Postmortem Toxicology Research Articles

Toxicology findings in cases of hanging in the City and County of San Francisco over the 3-year period from 2011 to 2013

In postmortem cases where the cause of death is hanging, toxicological analyses may be considered unnecessary by some medical examiners, toxicologists, and other persons involved in medico-legal investigations because the cause of death seems “obvious.” To ascertain if toxicological analyses are necessary when the cause of death is hanging, all 102 hanging cases (25 females; 77 males) from 2011 to 2013 that came under the jurisdiction of the San Francisco Office of the Chief Medical Examiner were examined from a total of 3912 sudden, unexpected, or violent death cases in the same period. Suicide was the manner of death in 99 of these cases, with two accidental and one undetermined death. The average age of decedents was 43.9 years (median 41), the youngest was an 11-year old male and the oldest was an 86-year old female. Of the 102 cases, 33 had negative toxicology while 69 cases had at least one positive toxicology result. Females were equally likely to have negative or positive results (12 and 13 cases respectively), but males were 37.5% more likely to have positive toxicology (n=56) rather than negative toxicology (n=21). For females, alcohol, mirtazapine, venlafaxine, and trazodone were the top psychoactive substances in peripheral blood while THC, cocaine, hydrocodone, bupropion, olanzapine, doxylamine, quetiapine and dextromethorphan were also reported. For males, alcohol, THC, cocaine, amphetamine, methamphetamine, bupropion, and diphenhydramine were the top psychoactive substances in blood, but several other drugs were also found in individual cases. Our study of hanging cases over a 3-year period support the idea that complete postmortem toxicology investigation of hangings should be performed, even when the “obvious” cause of death is asphyxia due to hanging. Many of these cases involved psychoactive substances (most often alcohol and cannabis), and having such knowledge provides a better understanding of the circumstances surrounding the decedent's death, their possible state of impairment, including the possibility of a staged suicide if the decedent was too impaired to perform a self-hanging.

Simultaneous Determination of 11 Illicit Phenethylamines in Hair by LC-MS-MS: In Vivo Application.

Existing phenethylamines are a class of synthetic compounds that differ from each other only in small changes to a largely conserved chemical structure. The recreational and illicit use of phenethylamines is a widespread problem. A simple procedure for the simultaneous quantitative determination in hair of 11 phenethylamines that are officially recognized as illicit by Italian legislation (p-methoxyamphetamine; p-methoxymethamphetamine; 3,4,5-trimethoxyamphetamine; 2,5-dimethoxyamphetamine; 2,5-dimethoxy-4-methylamphetamine; 2,5-dimethoxy-4-ethylamphetamine; 2,5-dimethoxy-4-bromoamphetamine; 2,5-dimethoxy-4-bromophenethylamine; 2,5-dimethoxy-4-iodophenethylamine; 2,5-dimethoxy-4-ethylthiophenethylamine and 2,5-dimethoxy-4-n-propylthiophenethylamine) has been developed and validated. Extraction from the matrix was performed after incubation in methanolic HCl and filtered reconstituted extracts were injected into a liquid chromatography/tandem mass spectrometry system (LC-MS-MS) without any further purification steps. This validated LC-MS-MS method has been used to determine the in vivo accumulation/retention of the above target analytes in hair after repeat oral administration to rats. This experiment further permitted investigation of the effect of pigmentation on the uptake of these phenethylamines by hair and the effect of hair pigmentation. The developed method could potentially be used for forensic and toxicological purposes, in the detection and quantitation of these illicit substances in human hair in workplace drug testing; drug-facilitated crime investigation; driver re-licensing; determining drug abuse history and postmortem toxicology.

