1	DRUG EVALUATION and CLASSIFICATION PROGRAM Sgt. Pete Lamb Richmond County Sheriff’s Office
2	DEC (DRE) Program Origin Los Angeles, 1970’s LAPD Traffic Officer Dick Studdard Drivers taken to hospitals to be evaluated by doctors Drivers not prosecuted Need to develop diagnostic procedures that officers could use to detect drug impairment
3	Development of DRE Program Len Leeds (LAPD Narcotics Officer) Research developed (medical classes & texts) 1979 DEC Program officially recognized by LAPD DEC Program evolved into a 3-step process using diagnostic procedures to determine:
4	The Three-Step Drug Evaluation Process Step One: Establish that the subject is impaired Step Two: Rule out medical impairment Step Three: Determine the category of drugs involved
5	Standardized and Systematic Standardized process Much like SFST’s Systematic Process 12 Steps LAPD sought validation and support from NHTSA
6	Validation Two phase validation Laboratory Validation planned and conducted by researchers at Johns Hopkins University in Maryland in 1984 Drugs used: Secobarbital (300mg) Valium (15mg and 30mg) Desoxyn (15mg and 30mg) Marijuana
7	Johns Hopkins study Neither volunteers or evaluators knew what was being taken (double blind) Some volunteers took placebos Results: DREs correctly identified… 95% of drug-free suspects as “not impaired” 98.7% of suspects taking strong doses as “impaired” The particular category of drugs 91.7% MORE ACCURATE THAN PHYSICIANS TAKING PART IN THE STUDY
8	1985 Field Validation Study 173 People arrested for DUI Drug charges Blood toxicology done DREs were correct in identifying at least one drug category PCP 92% correctly identified Narcotic Analgesics correct 85% Cannabis correct 78% Depressants correct 50%
9	Legal Standards Frye Standard met Arizona, 1990 Daubert Standard met Nebraska, 2004 UNITED STATES About 10,000 DREs, 1,000 DRE Instructors GEORGIA 80 DREs, 12 DRE Instructors
10	DRE Confirmation Rates National 84,176 evals Tox results 57,825 Stimulants 83.4% Depressants 71.5% Hallucinogens 40.2% PCP 71.5% Narcotics 71.8% Inhalants 61% Cannabis 86.3% TOTAL 83.7% Georgia 1,027 evals Tox results 826 Stimulants 91.2% Depressants 74.5% Hallucinogens 33.3% PCP 80% Narcotics 85% Inhalants 0% Cannabis 91% TOTAL 92.1%
11	12 Step Process Breath Alcohol Test Consistent with level of impairment? Interview with the Arresting Officer Roadside demeanor, paraphernalia, initial statements made, etc. Preliminary Examination First pulse Medical questions Equal tracking, equal pupils, initial angle of HGN onset
12	12 Step Process Examination of the Eyes Horizontal Gaze Nystagmus Present in certain categories Vertical Gaze Nystagmus Indicates high dosage for the individual Lack of Convergence
13	12 Step Process Divided Attention Psychophysical Tests Romberg Balance Test Walk and Turn One Leg Stand (twice) Finger to Nose
14	12 Step Process Examination of the Vital Signs Second Pulse taken Blood Pressure Body Temperature
15	12 Step Process Dark Room Examination Pupils Room light Near-total darkness Direct Light Reaction to light Rebound or Hippus Check for Marked Reddening of Conjunctiva Nasal d) Oral
16	12 Step Process Examination of Muscle Tone Third Pulse Check for Injection sites Suspect’s Statements Opinion of the Evaluator Toxicology
17	Definition of a Drug Taken from the California Penal Code, a “drug” is” ANY SUBSTANCE WHICH, WHEN TAKEN INTO THE HUMAN BODY, CAN IMPAIR THE ABILITY OF THE PERSON TO OPERATE A VEHICLE SAFELY.
