drugs and alcohol: memories of a medical examiner

Drugs andAlcohol:

Memoriesof a

MedicalExaminer

Warnings:

1. I will not lie to you.

2. I will use graphic images and strong language. You may hear a few short familiar Anglo-Saxon words.

If you are “offended”, I don’t care.If this is a problem, please leave now.

The refereed scientific literature, where one must persuade others of one’s truthfulness, backs what I have to sayto you tonight.

Unlike 50 years ago, there is no serious disagreement over themain points.

I will not lie to you.

I will not lie to you.

I will not lie to you.

It’s a fact of life that the executive branches ofgovernmentslie to maintain“politics asusual.”

Activist leaders of all kinds have no reason to be fully truthful.

People will believe even the most obvious untruths for emotional reasons.

I need to maintain credibility because I must testify in court under oath.

The vast majority of people whochoose todrink alcoholwill never have a problembecause of it.

It would be difficult to overstate the contri-bution of alcohol to ill-health & the caseload of a medicalexaminer.

Genetics plays a role, but ultimately why one person in ten ends up unable to contol their drinking remains a mystery.

I trained in pathology at the Chicago VA.

This story does not have a happy ending.

Blood alcohol levels:

.002 - .100 Happy

.100 - .200 Drunk

.200 - .300 Kisses mother-in-law;shoots best friend

.300 + Supposed to be dead; many are still driving

Some of the health consequences of heavy alcohol drinking….

Unpleasant short-term effects.

Unpleasant short-term effects.

Unpleasant short-term effects.

Where am I?

Unpleasant short-term effects.

Where is my car?

Unpleasant short-term effects.

How did I get this tattoo?

Unpleasant short-term effects.

Who is this woman?

Ruptured esophagus

Aspiration of gastric contents

The old story about one drinking killing however-many brain cells is simply not true.

Logarithmic vs. linear relationships.

Threshold effects.

One drinker in ten will lose control.

Personality changesreflect thebraindamage.

The abusive behavior of the heavy drinker is caused by brain damage.

Wernicke-Korsakoff brain syndrome

Liver failure

Liver failure

Liver failure

The end is seldom quick.

Overlooking one’s other health needs….

“The contribution of alcohol abusedomestic violence.”

Every adult knows that alcohol is the most effective way of relieving the agony of a partner’s verbal abuse.

The long-term results of this strategy are not salutary for either partner.

Adverse interpersonal consequences.

Adverse interpersonal consequences.

Adverse interpersonal consequences.

Impulsive behavior.

Impulsive behavior.

If you recognize that you have lost control over your alcohol consumption…

NIH: Alcohol-free fraternity house policies have no impact whatever on any measure of drinking behavior.At most, the location changes.

J. Primary Prevention 27: 477, 2006.

Harvard: Targeting the heaviest drinkers ignores the fact that the inexperiencedstudent drinking heavily is at the greatest risk of harm.

J. Drug Ed.34: 247, 2004.

Kent State: A massive “social norms” campaign utterly fails, because the students perceive it as “not credible”.

J. Am. College Health53: 61, 2004.

U. Minn: No one has a clearly-effective strategy to reduce underage campusdrinking.

J. Stud. Alcohol Supp. 14: 193, 2002.

Harvard again: No one has a campusalcohol policy that diminishes drinking.

J. Am. College Health 50: 223, 2002.

Brown U: Since no policy works, and“zero-tolerance policies” are notoriously ineffective, focus instead on disruptivestudent behaviors caused by drinking.

J. Am. College Health 50: 39, 2001.

Should a university administration mandate a “dry campus”?

Should a university administration mandate a “dry campus”?

YES!

Right or wrong, the legal drinking ageis 21. Turning a blind eye to illegal behavior sets a bad example.

Should a university administration mandate a “dry campus”?

YES!

Colleges are about learning rather than partying.

Should a university administration mandate a “dry campus”?

YES!

A dry-campus policy shifts the blameif something happens in a litigioussociety.

Should a university administration mandate a “dry campus”?

NO!

On a dry campus with enforcement, the drinking simply moves off-campus,where the dangers are greater.