Post-mortem toxicology: A pilot study to evaluate the use of a Bayesian network to assess the likelihood of fatality

The challenge of interpreting post-mortem drug concentrations is well documented and relies on appropriate sample collection, knowledge of case circumstances as well as reference to published tables of data, whilst taking into account the known issues of post-mortem drug redistribution and tolerance. Existing published data has evolved from simple data tables to those now including sample origin and single to poly drug use, but additional information tends to be specific to those reported in individual case studies. We have developed a Bayesian network framework to assign a likelihood of fatality based on the contribution of drug concentrations whilst taking into account the pathological findings. This expert system has been tested against casework within the coronial jurisdiction of Sunderland, UK. We demonstrate in this pilot study that the Bayesian network can be used to proffer a degree of confidence in how deaths may be reported in cases when drugs are implicated. It has also highlighted the potential for deaths to be reported according to the pathological states at post-mortem when drugs have a significant contribution that may have an impact on mortality statistics. The Bayesian network could be used as complementary approach to assist in the interpretation of post-mortem drug concentrations.

Comparative analysis of hospital and forensic laboratory ethanol concentrations: A 15 month investigation of antemortem specimens

Quantitative serum alcohol concentrations from regional hospitals (from specimens collected at time of hospital admission) were compared to results from whole blood (from specimens collected at the time of hospital admission) concentrations measured at the San Diego County Medical Examiner's Office (SDCMEO). Over a 15 month period (January 2012 to March 2013), the postmortem forensic toxicology laboratory analyzed a total of 2,321 cases. Of these, 280 were hospital cases (antemortem) representing 12% of the overall Medical Examiner toxicology casework. 59 of the 280 hospital cases (or 21%) screened positive for alcohol (ethanol). 39 of these 59 cases were included in the study based on available specimens for quantitative analyses. This investigation indicated that serum hospital ethanol concentrations correlated well (R2 = 0.942) with ethanol values determined at SDCMEO (generally measured in whole blood). There was an observed negative bias with an average of −14.1%. A paired t-test was applied to the data and it was shown that this observed bias is statistically significant. These differences in ethanol concentrations could result from differences in specimen, analytical techniques, and/or calibration. The potential for specimen contamination is also discussed.

Beyond the Boundaries of Forensic Toxicology - the Use of an Atypical Consultant in a Rare Case of Cerberin Poisoning

A severely decomposed body was found partially submerged in a creek. A bag of brown fibrous seeds was found nearby. Postmortem examination revealed saponified soft tissues and assorted skeletal elements without evidence of ante- or perimortem trauma. Anthropological, dental, and investigative evidence identified the decedent as a 31-year-old man who had been reported missing approximately two months prior after a suicide note was found at his residence. Investigation indicated he had purchased Cerbera seeds from the Internet. The fruits of the Cerbera “suicide” tree contain the toxin cerberin, a cardiac glycoside, which can induce heart block and lethal arrhythmias. Extensive putrefaction of the tissues and a lack of appropriate laboratory reference standards precluded identification of cerberin on postmortem toxicology. The seeds found at the scene were sent to a research botanist who identified them as Cerbera manghas L. of the plant family Apocynaceae. Based on these findings, the cause of death was determined to be cerberin poisoning. We are not aware of previously reported cases of cerberin poisonings within the United States, even though its use for suicidal and homicidal means has been well documented in eastern Asia and the Indian Ocean regions. The relative ease of obtaining these seeds through the Internet may result in deaths anywhere in the world. This case highlights the difficulties in identifying the putative toxin in postmortem samples when unusual and exotic poisons are used. Atypical consultants, a botanist in this particular case, may allow appropriate determination of the cause and manner of death.

