Identifying a Drugged Person

Transcription

1 Identifying a Drugged Person Tim McClure, Investigator Ford County Sheriff s Office Define Drug As It Relates To Law Enforcement Recognized as drugs in United States Pharmacopoeia or National Formulary Intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in man or animals Other than food, intended to affect the structure or function of the body Multijurisdictional Counterdrug Task Force Training 2 Working Definition of a DRUG A chemical substance, such as a narcotic or hallucinogen, that affects the central nervous system, causing changes in behavior and often addiction Multijurisdictional Counterdrug Task Force Training 3 1

2 Illicit Drug Use In 2005, an estimated 19.7 million Americans aged 12 or older were current (past month) illicit drug users Used an illicit drug during the month prior to the survey interview Represents 8.1 percent of the population aged 12 years old or older Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically Source: SAMHSA, Results from the 2005 National Survey on Drug Use and Health Multijurisdictional Counterdrug Task Force Training 4 Marijuana Use Marijuana was the most commonly used illicit drug (14.6 million past month users) Source: SAMHSA, Results from the 2005 National Survey on Drug Use and Health. Multijurisdictional Counterdrug Task Force Training 5 Source: SAMHSA, Results from the 2009 National Survey on Drug Use and Health. Multijurisdictional Counterdrug Task Force Training 6 2

3 Source: SAMHSA, Results from the 2009 National Survey on Drug Use and Health. Multijurisdictional Counterdrug Task Force Training 7 Seven Drug Categories Cannabis CNS Stimulants Narcotic Analgesics CNS Depressants Hallucinogens Dissociative Anesthetics Inhalants Multijurisdictional Counterdrug Task Force Training 8 Cannabis Marijuana Hashish Hash Oil Marinol Multijurisdictional Counterdrug Task Force Training 9 3

4 Central Nervous System Stimulants Cocaine Amphetamine Methamphetamine Multijurisdictional Counterdrug Task Force Training 10 Narcotic Analgesics Heroin Morphine Codeine Synthetic opiates Demerol Methadone Multijurisdictional Counterdrug Task Force Training 11 Central Nervous System Depressants Alcohol Barbiturates Valium Chloralhydrate Multijurisdictional Counterdrug Task Force Training 12 4

5 Hallucinogens LSD Peyote Psilocybin Multijurisdictional Counterdrug Task Force Training 13 Dissociative Anesthetics PCP Ketamine DXM Multijurisdictional Counterdrug Task Force Training 14 Inhalants Toluene Glue Paint Multijurisdictional Counterdrug Task Force Training 15 5

6 Definitions Associated with DRE Examinations Pupil size Nystagmus Convergence Blood pressure Pulse rate Body temperature Internal clock Multijurisdictional Counterdrug Task Force Training 16 Pupil Size Normal Range 2.5 to 5.0 mm (room light) 5.0 to 8.5 mm (near total darkness) 2.0 to 4.5 mm (direct light) Multijurisdictional Counterdrug Task Force Training 17 Pupil Size Multijurisdictional Counterdrug Task Force Training 18 6

7 Mydriasis (Dilated Pupils) Multijurisdictional Counterdrug Task Force Training 19 Miosis (Constricted Pupils) Multijurisdictional Counterdrug Task Force Training 20 Ptosis (Droopy Eyelids) Multijurisdictional Counterdrug Task Force Training 21 7

8 Nystagmus Involuntary jerking of the eyes Multijurisdictional Counterdrug Task Force Training 22 Strabismus A condition in which a person can not align both eyes simultaneously under normal conditions A condition in which the eyes deviate (turn) when looking at the object of regard Convergence Lack of convergence Multijurisdictional Counterdrug Task Force Training 23 Vital Signs Internal Clock: 30 sec +/- 5 sec Pulse: bpm Blood Pressure: / Body Temp: 98.6 F +/- 1 degree Multijurisdictional Counterdrug Task Force Training 24 8

9 Observations Suspect s Breath Odor of alcohol Chemical odor Cannabis odor Suspect s Face Normal Flushed Pale Other Multijurisdictional Counterdrug Task Force Training 25 Observations General Appearance Clean Orderly Disarranged Bloody Vomit Urine Eyes Normal Watery Bloodshot Pink/red Multijurisdictional Counterdrug Task Force Training 26 Observations Attitude Anxious Restless Agitated Excited Combative Disinterested Uninhibited Disoriented Drowsy Confused Hallucinating Loss of memory Cyclic mood swings Polite Antagonistic Stuporous Cooperative/indifferent Laughing Insulting Argumentative Fumbling Multijurisdictional Counterdrug Task Force Training 27 9

