Systemic Dissemination of Injected Foreign Material

A 32‐year‐old woman collapsed following an intravenous injection of material that included crushed pharmaceutical tablets. Resuscitation was attempted but was unsuccessful. She had an extensive past medical history of complications resulting from intravenous drug use. Death was due to mixed drug toxicity. The major findings at autopsy included a 10 mm deep skin sinus over the right femoral vein that was used as an injection site. Polarizable foreign material was present at the injection site and also within the lungs with a granulomatous reaction. Of note, a probe‐patent foramen ovale had permitted paradoxical embolization of this material into the systemic circulation with lodgement within the liver, portal lymph nodes, myocardium, spleen, kidneys, and pancreas. This case highlights the importance of checking for any intracardiac shunts, which may be quite small, and systemic dissemination of foreign material to multiple organs in intravenous drug users who present for medicolegal assessment.     

Enantiomeric Identification of Pregabalin by GC‐MS via Methylation and S‐TPC Chiral Derivatization

Pregabalin is a Schedule V controlled substance which is defined as the (S) enantiomer of 3‐(aminomethyl)‐5‐methylhexanoic acid. It is used legitimately to treat neuropathy in patients with diabetes as well as for epilepsy and fibromyalgia. Pregabalin is an amino acid and an amphoteric compound, which makes it difficult to analyze using the conventional GC‐MS instrumentation found in most forensic drug analysis laboratories. Problems associated with the traditional GC‐MS analysis of pregabalin include selective solubility, ring closure to the corresponding lactam in the GC injection port and/or the MS transfer line and difficulty with chiral derivatization due to the presence of a carboxylic acid moiety. Here, we show that these challenges can be overcome by methylating (capping) the carboxylic acid portion of the pregabalin molecule and converting to the corresponding methyl ester. Once the methyl ester is synthesized, chiral derivatization at the amine can be achieved to identify the controlled (S) enantiomer of pregabalin via GC‐MS.     

Maximizing order or harm? Arrests among a social network of people who inject drugs in a large urban city

Encountering the criminal justice system at the first point of entry---an arrest---is associated with heightened HIV and Hepatitis risk behavior among people who inject drugs (PWIDS). Intervening structurally through the criminal justice system impacts public health; therefore, determining arrest patterns is an important tool for risk reduction. Among a sample of 740 PWIDs, and their social network members recruited from predominantly African-American neighborhoods in Baltimore City, a third were recently arrested in the previous six months, and of those, the arrests were disproportionately African-American persons and characterized as nonviolent, i.e., drug possession/attempt to purchase (38%) and loitering (29%). Poisson regression models were built adjusted for age, sex, race, education level, homelessness, and monthly income after exploring bivariable characteristics of arrests using chi-squared tests. Active drug use was associated with a recent arrest (adjusted prevalence ratio: aPR 2.38 95% CI 1.6, 3.6), in addition to participants who recently reported attending a syringe exchange program (aPR 1.45 95% CI 1.1, 2.0). Our findings are suggestive of recent media coverage and burgeoning research revealing the prioritization of policing resources toward both communities of color and neighborhoods of intensified drug trafficking. Further research is warranted to contextualize the operationalization of criminal justice resources and the impact on community health.     

The Prevalence of Paraphernalia Found at the Scene of Drug‐Related Deaths

Many illicit drugs involve the use of paraphernalia, and the presence of paraphernalia found at the scene of death may suggest that the death is drug‐related. Few sources of objective data are available regarding the prevalence of drug paraphernalia found at the scene of drug‐related deaths or the likelihood of a death with drug paraphernalia found at the scene to be drug‐related. This study reviews the deaths which were investigated by the Bexar County Medical Examiner's Office in an attempt to provide objective data. Over 4000 deaths with scene investigations were reviewed, and the presence of paraphernalia was found to be strongly associated with the death being drug‐related, heroin‐related, or cocaine‐related with the relative risk for each being 5.0, 15.4, and 6.6, respectively. This confirms that the presence of drug paraphernalia at the scene of death strongly suggests the death to be drug‐related and in particular heroin‐related.     