18
19	Seven Drug Categories CNS Depressants CNS Stimulants Hallucinogens Dissociative Anesthetics Narcotic Analgesics Inhalants Cannabis
20	CNS DEPRESSANTS Subcategories Anti-depressants Anti-anxiety tranquilizers Anti-psychotic tranquilizers Barbiturates Non-Barbiturates Combinations Alcohol is considered separately
21	CNS Depressants
22	CNS Depressants Commonly abused: GHB (Gamma Hydroxy Butyrate) Rohypnol Seroquel Clonazapam Xanax Paxil Depakote Valium Ambien
23
24	Major Indicators of CNS Depressants Horizontal Gaze Nystagmus Vertical Gaze Nystagmus (high dosage) Lack of Convergence Normal Pupils (dilated with SOMA and Methaqualone) Reaction to Light is slow Pulse rate is down (may be elevated with alcohol and Methaqualone)
25	Major Indicators of CNS Depressants Blood Pressure is down Body Temperature is down Muscle tone is Flaccid
26	GHB GAMMA HYDROXYBUTYRATE “LIQUID X, GREVIOUS BODILY HARM, GEORGIA HOME BOY, EVERCLEAR” Used by Body Builders and Ravers Date Rape Drug Clear, salty tasting liquid Dosage/tolerance Onset 10-20 MIN Effects last up to 4 hours Cleared quickly
27	GHB Made From: Gamma Butyrolactone (GBL) and Sodium Hydroxide or Potassium Hydroxide Basically it is degreasing solvent or floor stripper mixed with drain cleaner. When GBL is ingested, GHB is produced in the body. GHB has a half life of 27 minutes Xyrem® (Schedule III drug for treatment of Cataplexy)
28
29	ROHYPNOL FLUNITRAZEPAM “Roofies, Circles, Forget me drug, Forget me pill, Getting roached, La Rocha, lunch money drug, Mexican valium, R-2, Rib, Rope, Rophies, Row-shay, Ruffles, Wolfies “ Illegal in U. S. (smuggled in from Mexico) Tasteless and odorless 1 MG dose lasts 8 – 12 hours
30
31	ROHYPNOL USES Boost high from alcohol or heroin Modulate Cocaine effects Popular Rave drug “date rape” drug
32	ROHYPNOL ACTIONS Sedative effects 10x more powerful than valium Effects appear 15-20 min Last 4 – 6 hours Residual effects up to 12 hours
33	CNS Stimulants Cocaine Methamphetamine Adderal Ritalin Ephedrine
34	Major Indicators of CNS Stimulants Dilated Pupils Slow Reaction to light Pulse, Blood Pressure and Body Temperature are all elevated Muscle tone is rigid
35	General Indicators of CNS Stimulants Bruxism (grinding of the teeth) Agitation Irritability Body Tremors
36	Methamphetamine
37	Methamphetamine 2006 United Nations World Drug report calls Meth the MOST ABUSED DRUG ON EARTH. 26 million meth addicts equals the combined number for cocaine and heroin users.
38	Pharmacokinetics of Meth Following oral administration, peak concentrations are usually seen in 2.5 to 3.5 hours Mean elimination half-life is 10 hours Rapid onset of effects following intravenous or smoking administration Duration of effects typically 4 to 8 hours but may last up to 12 hours
39	Pharmacodynamics of Meth Methamphetamine’s effects are similar to Cocaine but onset is slower and duration is longer. Unlike Cocaine, Methamphetamine does not have anesthetic properties
40	METHODS OF PRODUCTION Red Phosphorus method precursor chemicals are pseudoephedrine, iodine, and red phosphorus Lithium/ammonia (Nazi) method precursors pseudoephedrine, lithium metal, and anhydrous ammonia
41	METHAMPHETAMINE In 2005, DEA agents seized a methamphetamine laboratory from a Smyrna residence and arrested three visiting undocumented guest workers from Mexico. Agents seized over 10 pounds of crystal methamphetamine, 39 pounds of powdered methamphetamine, and several 30 to 55 gallon containers filled with liquid methamphetamine. Agents discovered 24 garbage bags full of empty pseudoephedrine packages that would have held an estimated 240,000 tablets.