10 Observations Speech Talkative Thick, slurred Incoherent Rapid Slow Non-communicative Repetitive Physical Actions Facial itching Dry mouth Nodding Droopy eyelids Low, raspy voice Body tremors Muscle tone Grinding of teeth Multijurisdictional Counterdrug Task Force Training 28 Observations Other Nasal redness Runny nose Track marks Perspiring Warm to the touch Intense headaches Residue of paint on person Debris Pills Vials Syringes Drug paraphernalia Multijurisdictional Counterdrug Task Force Training 29 Observations Multijurisdictional Counterdrug Task Force Training 30 10

11 Psychophysical Exams Multijurisdictional Counterdrug Task Force Training 31 Walk and Turn Instructions Demonstration Subject s Attempts Record Results Multijurisdictional Counterdrug Task Force Training 32 One-Leg Stand Instructions Demonstration Subject s Attempts Each leg Record Results Multijurisdictional Counterdrug Task Force Training 33 11

12 Rhomberg Test Instructions Demonstration Subject s Attempts Record Results Multijurisdictional Counterdrug Task Force Training 34 Multijurisdictional Counterdrug Task Force Training 35 Cannabis Multijurisdictional Counterdrug Task Force Training 36 12

13 Cannabis Schedule I Most widely abused illegal drug in the U.S. Derived from the Indian hemp plant Botanical name Cannabis Sativa Grows wild in climates all over the world Multijurisdictional Counterdrug Task Force Training 37 Cannabis: Methods of Ingestion Smoking Oral Multijurisdictional Counterdrug Task Force Training 38 Cannabis: Effects Horizontal gaze nystagmus -none Vertical nystagmus - none Lack of convergence/strabismus - present Pupil size - possibly dilated Reaction to light - normal Blood pressure - up Body temperature - normal Pulse rate - up Multijurisdictional Counterdrug Task Force Training 39 13

14 Cannabis: Effects Short-term memory loss Paranoia Loss of ambition Munchies Multijurisdictional Counterdrug Task Force Training 40 Cannabis: General Indicators Diminished inhibitions Impaired perception of time/distance Disorientation Body and/or eyelid tremors Reddening of the conjunctiva Possible debris in mouth Multijurisdictional Counterdrug Task Force Training 41 Central Nervous System Stimulants Multijurisdictional Counterdrug Task Force Training 42 14

15 Stimulants Drugs that speed up the body's metabolism Natural: caffeine, nicotine, cocaine Synthetic: amphetamine, methamphetamine, methcathinone Multijurisdictional Counterdrug Task Force Training 43 Stimulants: Method(s) of Ingestion Injected Oral Inhaled Smoked Multijurisdictional Counterdrug Task Force Training 44 Stimulants: Effects HGN - none VGN - none Lack of convergence - none Pupil size - dilated (mydriasis) Pupil reaction to light - slow to none visible Pulse rate - up Blood pressure - up Body temperature - up Bruxism Multijurisdictional Counterdrug Task Force Training 45 15

16 Stimulants: General Indicators Restlessness Euphoria Anxiety Talkativeness Irritability Runny nose Redness to nasal area Leg and eyelid tremors Rigid muscle tone Multijurisdictional Counterdrug Task Force Training 46 Methamphetamine Effects Multijurisdictional Counterdrug Task Force Training 47 16

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19 PET Scan of Long-Term Methamphetamine Brain Damage 19

20 Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH) Abuser After Protracted Abstinence 3 0 Normal Control METH Abuser (1 month detox) METH Abuser (24 months detox) ml/gm Source: Volkow, ND et al., Journal of Neuroscience 21, , CHERIE Multijurisdictional Counterdrug Task Force Training 59 Narcotic Analgesics Multijurisdictional Counterdrug Task Force Training 60 20

21 Narcotic Analgesics Strong painkilling drugs that also produce sleep Most drugs in this class are produced from the opium poppy Multijurisdictional Counterdrug Task Force Training 61 Narcotic Analgesics: Characteristics Pain relief (analgesic) Produces withdrawal signs and symptoms (when stopped after chronic administration) Stop withdrawal signs and symptoms (note: other N.A. can be substituted for relief of withdrawal symptoms Multijurisdictional Counterdrug Task Force Training 62 The Concept of Drug Tolerance The same dose of the drug will produce diminishing effects A steadily larger dose is needed to produce the same effect Multijurisdictional Counterdrug Task Force Training 63 21

22 Narcotics: Effects HGN - none VGN - none Lack of convergence - none Pupil size - constricted (miosis) Pulse rate - down Blood pressure - lowered Body temperature - down Multijurisdictional Counterdrug Task Force Training 64 Narcotics: General Indicators Slow reflexes, sluggish movements Slow, low, raspy speech Slow breathing, cold skin On the nod Droopy eyelids (ptosis) Dry mouth Euphoria Track marks Multijurisdictional Counterdrug Task Force Training 65 Method(s) of Ingestion Injected Oral Inhaled Smoked: Heroin, Opium, Morphine Multijurisdictional Counterdrug Task Force Training 66 22

