Forensic Issues in Alcohol Testing

156 Pages·2007·3.2 MB·English

by  MD

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Half Title Page
Forensic Issues
in
Alcohol Testing
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Title Page
Forensic Issues
in
Alcohol Testing
Edited by
Steven B. Karch, MD, FFFLM
Consultant Pathologist and Toxicologist
Berkeley, California
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
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CRC Press
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© 2008 by Taylor & Francis Group, LLC
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Library of Congress Cataloging-in-Publication Data
Forensic issues in alcohol testing / [edited by] Steven B. Karch.
p. ; cm.
“A CRC title.”
Includes bibliographical references and index.
ISBN-13: 978-1-4200-5445-3 (hardcover : alk. paper)
ISBN-10: 1-4200-5445-7 (hardcover : alk. paper)
1. Blood alcohol--Analysis. 2. Breath tests. 3. Drug testing. 4. Automobile drivers--Alcohol use. I.
Karch, Steven B.
[DNLM: 1. Alcoholic Intoxication--diagnosis. 2. Ethanol--adverse effects. 3. Ethanol--analysis. 4.
Forensic Medicine--methods. 5. Forensic Toxicology--methods. W 775 F7154 2007] I. Title.
RA565F6779 2007
615’.7828--dc22 2007008112
Visit the Taylor & Francis Web site at
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Contents
Chapter 1 Measuring Acute Alcohol Impairment......................................................................1
Christopher S. Martin, Ph.D.
Chapter 2 Update on Clinical and Forensic Analysis of Alcohol............................................21
Alan Wayne Jones, D.Sc. and Derrick J. Pounder, M.D.
Chapter 3 Post-Mortem Alcohol — Aspects of Interpretation................................................65
Derrick J. Pounder, M.D. and Alan Wayne Jones, D.Sc.
Chapter 4 Recent Advances in Biochemical Tests for Acute and Chronic
Alcohol Consumption..............................................................................................91
Anders Helander, Ph.D. and Alan Wayne Jones, D.Sc.
Chapter 5 Alcohol Determination in Point of Collection Testing.........................................119
J. Robert Zettl, B.S., M.P.A., DABFE
Index..............................................................................................................................................137
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Preface
This book provides an overview of clinical and forensic-medical aspects of man’s favorite
recreational drug, alcohol (ethanol or ethyl alcohol). Consumption of alcoholic beverages is increas-
ing worldwide as are many of the undesirable consequences of heavy drinking and drunkenness.
The effects produced by alcohol depend on the amounts consumed and the speed of drinking. Small
quantities cause euphoria and feelings of well-being whereas large amounts and high blood-alcohol
concentration (BAC) depress the central nervous system and cause a decrement in performance
and behavior, especially where skilled tasks like driving are concerned.
The various chapters of this book reflect different areas of interest for both forensic scientists
and clinical and forensic toxicologists. The acute effects of alcohol are major concerns for motor
and cognitive functioning. This is important for traffic safety because alcohol intoxication and
drunkenness are incriminated in many fatal crashes. Enforcement of drinking and driving laws
throughout the world depends to a large extent on the concentration of alcohol measured in a
specimen of blood, breath, or urine obtained from the suspect. This kind of “chemical testing” to
produce evidence for prosecution requires the use of highly reliable analytical methods to guarantee
legal security for the individual. The widespread adoption of concentration per se laws for driving
under the influence of alcohol tends to create a razor-sharp difference in penalty for those close to
the statutory limit. Small analytical or pre-analytical errors might make the difference in penalty
for those close to the statutory limit. Small analytical or pre-analytical errors might make the
difference between acquittal or punishment in borderline cases.
In addition to details of the analytical methods used to measure alcohol in body fluids, knowl-
edge is also provided about the disposition and fate of alcohol in the body and the factors influencing
absorption, distribution, and elimination processes. Alcohol also tops the list of drugs encountered
in postmortem toxicology. Although the methods of analysis are the same as for living subjects,
making a correct interpretation of the results is often problematic. When dealing with autopsy
specimens, various artifacts can arise because of the poor quality of blood and body fluid specimens,
postmortem diffusion and redistribution, sampling site differences, and the risk of postmortem
synthesis owing to microbial activity.
Judging whether a person drinks too much alcohol is not always easy because many people deny
that they have a drinking problem. Tolerance is also an issue. Heavy drinkers become tolerant to
many of alcohol’s effects and do not manifest the same degree of impairment as would be seen in
the naive drinker. This complicates making an early diagnosis and commencement of treatment for
those at greatest risk of becoming dependent on alcohol. Clearly there is an urgent need to develop
more objective ways to verify overconsumption of alcohol. Considerable research effort has been
devoted to evaluate biochemical tests with enough sensitivity and specificity to detect hazardous
drinking before this escalates to the point of causing organ and tissue damage. The final chapter of
this book describes recent advances in the field of alcohol biomarkers that are intended to disclose
both acute and chronic consumption of alcohol as well as relapse after a period of rehabilitation.
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The Editor
Steven B. Karch, M.D., FFFLM, received his under-
graduate degree from Brown University. He attended grad-
uate school in anatomy and cell biology at Stanford Univer-
sity. He received his medical degree from Tulane University
School of Medicine. Dr. Karch did postgraduate training in
neuropathology at the Royal London Hospital and in cardiac
pathology at Stanford University. For many years he was a
consultant cardiac pathologist to San Francisco’s Chief Med-
ical Examiner.
In the U.K., Dr. Karch served as a consultant to the
Crown and helped prepare the cases against serial murderer
Dr. Harold Shipman, who was subsequently convicted of
murdering 248 of his patients. He has testified on drug
abuse–related matters in courts around the world. He has a special interest in cases of alleged
euthanasia, and in episodes where mothers are accused of murdering their children by the trans-
ference of drugs, either in utero or by breast feeding.
Dr. Karch is the author of nearly 100 papers and book chapters, most of which are concerned
with the effects of drug abuse on the heart. He has published seven books. He is currently completing
the fourth edition of Pathology of Drug Abuse, a widely used textbook. He is also working on a
popular history of Napoleon and his doctors.
Dr. Karch is forensic science editor for Humana Press, and he serves on the editorial boards
of the Journal of Cardiovascular Toxicology, the Journal of Clinical Forensic Medicine (London),
Forensic Science, Medicine and Pathology, and Clarke’s Analysis of Drugs and Poisons.
Dr. Karch was elected a fellow of the Faculty of Legal and Forensic Medicine, Royal College
of Physicians (London) in 2006. He is also a fellow of the American Academy of Forensic Sciences,
the Society of Forensic Toxicologists (SOFT), the National Association of Medical Examiners
(NAME), the Royal Society of Medicine in London, and the Forensic Science Society of the U.K.
He is a member of The International Association of Forensic Toxicologists (TIAFT).