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Forensic Pharmacy

Forensic pharmacy is application of the sciences of drugs to legal issues. Forensic pharmacists engage in work relating to litigation, the regulatory process, and the criminal justice system. Forensic pharmacy overlaps with many other forensic fields. Pharmacists hold a variety of positions with local, state, and federal governments. Many pharmacists do freelance work as forensic litigation consultants. A forensic pharmacist can be a valuable resource in legal cases relating to malpractice, adverse drug reactions, drunk and drugged driving, health care fraud, poisoning, and numerous other types of civil and criminal cases.

The word Forensic is derived from Latin term Forencis, meaning a forum, a place for interaction or deliberations. Jurisprudence means study of fundamental laws and in case of pharmaceutical Jurisprudence, it is laws relating to pharmacy. Forensic Pharmacy or Pharmaceutical Jurisprudence is that branch of pharmacy, which deals with various legislations pertaining to drugs and pharmaceuticals, and profession of pharmacy. This subject encompasses the knowledge of various Acts, Rules, Statutes, Schedules, Sections etc., which directly or indirectly influence the profession of pharmacy in the country and various operations pertaining to procurement, manufacture and distribution of different kinds of dosage forms. Three important components of pharmacy profession education, industry and pharmacy practice are regulated by the pieces of legislation enacted from time to time.

The knowledge of Forensic Pharmacy is essential to understand the legal aspects pertaining to practice of pharmacy. The qualified persons are required to profess and should also be engaged in manufacturing, sales and distribution of drugs. Pharmacy is a noble and dedicated profession with a commitment to the cause of health care system of the country. In order to ensure this professional role of pharmacist, there has to be an ethical framework within which a pharmacist is supposed to function. He/she should be familiar with the types of laws governing his/her profession and also the developments that have contributed to the current status of pharma education, pharmacy practice and pharmaceutical industry.

Since ancient times, the human race has been depending upon the plant-derived drugs for the treatment of different human diseases. Apart from our own civilization, the Chinese, Greek, Arabian and Tibetian civilization have contributed significantly to the knowledge of medicinal plants. In our country Ayurveda, the Ancient Science of Life, based on ‘Tridosh’ theory of Vaat (wind), Pitta (bile) and Kapha (phlegm) is practiced from time immemorial. Our treatises or documents such as ‘Vedas’ and ‘Upanishads’ are full of information pertaining to medicinal plants. In ancient days, the medical care was in the able hands of ‘Maharshis’ and ‘Vaids’ who had a special status in the society. There was also the Siddha medicine mainly practiced in southern regions of the country. With the advent of Moghul rulers specially Babur, there came in a new system of medicine practiced by Hakims called as Unani System of Medicine, which got patronage during the rule of Shahjahan and Aurangazeb. With the arrival of East India Company and other European companies and thereafter British rule in nineteenth century, the Indian population was first introduced to the Allopathic System of Medicine, more commonly known as “Vilayati Medicines”. The modern system of medicine was introduced in India by the Dutch, the French,

the Portuguese and East India trading companies and the Missionaries from European countries. Until the end of the nineteenth century, the medicines of different systems were mostly derived from plants or other natural sources like animals and minerals. These drugs were in the form of extracts, tinctures, pills and pastes and most of them were freshly prepared. The Ayurvedic medical practitioners were mostly hereditary and they were following Guru-Shishya parampara, which was also true of Siddha and Unani practitioners (Hakims). The Homoeopaths were self-taught and relied mostly on literature from Germany. In the absence of legal requirements of registration as doctor, a large number of quacks surfaced in medical profession.

The hospital facilities were almost non-existent in rural areas. The railway administration and plantations provided good services to their employees. The Missionaries and charity hospitals for communities were serving limited cause of health care.

Forensics

Forensics is quite popular now in the general population. Television shows like CSI, NCIS, Bones, Crossing Jordan, and so on have forensics as the major theme. In the late 1970s and early 1980s, we had the show Quincy, M.E. One of the first things that happens when a person dies on television or in the movies is that forensics is called. This leads to the common misconception that ‘‘forensic’’ means death. While crime scene management and conducting autopsies for medicolegal purposes is certainly within the broad field of forensics, there are many other areas of forensics including forensic toxicology, forensic chemistry, document examination, handwriting analysis, forensic psychology, fraud examination, criminalistics (the scientific collection and examination of physical evidence as it relates to crime), forensic serology (the study of blood and other body fluids as evidence to help reconstruct a crime or accident), forensic geology, forensic photography, forensic meteorology, dactylocsopy (fingerprints), forensic dentistry, forensic engineering, forensic nursing, polygraph examination (the lie detector), forensic medicine, forensic pathology, death investigation, computer forensics, forensic audiology, forensic optometry, recorded evidence, forensic economics, accident reconstruction, forensic anthropology, and of course forensic pharmacy. Nonscientific disciplines, such as accounting, have forensic applications, that is forensic accounting. In fact, almost every profession has a forensic application. Unnatural death can involve criminal wrongdoing or civil liability. Forensics is important to death investigation. Dictionaries define forensic as ‘‘applied to law’’ or as ‘‘science applied to law.’’ Forensics is not to be confused with than atology, the study of death. A funeral director or embalmer is not a forensic specialist. An autopsy conducted in medical school for teaching purposes is not a forensic procedure. However, an autopsy conducted to determine whether a crime was committed is a forensic procedure.

Branches of Forensic Medicine

Forensic medicine is a multidisciplinary subject, drawing primarily from medicine, chemistry, and biology, but also from physics, psychology, computer science, geology, and social science. Forensic medicine covers a wide spectrum of professional interests and, in fact, deals with any aspect of

medicine which interacts with the law. There are many branches in the practice of Forensic Medicine, including forensic pathology, clinical forensic medicine, forensic toxicology, forensic serology, forensic psychiatry, and forensic anthropology.

1)Forensic Pathology

Forensic pathology deals with the study of the cause and manner of death by examination of a dead body during the medicolegal investigation of criminal law and civil law cases in some jurisdictions.