23 CNS Depressants Multijurisdictional Counterdrug Task Force Training 67 Depressants Drugs that slow down the body's metabolism Barbiturates: sleeping pills Tranquilizers: anxiety-fighting depressants Methaqualone: non-barbiturate hypnotic Multijurisdictional Counterdrug Task Force Training 68 Depressants: General Indicators Drowsiness Droopy eyelids (ptosis) Thick, slurred speech Lack of coordination Slow, sluggish reactions Flaccid muscle tone Reduced social inhibitions In other words, drunk Multijurisdictional Counterdrug Task Force Training 69 23

24 Depressants: Effects HGN - present VGN - present Lack of convergence - present Pupil size - normal Pupil reaction to light - slow Pulse rate - down (Qualudes & alcohol) Blood pressure - lowered Temperature - normal Multijurisdictional Counterdrug Task Force Training 70 Depressants: Method(s) of Ingestion Oral Injected Multijurisdictional Counterdrug Task Force Training 71 Hallucinogens Multijurisdictional Counterdrug Task Force Training 72 24

25 Notable Hallucinogens Lysergic Acid Diethylamide (LSD) Psilocybin Mushrooms Peyote (mescaline) Multijurisdictional Counterdrug Task Force Training 73 Hallucinogens Drugs that cause distortions of reality This class of drug can alter vision, sense of smell and touch Some can be absorbed through skin Multijurisdictional Counterdrug Task Force Training 74 Hallucinogens: Effects HGN - none VGN - none Lack of convergence - none Pupil size - dilated Pupil reaction to light - normal Pulse rate - up Blood pressure - up Body temperature - up Multijurisdictional Counterdrug Task Force Training 75 25

26 Hallucinogens: General Indicators Dazed appearance Body tremors Perspiring Rigid muscle tone Difficulty with speech Statements suggesting hallucinations Distorted sensory perceptions Multijurisdictional Counterdrug Task Force Training 76 Dissociative Anesthetics PCP Ketamine DXM Multijurisdictional Counterdrug Task Force Training 77 Multijurisdictional Counterdrug Task Force Training 78 26

27 Coricidan OD clip Multijurisdictional Counterdrug Task Force Training 79 PCP: General Indicators Slow, slurred speech Disorientation Loss of memory Agitation, excitement Blank stare ( yard stare ) Non-communicative Rigid muscle tone Multijurisdictional Counterdrug Task Force Training 80 PCP: General Indicators Loss of a sense of personal identity Sensory distortions Auditory hallucinations A feeling of extreme heat, profuse perspiration Increased pain threshold Multijurisdictional Counterdrug Task Force Training 81 27

28 PCP: Effects HGN - present (early onset) VGN - present Lack of convergence - present Pupil size - normal Pupil reaction to light - normal Pulse rate - up Blood pressure - up Body temperature - up Multijurisdictional Counterdrug Task Force Training 82 Inhalants Volatiles paint thinners gasoline Aerosols hair sprays spray paints Alkyl nitrites Nitrous oxide Schedule IV Multijurisdictional Counterdrug Task Force Training 83 Inhalants: General Indicators Odor of inhaled substance Traces of substance on face, nose, hands, clothing Bloodshot, watery eyes Confused, disoriented appearance Flushed face, possible sweating Slow, thick, slurred speech Multijurisdictional Counterdrug Task Force Training 84 28

29 Inhalants: Effects HGN - present VGN - present Lack of convergence - present Pupil size - normal (may be dilated with certain anesthetic gases) Pupil reaction to light - slow Pulse rate - up Blood pressure - up or down Body temperature - up, down, normal Muscle tone - usually normal Multijurisdictional Counterdrug Task Force Training 85 Drugs Which Induce Nystagmus CNS Depressants (Most) Inhalants Dissociative Anesthetics Multijurisdictional Counterdrug Task Force Training 86 PCP Usually Causes Immediate Onset of Nystagmus Multijurisdictional Counterdrug Task Force Training 87 29

30 Drugs That Cause Lack of Convergence CNS depressants Inhalants Dissociative anesthetics Cannabis Strabismus Multijurisdictional Counterdrug Task Force Training 88 Drugs Which Usually Don t Affect Pupil Size CNS Depressants Inhalants PCP Multijurisdictional Counterdrug Task Force Training 89 Drugs Which Cause Pupil Dilation CNS stimulants Hallucinogens POSSIBLY Cannabis (slight dilation) Multijurisdictional Counterdrug Task Force Training 90 30

31 Narcotic Analgesics Usually Cause Pupil Constriction Multijurisdictional Counterdrug Task Force Training 91 Polydrug Use Using two or more drugs at the same time Examples: PCP and marijuana; heroin and cocaine; many others Multijurisdictional Counterdrug Task Force Training 92 Field Studies Los Angeles Field Study 72% of suspects had 2 or more drugs New York Certification Training Study 67% of suspects had 2 or more drug categories other than alcohol Multijurisdictional Counterdrug Task Force Training 93 31