Acute Coronary Artery Thrombosis Associated with Synthetic Cannabinoid Intoxication

Synthetic cannabinoids are drugs of abuse that have rapidly gained popularity in the United States primarily due to their easy availability, inconsistent regulation, and lack of detectability on routine drug screens. Numerous case reports of adverse physical and psychological effects occurring in certain users have raised concerns that these drugs may not be as harmless as advertised, nor as similar to their plant-derived cannabis counterpart tetrahydrocannabinol (THC), as users may assume. Presented is a case of a 57-year-old man who died as a result of an acute coronary artery thrombosis immediately after smoking synthetic cannabinoids. Synthetic cannabinoids in this case were confirmed on directed postmortem toxicology testing, despite the routine postmortem drug screen being negative. Adverse cardiovascular side effects in association with these substances have only been reported in a few individuals; however, public education of the possibility for serious outcomes is needed. Medical examiners should be made aware of the potential toxicity of these drugs and the fact that they are only detected through specialized toxicological analysis. Additional research and case reports are necessary to fully understand the chemical composition and subsequent side effect profile of these drugs.

Child, Adolescent and Young Adult Suicides: A Comparison Based on the Queensland Suicide Registry

Objective: The incidence of suicides increases rapidly up to the age of 20 years. Despite major developmental changes, only a limited number of studies has compared characteristics of child, adolescent and young adult suicides. The aim of the current study was to compare demographic, psychosocial and psychiatric characteristics of suicides in three youngest age groups - 10-14 years, 15-19 years and 20-24 years - in Queensland, Australia, between 2002 and 2011. Methods: The Queensland Suicide Register (QSR) contains information from a variety of sources, including: police report of death to a Coroner, post-mortem autopsy report, toxicology report and Coroner’s findings. Annual suicide rates were calculated by gender and age group. Odds Ratios (OR) with 95% confidence intervals (95% CI), Chi2 test are presented. Results: Between 2002 and 2011, there were 850 youth suicides recorded in the QSR - 43 aged 10-14 years, 295 aged 15-19 years and 512 aged 20-24 years. The proportion of males increased with age (51.2%, 69.5% and 76.6%). However, the proportion of Indigenous people decreased significantly with age (45.2%, 18.1% and 14.5%). Hanging was the most frequent suicide method for all age groups and for both genders, decreasing significantly with age for both genders. Prevalence of a diagnosed psychiatric disorder, substance use and psychiatric treatment increased with age. Evidence of untreated mental health problems was reported without significant differences between age groups. Similarly, there were no significant differences in history of previous suicide attempts and communication of suicide intent. Suicide in social group and attention to suicide in media, family conflict, school/ work-related problems and childhood trauma decreased significantly with age while relationship problems increased. Conclusion: Suicides in early adolescence were characterised by higher prevalence of family conflicts, schoolrelated problems and suicides in social groups. Suicides in young adults had significantly higher prevalence of psychiatric disorders and were much more impacted by relationship problems. The characteristics of suicides in late adolescents fell in between the other age groups.

Brain tissue: a viable postmortem toxicological specimen.

Brain tissue may be a valuable specimen in interpretation of postmortem toxicology. The protected and isolated position of the brain eliminates or at least attenuates many of the interpretive challenges with postmortem blood specimens. This study presents data for 30 drug and drug metabolites in cases submitted to the Sedgwick County Regional Forensic Science Center for autopsy examination from 2007 to 2014. Drug concentration in heart and femoral blood is compared with the drug concentration in brain tissue. There is a positive correlation of blood to brain concentrations, thus providing another tool for the toxicologist or pathologist to utilize in case interpretation.

Mortality related to novel psychoactive substances in Scotland, 2012: An exploratory study

