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Title: A study of drug use, pathology and post-mortem tissue distribution in the West of Scotland
Author: Fitrasanti, Berlian Isnia
ISNI:       0000 0004 6493 9930
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 2018
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Drug abuse has always been a world problem. Recently people abuse both controlled and prescribed drugs. Opioids, cocaine, cannabis and amphetamines are the most widely abused drugs. The picture of the drug abuse problem in Scotland can be understood by an extensive study of drug prevalence and characteristics of drug use in the region. In drug-related deaths, post-mortem analysis, which includes autopsy and collecting samples for histological and toxicological analysis, is necessary to be carried out to investigate whether any drug has contributed to the cause of death. The samples which are commonly collected for toxicological analysis are blood and urine. However, when those fluids are not available, body tissues may be taken as alternative samples, such as liver and skeletal muscle. In this case, it is necessary to understand how drugs move and diffuse to these tissues after death. This phenomenon, which is known as post-mortem redistribution, may cause difficulties in the interpretation of post-mortem drug concentrations. Several studies have tried to investigate post- mortem redistribution including how drugs diffuse in the body after death. However, post-mortem redistribution is still not completely understood. This study proceeded by interrogating post-mortem data within the period of 2011-2016 held by Forensic Medicine and Science (FMS), University of Glasgow to review trends of drug-related death in the West of Scotland in which amphetamine-type stimulants (ATS), cocaine and opioids were detected. Opioids were most commonly detected (81.9%) in drug-related deaths in the West of Scotland, followed by cocaine (21.6%) and ATS (9.4%). The interrogation of post- mortem data within the period of 2007-2016 was also carried out to understand certain pathological conditions which are caused by drug abuse. From the results, it is clear that in the West of Scotland people tend to abuse multiple drugs. This trend may apply in the other part of the country and around the world. It is also clear that, even though methadone was prescribed to assist users to stop from drug addiction, especially heroin, many methadone users still abuse other drugs, as methadone was found in most of the cases in addition to other drugs. For this reason, it is important to investigate the results of drug addiction therapy and educate potential users. Subsequently, methods were adapted for analysing liver and muscle samples from the FMS in-house methods for analysing ATS and basic drugs in autopsy blood and validated according to the standard practices for method validation in forensic toxicology (SWGTOX, May 2013). All ATS drugs (amphetamine, methamphetamine, MDA, PMA, PMMA, MDMA and MDEA) and basic drugs (amitriptyline, citalopram, methadone, mirtazapine, sertraline and tramadol) gave acceptable bias, precision, linearity, recovery and stability for analysing liver and muscle samples. An experimental model for drug diffusion in tissues was studied to simulate and understand drug diffusion in humans. The diffusion rate that was used in this model is in accordance with the volume of distribution of each drug. This model is easy and simple to be carried out in any small laboratory. Blood, liver and muscle samples were analysed from 10 cases collected during the period from August 2016 to April 2017 after the next of kin signed the informed consent forms. Four basic drugs (amitriptyline, methadone, mirtazapine and sertraline) were found in 9 cases and analysed to investigate the ratios between blood, muscle, right liver and left liver. The ratios of drug concentrations of muscle:blood, left liver:right liver were found to be lower than 2. As a result, drug concentrations in muscle can be reliable for toxicological interpretation when blood is not available. The ratio of drug concentration in liver and blood has been suggested as a marker of post-mortem redistribution(1) and this study has shown that the ratio of drug concentration in liver and muscle can also be diagnostic in cases where blood is not available.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RA1001 Forensic Medicine. Medical jurisprudence. Legal medicine