32 Prevalence of Polydrug Use P.I.R.E.* DRE database indicates that 25% of all DRE-reported cases revealed two or more drug categories detected (2005) *Pacific Institute of Research and Evaluation Multijurisdictional Counterdrug Task Force Training 94 Two Drugs in Combination: How Do They Affect Pupil Size? Situation #1 Neither drug affects pupil size Example: PCP and Valium Neither one affects the size of the pupils The combination will also not affect pupil size Multijurisdictional Counterdrug Task Force Training 95 Null Effect No action plus no action equals no action If neither drug affects a particular indicator of impairment, their combination also will not affect that indicator Multijurisdictional Counterdrug Task Force Training 96 32

33 Two Drugs in Combination: How Do They Affect Pupil Size? Situation #2 One drug affects the pupil size, but the other does not Example: PCP and cocaine Cocaine dilates pupils, PCP doesn t affect pupils The combination will affect pupil size Multijurisdictional Counterdrug Task Force Training 97 Overlapping Effect Action plus no action equals action If one drug affects a particular indicator of impairment, and another drug has no effect on that indicator, the combination of those two drugs will affect the indicator, in the same way as the first drug alone Multijurisdictional Counterdrug Task Force Training 98 Two Drugs in Combination: How Do They Affect Pupil Size? Situation #3 The two drugs affect pupil size in the same way Example: LSD and cocaine Cocaine dilates pupils; so does LSD The combination will affect pupil size Multijurisdictional Counterdrug Task Force Training 99 33

34 Additive Effect Action plus the same action produces reinforced action If two drugs independently affect some indicator in the same way, their use in combination will also affect the indicator and the effect may be reinforced Multijurisdictional Counterdrug Task Force Training 100 Two Drugs in Combination: How Do They Affect Pupil Size? Situation #4 The two drugs affect pupil size in exactly opposite ways Example: heroin and cocaine Cocaine dilates pupils, heroin constricts pupils We can t predict how the combination will affect pupil size Multijurisdictional Counterdrug Task Force Training 101 Antagonistic Effect Action versus opposite action: can t predict the outcome If two drugs affect some indicator in exactly opposite ways, their use in combination could affect that indicator in any possible way Multijurisdictional Counterdrug Task Force Training

35 The Effects of Drug Combinations Null Effect Overlapping Effect Additive Effect Antagonistic Effect Multijurisdictional Counterdrug Task Force Training 103 Common Combinations of Drugs cocaine & cannabis cocaine & heroin PCP & cannabis alcohol & practically anything else Multijurisdictional Counterdrug Task Force Training 104 Sample Drug Influence Evaluation Face Sheet This is NOT a DRE course, although we are using DRE principles This DRE form is only used as an example It is important for you to document, document, document all information observed! Multijurisdictional Counterdrug Task Force Training

36 DEC Testify Multijurisdictional Counterdrug Task Force Training 106 Components on the Drug Evaluation Narrative Report 1. Location 2. Witnesses 3. Breath Alcohol Test 4. Notification & interview of arresting officer 5. Initial observations of the suspect 6. Medical problems & treatment Multijurisdictional Counterdrug Task Force Training 107 Components on the Drug Evaluation Narrative Report 7. Psychophysical indicators of impairment 8. Clinical indicators of impairment 9. Signs of ingestion 10. Suspect s statements 11. Officer s opinion 12. Toxicological sample 13. Miscellaneous Multijurisdictional Counterdrug Task Force Training

37 Web site Mamasite.net Erowid.org DEA Knoa.org NNOA-National Narcotics Officers Association Mctft.com Multijurisdictional Counterdrug Task Force Training 109 Investigator Tim McClure Ford County Sheriff s Office 507 Ave. L Dodge City, Ks tmcclure@fordcounty.net Phone Cell-m Multijurisdictional Counterdrug Task Force Training 110 For more information about training with MCTFT, call