Should a university administration mandate a “dry campus”?

NO!

Like it or not, a historic function of colleges in general and the Greek system in particular is to provide a relatively protected environment where young people can explore and make mistakes without dire consequences.

Maynard Peters…

elitestock-carracer

Smoking marijuana is like…

Smoking marijuana is like…

… and you shouldn’t do either while you are driving a car.

What did the two stoners saywhen they ran out of dope?

Hey, this music sounds terrible!

The effects of tetrahydrocannabinol,the active ingredient of marijuana,occur on the anadamine receptor.

Marijuana smokingresults invery fewdomesticviolencecalls.

Studies showing poorer performances by heavy users ignore the possibility that stoners might be stupider to begin with.

The world’s“curious” marijuana Iaws reflect the activism of America’sfirst drug czar,Harry Anslinger.

At the time that our government got us into theVietnam war,people could get life in prison for possession of a single joint.

I recall that in the 1950’s, being drunk and even driving drunk was often considered funny.

“The law of the alien’s poison.”

The minority culture always prefers a different drug from the majority culture.

The majority culture always bans and stigmatizes the minority’s drug.

In J.S. Bach’s era, there was such fear of coffee that the enlightened composerfrote a cantata to destigmatize it.

Anslinger’s campaign against marijuana reflected his era’s racial hatreds and fears.

“Politics as usual”…

“Politics as usual”…

“Politics as usual”…

My best marijuana case….

Do our politicians have a darker reason for keeping marijuana illegal?

I don’t know.

Despite all the objective facts, it is my honest, considered opinion that campus Greeks should shun marijuana.

The verdict on the health effects is not in. It’s not clear that there are no major long-term adverse brain effects.

Right or wrong, marijuana is illegal.Society is based on respect for law.

Marijuana-smoking is self-absorption.During the college years, the capacity for friendship is as its peak. Don’t waste it.

This year, one million Americans will take anabolic steroids to “muscle up.”

Insofar as this reflects America’s increased appreciation of physicalfitness, we might appreciate this.

However, the drugs have poisoned the supposed wholesome spirit of sports, and do post health risks.

Bryan Lee MD

Lambda Chi AlphaSigma Rho 310

Natural Bodybuilder

The other illegal drugs, most notably heroin and cocaine, have been part of American culture for over 100 years.

What I can dofor you is share, in no particular order, some facts that you may or may not already know.

If you already an addict, you will not learnanything.

However, it isvery likely that many of youare considering doing someexperimenting.

I am going to give you facts that will help you make the right decision about trying heroin and cocaine.

The only things that have shown to decrease drug abuse in the US have been methadone maintenance…

… and the availabilityof drug testing foremployers.

Whether or not this is really Chris Farley, the findings in heroin overdose are very familiar.

Casual experimentersare at thegreatest risk.

Do you know why dealers cut their heroin with inert substances?

Baby powder here. Sound business practice.

Heroin, manufactured from opium,has legitimate medical uses, especiallyfor the control of severe pain.

Some people become addicted because of chornic pain. Thanks to our “war on drugs”, we cannot alwaystreat these people appropriately.

I’m needle-shy.

Tracks

Tracks

Tracks

Tracks

Tracks

If you choose to experiment with needle drugs, there is an infection risk.

If you choose to experiment with needle drugs, there is an infection risk.

Erectile dysfunction is expected in people taking opiates for any reason.

Fecal impaction

Fecal impaction

Buprenorphine (“Suboxone”)

Cocaine’s effectson the body and mind are notoriouslyunpredictable.

Cocaine heart

Brain hemorrhage

Excited delirium

Because of the effects on the heart, I will certifyany otherwise-unexplained death as due to cocaine if any amount of cocaine or its major metabolite is present.

Dealing with a cocaine-addicted brother at LambdaChi Alpha

The story had a happy ending.

Many similar stories do not end well.

In my experience, people become addicted to heroin in order to escapethe pain of intolerable livingsituations.

Happy Dust

In my experience,people become involved with cocaine as an activity to share with friends.

Who needs an altered mind?

Friends.