be injected, smoked, snorted; Opium can be swallowed or smoked; scheduled drugs.

**Acute Effects** - Euphoria; drowsiness; impaired coordination; dizziness; confusion; nausea; sedation; feeling of heaviness in the body; slowed or arrested breathing

**Health Risks** - Constipation; endocarditis; hepatitis; HIV; addiction; fatal overdose

#### *7.2.1. Stimulants*

Alkaloids found in *Coca* leaves (Cocaine) or chemically synthesized (amphetamines and methamphetamines, methylenedioxyamphetamines, methylenedioxyamphe-tamines, amphetamine-like compounds, phenethylamine derivatives); Cocaine can be snorted, smoked, injected; Amphetamine derivatives can be swallowed, snorted, smoked, injected; scheduled drugs.

**Acute Effects** - Increased heart rate, blood pressure, body temperature, metabolism; feelings of exhilaration; increased energy, mental alertness; tremors; reduced appetite; irritability; anxiety; panic; paranoia; violent behavior; psychosis. **for MDMA** - Mild hallucinogenic effects; increased tactile sensitivity; empathic feelings; lowered inhibition; anxiety; chills; sweating; teeth clenching; muscle cramping

**Health Risks** - Weight loss, insomnia, sleep disturbances; cardiac or cardiovascular compli‐ cations; depressions; stroke; seizures; addiction. **for MDMA** - Sleep disturbances; depression; impaired memory; hyperthermia; addiction.

**Also, for cocaine** – Nasal damage from snorting

**Also, for methamphetamine** – Severe dental problems

#### *7.2.2. Dissociative drugs*

**Synthetic drugs:** Ketamine (injected, snorted, smoked); Phencyclidine (PC) and analogs (swallowed, smoked, injected). **Naturally occurring**: salvinorine from *Salvia divinorum* (chewed, swallowed, smoked).

**Acute Effects** - Feelings of being separate from one's body and environment; impaired motor function

**Also, for ketamine** - Analgesia; impaired memory; delirium; respiratory depression and arrest; death

**Also, for PCP and analogs** - Analgesia; psychosis; aggression; violence; slurred speech; loss of coordination; hallucinations

**Health Risks** - Anxiety; tremors; numbness; memory loss; nausea

#### *7.2.3. Hallucinogens*

**Synthetic drugs***:* Lysergic acid diethylamide (LSD, swallowed, absorbed through mouth tissues).

**Naturally occurring**: Mescaline, from the peyote cactus (Lophophora williamsii), the San Pedro cactus (Echinopsis pachanoi) and in the Peruvian torch (Echinopsis peruviana), (swallowed, smoked); Psilocybin, from mushrooms of genus Psilocybe, such as P. azurescens, P. semilanceata, and P. cyanescens, and from about a dozen other genera (swallowed).

**Acute Effects** - Altered states of perception and feeling; hallucinations; nausea

**Also, for LSD** - Increased body temperature, heart rate, blood pressure; loss of appetite; sweating; sleeplessness; numbness, dizziness, weakness, tremors; impulsive behavior; rapid shifts in emotion

**Also, for Mescaline** - Increased body temperature, heart rate, blood pressure; loss of appetite; sweating; sleeplessness; numbness, dizziness, weakness, tremors; impulsive behavior; rapid shifts in emotion

**Also, for Psilocybin** - Nervousness; paranoia; panic

**Health Risks, for LSD** - Flashbacks, Hallucinogen Persisting, Perception Disorder

#### *7.2.4. Anabolic steroids*

#### **inhalants**

**Health Risks** - Weight loss, insomnia, sleep disturbances; cardiac or cardiovascular compli‐ cations; depressions; stroke; seizures; addiction. **for MDMA** - Sleep disturbances; depression;

**Synthetic drugs:** Ketamine (injected, snorted, smoked); Phencyclidine (PC) and analogs (swallowed, smoked, injected). **Naturally occurring**: salvinorine from *Salvia divinorum*

**Acute Effects** - Feelings of being separate from one's body and environment; impaired motor

**Also, for ketamine** - Analgesia; impaired memory; delirium; respiratory depression and arrest;

**Also, for PCP and analogs** - Analgesia; psychosis; aggression; violence; slurred speech; loss

**Synthetic drugs***:* Lysergic acid diethylamide (LSD, swallowed, absorbed through mouth

**Naturally occurring**: Mescaline, from the peyote cactus (Lophophora williamsii), the San Pedro cactus (Echinopsis pachanoi) and in the Peruvian torch (Echinopsis peruviana), (swallowed, smoked); Psilocybin, from mushrooms of genus Psilocybe, such as P. azurescens, P. semilanceata, and P. cyanescens, and from about a dozen other genera (swallowed).

**Also, for LSD** - Increased body temperature, heart rate, blood pressure; loss of appetite; sweating; sleeplessness; numbness, dizziness, weakness, tremors; impulsive behavior; rapid

**Also, for Mescaline** - Increased body temperature, heart rate, blood pressure; loss of appetite; sweating; sleeplessness; numbness, dizziness, weakness, tremors; impulsive behavior; rapid

**Acute Effects** - Altered states of perception and feeling; hallucinations; nausea

**Health Risks, for LSD** - Flashbacks, Hallucinogen Persisting, Perception Disorder

impaired memory; hyperthermia; addiction.

98 Toxicology Studies - Cells, Drugs and Environment

*7.2.2. Dissociative drugs*

function

death

tissues).

(chewed, swallowed, smoked).

of coordination; hallucinations

*7.2.3. Hallucinogens*

shifts in emotion

shifts in emotion

**Also, for Psilocybin** - Nervousness; paranoia; panic

**Also, for cocaine** – Nasal damage from snorting

**Also, for methamphetamine** – Severe dental problems

**Health Risks** - Anxiety; tremors; numbness; memory loss; nausea

**Acute Effects, for Anabolic steroids** - No intoxication effects.

**for Inhalants (varies by chemical)** - Stimulation; loss of inhibition; headache; nausea or vomiting; slurred speech; loss of motor coordination; wheezing

**Health Risks, for Anabolic steroids** - Hypertension; blood clotting and cholesterol changes; liver cysts; hostility and aggression; acne; in adolescents—premature stoppage of growth; in males—prostate cancer, reduced sperm production, shrunken testicles, breast enlargement; in females—menstrual irregularities, development of beard and other masculine characteristics

**for Inhalants** - Cramps; muscle weakness; depression; memory impairment; damage to cardiovascular and nervous systems; unconsciousness; sudden death.
