A study of drug use, pathology and post-mortem tissue distribution in the West of Scotland

Fitrasanti, Berlian Isnia (2018) A study of drug use, pathology and post-mortem tissue distribution in the West of Scotland. PhD thesis, University of Glasgow.

Abstract

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.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: Post-mortem redistribution, liver, muscle, diffusion.
• Subjects: R Medicine > RA Public aspects of medicine > RA1001 Forensic Medicine. Medical jurisprudence. Legal medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Supervisor's Name: Torrance, Dr Hazel and Turner, Dr Marjorie
• Date of Award: 2018
• Embargo Date: 23 January 2022
• Depositing User: Miss Berlian Isnia Fitrasanti
• Unique ID: glathesis:2018-8695
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 24 Jan 2018 12:26
• Last Modified: 25 Jan 2021 08:30
• URI: https://theses.gla.ac.uk/id/eprint/8695