BackgroundThe growth of novel psychoactive substances (NPS) over the last decade, both in terms of availability and consumption, is of increasing public health concern. Despite recent increases in related mortality, the circumstances surrounding and characteristics of individuals involved in NPS deaths at a population level remain relatively unknown. MethodsThe Scottish National Drug Related Death Database (NDRDD) collects a wide-range of data relating to the nature and circumstances of individuals who have died a drug-related death (DRD). We conducted exploratory descriptive analysis of DRDs involving NPS recorded by the NDRDD in 2012. Statistical testing of differences between sub-groups was also conducted where appropriate. ResultsIn 2012, we found 36 DRDs in Scotland to have NPS recorded within post-mortem toxicology. However, in only 23 of these cases were NPS deemed by the reporting pathologist to be implicated in the actual cause of death. The majority of NPS-implicated DRDs involved Benzodiazepine-type drugs (13), mainly Phenazepam (12). The remaining 10 NPS-implicated deaths featured a range of different Stimulant-type drugs. The majority of these NPS-implicated deaths involved males and consumption of more than one drug was recorded by toxicology in all except one case.NPS-implicated deaths involving Benzodiazepine-type NPS drugs appeared to involve older individuals known to be using drugs for a considerable period of time, many of whom had been in prison at some point in their lives. They also typically involved combinations of opioids and benzodiazepines; no stimulant drugs were co-implicated.Deaths where stimulant-type NPS drugs were implicated appeared to be a younger group in comparison, all consuming two or more Stimulant-type drugs in combination. ConclusionThis exploratory study provides an important insight into the circumstances surrounding and characteristics of individuals involved in NPS deaths at a population level. It identifies important issues for policy and practice, not least the prominent role of unlicensed benzodiazepines in drug-related mortality, but also the need for a range of harm reduction strategies to prevent future deaths.

Prescription opioid abuse based on representative postmortem toxicology

Opioids are important medications for pain and opioid maintenance treatment. Increasing use and abuse of prescription opioids has, however, caused worldwide concern. Our aim was to estimate the ratio between prescription opioid abuse and total use, based on representative postmortem toxicology. Our material included all the medico-legally examined deaths in Finland during 2010–2011 involving positive findings involving buprenorphine, codeine, fentanyl, methadone, oxycodone, or tramadol. We studied drug abuse by age group, with “abuse” meaning licit opioids used illicitly as narcotics. Drug-abuse history, drug injecting, or laboratory findings of illicit drugs defined an abuser case. We then compared abuser cases and other opioid-related cases between the opioids with the number of fatal poisonings, accidents, suicides, alcohol findings, concomitant opioid use, and median postmortem blood opioid concentrations. Opioid findings numbered 2499 in 2088 cases. Drug abuse involved 545 opioid-positive cases, which in Finland represented 0.5% of those deceased. The proportion of abuser cases among all opioid-related cases for buprenorphine was 85.5%, for methadone 82.4%, for tramadol 29.4%, for codeine 16.3%, for fentanyl 14.5%, and for oxycodone 6.9%. Abuse in age-groups >60 was rare. Concomitant other opioid findings were more frequent in abuser- than in other cases for codeine, oxycodone, and tramadol, whereas alcohol findings were more frequent in buprenorphine, codeine, and fentanyl abuse. Buprenorphine and methadone were most often related to drug abuse. Every other opioid studied involved some abuse, and especially tramadol. Abuse and fatal poisonings were concentrated in men aged 20–49.

Injuries in the vulnerable road user fatalities; a study from Sri Lanka

Vulnerable Road Users defined as people at risk in traffic due to absence of an outside protective shield to absorb energy during a collision are mainly pedestrians, bicycle riders and motor cyclists. In low income countries, deaths of VRUs outnumber vehicular drivers and occupants. A forensic pathologist not only reports the cause of death but also forms opinions on type of road user. We attempted to find whether pedestrians could be differentiated from other types of VRUs. A retrospective descriptive study, based on case records of VRUs fatalities from 2005 to 2012 referred to a tertiary care unit for post-mortem examination, was conducted. A pro-forma was developed to extract data from the post-mortem reports and toxicology reports. Data was analysed using SPSS version16. Out of the 328 cases 48% (n = 157) were pedestrians while 45% (n = 147) were riders/pillion riders of two wheeled vehicles and 5% (n = 16) were drivers/occupants of three-wheelers. The majority (87%) was males and 43% of pedestrians were elderly. 59% had 10–25 injuries and 87% had external injuries in the head, face and neck. The majority of skeletal injuries were in the skull followed by ribs. Analysis of different variables of pedestrians to other types of VRUs showed that the variables of, elderly male, road crosser, skull injuries, brain injuries, cause of death being head injuries and multiple injuries were significantly greater among pedestrian group (p: <0.001). The traffic hours (peak and off peak), number of injuries, rib injuries, limb injuries, crushed/run over injuries or lung and liver injuries had no significant association. Although some features helped in determining a pedestrian, many other factors were not associated to differentiate a pedestrian from other VRUs. Therefore, a forensic pathologist has to be cautious in expressing opinions when other corroborative evidence is lacking.