38 Identifying Drugged Persons

39 Identifying Drugged Persons The information presented in this MCTFT course represents a multijurisdictional approach to counterdrug efforts. It will not change, modify or supersede any regulations, policies and procedures of your agency or department. * * * * Print date: July 20, 2007 Multijurisdictional Counterdrug Task Force Training Multijurisdictional Counterdrug Task Force Training 2 Multijurisdictional Counterdrug Task Force Training (MCTFT) Multijurisdictional Counterdrug Task Force Training (MCTFT) has been established for the purpose of providing a unique, tuitionfree, in-depth series of courses covering all aspects of counterdrug law enforcement. Multijurisdictional Counterdrug Task Force Training (MCTFT) A federally funded partnership through the Department of Defense between the Florida National Guard and St. Petersburg College A nationally responsive program located at the Southeastern Public Safety Institute (SEPSI) of St. Petersburg College in St. Petersburg, FL Multijurisdictional Counterdrug Task Force Training 3 Multijurisdictional Counterdrug Task Force Training 4 Course Description This session has been designed to improve your ability to recognize individuals who may be medically impaired or under the influence of drugs Course Description It is likely you have encountered individuals who were under the influence of drugs rather than alcohol Depending upon the specific type(s) of drugs the individual has taken, some individuals may appear similar to persons who are under the influence of alcohol Other individuals will look and behave differently from an alcohol-impaired individual Multijurisdictional Counterdrug Task Force Training 5 Multijurisdictional Counterdrug Task Force Training 6 1

40 Course Description It is important that you be able to recognize suspects who may be under the influence of drugs so that you will know when to summon assistance from physicians, trained Drug Recognition Experts (DREs) or other appropriate persons Course Description This training program will not qualify you to perform the functions of a DRE; it will, however, assist you in recognizing some of the signs and symptoms associated with drug influence or when an individual needs medical attention Multijurisdictional Counterdrug Task Force Training 7 Multijurisdictional Counterdrug Task Force Training 8 Course Objectives To define drug as it relates to traffic safety To recognize impairment associated with drug use To identify the seven categories of drugs and recognize the major observable indicators To successfully document the observable impairment Define Drug As It Relates To Law Enforcement Recognized as drugs in United States Pharmacopoeia or National Formulary Intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in man or animals Other than food, intended to affect the structure or function of the body Multijurisdictional Counterdrug Task Force Training 9 Multijurisdictional Counterdrug Task Force Training 10 Working Definition of a DRUG A chemical substance, such as a narcotic or hallucinogen, that affects the central nervous system, causing changes in behavior and often addiction Illicit Drug Use In 2005, an estimated 19.7 million Americans aged 12 or older were current (past month) illicit drug users Used an illicit drug during the month prior to the survey interview Represents 8.1 percent of the population aged 12 years old or older Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically Source: SAMHSA, Results from the 2005 National Survey on Drug Use and Health Multijurisdictional Counterdrug Task Force Training 11 Multijurisdictional Counterdrug Task Force Training 12 2

41 Marijuana Use Marijuana was the most commonly used illicit drug (14.6 million past month users) Types of Drugs Used by Past Month Illicit Drug Users Aged 12 or Older: 2005 Source: SAMHSA, Results from the 2005 National Survey on Drug Use and Health. Multijurisdictional Counterdrug Task Force Training 13 Source: SAMHSA, Results from the 2005 National Survey on Drug Use and Health. Multijurisdictional Counterdrug Task Force Training 14 Types of Drugs Used by Past Month Illicit Drug Users Aged 12 or Older: 2005 Seven Drug Categories Cannabis CNS Stimulants Narcotic Analgesics CNS Depressants Hallucinogens Dissociative Anesthetics Inhalants Source: SAMHSA, Results from the 2005 National Survey on Drug Use and Health. Multijurisdictional Counterdrug Task Force Training 15 Multijurisdictional Counterdrug Task Force Training 16 Cannabis Marijuana Hashish Hash Oil Marinol Central Nervous System Stimulants Cocaine Amphetamine Methamphetamine Multijurisdictional Counterdrug Task Force Training 17 Multijurisdictional Counterdrug Task Force Training 18 3

42 Narcotic Analgesics Heroin Morphine Codeine Synthetic opiates Demerol Methadone Central Nervous System Depressants Alcohol Barbiturates Valium Chloralhydrate Multijurisdictional Counterdrug Task Force Training 19 Multijurisdictional Counterdrug Task Force Training 20 Hallucinogens LSD Peyote Psilocybin Dissociative Anesthetics PCP Ketamine DXM Multijurisdictional Counterdrug Task Force Training 21 Multijurisdictional Counterdrug Task Force Training 22 Inhalants Toluene Glue Paint Definitions Associated with DRE Examinations Pupil size Nystagmus Convergence Blood pressure Pulse rate Body temperature Internal clock Multijurisdictional Counterdrug Task Force Training 23 Multijurisdictional Counterdrug Task Force Training 24 4

43 Pupil Size Pupil Size Normal Range 2.5 to 5.0 mm (room light) 5.0 to 8.5 mm (near total darkness) 2.0 to 4.5 mm (direct light) Multijurisdictional Counterdrug Task Force Training 25 Multijurisdictional Counterdrug Task Force Training 26 Mydriasis (Dilated Pupils) Miosis (Constricted Pupils) Multijurisdictional Counterdrug Task Force Training 27 Multijurisdictional Counterdrug Task Force Training 28 Ptosis (Droopy Eyelids) Nystagmus Involuntary jerking of the eyes Multijurisdictional Counterdrug Task Force Training 29 Multijurisdictional Counterdrug Task Force Training 30 5