42	METHAMPHETAMINE INTOXICATION The Rush 5 minutes of intense euphoria “orgasmic” pleasure Rapid flight of ideas Sexual stimulation High energy Obsessive compulsive activity Thought blending Word salad Dilated pupils
43	Tweaking A meth binge typically lasts 3 – 15 days Meth is metabolized slowly, tolerance develops quickly User tries to keep high going by taking more and more of the drug. The rush grows less extreme…the user can’t stay high User grows irritable and has not slept for days
44	Tweaking (cont.) Pupils begin returning to normal Possible auditory hallucinations User often behaves or reacts violently and is very dangerous to himself and others Paranoia, delusions, anxiety
45
46	Dopamine Blues Normal pleasurable experience releases Dopamine Cocaine releases about 400% more Crystal Meth releases about 1,500% more dopamine Meth kills dopamine producing cells in the brain
47	“Downside of Methamphetamine” User may take a depressant or narcotic to ease the bad feelings Intense fatigue Continuing stimulation Craving Constricted pupils are likely Symptoms very similar to one under the influence of Narcotic Analgesic “feeling bad”
48	FACES OF METH The effects of continued methamphetamine use on the body over time
49	Esther Allison December 2000
50	Esther Allison 7 months later
51	Glenn Lagrew 1993
52	Glenn Lagrew 4 years later
53	Glenn Lagrew 2001
54	Glenn Lagrew 3 years later
55	James Hibbs October 2002
56	James Hibbs Four months later
57	Jennifer Lundgren July 2003
58	Jennifer Lundgren 17 months later
59	Joseph Harris December 1999
60	Joseph Harris 3 months later
61	Patrick Lucas October 1999
62	Patrick Lucas 5 years later
63	Perry Bennett August 1996
64	Perry Bennett 4 years later
65	Theresa Baxter June 2001
66	Theresa Baxter 3 years 5 months later
67	Hallucinogens
68
69
70
71	Major Indicators of Hallucinogens Dilated Pupils Normal Reaction to light, but certain psychedelic amphetamines cause slowing Pulse, blood pressure and body temperature are elevated
72	General Indicators of Hallucinogens Hallucinations Synesthesia Nausea Difficulty with speech Body Tremors Poor perception of time and distance Piloerection (Goose bumps)
73	MDMA METHYLENEDIOXYMETHAMPHETAMINE “ECSTASY, X, E, X-TC, CLARITY, LOVER’S SPEED” “candy flipping” combining ecstasy and LSD
74
75	COMMON CONTAMINANTS Chalk Amphetamines Caffeine Ketamine Ephedrine PMA (paramoxyamphetamine) often sold as MDMA
76	DOSAGES THRESHOLD – 30 MG AVERAGE – 75-125 MG LETHAL DOSE – 106 - ~ 6000MG
77	MDMA ACTIONS DURATION PRIMARY EFFECTS 3 - 4 HRS “CRASH” 2 - 6 HRS HANGOVER MAY LAST UP TO 5 DAYS Usually taken in conjunction with: Alcohol, Marijuana, Cocaine, GHB, Ketamine, Methamphetamine, Nitrous Oxide POST – MDMA DEPRESSION
78	Pharmacodynamics of Ecstasy MDMA is a phenylethylamine with stimulant and psychedelic effects Close to MDA MDMA increases levels of norepinephrine and dopamine. MDMA destroys serotonin-producing neurons
79
80	ECSTASY BEHAVIORAL EFFECTS Increased energy Empathy toward others Increased affection (“Hug drug”) Euphoria Decreased inhibitions Extreme relaxation
81	ACUTE SIDE EFFECTS Hyperthermia Dehydration Cardiovascular stimulation
82
83	Dissociative Anesthetics PCP KETAMINE DEXTROMETHORPHAN
84	Major Indicators of Dissociative Anesthetics Horizontal, Vertical and Resting Nystagmus Pulse, blood pressure and body temperature are all elevated
85	General Indicators of Dissociative Anesthetics Blank Stare Mood Swings Increased Pain Threshold Difficulty with speech Incomplete Verbal responses
86	PCP PHENYLCYCLOHEXYLPIPERIDINE PHENCYCLIDINE “Angel Dust, Embalming fluid, Wet” SERNYL Was used as an IV anesthetic
87
88	Pharmacodynamics of PCP PCP is a NMDA-receptor antagonist Blocks dopamine reuptake and elevates synaptic dopamine levels High affinity to sites in the cortex and limbic structures
89	Pharmacokinetics of PCP PCP is highly lipid soluble and is stored in fat and brain tissues. Plasma binding of PCP is 65% and the average half-life ranges from 7 to 46 hours.
90	Interpretation of blood concentrations No direct correlation between blood concentrations and behavioral or physical findings Psychiatric hospital ER – 63 patients PCP concentrations from .3 to 143ng/mL Up to 842ng/mL in 22 patients Arrests – 26 individuals for public intoxication PCP concentrations from 12 to 118ng/mL
91	PCP Overdose Signs At high doses of PCP, blood pressure, pulse rate, and respiration drop. This may be accompanied by nausea, vomiting, blurred vision, flicking up and down of the eyes, drooling, loss of balance, and dizziness. High doses of PCP can also cause seizures, coma, and death.