The Categories of Medicolegal Cases

  • (a) Violent deaths, i.e., unnatural deaths (homicides, suicides, unintentional injuries)

  • (b) Sudden and unexpected deaths

  • (c) Deaths with suspicion, i.e., those that may be due to violence

  • (d) Death in police custody, in prison, and correctional institutions

  • (e) Deaths without physician attendance

  • (f) Deaths related to therapeutic misadventure (medical malpractice)

The Objectives of Medicolegal Investigation

(a)To determine the cause of death (b)To determine the manner of death

(c)To determine the primary, secondary and contributory factors in the cause of death when trauma and disease are present simultaneously

(d)To estimate the time of death and injury (e)To interpret how the injury occurred and the nature of weapon used (if any) (f)To identify the deceased if unknown (g)To collect evidence from the bodies that can be used in criminal law cases

(h)To provide expert testimony from forensic pathologists in criminal and civil law cases if the case goes to trial

2)Clinical Forensic Medicine

Clinical forensic medicine refers to a branch of forensic medicine that involves an evaluation and interpretation of injuries and illness in living individuals. Clinical forensic medicine is principally concerned with the provision of forensic medical services to the living patients and medical advice

particularly in the investigation of crimes. In broad terms, a forensic pathologist generally does not deal with living individuals, and a forensic physician generally does not deal with the deceased. However, there are doctors, worldwide, who are involved in both the clinical and the pathological aspects of forensic medicine. There are many areas where both clinical and pathological aspects of forensic medicine overlap. In the United Kingdom and Australia, clinical forensic medicine is practiced by a group of doctors who are not forensic pathologists. Most of these are general practitioners, although there are now more and more members with other postgraduate qualifications. In continental Europe and China, where doctors in institutes of legal medicine are the clinical forensic practitioners, they often are also forensic pathologists. In the United States, there is no specific group of doctors providing clinical forensic medical service. Instead, forensic nurses provide direct services to individual clients who are in some way involved in the criminal justice system. Forensic nurses deal with patients who have allegedly committed or who have been convicted of a criminal offence, or are victims of an alleged crime.

Major Tasks of Clinical Forensic Medicine

(a)To conduct medical examination and assessments of victims and assailants of violence, physical abuse, and sexual assault

(b)To provide expert opinion as to the degree of injuries and illness resulted from trauma for possible liability in criminal proceedings and civil compensation

(c)To perform medical examinations and assessments of motorists who may have been driving under the influence of alcohol and/or drugs (d)To conduct assessments of work ability for the purpose of workers’ compensation (e)To assess the mental health of victims and assailants for legal and court purposes (f)To evaluate the adequacy of care and service of detained persons

3)Forensic Toxicology

Forensic toxicology is an interdisciplinary field applying the methods of analytical chemistry, pharmacology, and toxicology to the analysis and interpretation of drugs and chemicals in biological samples for legal purposes. A forensic toxicologist must work closely with forensic pathologists, considering the context of an investigation. In particular, they must consider any recorded clinical signs and symptoms, any pathological changes caused by poisonings, and any evidence collected at a crime scene that may narrow the search, such as pill bottles, powders, trace residue, and chemicals. Provided with this information and samples with which to work, the forensic toxicologist must determine which toxic substances are present, in what concentrations, and the probable effect of those chemicals on the person. The forensic toxicologist is involved not only in the analysis of body fluids and tissue for drugs and poisons, but also in the interpretation of the resulting information in a judicial context.

Toxicology is the science dealing with properties, action, toxicity, fatal dose, detection estimation of, interpretation of the result of toxicological analysis and management of Poisons.

Poison: A Poison is defined as any substance which when administered in living body through any route (Inhalation, Ingestion, surface absorption etc) will produce ill-health or death by its action which is due to its physical chemical or physiological properties. Eg: alphose, sulphuric acid, arsenic etc.

Clinical Toxicology: Deals with human diseases caused by, or associated with abnormal exposure to chemical substances.

Toxicology refers to toxins produced by living organism which are dangerous to man, eg: snake venom, fungal and bacterial toxins etc.

Chelating Agents : are the substances which act on absorbed metallic poisons. They have greater affinity for metals as compared to endogenous enzymes. The complex of agent and metal is more water soluble than metal itself, resulting in higher renal excretion of the complex. E.g.: British anti-lewisite (B.A.L., dimercaprol), E.D.T.A. (ethylene diamine-acetic acid), Penicillamine (Cuprimine),Desferroxamine etc.

Ecotoxicology: It is concerned with the toxic effects of chemical and physical agents on living organisms, especially in population and communities within defined population.

Acute poisoning is caused by an excessive single dose, or several dose of a poison taken over a short interval of time.

Chronic Poisoning is caused by smaller doses over a period of time, resulting in gradual worsening. eg:

arsenic, phosphorus, antimony and opium.

Subacute poisoning shows features of both acute and chronic poisoning.

Fulminant poisoning is produced by a massive dose. In this death occur rapidly, sometimes without preceding symptoms.

Parasuicide (attempted suicide or pseudicide) is a conscious often impulsive, manipulative act, undertaken to get rid of an intolerable situation.

Culpable Homicide: Causing death of a person by an act, with the intention of causing such bodily injury and is likely to cause death, or with the knowledge that he is likely, by such an act to cause death.

Sources of Poison:

  • 1. Domestic or household sources - In domestic environment poisoning may more commonly occur from

detergents, disinfectants, cleaning agents, antiseptics, insecticides, rodenticides etc.

  • 2. Agricultural and horticultural sources- different insecticides, pesticides, fungicides and weed killers.

  • 3. Industrial sources- In factories, where poisons are manufactured or poisons are produced as by

products.

5.

From uses as drugs and medicines Due to wrong medication, overmedication and abuse of drugs.

  • 6. Food and drink contamination in way of use of preservatives of food grains or other food material,

additives like colouring and odouring agents or other ways of accidental contamination of food and drink.

  • 7. Miscellaneous sources- snakes bite poisoning, city smoke, sewer gas poisoning etc.

Classification of poisons

  • 1. According to the site and mode of action

(A). local Action

Corrosive Strong Acid: mineral acid and organic acid Strong alkali

Metallic: Mercuric Chloride Irritant Mechanical: Glass Powder Chemical

Inorganic: weak acid, weak alkalies, Inorganic non-metals, Inorganic Metals. Organic: Chemical preparations, Animal and vegetable origin

(B) Remote Action

Neurotics

• C.N.S. Poisons

i. Somniferous: opium and its alkaloids, Barbiturates. ii. Inebriant (Intoxicant): Alcohol, ether, Chloroform. iii. Stimulant iv. Deliriant: Dhatura, Belladona, Hyocyamus, cannabia indica.

v. Stupefaciant

vi. Hallucinogens

vii. Convulsant:

• Spinal (Convulsant)

  • i. Strychnos Nux Vomica

• Peripheral Nerves

  • i. Local Anaesthetics: Cocaine, Procaine.

ii. Relaxants (curare).

Cardiac Poisons

• KCN, NaCN, Digitalis, Aconite, Nicotine, Quinine, Oleander Asphyxiants: Carbon Dioxide, CO, hydrogen sulphide Nephrotoxic: Oxalic Acid, Mercury, Cantherides Hepatotoxic: Phosphorus, Carbon tetrachloride, Chloroform. Miscellaneous: Food Poisons.

(C). Combined local and remotes action:

Classification of Poison according to motive or nature of use:

  • 1. Homicidal: Arsenic, Aconite, Digitalis, Abrus Precatorius, Strychnos nux vomica.

  • 2. Suicidal: Opium, Barbiturate, Organophosphorus, carbolic acid, copper sulphate.

  • 3. Accidental: Aspirin, organophosphorus, copper sulphate, snakes bite, Ergot, CO, CO2, H2S.