44 Strabismus A condition in which a person can not align both eyes simultaneously under normal conditions A condition in which the eyes deviate (turn) when looking at the object of regard Convergence Lack of convergence Vital Signs Internal Clock: 30 sec +/- 5 sec Pulse: bpm Blood Pressure: / Body Temp: 98.6 F +/- 1 degree Multijurisdictional Counterdrug Task Force Training 31 Multijurisdictional Counterdrug Task Force Training 32 Observations Observations Suspect s Breath Odor of alcohol Chemical odor Cannabis odor Suspect s Face Normal Flushed Pale Other General Appearance Clean Orderly Disarranged Bloody Vomit Urine Eyes Normal Watery Bloodshot Pink/red Multijurisdictional Counterdrug Task Force Training 33 Multijurisdictional Counterdrug Task Force Training 34 Observations Attitude Anxious Restless Agitated Excited Combative Disinterested Uninhibited Disoriented Drowsy Confused Hallucinating Loss of memory Cyclic mood swings Polite Antagonistic Stuporous Cooperative/indifferent Laughing Insulting Argumentative Fumbling Observations Speech Talkative Thick, slurred Incoherent Rapid Slow Non-communicative Repetitive Physical Actions Facial itching Dry mouth Nodding Droopy eyelids Low, raspy voice Body tremors Muscle tone Grinding of teeth Multijurisdictional Counterdrug Task Force Training 35 Multijurisdictional Counterdrug Task Force Training 36 6

45 Observations Other Nasal redness Runny nose Track marks Perspiring Warm to the touch Intense headaches Residue of paint on person Debris Pills Vials Syringes Drug paraphernalia Observations Multijurisdictional Counterdrug Task Force Training 37 Multijurisdictional Counterdrug Task Force Training 38 Psychophysical Exams Rhomberg Test Instructions Demonstration Subject s Attempts Record Results Multijurisdictional Counterdrug Task Force Training 39 Multijurisdictional Counterdrug Task Force Training 40 Walk and Turn Instructions Demonstration Subject s Attempts Record Results One-Leg Stand Instructions Demonstration Subject s Attempts Each leg Record Results Multijurisdictional Counterdrug Task Force Training 41 Multijurisdictional Counterdrug Task Force Training 42 7

46 Eye Examination: Detecting Signs of Drug Influence Cannabis Multijurisdictional Counterdrug Task Force Training 43 Multijurisdictional Counterdrug Task Force Training 44 Cannabis Schedule I Most widely abused illegal drug in the U.S. Derived from the Indian hemp plant Botanical name Cannabis Sativa Grows wild in climates all over the world Cannabis: Methods of Ingestion Smoking Oral Multijurisdictional Counterdrug Task Force Training 45 Multijurisdictional Counterdrug Task Force Training 46 Cannabis: Effects Cannabis: Effects Horizontal gaze nystagmus -none Vertical nystagmus - none Lack of convergence/strabismus - present Pupil size - possibly dilated Reaction to light - normal Blood pressure - up Body temperature - normal Pulse rate - up Short-term memory loss Paranoia Loss of ambition Munchies Multijurisdictional Counterdrug Task Force Training 47 Multijurisdictional Counterdrug Task Force Training 48 8

47 Cannabis: General Indicators Central Nervous System Stimulants Diminished inhibitions Impaired perception of time/distance Disorientation Body and/or eyelid tremors Reddening of the conjunctiva Possible debris in mouth Multijurisdictional Counterdrug Task Force Training 49 Multijurisdictional Counterdrug Task Force Training 50 Stimulants Drugs that speed up the body's metabolism Natural: caffeine, nicotine, cocaine Synthetic: amphetamine, methamphetamine, methcathinone Stimulants: Method(s) of Ingestion Injected Oral Inhaled Smoked Multijurisdictional Counterdrug Task Force Training 51 Multijurisdictional Counterdrug Task Force Training 52 Stimulants: Effects Stimulants: General Indicators HGN - none VGN - none Lack of convergence - none Pupil size - dilated (mydriasis) Pupil reaction to light - slow to none visible Pulse rate - up Blood pressure - up Body temperature - up Bruxism Restlessness Euphoria Anxiety Talkativeness Irritability Runny nose Redness to nasal area Leg and eyelid tremors Rigid muscle tone Multijurisdictional Counterdrug Task Force Training 53 Multijurisdictional Counterdrug Task Force Training 54 9

48 Meth Use 18 months later Meth Use 42 years old After just three years and five months of meth use 40 pounds lighter Multijurisdictional Counterdrug Task Force Training 55 Multijurisdictional Counterdrug Task Force Training 56 Meth Use 4 Years Later Methamphetamine Effects Multijurisdictional Counterdrug Task Force Training 57 Multijurisdictional Counterdrug Task Force Training 58 Narcotic Analgesics Narcotic Analgesics Strong painkilling drugs that also produce sleep Most drugs in this class are produced from the opium poppy Multijurisdictional Counterdrug Task Force Training 59 Multijurisdictional Counterdrug Task Force Training 60 10

