Medicolegal issues with

substance abusers
DR.HAZDALILA YAIS RAZALI
MEMJ 2019/20
 Terminology Definition
Addiction:
◦ Generally applied to patterns of heavy use of psychoactive drugs.
◦ While addiction has been replaced technically by the more specific term “substance dependence,” it continues to be
used widely.
◦ Compulsive use leading to physical symptoms of withdrawal when use is discontinued.

Substance dependence= “drug dependence,”

◦ cluster of cognitive, behavioural and physiological symptoms indicating continued substance use despite the
occurrence of significant substance-related problems
◦ a pattern of repeated self-administration that usually results in tolerance, withdrawal and compulsive drug-taking
behaviour.

Substance abuse = “drug abuse,”

◦ maladaptive pattern of substance use resulting in recurrent and significant adverse consequences related to the
repeated use of a drug.
◦ Substance abuse is not characterized in terms of tolerance and withdrawal; instead, it includes only the harmful
consequences of repeated use (for example, when such use becomes physically hazardous; causes failure to fulfill
obligations at work, school or home; or creates legal, social or interpersonal problems).
◦ “drug abuse refers to the use, usually by self-administration, of any drug in a manner that deviates from the approved
medical or social patterns within a given culture.”
Withdrawal:
◦ chronic intake of a substance is abruptly discontinued.

Tolerance:
◦ The need to use an increasing amount of a drug to attain the desired effects, or the decreased intensity in
effects experienced with the continued use of the same amount of the substance.

Intoxication:
◦ The development of a reversible, substance-specific syndrome during or after substance use. It becomes a
clinical problem when significant maladaptive patterns of behaviour lead to distress and impairment.

Morbidity:
◦ From the Latin word “morbidus” (meaning “sick” or “unhealthy”)
◦ a state of disease or disability from any cause.

◦ DSM V
Distribution of drug dependence
according to age
 Types of drug being abuse in Malaysia 2017 - NADA
New Repeat Total

53.77
42.99

38.89

37.9
31.61
28.55

16.3
17

14.52

3.98

3.79
4.7

2.85
2.17

1.16

0.06

0.05

0.04

0.03
0.01
0
Me t h (Cr yst a l) Opiod (H e r oin & Met h (T a bs) Ma r ijua na E c st a sy & Ot he r s Psyc hot r ophic
Mor phine) Amphe t ha mine dr ug s
Criminal aspect of drug abusers
It is illegal to possess, manufacture or
distribute drugs with the potential for abuse
Dangerous Drugs Act 1952 regulates the import,
export, manufacture, sale and use of opium,
dangerous drugs and related materials.
Personal use
Self-administration (basically for private use),
section 15 DDA,
least serious offence compared to possession and trafficking.
Proven by chemical tests conducted on the urine or blood
sample of the accused person
a fine not exceeding RM5,000.00 or an imprisonment term
not exceeding 2 years
Possession
Section 6 or section 12(2) DDA 
The legal concept of “possession” requires three main ingredients to be proven
• Custody, control, and knowledge.

Punishment:
 a mere fine to life imprisonment and whipping, depending on the weight of the drugs in
question.

For example:
◦ 2-5 grams of Heroin, Section 39A(1) - prison for 2-5 years and 3-9 strokes of the cane.
◦ > 5 grams of Heroin, Section 39A(2) - imprisonment from 5 years to life and a minimum of 10
strokes of the cane under
Trafficking
To prove an offence of drug trafficking,
◦ ONE is in possession of dangerous drugs
◦ Possession is for the purposes of trafficking in the said drugs.

Capital punishment is the highest punishment for the offence - mandatory

sentence of death by hanging.
Under section 39B of the Dangerous Drugs Act,
15 gm or more heroin and morphine;
1,000 gm or more opium (raw or prepared)
200 gm or more cannabis
40 gm or more cocaine
Dangerous Drugs (Special Preventive
Measures) Act 1985
Power of preventive detention for alleged drug trafficking
activities.
Individual can be detain for not more than 60 days for drug
related offences.
◦ Following then, individuals can be detained for a period not more
than 2 years by the Home Ministry.
◦ Offenders can be strapped with an electronic monitoring device
(EMD) to monitor their movements.
Dangerous Drugs (Forfeiture of
Property) Act 1988
Powers to trace, freeze and forfeit the assets of
the drug traffickers,

Onus is placed on the liable person or drug

trafficker to prove that his properties were
gained through legal means.
Drug Dependents (Treatment and
Rehabilitation) Act 1983
Treatment and rehabilitation of drug dependents.
Police power -> from 14th January 2017 -> National Anti-Drug Agency (NADA), Ministry of Home
Affairs
NADA
- adopted a paradigm shift -> voluntary basis known as Cure & Care 1Malaysia Clinic.
- It is an alternative to compulsory drug rehabilitation centres
- It has received recognition and is regarded as one of the best practice to be followed in the
whole region.
Post Mortem of Drug Abuser
Clothes and the belongings
- to check for needle, syringe and tourniquet,
- photographs of the scene are to be taken and to search for any drugs etc
- any drugs found should be preserve

Universal precaution
- Prevention of infectious diseases like HIV, Hepatitis B etc during the conduct of autopsy.

Body is to look for any caches of drugs that may be in orifices etc.
Post Mortem of Drug Abuser - external
Wasting and signs of self neglect
Body may be tattooed to hide scars (railroad tracks),
Stains at tips of fingers
Needle track scars
Fibrosed veins
Recent injection sites may show zones of inflammation.
Regional lymph nodes may be enlarged.
Look for the perforation of nasal septum.
Froth may be at mouth nose.
Post Mortem of Drug Abuser - internal
G.I.T. may contain pills/capsules
Enlarged lymphnodes
Signs of congestion of visceras
Hepatospleenomagaly
Valvular heart diseases
Brain may show edema and focal areas of necrosis due to hypoxia.
Blood, urine etc are mandatory to preserve for chemical analysis.
Postmortem drug toxicology analysis
A large degree of error can arise from
attempting to estimate antemortem drug
concentrations and the ingested dose from
postmortem measurements. The chosen site
and technique for postmortem blood sampling
can greatly influence the concentration of drug
measured.
Specimen Particular advantages
Blood/plasma/serum Preferred specimen for most substances
Bile Morphine, buprenorphine, tramadol,
benzodiazepines, MDMA
Bone Qualitative analysis of morphine, benzodiazepines,
amphetamines
Brain Centrally acting drugs, e.g. morphine, cocaine,
limited literature data
Fat THC, and other drugs, but little literature to interpret
results
Gastric contents Orally administered drugs/poisons
Hair All substances, particularly basic substances, and
most metals
Muscle Most drugs, however literature contains little data to
interpret concentrations
Pleural effusion Most drugs, but drugs subject to concentration
changes, hence difficult to interpret
Vitreous humour Ethanol, some biochemistries, e.g. glucose, urea,
creatinine