drugs and alcohol: memories of a medical examiner

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Drugs and Alcohol: Memories of a Medical Examiner

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Page 1: Drugs and Alcohol: Memories of a Medical Examiner

Drugs andAlcohol:

Memoriesof a

MedicalExaminer

Page 2: Drugs and Alcohol: Memories of a Medical Examiner

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.

Page 3: Drugs and Alcohol: Memories of a Medical Examiner
Page 4: Drugs and Alcohol: Memories of a Medical Examiner

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.

Page 5: Drugs and Alcohol: Memories of a Medical Examiner

I will not lie to you.

Page 6: Drugs and Alcohol: Memories of a Medical Examiner

I will not lie to you.

Page 7: Drugs and Alcohol: Memories of a Medical Examiner

I will not lie to you.

Page 8: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 9: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 10: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 11: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 12: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 13: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 14: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 15: Drugs and Alcohol: Memories of a Medical Examiner

I trained in pathology at the Chicago VA.

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Page 18: Drugs and Alcohol: Memories of a Medical Examiner

This story does not have a happy ending.

Page 19: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 20: Drugs and Alcohol: Memories of a Medical Examiner

Some of the health consequences of heavy alcohol drinking….

Page 21: Drugs and Alcohol: Memories of a Medical Examiner

Unpleasant short-term effects.

Page 22: Drugs and Alcohol: Memories of a Medical Examiner

Unpleasant short-term effects.

Page 23: Drugs and Alcohol: Memories of a Medical Examiner

Unpleasant short-term effects.

Where am I?

Page 24: Drugs and Alcohol: Memories of a Medical Examiner

Unpleasant short-term effects.

Where is my car?

Page 25: Drugs and Alcohol: Memories of a Medical Examiner

Unpleasant short-term effects.

How did I get this tattoo?

Page 26: Drugs and Alcohol: Memories of a Medical Examiner

Unpleasant short-term effects.

Who is this woman?

Page 27: Drugs and Alcohol: Memories of a Medical Examiner

Ruptured esophagus

Page 28: Drugs and Alcohol: Memories of a Medical Examiner

Aspiration of gastric contents

Page 29: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 30: Drugs and Alcohol: Memories of a Medical Examiner

Logarithmic vs. linear relationships.

Page 31: Drugs and Alcohol: Memories of a Medical Examiner

Threshold effects.

Page 32: Drugs and Alcohol: Memories of a Medical Examiner

One drinker in ten will lose control.

Page 33: Drugs and Alcohol: Memories of a Medical Examiner

Personality changesreflect thebraindamage.

Page 34: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 35: Drugs and Alcohol: Memories of a Medical Examiner

Wernicke-Korsakoff brain syndrome

Page 36: Drugs and Alcohol: Memories of a Medical Examiner

Liver failure

Page 37: Drugs and Alcohol: Memories of a Medical Examiner

Liver failure

Page 38: Drugs and Alcohol: Memories of a Medical Examiner

Liver failure

Page 39: Drugs and Alcohol: Memories of a Medical Examiner

The end is seldom quick.

Page 40: Drugs and Alcohol: Memories of a Medical Examiner

Overlooking one’s other health needs….

Page 41: Drugs and Alcohol: Memories of a Medical Examiner

“The contribution of alcohol abusedomestic violence.”

Page 42: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 43: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 44: Drugs and Alcohol: Memories of a Medical Examiner

Adverse interpersonal consequences.

Page 45: Drugs and Alcohol: Memories of a Medical Examiner

Adverse interpersonal consequences.

Page 46: Drugs and Alcohol: Memories of a Medical Examiner

Adverse interpersonal consequences.

Page 47: Drugs and Alcohol: Memories of a Medical Examiner

Impulsive behavior.

Page 48: Drugs and Alcohol: Memories of a Medical Examiner

Impulsive behavior.

Page 49: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 50: Drugs and Alcohol: Memories of a Medical Examiner

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.

Page 51: Drugs and Alcohol: Memories of a Medical Examiner

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.

Page 52: Drugs and Alcohol: Memories of a Medical Examiner

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

J. Am. College Health53: 61, 2004.

Page 53: Drugs and Alcohol: Memories of a Medical Examiner

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

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

Page 54: Drugs and Alcohol: Memories of a Medical Examiner

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

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

Page 55: Drugs and Alcohol: Memories of a Medical Examiner

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.

Page 56: Drugs and Alcohol: Memories of a Medical Examiner

Should a university administration mandate a “dry campus”?