  • 4. Abortifacient: Ergot, Quinine, Calotropis, Plumbago.

  • 5. Stupefying agent: Dhatura, cannabis, chloral hybrate.

  • 6. Agents used to cause bodily injury: Corrosive acids and alkalies.

  • 7. Cattle Poison: Abrus precatorius, Calotropis, plumbago.

  • 8. Used for malingering: semicarpus anacardium

Ideal Suicidal poison: should be easily available, No bad taste, cause No pain, cheap, highly toxic, tasteless or pleasant taste, capable of being taken with food or drink. Ideal Homicidal poison: it should be cheap, easily available, colorless tasteless odourless, highly toxic, No residual product lest, S/S resembles natural diseases, No antidote, Shows no post-mortem changes capable of being administered with food or drink.

Route of Administration/absorbtion:

Oral (commonest) eg: alphos, acids,

Inhalation: gas poison

Parenteral (IM, IV, Sub-Cutaneous, Intra-Dermal)

Natural Orifices other than mouth (Nasal, Rectal, Vaginal, Urethral),Ulcers, wounds and intact skin.

Fate of poison in body: A part of the poison taken orally gets eliminated unabsorbed by means of defecation and vomiting. Before absorption the poison may exert its effects in the G.I. Tract. When absorbed, the poison reaches different parts of the body and organs through circulation. Some poisons reach some tissues easily. Others may not cross some tissue barrier. Cumulative poisons get accumulated in some organs or tissues. A part of poison is eliminated as such through different route of elimination. But major part is detoxified or metabolized in the body and than excreted after exerting its toxic effects on the body. Liver is the main organ to detoxify or metabolize most of the poisons. Certain poisons like Chloroform, Phosphorus, Nitrates and Acetic acid disappear by evaporation or oxidized or destroyed in the body and no trace of them can be detected in the body of post-mortem is delayed.

Excretion of poisons: Unabsorbed poisons are excreted through faeces and vomitus. Absorbed poisons are excreted mostly by urine. A part of volatile poison is exhaled out. Some portion of poison is excreted through bile, saliva, milk, sweat, tear, hair and nails.

Factors influencing the actions of a poison in the body:

  • 1. Quantity: A high dose of poison acts quickly and often resulting in fatal consequences. A moderate

dose causes acute poisoning. A low dose may have sub-clinical effects and causes chronic poisoning on

repeated exposure. Very large dose of Arsenic may produce death by shock without dose irritant symptoms, while smaller dose than lethal dose produces its therapeutic effects.

  • 2. Physical form: Gaseous or volatile poisons are very quickly absorbed and are thus most rapidly

effective. Liquid poisons are more rapid than solid poisons. Some poisonous vegetable seeds may pass

through the intestinal canal ineffective when taken intact due to their impermeable pericarp. But when taken crushed, they may be rapidly fatal.

  • 3. Chemical form: Chemically pure arsenic and mercury are not poisonous because these are insoluble

and are not absorbed. But white arsenic(arsenic oxide) and mercuric chloride are deadly poisonous.

Barium sulphide is deadly toxic but barium sulphate is non-toxic.

  • 4. Concentration (or dilution): concentrated form of poison are absorbed more rapidly and are also

more fatal but there are some exceptions too.

  • 5. Condition of the stomach: food content presence of food-stuff acts as diluent of the poison and

hence protects the stomach wall. Dilution also delays absorption of poison. Empty stomach absorbs poison most rapidly. In cases of achlorohydria, KCN and NaCN is ineffective due to lack of hydrochloric

acid, which is required for the conversion of KCN and NaCN to HCN before absorption.

  • 6. Route of administration: absorption rate is different for different routes.

  • 7. Age: some poisons are better tolerated in some age groups. Opium and its alkaloids are tolerated

better by elderly subjects but badly by children and infants. Belladonna group of drugs are better

tolerated by children than by adults.

8.

State of body health: A well built person with good health can tolerate the action of poison better

than a weak person.

  • 9. Presence of disease: In certain diseased conditions some drugs are tolerated exceptionally well e.g.:

sedatives and tranquilizers are tolerated in very high dose by manic and deliriant patients.

  • 10. Intoxication arid poisoning states : In certain poisoning cases some drugs are well tolerated, like, in

case of strychnine poisoning, barbiturates and sedatives are better tolerated. Whereas in case of

barbiturate poisoning any sedative or tranquilizer will accentuate the process of death.

  • 11. Sleep : Due to slow metabolic process and depression of other body functions during sleep, usually

the absorption and action of the poison is also slow. But depressant drugs may cause, more harm during

the state of sleep.

  • 12. Exercise : Action of alcohol on C.N.S. is slowed during exercise because more blood is drawn to the

muscles during exercise.

  • 13. Cumulative action of poisons: Preparations of cumulative poisons (poisons which are not readily

excreted from the body and are retained in different organs of the body for a long time) like lead may not cause any toxic effect when enters the body in low dose. But when such poisons enter over a long period of time, may cause harm when their concentration in different tissue reaches high level due to

their cumulative property.

  • 14. Tolerance may develop by individuals on long term exposue to a particular poison.

  • 15. Idiosyncracy: some persons may react adversely to a particular drug though the general population

tolerates the drug well.

Signs and symptoms:

The signs and symptoms may be different for different poisons and is responsible on the nature and action of the poison. They can be local, remote or combined and are will be taught in the individual poisons.

Diagnosis of poisoning

In the Living

  • 1. History of the case as stated by the patient himself and his/her relatives or friend. Full information

about time of onset of the present illness, Initial symptoms, progress, relation with food, condition of other persons taking same food or drink, possible source, any previous history of poisoning, H/o

depression, quarrel. Also note down the color, smell, consistency, taste and quantity of the possible poisonous substance.

3.

Details of examination.

  • 4. Preservation and laboratory investigation of vomitus, excreta, stomach wash, scraps from any stains

area on the body, blood, stained part of the clothes, contents of a doubtful container, left over ant part of food or drink.

In the Dead:

  • 1. History of the case as stated by police or relatives. H/o 2 or more vital points (1 how long the victim

survived after initial symptoms. 2. anytreatment).

  • 2. Post-mortem Examination (external and internal)

  • 3. Chemical Analysis: detection of poison in the body fluids.

  • 4. Preservation of viscera and other material for lab. Examination.

Postmortem Findings in Case Of Death Due To Suspected Poisoning

External Examination

  • 1. Postmortem staining: Deep blue - In case of asphyxiant poisons and aniline. Bright red or cherry red -

In case of CO and HCN poisoning.

  • 2. Deep cyanosis - With opium and cardiac poisons.

  • 3. Early rigor mortis - With strychnine.

  • 4. Early appearance of the sign of decomposition - With H2S gas.

  • 5. Detectable smell - In case of volatile poisons, opium and HCN, KCN or NaCN.

  • 6. Haemorrhagic spots under the skin and mucus membrane:

Phosphorus.

.

