# 6

Examining what the scientists, detectives and medical examiners know about metabolism and metabolites

and

Examining how thoughtful and shrewd adult drug addicts are; removing any notion that they are possessed zombies having absolutely no cognitive control over their lives and that they cannot possibly have advanced powers to manipulate other people.

One of the greatest discoveries in medical science came in identifying opium as an effective medicine, in small quantities and used in Paregoric:

The principal active ingredient in Paregoric is powdered opium. In the United States the formula for Paregoric, U.S.P. is tincture of opium 40 ml, anise oil 4 ml, benzoic acid 4 g, camphor 4 g, glycerin 40 ml, alcohol 450 ml, purified water 450 ml, diluted alcohol^[14] to 1000 ml, and contains the equivalent of 0.4 mg/ml of anhydrous morphine; one ounce of paregoric contains 129.6 mg (2 grains) of powdered opium, or the equivalent of 13 mg of anhydrous morphine.^[15][16] The average adult dose is 4 ml by mouth which corresponds to 16 mg of opium, or 1.6 mg of anhydrous morphine."^[2]
It is unclear when the current formula for Paregoric, U.S.P. was developed in the United States, and more research is needed. For example, one formula for "Camphorated Tincture of Opium (Paregoric Elixir)" attributed to the United States Pharmacoepia of 1863 is: "Macerate 1 drachm each powdered opium and benzoic acid, 1 fluid drachm of anise, 2 ounces clarified honey, and 2 scruples camphor, in 2 pints diluted alcohol for 7 days, and filter through paper."^[17] A slightly different formula is given in the 1926 pharmacoepia.^[18]
The current formula for Paregoric, U.S.P. should not be assumed to be universal. For example, in the United Kingdom the formula for Paregoric, B.P. is tincture of opium 5 ml, benzoic acid 500 mg, camphor 300 mg, anise oil 0.3 ml, alcohol (60%) to 100 ml, and contains about 1/30th grain of anhydrous morphine in 60 minims,^[15] which is 25% stronger than Paregoric, U.S.P.
https://en.wikipedia.org/wiki/Paregoric

Paregoric with opium saves young children's lives by stemming diarrhea and by suppressing cough. 

Opium, like heroin, an alkaline substance produced from the poppy plant, enters the body by many routes (oral, intravenous, snorted, etc.) and is metabolized by the liver.  It is broken down, chemically, and a byproduct is excreted through the kidneys and collected in the urinary bladder as morphine.  Not every detective or police officer knows this.  Every hard-core junky knows this and, in mostly urban settings, junkies have been known to drink each other's urine for the purpose of utilizing the morphine.  Every Forensic Pathologist should know this.

Why is this an issue?

At hospital admission, urine screening produces a quicker snapshot for Physicians than bloodwork.  When the patient is unconscious, the Doctors need to have the results of a urine screening so they can provide the best care.  In the case of a Heroin or Opium overdose, the urine screen will not test positive for Heroin or Opium because the patient's liver has performed a chemical reaction and converted the substance used into a metabolite.  

When a prosecutor or family receives a death certificate or toxicology report, and they knew that the decedent was a heroin/opium abuser, there may be puzzlement when the substance found in their system is listed as morphine.

As the reader can see by examining the ingredients listed above for Paregoric, it is clear that Opium constitutes 40ml (30ml, roughly constitutes one ounce).  A much larger volume of other ingredients are used, for example 450ml of water and 450ml of diluted alcohol.  This scientific and laboratory controlled mixture produces a regulated and uniform substance which has performed its medicinal purpose for more than 100 years.

In the case of illicit substances, like powdered cocaine or heroin for example,  persons along the supply chain are commonly known to reduce the volume of the active substance by increasing inert substances.  In the criminal narcotics world, these additional inert substances increase is known as "cutting" or "stepping on" the batch.  It is a means by which distributors who have absolutely no regard for the abuser's health/safety nor for their loved ones can increase their profit by stretching a fixed amount of the illicit substance.

In a Northern Virginia case from the 1980s, a young man fell from the fourth floor of a parking garage and he was pronounced dead by a physician at the Fairfax Hospital.  The Northern Virginia Medical Examiner performed the autopsy and did not rule the death "accidental."  Instead, because she found that all of the coronary arteries and aorta were occluded by plaque originating from the cutting agents used for Cocaine (Manitol, powdered sugar, powdered milk) and the toxicology report indicated a high level of cocaine in the subject's blood, she ruled that death was caused by coronary artery disease, cause by extreme cocaine related obstructions.

If the reader harkens back to the example of KoolAid dissolved in a gallon of water, the reader must understand that dissolved substances like sugar, mannitol, flour, powdered milk can precipitate out from the solutions into which they are placed.  These precipitated, reverse-dissolved, non-active ingredients can be as harmful or more harmful than the regulated substance because they can cause infection and they can form blockages in the circulatory system, lungs, at the point of injection or inhalation.  Examine the following photo of a subject who, through prolonged cocaine abuse, perforated the soft palate at the roof of his mouth:

Intravenous substance abusers are very resourceful and single-minded about bathing their brains in their substance of choice.  Intravenous abusers start by injecting at the bend in their right or left arm.  This site allows them ease for tying-off so as to raise the vein, however, it leaves track-marks and drops of blood.  So these abusers adapt.  They start wearing long sleeved shirts...even on the hottest days.  These veins are not forgiving and, with over use and infections, they may collapse.  Resourceful abusers move to site backups and they have been known to inject between toes, under the tongue and even into their own jugular veins.

Judges are fully aware that adult abusers continue to make conscious and self-serving decisions as they go about; stealing to support their habits, destroying relationships between family and friends, neglecting spouses, children, employers.  Judges, like most of society, are not willing to entertain the "devil made me do it" defense and defense attorneys know better than to advance such nonsense.

High School Football Coach Wisdom :

Men, in life, there are three decisions which are yours and yours alone which you can make:

1.  You can chose your faith.

2.  You can chose your friends.

3.  You can chose what you put into your bodies.