92	KETAMINE SEDATIVE-HYPNOTIC “Special K, Ketalar, Ketajet, Ketaset, Ket or Vitamin K, Green, 1980 Acid, Super C, Vitamin K, Super Acid, God, Honey Oil, Blast, and Gas.” A dose is called a “bump.” “Calvin Klein” - combo of cocaine and ketamine “Product 19” - combo of MDMA and ketamine
93	KETAMINE General anesthetic Analgesic Rapid onset Lasts about an hour (dependant on dosage)
94
95	Pharmacodynamics of Ketamine Structurally similar to PCP but 10 to 50 times less potent in blocking NMDA effects Ketamine blocks dopamine uptake and elevates synaptic dopamine levels
96	Pharmacokinetics of Ketamine Plasma half-life is 2.3 ±.5hrs
97	Interpretation of blood concentrations No direct correlation between Ketamine concentrations and behavior Drowsiness, perceptual distortions and intoxication may be dose-related in a concentration range of 50 – 200ng/mL Analgesia begins at about 100ng/mL
98	“K Hole” Increased heart rate Slurred speech Paralyzed feeling Amnesia Nausea Hallucinations Slowed breathing
99	DXM Dextromethorphan
100
101	DEXTROMETHORPHAN (DXM) DISSOCIATIVE EFFECTS “Plateaus” 100-200mg – mild stimulant effect 200-500mg – intoxication, drunk-like 500-1000mg – mild hallucinations and mild Dissociative effects +1000mg – full Dissociative effects
102	DXM Overdose Possible panic or psychological breakdown as the result of a strong trip Mixing DXM with other depressants can result in overdose through respiratory failure. Mixing DXM with alcohol results in vomiting or alcohol poisoning. Mixing DXM with other serotonin-affecting hallucinogens (especially Ecstasy) can lead to Serotonin Syndrome and chronic depression.
103
104	Narcotic Analgesics Propoxyphene Methadone Oxycodone Hydrocodone Heroin Many others
105	Major Indicators of Narcotic Analgesics Constricted Pupils (miosis) Little or no reaction to light Pulse, blood pressure and body temperature are depressed Muscle tone is usually normal
106	Effects of Narcotic Analgesics “On the Nod” Ptosis Facial itching Euphoric Hippus
107
108	Inhalants Nitrous Oxide Toluene Kerosene Paint thinners “Dust off”
109
110	Major Indicators of Inhalants Horizontal and Vertical Gaze Nystagmus Lack of Convergence is present Pupils are usually normal but may be dilated Reaction to light is slow Pulse rate is up Blood pressure is down with anesthetic gases but up with volatile solvents and aerosols Body temperature…?
111	General Indicators of Inhalants Flushed face Headaches Confusion Slurred speech, bloodshot eyes, drunk-like behavior Odor of substance and residue around nose and mouth
112
113	Inhalants Duration of effects Six to eight hours for most volatile solvents Aerosols and Anesthetic gases usually have very short duration
114	Cannabis Marijuana Marinol Hashish
115	Major Indicators of Cannabis Lack of Convergence Dilated Pupils (but not always) Elevated Pulse and blood pressure
116	Cannabis General Indicators Marked Reddening of the Conjunctiva Memory Loss Body tremors Increased Appetite Relaxed Inhibitions Disorientation Rebound Dilation Eyelid Tremors
117
118
119
120
121	Overdose on Cannabis?
122
123
124
125	Issues facing DREs in DUI Drug Cases The “negative” toxicology report
126
127	GOING FISHING The Officer The Suspect The Toxicologist
128
129
130
131	“It was a blue fish”
132	Which of these catches a blue fish?
133	Below cutoff level TOXICOLOGY RESULTS
134	“No Drugs Found”
135	Who is correct? Was the officer wrong when he said the person was under the influence of drugs? Can the toxicologist say that the person was not impaired by drugs at the time of arrest? Can a “therapeutic” dose of a drug impair a person’s ability to drive a motor vehicle?
136
137	DRUG TRENDS N-BENZYLPIPERAZINE (BZP) and 3-TRIFLUOROMETHYLPHENYL- PIPERAZINE (TFMPP) PCP analog sold as Ecstasy
138	DRUG TRENDS “BUG DOPE” Insecticide is sprayed on a metal grill. The grill is heated via an electrical current until the insecticide flakes off. The flakes are then smoked
139	DRUG TRENDS “CHEESE” Mixture of Tylenol PM and 8 – 10% heroin One death of an 18-year old reported in Dallas, Texas
140	DRUG TRENDS Salvia Divinorum Salvinorin A (Divinorin A) acts as a potent agonist on the Kappa opioid receptor Cause illusions and hallucinations similar to psilocybin, mescaline and ketamine Short duration of effects Available on the internet Scheduled in Tennessee, Louisiana, Delaware and Missouri
141
142
143	DRUG TRENDS METH Recycling Methamphetamine users will urinate into containers during binges and then drink it in an attempt to continue the high
144	Resources Erowid.com projectghb.org clubdrugs.org streetdrugs.org Bluelight.nu (pillreports) Dancesafe.org EcstasyData.org “BUZZED” Cynthia Kuhn, Wilkie Wilson, Duke Univ. (ISBN#0-393-32493-1)
145	CONTACT Sgt. Pete Lamb Richmond County Sheriff’s Office Office: 706-821-1000 Pager: 706-732-7032 Email: plamb@augustaga.gov