  • 7. Ulceration on lips and near the angles of mouth - Corrosive poisons.

  • 8. Stain near mouth and on hands - Nitric acid and copper sulphate.

  • 9. White froth from mouth and nose Opium and its

alkaloids.

.

  • 10. Blood tinged froth from mouth and nose Organophosphorus compounds.

  • 11. Alopecia, hyperpigmentation and hyperkeratosis - Arsenic poisoning over a long period.

  • 12. Staining, erosion and ulceration near the female external genitalia - Use of abortifacient agents or

torturing agents.

Internal findings: The G.I.T. should be examined very carefully since signs of corrosive or irritant poisons are likely to be find therein. These signs are Hyperemia, softening, ulceration and perforation. Apart from this below given is a brief note of internal finding in cases of poisoning.

  • 1. Corrosion, ulceration and desquamation of inner aspects of lips, mucus membrane of mouth and

tongue - Corrosive agents.

  • 2. Soft, swollen, sodden, translucent, bleached tongue and mucus membrane of mouth-Corrosive alkali

  • 3. Hardening of mucus membrane - Phenol

  • 4. Phenol Yellowish discoloration - Nitric acid

  • 5. Bluish discolouration - Copper sulphate

  • 6. Carbonization and charring- Conc. Sulphuric acid

  • 7. Chalky appearance and consistency of teeth -:Sulphuric acid

  • 8. Blue lining in the gum - Chronic lead poisoning

  • 9. Swollen gum, loose teeth, foetid smell - Acute mercuric chloride poisoning; chronic phosphorus

poisoning

  • 10. Corrosion, irritation, desquamation and haemorrhage in the inner wall of the esophagus - Corrosive

and irritant poisons

  • 11. Hardening and whitish discolouration In case of Carbolic acid poisoning

  • 12. Discoloration and staining of inner aspects of mouth - With coloured poisons

  • 13. Oesophageal stricture - A complication of sulphuric acid ingestion

  • 14. Stomach

    • (a) Thickening and softening of the wall -Corrosive and irritant poisons

    • (b) Hard wall- Carbolic acid

    • (c) - Hard and leathery wall- Formaldehyde

    • (d) Hyperemia haemorrhageand desquamation of mucus membrane Irritant poison

    • (e) Laceration and sloughing Corrosive poison

    • (f) Perforation - H2SO4 and HN3

    • (g) Yellowish discolouration of mucus membrane - HNO3; Bluish - CuSO4; Slaty grey - HgCl3 .

(h) Stomach content - Blood - Corrosive and irritant; Yellowish HNO3 Bluish - CuSO4 Luminous in dark - Phosphorus; Detectable tablet - soneryl; Powder oxalic acid, white arsenic; Detectable smell - kerosene, alcohol, chloroform, organophosphorus compounds, chlorinated hydrocarbons, opium, cyanogen, formaldehyde, phosphorus; Detectable liquid - kerosene.

  • 15. Small intestine - May show irruption, sometimes may show presence of poisonous remains.

  • 16. Large intestine - May show ulcerations, as in case of HgCI3 similar in appearance of ulcers of bacillary

dysentery. It particularly involves the ascending and transverse colons.

  • 17. Liver - Different degenerative changes occur in cases of poisoning with poisons like phosphorus,

carbon tetra-chloride, chloroform, tetrachlorethylene and many other poisons. The type and extent of the degenerative changes occur depending on the type of poison, dose, duration of the exposure and

physical condition of the patient.

  • 18. Kidneys - Swollen, reddish, soft, sometime greasy in touch with haemorrhage in calyces and other

degenerative changes - cases of poisoning with mercury, oxalic ad carbolic acid, phosphorus, antherides, viper snake venom and many others. In case oxalic acid poisoning, white powder of oxalate

crystals are present in the tubules and the calyces .

  • 19. Urinary bladder - Haemorrhage in cases of abrus precatorius, viper snake bite eg, cantheride

poisoning.

  • 20. Larynx and trachea - Hyperaemic, inflamed -In cases of inhalation of irritating gases leaking of

corrosive agents while ingestion vomiting; froth in the lumen of trachea and larynx in case of opium and

organo:phosphorus poisoning.

  • 21. Chest cavity -Smell of volatile poisons cyanogen, opium etc. can be detected.

  • 22. Lungs - Voluminous, congested, presence of Tardieu's spots - In case of asphyxiants and inhaled

poisons. Cut section gives blood stained frothy-fluid in case of opium and other asphyxiants.

  • 23. Heart- Presence of subendocardial haemorrhagic spots in cases of arsenic, phosphorus, mercuric

chloride etc.

  • 24. Brain and spinal cord - Congestion and edema of brain and spinal cord in cases of cerebral and spinal

poison (e.g. strychnine: respectively. Brain may be congested. oedematous with occasional

haemarrhagic points at places in cases of asphyxiant poisons.

  • 25. Uterus and vagina - Staining, congestion haemorthage, ulceration in cases of attempted abortion by

use of local abortifacient agents.

Preservation of viscera and other materials

In all cases of poisoning

1. Stomach with its full contents.

2.

Half of Liver or 500 gms whichever is more.

  • 3. A loop of small intestine.

  • 4. Half of each kidney.

  • 5. Some portion of spleen

In some particular poisons

  • 1. Blood 100ml: in cases of absorbed poisons.

  • 2. Urine 100ml in all cases where blood is preserved.

  • 3. Part of both lungs in cases of Volatile poisons.

  • 4. Heart in case of cardiac poisons.

  • 5. Brain in cerebral poisons.

  • 6. Spinal in spinal poisons.

  • 7. Bones in arsenic and lead.

  • 8. Hair in arsenic and copper.

  • 9. Nails in arsenic.

    • 10. Skin-scrap from areas stained with a suspected poison.

    • 11. Stained areas of dress, suspected packet of poision, strips of tablets recovered from pocket.

Preservative used

For Viscera: absolute alcohol or rectified spirit. Exception: alcohol, chloroform, chloral hydrate, formaldehyde, ether, phosphorus (alcohol prevents the luminosity of phosphorus in dark) etc.

Blood should be preserved in fluoride, oxalate, E.D.T.A., gold chloride or citrate Urine and clothes:

without any preservative.

Management of a case of poisoning

Immediate resuscitative (Basic Management) measures in comatose patient should be adopted to stabilize respiration, circulation and the correct CNS depression.

A) Airway: opening up and cleaning the airways (oral cavity, Nostrils) of secretions, vomit or any foreign body. Pull tongue forward

B) Breathing: Supplemental oxygen therapy should be administered

C) Circulation: I.V. fluid administration

D) Depression of CNS should be corrected

Specific Management

  • 1. Removal of patient from source of exposure: Patient should be removed away from the source of

poison as quickly as possible.