49 Narcotic Analgesics: Characteristics Pain relief (analgesic) Produces withdrawal signs and symptoms (when stopped after chronic administration) Stop withdrawal signs and symptoms (note: other N.A. can be substituted for relief of withdrawal symptoms The Concept of Drug Tolerance The same dose of the drug will produce diminishing effects A steadily larger dose is needed to produce the same effect Multijurisdictional Counterdrug Task Force Training 61 Multijurisdictional Counterdrug Task Force Training 62 Narcotics: Effects Narcotics: General Indicators HGN - none VGN - none Lack of convergence - none Pupil size - constricted (miosis) Pulse rate - down Blood pressure - lowered Body temperature - down Slow reflexes, sluggish movements Slow, low, raspy speech Slow breathing, cold skin On the nod Droopy eyelids (ptosis) Dry mouth Euphoria Track marks Multijurisdictional Counterdrug Task Force Training 63 Multijurisdictional Counterdrug Task Force Training 64 Method(s) of Ingestion CNS Depressants Injected Oral Inhaled Smoked: Heroin, Opium, Morphine Multijurisdictional Counterdrug Task Force Training 65 Multijurisdictional Counterdrug Task Force Training 66 11

50 Depressants Depressants: General Indicators Drugs that slow down the body's metabolism Barbiturates: sleeping pills Tranquilizers: anxiety-fighting depressants Methaqualone: non-barbiturate hypnotic Drowsiness Droopy eyelids (ptosis) Thick, slurred speech Lack of coordination Slow, sluggish reactions Flaccid muscle tone Reduced social inhibitions In other words, drunk Multijurisdictional Counterdrug Task Force Training 67 Multijurisdictional Counterdrug Task Force Training 68 Depressants: Effects Depressants: Method(s) of Ingestion HGN - present VGN - present Lack of convergence - present Pupil size - normal Pupil reaction to light - slow Pulse rate - down (Qualudes & alcohol) Blood pressure - lowered Temperature - normal Oral Injected Multijurisdictional Counterdrug Task Force Training 69 Multijurisdictional Counterdrug Task Force Training 70 Hallucinogens Notable Hallucinogens Lysergic Acid Diethylamide (LSD) Psilocybin Mushrooms Peyote (mescaline) Multijurisdictional Counterdrug Task Force Training 71 Multijurisdictional Counterdrug Task Force Training 72 12

51 Hallucinogens Hallucinogens: Effects Drugs that cause distortions of reality This class of drug can alter vision, sense of smell and touch Some can be absorbed through skin HGN - none VGN - none Lack of convergence - none Pupil size - dilated Pupil reaction to light - normal Pulse rate - up Blood pressure - up Body temperature - up Multijurisdictional Counterdrug Task Force Training 73 Multijurisdictional Counterdrug Task Force Training 74 Hallucinogens: General Indicators Dissociative Anesthetics Dazed appearance Body tremors Perspiring Rigid muscle tone Difficulty with speech Statements suggesting hallucinations Distorted sensory perceptions PCP Ketamine DXM Multijurisdictional Counterdrug Task Force Training 75 Multijurisdictional Counterdrug Task Force Training 76 PCP: General Indicators PCP: General Indicators Slow, slurred speech Disorientation Loss of memory Agitation, excitement Blank stare ( yard stare ) Non-communicative Rigid muscle tone Loss of a sense of personal identity Sensory distortions Auditory hallucinations A feeling of extreme heat, profuse perspiration Increased pain threshold Multijurisdictional Counterdrug Task Force Training 77 Multijurisdictional Counterdrug Task Force Training 78 13

52 PCP: Effects Inhalants HGN - present (early onset) VGN - present Lack of convergence - present Pupil size - normal Pupil reaction to light - normal Pulse rate - up Blood pressure - up Body temperature - up Volatiles paint thinners gasoline Aerosols hair sprays spray paints Alkyl nitrites Nitrous oxide Schedule IV Multijurisdictional Counterdrug Task Force Training 79 Multijurisdictional Counterdrug Task Force Training 80 Inhalants: General Indicators Inhalants: Effects Odor of inhaled substance Traces of substance on face, nose, hands, clothing Bloodshot, watery eyes Confused, disoriented appearance Flushed face, possible sweating Slow, thick, slurred speech HGN - present VGN - present Lack of convergence - present Pupil size - normal (may be dilated with certain anesthetic gases) Pupil reaction to light - slow Pulse rate - up Blood pressure - up or down Body temperature - up, down, normal Muscle tone - usually normal Multijurisdictional Counterdrug Task Force Training 81 Multijurisdictional Counterdrug Task Force Training 82 Drugs Which Induce Nystagmus PCP Usually Causes Immediate Onset of Nystagmus CNS Depressants (Most) Inhalants Dissociative Anesthetics Multijurisdictional Counterdrug Task Force Training 83 Multijurisdictional Counterdrug Task Force Training 84 14