THE FUNNY SIDE OF DRUG DEALING: RISK,HUMOR, AND NARRATIVE IDENTITY

In this study, we explore the role humor plays in the narrated identities of drug dealers, in their negotiation of the threat of formal punishment, and in their cultural membership and authority. By drawing from interview and observation data gathered from 33 active drug dealers residing in St. Louis, Missouri, we find that humor facilitates identity work among illicit drug dealers in several ways. Humor is an important symbolic boundary marker distinguishing dealers from others they consider “stupid” or less circumspect. It also indicates dealers’ identities as “smart” and simultaneously establishes and validates their subcultural authority and membership in the symbolic group of “smart” dealers. Furthermore, drug dealers use denigrating humor in their narratives to distance their former and virtual identities from their present identities. Finally, humor also reduces dealers’ perceptions of the threats posed by police and potential snitches by casting dealers’ present identities and former reactions to the threat of punishment in a positive light. We conclude by discussing implications for narrative criminology, extant humor research, and current understanding of symbolic boundaries, identity work, and deterrence.     

Drug Recognition Evaluation and Chemical Confirmation of a 25C‐NBOMe‐Impaired Driver

This case report details an individual arrested for drug‐impaired driving after leaving the scene of multiple motor vehicle collisions and evading police. The driver was examined by a drug recognition expert and failed the drug recognition evaluation. The driver admitted to using cocaine, marijuana, an antidepressant medication and “N‐bomb,” a novel psychoactive substance that possesses hallucinogenic properties. Toxicological analyses at the Centre of Forensic Sciences’ Toronto laboratory revealed only the substance 2‐[4‐chloro‐2,5‐dimethoxyphenyl]‐N‐[(2‐methoxyphenyl)methyl]ethanamine (25C‐NBOMe) in the accused's urine. This is the first report in which 25C‐NBOMe was identified through DRE and toxicological analyses in a drug‐impaired driver.     

Fingerprint Change: Not Visible,But Tangible

Hand–foot syndrome, a chemotherapy‐induced cutaneous toxicity, can cause an alteration in fingerprints causing a setback for cancer patients due to the occurrence of false rejections. A colon cancer patient was fingerprinted after not having been able to use fingerprint recognition devices after 6 months of adjuvant chemotherapy. The fingerprint images were digitally processed to improve fingerprint definition without altering the papillary design. No evidence of skin toxicity was present. Two months later, the situation returned to normal. The fingerprint evaluation conducted on 15 identification points highlighted the quantitative and qualitative fingerprint alteration details detected after the end of chemotherapy and 2 months later. Fingerprint alteration during chemotherapy has been reported, but to our knowledge, this particular case is the first ever reported without evident clinical signs. Alternative fingerprint identification methods as well as improved biometric identification systems are needed in case of unexpected situations.     

Enhancing Information Sharing in Family Drug Courts: A Lean Six Sigma Case Study

Given the variety of stakeholders involved in cases within family drug courts, efficient communication and information sharing, which are needed to support decision‐making, can be quite challenging. Through a case study in one family drug court system, this research employed an action research approach to improve the information sharing process following the Lean Six Sigma methodology. The solutions implemented through this study contributed to improving the quality of the services provided by this court system and its overall productivity. In addition, this research extends our knowledge about methods for improving court systems from which others can learn to guide future improvement efforts.     

“Good moral characters”: how drug felons are impacted under state marijuana legalization laws

This article examines how drug felons will be impacted by marijuana legalization in the United States. What will happen to drug felons whose charges would be legal under current law? Can drug felons work in the newly developing legal marijuana industries? In this article we will overview the statistics on arrests and convictions with their high rates of racial disparities. The war on drugs has inspired the development of more repressive criminal justice tactics such as asset forfeiture, high rates of re-incarceration during parole for marijuana violations, drug courts and their further reach into lifestyles, and the difficulties of prisoner reentry, especially for drug felons, who are barred from many jobs and social services. We will look at the regulations of felony offenders working in the cannabis industry. And we will consider the outcomes of retroactive ameliorative relief for this case of marijuana possession felonies under legalization.