  • 2. Removal of the unabsorbed poison. In case of contact poison washing of affected area with soap

water with gentle rubbing will be helpful. In cases of ingested poisons Gastric lavage is useful within 3 hours of ingestion and is done by stomach tube( Ewald or Boas tube) or by Ryle’s tube followed by emesis (physical or by drugs like Ipecacuanha 1-2 gm, mustard oil 1 Tsf in a glass of water, concentrated salt solution 6%, Zinc Sulfate 1-2gm in water, apomorphine hcl 1-2ml o 3 mg /ml). In case of injected poison ligature is applied above the wound. In cases of inhaled poison the patient should be

immediately removed to fresh air.

  • 3. Diluting the poison and delaying the absorption by water or food.

  • 4. Elimination of absorbed poison by increases urination (diuresis), increased perspiration (diaphoresis),

Dialysis, use of chelating agents.

  • 5. Use of specific antidote

  • 6. Symptomatic treatment including safeguarding respiration and maintenance of circulation.

Counterindications of gastric lavage with stomach tube:

  • 1. In corrosive poisons.

  • 2. Convulsant poisons.

  • 3. Unconscious or semi-conscious patients

  • 4. In infants and children: Ryle’s tube or infant feeding tube is used.

Antidote: Antidotes are substances which counteract the effect of poison. They are divided into Mechanical, Chemical, Physiological and specific receptor antagonists.

Physical or mechanical antidote prevents the action of poison mechanically, without destroying or inactivating the damaging actions of the poisons. Eg: adsorbents like activated charcoal, Demulcents like egg albumin, starch or milk, Diluents like water or milk, bulky food like boiled rice or vegetables.

Chemical antidotes are substances which disintegrate and inactivate poisons by undergoing chemical reaction with them. Eg: Weak acids and alkali, common salt, egg albumin, KMNO4. Physiological antidote have their own action producing signs and symptoms opposite to that produced by the poison. Eg: Naloxone for morphine, Neostigmine for datura or hyoscin group, Barbiturate for strychnine.

Serological Antidote: Anti-snake venom serum for snake bites poisoning.

Universal Antidote: It is a combination of physical and chemical antidotes. When the exact nature of poison is not known then universal antidote is used which acts against a wide range of poisons.

Constituents

Activated charcoal

2 parts

Magnesium oxide

1 part

Tannic acid

1 part

Dose

1TSF (15gms) in a glass water (can be repeated)

Activated charcoal for its adsorbent action, Magnesium oxide neutralizes acids poisons, tannic acid precipitates alkaloids.

Household antidotes:

  • 1. Strong liquid tea (contains tannic acid) precipitate alkaloid and metallic poisons.

  • 2. Starch for iodine.

  • 3. Milk and raw egg for mercury, arsenic, heavy metal.

  • 4. Flour suspension and mashed potatoes can be used in place of activated charcoal.

  • 5. Milk of magnesia or soap solution for acid poisoning.

  • 6. Orange, lemon juice or vinegar for alkali poisoning.

Chelating agents: are the substances which act on absorbed metallic poisons. They have greater affinity for metals as compared to endogenous enzymes. The complex of agent and metal is more water soluble than metal itself, resulting in higher renal excretion of the complex. Eg: British anti-lewisite (B.A.L., dimercaprol), E.D.T.A. (ethylene diamine acetic acid), Penicillamine (Cuprimine), Desferroxamine etc.

B.A.L. (British Anti-Lewisite, 2-3 dimercaptopropanol) has 2 unsaturated SH radicals which combines with metal in circulation , thus tissue enzymes are spared. Usefuls in cases of Arsenic, mercury, copper, bismuth, gold etc Dose: 3-4 mg/kg BW as a preparation of 10% with 20% Benzyl benzoate in arachis oil given deep intra-muscular (may cause embolism on I.V. inj.)4 hourly fo0r first 2 days followed by twice daily for 10 days E.D.T.A. (Ethylene diamine tetra-acetic acid) it combines with sodium to form sodium salt and then with calcium to form disodium calcium edentate which combines with free metal and inactivates it biologically. It is best chelate for lead. Dose for adults 1gm twice daily at 12 hour interval slow I.V. Injection mixed with 5% glucose saline.

Penicillamine: It has stable SH radical which combines with free metal. Dose 30mg/Kg BW/Day in 4 divide doses for 7 days.

Desferrioxamine: It is specific antidote for iron. Dose 8-12 gm orally. For absorbed iron 2gm I.V. with 50% laevulose solution.

Duties of a Registered Medical Practitioner in connection with poisoning cases :

  • (a) Try to save the life of the patient and give emergency necessary treatment.

  • (b) If necessary, the patient should be sent to a better hospital, if possible a government hospital, if the

condition of the patients demands and permits the shift.

  • (c) To take a detailed history of the case as to when and how the symptoms started what is the progress;

whether related to taking of any food or drink ; whether the number of sufferer is more than one

whether any treatment was already given and whether there is any history of previous poisoning.

  • (d) The doctor should himself record full history of the case, the signs and symptoms and progress.

  • (e) The doctor should collect and preserve the vomitus, stool, urine, clothes stained with poison or

vomitus, doubtful container with remaining part of the poison, if any, and if necessary blood, for

laboratory investigations.

  • (f) The doctor should arrange for a reliable attendant of his own choice, for _ patient.

  • (g) The doctor should. inform the police station of the area about the case irrespective of whether the

patient survives or dies and whether it appears to be a case of suicide or homicide or accident.

  • (h) If death is apprehended then arrangement for recording dying declaration should be made.

  • (i) In case of death, death certificate should mention about the poisoning or suspected poisoning with

recommendation for post-mortem examination.

Forensic Serology

Forensic serology, also known as Science of Forensic Material Evidence or Forensic Physical Evidence, is the application of biology to law enforcement. The forensic biology deals with the study of serological and DNA analyses of bodily (physiological) fluids for the purpose of identification and individualization. The type of material typically examined includes, but is not limited to blood, semen, saliva, and dental pulp from victims and assailants collected at crime scenes and from articles of physical evidence. These types of physiological fluids are frequently generated during the commission of violent crimes such as homicides, rapes, assaults, and hit and run motor vehicle fatalities. The ultimate goal is to identify what type of material is present and then, through the use of DNA analysis, link that material to a specific person. Paternity tests usually are also performed by forensics serologists.

Forensic Psychiatry

Forensic psychiatry involves both psychology and psychiatry science in relation to the law and legal system. It studies, evaluates, and identifies mentally-related illnesses and human behavior to obtain legal evidence.Forensic psychiatrists are frequently required to do behavioral and psychological evaluations of criminals, victims of crime, and individuals involved in major disasters. Forensic psychiatrists consult and testify regarding competency, sentencing recommendations, treatment recommendations, and assessment of future risk of criminals. They may write reports on criminal responsibility, criminal profiles, and exaggerated or faked symptoms of criminals and non-criminals. Forensic psychiatry experts may also testify on criminal evaluations, malingering, feigned symptoms, forensic assessment, personality disorders, settled insanity, mental status, mental capacity, wrongful commitment, and inadequate informed consent.