53 Drugs That Cause Lack of Convergence CNS depressants Inhalants Dissociative anesthetics Cannabis Strabismus Drugs Which Usually Don t Affect Pupil Size CNS Depressants Inhalants PCP Multijurisdictional Counterdrug Task Force Training 85 Multijurisdictional Counterdrug Task Force Training 86 Drugs Which Cause Pupil Dilation CNS stimulants Hallucinogens POSSIBLY Cannabis (slight dilation) Narcotic Analgesics Usually Cause Pupil Constriction Multijurisdictional Counterdrug Task Force Training 87 Multijurisdictional Counterdrug Task Force Training 88 Polydrug Use Using two or more drugs at the same time Examples: PCP and marijuana; heroin and cocaine; many others Field Studies Los Angeles Field Study 72% of suspects had 2 or more drugs New York Certification Training Study 67% of suspects had 2 or more drug categories other than alcohol Multijurisdictional Counterdrug Task Force Training 89 Multijurisdictional Counterdrug Task Force Training 90 15

54 Prevalence of Polydrug Use P.I.R.E.* DRE database indicates that 25% of all DRE-reported cases revealed two or more drug categories detected (2005) Two Drugs in Combination: How Do They Affect Pupil Size? Situation #1 Neither drug affects pupil size Example: PCP and Valium Neither one affects the size of the pupils The combination will also not affect pupil size *Pacific Institute of Research and Evaluation Multijurisdictional Counterdrug Task Force Training 91 Multijurisdictional Counterdrug Task Force Training 92 Null Effect No action plus no action equals no action If neither drug affects a particular indicator of impairment, their combination also will not affect that indicator Two Drugs in Combination: How Do They Affect Pupil Size? Situation #2 One drug affects the pupil size, but the other does not Example: PCP and cocaine Cocaine dilates pupils, PCP doesn t affect pupils The combination will affect pupil size Multijurisdictional Counterdrug Task Force Training 93 Multijurisdictional Counterdrug Task Force Training 94 Overlapping Effect Action plus no action equals action If one drug affects a particular indicator of impairment, and another drug has no effect on that indicator, the combination of those two drugs will affect the indicator, in the same way as the first drug alone Two Drugs in Combination: How Do They Affect Pupil Size? Situation #3 The two drugs affect pupil size in the same way Example: LSD and cocaine Cocaine dilates pupils; so does LSD The combination will affect pupil size Multijurisdictional Counterdrug Task Force Training 95 Multijurisdictional Counterdrug Task Force Training 96 16

55 Additive Effect Action plus the same action produces reinforced action If two drugs independently affect some indicator in the same way, their use in combination will also affect the indicator and the effect may be reinforced Two Drugs in Combination: How Do They Affect Pupil Size? Situation #4 The two drugs affect pupil size in exactly opposite ways Example: heroin and cocaine Cocaine dilates pupils, heroin constricts pupils We can t predict how the combination will affect pupil size Multijurisdictional Counterdrug Task Force Training 97 Multijurisdictional Counterdrug Task Force Training 98 Antagonistic Effect Action versus opposite action: can t predict the outcome If two drugs affect some indicator in exactly opposite ways, their use in combination could affect that indicator in any possible way The Effects of Drug Combinations Null Effect Overlapping Effect Additive Effect Antagonistic Effect Multijurisdictional Counterdrug Task Force Training 99 Multijurisdictional Counterdrug Task Force Training 100 Common Combinations of Drugs Sample Drug Influence Evaluation Face Sheet cocaine & cannabis PCP & cannabis cocaine & heroin alcohol & practically anything else This is NOT a DRE course, although we are using DRE principles This DRE form is only used as an example It is important for you to document, document, document all information observed! Multijurisdictional Counterdrug Task Force Training 101 Multijurisdictional Counterdrug Task Force Training

56 Components on the Drug Evaluation Narrative Report 1. Location 2. Witnesses 3. Breath Alcohol Test 4. Notification & interview of arresting officer 5. Initial observations of the suspect 6. Medical problems & treatment Components on the Drug Evaluation Narrative Report 7. Psychophysical indicators of impairment 8. Clinical indicators of impairment 9. Signs of ingestion 10. Suspect s statements 11. Officer s opinion 12. Toxicological sample 13. Miscellaneous Multijurisdictional Counterdrug Task Force Training 103 Multijurisdictional Counterdrug Task Force Training 104 For more information about training with MCTFT, call