Interpretación de resultados toxicológicos post-mórtem: criterios de garantía de calidad

The correct interpretation of postmortem toxicology results offers an explanation on the meaning and significance of the obtained analytical results. Interpretation agreement to reality will depend on the quality of the sample and analytical results. It will also depends on the knowledge of the existence of different postmortem phenomena and the circumstances in which the death occurred. The whole process is hampered by the lack of recommendations or protocols to guide the toxicologist in the process of interpretation. Therefore, it is the more complex stage of toxicological research. In order to assist the forensic toxicologist in this task, this review of the existing knowledge on this matter is presented.

Utility of urinary ethyl glucuronide analysis in post-mortem toxicology when investigating alcohol-related deaths

Use and abuse of alcohol are common findings when unnatural deaths are investigated as evidenced by high blood- and urine- alcohol concentrations (BAC and UAC) at autopsy. Because ethanol is metabolized in the liver until the time of death, the autopsy BAC or UAC might be negative even though the deceased had consumed alcohol in the immediate ante-mortem period. Analysis of the non-oxidative metabolite of ethanol [ethyl glucuronide (EtG)] offers a more sensitive test of recent drinking. In this paper, we determined the concentrations of ethanol and EtG in urine samples from 972 consecutive forensic autopsies. In 425 cases (44%) both EtG and ethanol were positive, which supports ante-mortem drinking. In 342 cases (35%), both EtG and ethanol was negative, which speaks against any consumption of alcohol just before death. In 181cases, ethanol was negative in urine (<0.2g/kg), whereas EtG was positive (>0.5mg/L), which points towards ingestion of alcohol some time before death. In these cases, mean and median concentrations of EtG were 53.2mg/L and 23.7mg/L, respectively, although there was no mention of alcohol on 131 of the death certificates. Alcohol was mentioned on death certificates as an underlying or immediate cause of death or a contributing factor in 435 (45%) cases, which rose to 566 (58%) cases when positive EtG results were included. This article demonstrates the usefulness of EtG analysis in routine post-mortem toxicology when ante-mortem drinking and alcohol-related deaths are investigated.

O40: The effect of the national drug law reform on the incidence of 3,4-methylenedioxypyrovalerone (MDPV) among users of illegal drugs in Finland