Page 57: Drugs and Alcohol: Memories of a Medical Examiner

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.

Page 58: Drugs and Alcohol: Memories of a Medical Examiner

Should a university administration mandate a “dry campus”?

YES!

Colleges are about learning rather than partying.

Page 59: Drugs and Alcohol: Memories of a Medical Examiner

Should a university administration mandate a “dry campus”?

YES!

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

Page 60: Drugs and Alcohol: Memories of a Medical Examiner

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.

Page 61: Drugs and Alcohol: Memories of a Medical Examiner

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.

Page 62: Drugs and Alcohol: Memories of a Medical Examiner
Page 63: Drugs and Alcohol: Memories of a Medical Examiner

Maynard Peters…

elitestock-carracer

Page 64: Drugs and Alcohol: Memories of a Medical Examiner

Smoking marijuana is like…

Page 65: Drugs and Alcohol: Memories of a Medical Examiner

Smoking marijuana is like…

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

Page 66: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 67: Drugs and Alcohol: Memories of a Medical Examiner

Hey, this music sounds terrible!

Page 68: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 69: Drugs and Alcohol: Memories of a Medical Examiner

Marijuana smokingresults invery fewdomesticviolencecalls.

Page 70: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 71: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 72: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 73: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 74: Drugs and Alcohol: Memories of a Medical Examiner

“The law of the alien’s poison.”

Page 75: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 76: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 77: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 78: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 79: Drugs and Alcohol: Memories of a Medical Examiner

“Politics as usual”…

Page 80: Drugs and Alcohol: Memories of a Medical Examiner

“Politics as usual”…

Page 81: Drugs and Alcohol: Memories of a Medical Examiner

“Politics as usual”…

Page 82: Drugs and Alcohol: Memories of a Medical Examiner

My best marijuana case….

Page 83: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 84: Drugs and Alcohol: Memories of a Medical Examiner

I don’t know.

Page 85: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 86: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 87: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 88: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 89: Drugs and Alcohol: Memories of a Medical Examiner

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.

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Bryan Lee MD

Lambda Chi AlphaSigma Rho 310

Natural Bodybuilder

Page 95: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 96: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 97: Drugs and Alcohol: Memories of a Medical Examiner

If you already an addict, you will not learnanything.

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

Page 98: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 99: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 100: Drugs and Alcohol: Memories of a Medical Examiner

… and the availabilityof drug testing foremployers.

Page 101: Drugs and Alcohol: Memories of a Medical Examiner

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

Casual experimentersare at thegreatest risk.

Page 102: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 103: Drugs and Alcohol: Memories of a Medical Examiner

Baby powder here. Sound business practice.

Page 104: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 105: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 106: Drugs and Alcohol: Memories of a Medical Examiner

I’m needle-shy.

Page 107: Drugs and Alcohol: Memories of a Medical Examiner

Tracks

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Tracks

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Tracks

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Tracks

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Tracks

Page 112: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 113: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 114: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 115: Drugs and Alcohol: Memories of a Medical Examiner

Fecal impaction

Page 116: Drugs and Alcohol: Memories of a Medical Examiner

Fecal impaction

Page 117: Drugs and Alcohol: Memories of a Medical Examiner

Buprenorphine (“Suboxone”)

Page 118: Drugs and Alcohol: Memories of a Medical Examiner

Cocaine’s effectson the body and mind are notoriouslyunpredictable.

Page 119: Drugs and Alcohol: Memories of a Medical Examiner

Cocaine heart

Page 120: Drugs and Alcohol: Memories of a Medical Examiner

Brain hemorrhage

Page 121: Drugs and Alcohol: Memories of a Medical Examiner

Excited delirium

Page 122: Drugs and Alcohol: Memories of a Medical Examiner

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.

Page 123: Drugs and Alcohol: Memories of a Medical Examiner

Dealing with a cocaine-addicted brother at LambdaChi Alpha

Page 124: Drugs and Alcohol: Memories of a Medical Examiner

The story had a happy ending.

Many similar stories do not end well.

Page 125: Drugs and Alcohol: Memories of a Medical Examiner

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

Happy Dust

Page 126: Drugs and Alcohol: Memories of a Medical Examiner

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

Page 127: Drugs and Alcohol: Memories of a Medical Examiner

Who needs an altered mind?

Page 128: Drugs and Alcohol: Memories of a Medical Examiner

Friends.

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