Forensic Anthropology

Forensic anthropology is the application of the science of physical anthropology and human osteology (the study of the human skeleton) in criminal cases where the victim's remains are decomposed, burned, mutilated, or otherwise unrecognizable. Forensic anthropologists can assist in the recovery of remains, assess age, race, sex, stature, ancestry, and analyze trauma and disease of human remains of crime and natural disasters. Forensic anthropologists frequently work in conjunction with forensic pathologists, forensic odontologists, and homicide investigators to identify a decedent. They also assist in discovering evidence of trauma and determining the postmortem interval.

Role of Pharmacist in Forensic science

With training in pharmacology, a pharmacologist has an expert knowledge as well as working experience in the subjects of therapeutics, pharmacokinetics, and toxicology along with exposure to subjects such as forensic medicine during the medical education. All these knowledge domains can be applied and act as an interface to the forensic situations. The skills and expertise of a forensic pharmacologist can be useful in a large and diverse number of legal cases. With an ever increasing incidence of criminal and civil cases in India, the development and inclusion of forensic pharmacologist in the judicial system of India are the need of the hour. The research in pharmacology has witnessed great technological advancement that allows it to expand its scope beyond the domain of therapeutics, thus enabling Indian pharmacologists to explore the niche area of Forensic Pharmacology. Differing pharmacokinetics and pharmacodynamics of drugs in living and dead, drug interactions, abuse of drugs, personal injury or death due to drug exposure leading to medico-legal issues, environmental exposure to chemicals, and doping and forensic pharmacovigilance are the diverse aspects of Forensic Pharmacology.

In many countries, forensic pharmacologists have been a valuable resource in different criminal and civil cases. They apply their knowledge of pharmacology to civil/legal issues such as resolving litigations, drug regulatory process, and the criminal justice system.

It has been proven through different research studies and case studies that comprehensive investigation plays an unflinching role in the determination of the cause of death in crime scenes with positive drug screens. Even the general public is aware of the role of forensic sciences in the legal system of justice.

With increased exposure to the work of the forensic scientists, there has been an increased enrollment in criminal justice system and forensic science courses in schools and colleges in countries like United States of America and Australia. Forensic sciences encompasses the broader application of different branches of science to legal matters. The domain of Forensic Pharmacology focuses on the knowledge of action and interaction of different chemicals in the living beings and its application to legal matters.

Forensic Pharmacology answers the questions of association of chemicals with an individual's behavior, illness, injury, or death. It can be described as the interpretation of the effects of drugs and their duration of action with the purpose of facilitating a medico-legal process.

The pharmacologist conducts an analysis of the body fluids and tissues and interprets the chemical data to help the attorneys in assessing the role of a drug or specific chemical in the behavior, illness, injury, or death of an individual. The forensic pharmacologist can be of great help in both criminal and civil cases. The exact role of a pharmacologist in forensic sciences is to analyze, assess, review, and support the attorney's position. He may be asked to provide a written report if his review positively supports the attorney's case. In the case of a trial, the forensic pharmacologist may be needed to testify and clearly explain the findings in the court. The role of a forensic pharmacologist also involves helping the attorney in preparing a cross-examination of the expert on the opposite side.

Fingerprints

Sir William Herschel was one of the first to advocate the use of fingerprinting in the identification of criminal suspects. While working for the Indian Civil Service, he began to use thumbprints on documents as a security measure to prevent the then-rampant repudiation of signatures in 1858.In 1877 at Hooghly (near Kolkata), Herschel instituted the use of fingerprints on contracts and deeds, and he registered government pensioners' fingerprints to prevent the collection of money by relatives after a pensioner's death.

In 1880, Dr. Henry Faulds, a Scottish surgeon in a Tokyo hospital, published his first paper on the subject in the scientific journal Nature, discussing the usefulness of fingerprints for identification and proposing a method to record them with printing ink. He established their first classification and was also the first to identify fingerprints left on a vial. Returning to the UK in 1886, he offered the concept to the Metropolitan Police in London, but it was dismissed at that time.

With increased exposure to the work of the forensic scientists, there has been an increased enrollment

Faulds wrote to Charles Darwin with a description of his method, but, too old and ill to work on it, Darwin gave the information to his cousin, Francis Galton, who was interested in anthropology. Having been thus inspired to study fingerprints for ten years, Galton published a detailed statistical model of fingerprint analysis and identification and encouraged its use in forensic science in his book Finger Prints. He had calculated that the chance of a "false positive" (two different individuals having the same fingerprints) was about 1 in 64 billion.Women clerical employees of the LA Police Department getting fingerprinted and photographed in 1928.

Juan Vucetich, an Argentine chief police officer, created the first method of recording the fingerprints of individuals on file. In 1892, after studying Galton's pattern types, Vucetich set up the world's first fingerprint bureau. In that same year, Francisca Rojas of Necochea was found in a house with neck injuries whilst her two sons were found dead with their throats cut. Rojas accused a neighbour, but despite brutal interrogation, this neighbour would not confess to the crimes. Inspector Alvarez, a colleague of Vucetich, went to the scene and found a bloody thumb mark on a door. When it was compared with Rojas' prints, it was found to be identical with her right thumb. She then confessed to the murder of her sons.

A Fingerprint Bureau was established in Calcutta (Kolkata), India, in 1897, after the Council of the Governor General approved a committee report that fingerprints should be used for the classification of criminal records. Working in the Calcutta Anthropometric Bureau, before it became the Fingerprint Bureau, were Azizul Haque and Hem Chandra Bose. Haque and Bose were Indian fingerprint experts who have been credited with the primary development of a fingerprint classification system eventually named after their supervisor, Sir Edward Richard Henry. The Henry Classification System, co-devised by Haque and Bose, was accepted in England and Wales when the first United Kingdom Fingerprint Bureau was founded in Scotland Yard, the Metropolitan Police headquarters, London, in 1901. Sir Edward Richard Henry subsequently achieved improvements in dactyloscopy.In the United States, Dr. Henry P. DeForrest used fingerprinting in the New York Civil Service in 1902, and by December 1905, New York City Police Department Deputy Commissioner Joseph A. Faurot, an expert in the Bertillon system and a fingerprint advocate at Police Headquarters, introduced the fingerprinting of criminals to the United States.

Uhlenhuth Test

The Uhlenhuth test, or the antigenantibody precipitin test for species, was invented by Paul Uhlenhuth in 1901 and could distinguish human blood from animal blood, based on the discovery that the blood of different species had one or more characteristic proteins. The test represented a major breakthrough and came to have tremendous importance in forensic science. The test was further refined for forensic use by the Swiss chemist Maurice Müller in the 1960s.

DNA

Forensic DNA analysis was first used in 1984. It was developed by Sir Alec Jefferys, who realized that variation in the genetic code could be used to identify individuals and to tell individuals apart from one another. The first application of DNA profiles was used by Jefferys in a double murder mystery in a small England town called Narborough, Leicestershire in 1985. A 15-year-old school girl by the name of Lynda Mann was raped and murdered in Carlton Hayes psychiatric hospital. The police did not find a suspect but were able to obtain a semen sample.

