FM13.20 | Drug Abuse, Mushroom & Food Poisoning — Summary & Reflection

KEY TAKEAWAYS

FM13.20 spans three domains:

Drug abuse: Major classes — tobacco (nAChR), cannabis (CB1), amphetamines/MDMA (monoamine release), cocaine (transporter block), LSD/psilocybin (5-HT2A), designer drugs (NPS — variable), solvents (CNS depression). MDMA/rave: serotonin syndrome (clonus, hyperthermia). NDPS Act 1985 governs all scheduled substances. Hair analysis for chronic use timeline.

Mushroom poisoning: The 6-hour rule — early onset (<6 h) = less lethal (muscarine, ibotenic acid); late onset (>6 h) = amatoxin (Amanita phalloides). Alpha-amanitin → RNA pol II inhibition → hepatorenal failure. Three-phase course: GI → false recovery → fulminant failure. No antidote; N-acetylcysteine + liver transplant if severe.

Food poisoning: Short incubation = preformed toxin (Staph 1–6 h; Bacillus cereus emetic type 1–6 h); intermediate = C. perfringens (8–24 h); long = Salmonella/Vibrio (12–72 h). Botulism = descending flaccid paralysis (pre-synaptic ACh block); antitoxin + ventilatory support. FSSA 2006 governs food safety law in India.

REFLECT

Eighty guests at a wedding feast develop vomiting and diarrhoea within 2 hours of eating. Three of the most elderly guests are hospitalised with dehydration. As the forensic medicine specialist called to assist the health authorities: describe the epidemiological investigation you would conduct (attack rate analysis, food vehicle identification). What specimens would you collect and how? Which statute governs your reporting obligation to public health authorities? And if the caterer is found to have stored food at unsafe temperatures — what criminal and civil legal provisions might be applicable?