Introduction In 2010, the Finnish drug legislation was improved in order to be able to react to emerging new psychoactive substances (NPS) more effectively. The amended Narcotics Act allows for a more rapid categorization of NPS as illegal narcotics at the initiative of the Finnish government. In this study, we sought to examine the prevalence of MDPV among drivers suspected of driving under the influence of drugs (DUID) in Finland, before and after the amendment of the Narcotics Act. In addition, the prevalence of MDPV in medico-legal autopsy cases was assessed. MDPV is a novel psychoactive drug with stimulant effects. It has been exceptionally popular among users of illegal drugs in Finland. MDPV was the first drug to be scheduled according to the amended Narcotics Act. Methods Since August 2009, MDPV has been included in the screening of post-mortem toxicology samples in Finland. Accordingly, serum samples from suspected DUID offenders have been analyzed for the presence of MDPV since September 2009. The analysis of MDPV was carried out using LC-MS/MS (DUID) and GC-MS (post-mortem toxicology) systems that have been described in detail elsewhere. We studied the MDPV positive cases between 2009 and 2012. Also, the concomitant use of other psychoactive drugs and the demographics of the users were examined. Results In DUID cases, the total number of MDPV positive cases was 486. Of these, 214 were from the time before the scheduling of the substance. In autopsy cases the numbers were 38 and 18 respectively. The number of MDPV positives decreased both in DUID cases and in autopsied after the scheduling of the drug. In most cases, MDPV was detected among several other psychoactive substances, the most prevalent co-findings being amphetamine and benzodiazepines. The mean (median) serum concentration of MDPV in DUID cases was 0.11 (0.03) mg/L. The mean (median) postmortem blood concentration in autopsy cases was 0.55 (0.12) mg/L. Conclusion Contrary to the expectations of some experts, MDPV did not completely disappear from the market after its national scheduling as an illegal narcotic. Nevertheless, the number of cases both in DUID suspects and in post-mortem toxicology decreased after the amendment. As seen in some other similar studies, the chances to limit and control the use of new psychoactive drugs by means of national legislation are somewhat limited. However, if no measures are taken in terms of the legal status of NPS, the efficacy of the available methods of controlling distribution, and of limiting harm to users and non-users, will be marginal. It is crucial to act fast in defining the legal status and in informing authorities and consumers about the dangers associated with the drug. This cannot be accomplished without rapid measures in the analyzing laboratories to include new substances into the screening methods. Also, extensive scientific research on these substances must be encouraged in order to better identify potentially dangerous substances.

Ethanol Analysis in Postmortem and Human Performance Forensic Toxicology Cases

Ethanol analysis is probably the most common procedure performed in forensic and analytical toxicology laboratories worldwide. Ethanol poisoning is very important in both clinical and forensic investigations. In clinical evaluations, measuring the ethanol concentration is necessary for the timely and appropriate delivery of care to patients who may experience discomfort or life threatening ethanolic overdose or mixed ethanol-drug intoxication. In forensic toxicology investigations, ethanol is routinely measured in both human performance forensic toxicology cases such as drug-facilitated crimes and driving-under-the-influence cases, as well as in postmortem forensic toxicology cases. This review presents information regarding the most commonly analyzed biological specimens used in alcohol analysis including, among others, blood, breath, urine, oral fluid, and vitreous humor. Additionally, it presents the various chemical, biochemical, gas chromatographic, and breath testing techniques commonly employed in ethanol analysis and considers the main advantages and disadvantages of each. Finally, a brief discussion of quality assurance in alcohol analysis is presented.

Synovial fluid: an alternative toxicologic specimen?

Although blood is the most commonly used specimen in forensic toxicology, it is not always available. In those cases, alternative samples are sought on which to perform toxicology testing. The current study assessed the usefulness of synovial fluid for postmortem cocaine and opiate/opioid testing. One hundred four cases were sampled, with 98 cases being tested representing 24 negative controls and 74 cases positive for cocaine, benzoylecgonine, morphine, 6-monoacetylmorphine, hydrocodone, and/or oxycodone. Synovium demonstrated excellent correlation and predictability when compared with blood, although it was not as sensitive for 6-monoacetylmorphine as either vitreous or urine. The authors recommend further study to assess the usefulness of synovial fluid in postmortem toxicology to include the evaluation of its utilize for more drugs and the development of further assays to use its potential even in limited quantities.

How Alcohol Kills: Alcohol-Attributable and Alcohol-Associated Deaths in a Medical Examiner Population