In 1986, Dawn Ashworth, 15 years old, was also raped and strangled in a nearby village of Enderby. Forensic evidence showed that both killers had the same blood type. Richard Buckland became the suspect because he worked at Carlton Hayes psychiatric hospital, had been spotted near Dawn Ashworth's murder scene and knew unreleased details about the body. He later confessed to Dawn's murder but not Lynda's. Jefferys was brought into the case to analyze the semen samples. He concluded that there was no match between the samples and Buckland, who became the first person to be exonerated using DNA. Jefferys confirmed that the DNA profiles were identical for the two murder semen samples. To find the perpetrator, DNA samples from the entire male population, more than 4,000 aged from 17 to 34, of the town were collected. They all were compared to semen samples from the crime. A friend of Colin Pitchfork was heard saying that he had given his sample to the police claiming to be Colin. Colin Pitchfork was arrested in 1987 and it was found that his DNA profile matched the semen samples from the murder.Because of this case, DNA databases were developed. There is the national (FBI) and international databases as well as the European countries (ENFSI : European Network of Forensic Science Institutes). These searchable databases are used to match crime scene DNA profiles to those already in a database.

Forensic Pharmacologist and Toxicologist

Many a time, a forensic pharmacologist and forensic toxicologist are considered to be the same. The forensic toxicologist is also involved in drug testing and in testifying for the attorney in criminal cases, but a forensic pharmacologist is engaged in forensics in a much broader way. His area of expertise includes a much broader range of cases such as adverse drug reactions to medicines, overdose of medicines, drug interactions, and personal injury resulting from an exposure to medicines, effects from drug abuse or industrial chemicals, and induction of cancer by chemicals.

Forensic Pharmacology: Need of the Hour

Forensic Pharmacology is not a new subspecialty. The only thing new about it is probably the use of the

terminology “Forensic Pharmacology” to define a subspecialty of pharmacology that focuses on the legal

application of the knowledge that a pharmacologist already possesses. And thus, such subspecialty needs recognition among the Indian pharmacologists.

Toxicology is concerned with the deleterious effects of the drugs and chemical agents on all living systems. Toxicology is included as a part of forensic medicine for medical curriculum in India. It is defined as the science that involves detection of drugs and poisons in biological specimens and its application for medico-legal purposes. However, it is much different from the interpretation of effects, use or abuse of drugs, and its duration of action for the medico-legal process which is referred to as

Forensic Pharmacology. A fine line differentiates “Forensic Pharmacology” from “toxicology.” Some textbooks use term such as “pharmacological toxicology” for assessing the toxicity of therapeutic agents (drugs). Forensic Pharmacology is included as a part of forensic medicine, which discusses toxicities from the drugs in common therapeutic use, commonly abused drugs, drugs having no medicinal value and

“street” or “designer drugs.”

An important and extensively studied branch of pharmacy curriculum in India is “Forensic Pharmacy” or “Pharmaceutical Jurisprudence,” which deals with various laws pertaining to drugs and pharmaceuticals

and profession of pharmacy. It includes the knowledge of various acts, rules, and schedules which directly or indirectly influence various operations pertaining to procurement, manufacture, and distribution of drugs. The knowledge of Forensic Pharmacy is essential to understand the legal aspects pertaining to practice of pharmacy. The forensic pharmacist is required to profess and should also be engaged in manufacturing, sale, and distribution of drugs. Similarly, Forensic Pharmacology guides us to investigate whether a drug or a chemical was related to an individual's behavior, illness, injury, or death.

With continued new drug developments, there are multiple new drugs hitting the markets every year. Few of them are new molecules in the market and claim to contain “nonillegal” compounds although they may exhibit important psychoactive effects. Such drugs are called as “smart drugs.” Also, in addition to new drugs or chemicals, new ways to abuse existing drugs are found, for example, scopolamine has become a drug of abuse for recreational and predatory purposes.[13] Thus, the forensic pharmacologists need to keep themselves updated with the knowledge of new legal and illegal drugs, their pharmacological or toxicological effects and also guide the community and regulatory authorities regarding the possible abuse of such drugs or chemicals to commit the crimes.

Application of the biotechnological advances to pharmacology and toxicology has widely extended our understanding and overall scope of these subjects. Similarly, advances in analytical techniques have made detection of drugs and chemicals much easier which can help resolving medico-legal cases with the guidance from experts such as a forensic pharmacologist. Some drugs can even alter the neurotransmitters and hence lead to a poor impulse control and subsequent aggression in behavior. The role of a forensic pharmacologist becomes significant in this case because he/she is needed to testify the truth of these claims. He/she has to observe, assess, and analyze the violent behavior and use of the drug and determine the likelihood of the relation of impulsive behavior to the drug use.

Pharmacology is evolving as a subject, and Indian pharmacologists need to look at different aspects of pharmacology beyond therapeutics. Forensic Pharmacology offers a unique opportunity to expand the existing knowledge of the drugs, their mechanisms, actions, and its medico-legal impacts. It adds additional dimension to forensic medicine and provides a scope for further research.

The Science of “Drugs and Forensics”

Forensics as a science and profession is considered to be important for the investigation of illness, injury, or deaths. It is defined as the application of the sciences of drugs to the application of legal code

of conduct. The pharmacologist as an expert in the science of drugs and is involved in the clinical, distributive, and administrative aspect of pharmacy.

Scope of Forensic Pharmacology

There are many criminal and civil cases involving the use of drugs and other chemicals which come under the forensic law. The forensic pharmacologist needs a specific recognition in his profession because of the highly specific nature of his expertise, skill, and work. Various scenarios where the expertise of a forensic pharmacologist can be useful include:

Drug abuse

A national survey conducted by the Indian Ministry of Social Justice and Empowerment in 2004 has brought forth the fact that drug abuse was quite commonly seen among Indian males aged 1260 years. The most common abuse was in the use of tobacco (55.8%), alcohol (21.4%), cannabis (3.0%), opiate (0.7%), and sedatives (0.1%).

In criminal courts, crimes which are committed by the individuals under the influence of a drug or medication are one of the most frequently reported ones. These crimes could be the results of the effect of medicine resulting in a change in the behavior or thought process of the person. Forensic

Pharmacology deals with the study of “drugs of abuse”, examples of which are cannabinoids, central

nervous system (CNS) stimulants such as cocaine, heroin, marijuana, tobacco, and amphetamine-related drugs, CNS depressants such as alcohol, benzodiazepines, and opioids, hallucinogens such as lysergic acid diethylamide, mescaline, and phencyclidine, dissociative anesthetics such as ketamine, inhalants such as chloroform and anabolic steroids. Such drugs are often involved in criminal and civil matters concerning personal injury, motor vehicle accidents, drug overdose, and murder. Also, their actions and

addiction liability has profound medico-legal implications.

Sports medicine and doping

The identification of androgens as ergogenic or performance enhancing agents dates back to the 1930's. Commonly used ergogenic drugs include anabolic steroids, narcotic analgesics, diuretics, beta blockers, growth hormone, oral peptide hormones, amphetamines, caffeine, cocaine, sympathomimetic agents, and erythropoietin. Several sportsperson have been found guilty of using such ergogenic agents to enhance their performance in sports. World Anti-Doping Agency has stringent guidelines on the use of ergogenic drugs. National Anti-Doping Agency is the national organization responsible for promoting,

coordinating, and monitoring the doping control program in sports with a vision of “dope free” sport in

India. A forensic pharmacologist can help in achieving this vision with the better use of analytical methods to detect the doping and can also help in avoiding accidental use of ergogenic drugs by athletes. Additionally, they can also advise on the drug interactions and use of drugs for therapeutic purposes in athletes.

Blood levels

The forensic pharmacologist can assess and analyze the blood samples of a person to determine high and borderline doses, signs of toxicity, lack of therapeutic effect, or a suspected case of poor adherence. A pharmacologist is well-versed to detect alterations in postmortem and ante-mortem blood levels. The pharmacologist can also closely monitor the narrow therapeutic range of different drugs such as digoxin, lithium, or theophylline.

Drugs, alcohol, and driving

Forensic pharmacologist is armed with the knowledge of pharmacokinetics, pharmacodynamics, drug interactions, and adverse reactions. He is the most well-suited to analyze the data collected and make an informed decision in favor of or against his attorney's case. The forensic pharmacologist can interpret the concentration of alcohol in blood and its typical effects. Pharmacokinetics is employed to measure the blood level of alcohol at the time of the alleged crime. Drug interactions, synergistic or antagonistic effect of different drugs on alcohol absorption or metabolism, and the disease state present in the individual can be easily assessed by the forensic pharmacologist and provide a great help to the medico- legal and judicial system.

Criminal cases

Forensic pharmacologists play an important role in a wide range of criminal cases. There are many cases where a forensic pharmacologist can provide a testimonial such as use of drug or poison as a weapon, mental impairment caused due to the effect of a medication, or the use of a specific drug as the reason for criminal aggression. Drug use and their effect on the victim form a major reason for a large number of criminal events. Drugs are frequently used in suicide attempts and as a tool of homicide or sexual assault. The most commonly used date drugs are flunitrazepam, alcohol, gamma-hydroxybutyrate, and ketamine.

Forensic pharmacovigilance

Commonly encountered problems with the use of medication in clinical practice are adverse drug reactions, drug interactions, systematic medical errors in use, unexpected failures of effectiveness, or quality problems by users. Considering the patient safety, such problems should be reported and scrutinized in detail.

Pharmacovigilance is the well-known science related to the adverse effects or any other drug-related problems.[30,31] It helps in improving patient safety in therapeutics by detection, warning, management, and advice which can reduce the harm and benefit in practice. Pharmacovigilance can also be used as an important medical discipline in forensic cases in a variety of ways, e.g., establishing the effects of the drugs leading to crime, e.g., could this drug (or chemical) have caused this harmful effect in the person and did it really cause the effect either (criminal case)? Any injury or death in the form of adverse drug reactions that are caused by counterfeit, contamination, adulteration, or other substandard medicinal products which is identified by application of standard pharmacovigilance procedure is termed as “forensic pharmacovigilance” and it forms an integral part of Forensic Pharmacology.

In context of civil cases, Forensic Pharmacovigilance can play an important role when some previously unsuspected class effect emerges when the drug is available in public domain after licensing, as compared to the use in restricted group who took part in its clinical trials. The teratogenicity with Thalidomide is the classic example. Recently, there were concerns of bladder cancer with use of anti- diabetic medication Pioglitazone, and it was banned in India for a brief period. It differs from Pharmacovigilance as it considers the medico-legal implications as well.

Off-label drug use

Forensic pharmacologist also plays a significant role in civil cases which involve review of insurance claims. Forensic pharmacologist can review the use of “off-label” use of a drug and enable the initiation of a malpractice law suit. The forensic pharmacologist can testify about the appropriateness and urgency of the unlabeled use of a drug.

Environmental toxicology and ecotoxicology

Due to increased urbanization and industrialization, we currently inhale, ingest, or absorb several different chemicals, which at certain dosage or durations of time can lead to subsequent morbidities or mortalities. Dr. Dewan highlighted the importance of teaching regarding prevention, monitoring, evaluation, diagnosis, and treatment of toxic exposures including intentional, unintentional, occupational, and environmental exposures. A forensic pharmacologist can play an important role in spreading the awareness about evaluation, diagnosis, treatment, and prevention of toxic exposures and also help in resolving the medico-legal issues surrounding it.

Career Path of a Forensic Pharmacologist

The forensic pharmacologist should be able to isolate, identify and quantify drugs, and chemicals in biological materials. Also, the forensic expert is also expected to be trained in following court decorum and remaining unaffected by the witness stand. He should also have excellent communication skills. A forensic pharmacologist who has to testify should be an expert in all drug-related topics which may include:

Prescription or dispensation of the wrong drug

Use of counterfeit drugs

Incorrect storage of drugs

Incorrect calculation of dosage

Administration of a wrong dose

Harmful drug interactions

Adverse events related to drug use

Adverse drug reactions.

It can be said that the forensic pharmacologist will review a case akin to a clinical pharmacologist or assess an administrative problem or a clinical challenge but with his focus on the specific legal issue

involved. A forensic pharmacologist can be a part-time forensic scientist or do a regular job in the domain of forensic practices.

Services Provided by Forensic Pharmacologist

The services provided by a forensic pharmacologist can be classified as administrative, clinical evaluation, and distributive. The administrative role includes employment testing, patents, or scientific fraud. Clinical evaluations involve the inappropriate use of chemical agents, adverse drug reactions, date rape drugs, drugged and drunk driving, drug-induced violence, drug interactions, impaired capacity, medication errors, poisoning, or substance abuse. The distributive role of a forensic pharmacologist is related to adulteration or contamination of drugs and use of counterfeit drugs.

Conclusions

In cases where validation cannot be made between the uses of a drug with a specific associated outcome, it becomes difficult for a judiciary to offer radical explanation. In such cases, a forensic pharmacologist can make a useful contribution by utilizing his or her knowledge of drug-related problems and pharmacology to provide relevant results and data which is helpful in assisting the legal system to take the right decision. Medical education in India needs to focus on developing Forensic Pharmacology as a subspecialty.

Pharmacists have training in therapeutics, chemistry, pharmacology, pharmacokinetics, and toxicology. All of these areas can be applied to a variety of forensic situations. The skills of pharmacists can be useful in legal cases involving malpractice, personal injury, drunk and drugged driving, fraud, criminal poisoning, date rape, and worker’s compensation.