Forensic pathologists frequently encounter the myriad effects of acute and chronic ethanolism and the many ways that alcohol contributes to sudden natural and unnatural deaths. Alcohol may act as risk factor for sudden death or directly participate as a cause of sudden death through its acute and chronic toxic effects. This retrospective descriptive study examines the causes and manner of deaths potentially attributable to alcohol and the results of postmortem toxicology testing for ethanol in unnatural deaths and alcohol-attributable natural deaths over a five-year period in a large medical examiner's office. Ethanol was detected in all types of unnatural deaths as well as alcohol-attributable natural deaths due to the complications of chronic ethanol abuse with a wide range of overlapping concentrations. Of the unnatural deaths involving individuals with a detectable ethanol concentration, 61% were accidents, 25% suicides, and 14% were homicides; ethanol was detected in 40.2% of accidents, 42.0% of suicides, and 53.1% of homicides. Ethanol was also detected in 41% of deaths due to chronic alcoholism. For the unnatural deaths involving intoxicated individuals and deaths due to chronic alcoholism, the deaths were certified as a wide variety of causes. In general, the results are similar to those in the existing literature. Forensic pathologists need to be well-versed in interpreting postmortem ethanol concentrations and determining the role of acute and/or chronic ethanolism in sudden deaths.

Profiles of pregabalin and gabapentin abuse by postmortem toxicology

Pregabalin (PRG) and gabapentin (GBP) are used in the treatment of neuropathic pain and epilepsy, and PRG also in generalized anxiety disorder. There is increasing evidence that PRG possesses considerable abuse potential. PRG may have a higher addiction potential than GBP due to its rapid absorption and faster onset of action. Our objective is to estimate the proportion of all PRG- and GBP-related fatalities attributable to PRG and GBP abuse. We investigated all medico-legal death cases in Finland in which PRG or GBP was found in postmortem toxicology during 2010–2011. PRG was found in 316 cases and GBP in 43 cases. Drug abuse was associated with 48.1% of the PRG and 18.6% of the GBP findings. PRG poisoning accounted for 10.1% of all PRG cases and GBP poisoning for 4.7% of all GBP cases. In the drug abuser cases, PRG poisoning represented 19.1%, and GBP poisoning 12.5%. The median blood concentration of PRG was 15mg/L in the abuser group and 5.8mg/L in the other cases. For GBP, these concentrations were 12mg/L and 8.3mg/L, respectively. In the PRG abuser group, 91.4% of cases showed concomitant opioid use, while in the rest of these cases neither alcohol nor opioids were detected, but other central nervous system acting drugs were found in each abuser case. In the GBP abuser group, 87.5% of cases showed concomitant opioid use. PRG abuse with high doses is increasingly common and can be fatal when combined with opioids.

Validation of a multi-analyte LC–MS/MS method for screening and quantification of 87 psychoactive drugs and their metabolites in hair

A multi-analyte method for the detection and quantification of 87 psychoactive drugs (antidepressants, antipsychotics, benzodiazepines, and z-drugs) in human hair has been developed and fully validated using the liquid chromatography-tandem mass spectrometry system. Due to the remarkable increase in requests of hair sample tests (such as for driver's license renewals, child custody, DFA cases, and postmortem toxicology), we focused on the development of a rapid sample preparation. About 20mg of hair samples, previously washed and cut into snippets, was ultrasonicated with 700μl of methanol. Samples were then directly analyzed using a 4000 QTRAP (AB SCIEX, Foster City, CA, USA) with an electrospray ionization (ESI) Turbo V(TM) Ion Source. The validation criteria parameters were satisfactory and in accordance with the international guidelines. All the compounds tested were successfully detected. One important aspect is the LODs in the low picogram per milligram concentration which may suggest a potential use of this method in cases of detection of single drug exposure. However, the LC-MS/MS method has been successfully applied for the analysis of postmortem cases (n = 9).

Morphine Concentrations in Skeletal Muscle

Skeletal muscle constitutes a large percentage of the total body volume, making it a potentially widely available specimen for drug quantitation when blood is not available for toxicological testing. Morphine is a commonly encountered opiate in postmortem toxicology known to have stable blood concentrations in peripheral vessels. Morphine concentrations were measured in both femoral blood and skeletal muscle to assess the stability and predictability of skeletal muscle concentrations as compared with femoral concentrations. Analysis showed skeletal muscle was a sensitive matrix for the detection of morphine; however, there is significant disparity between the skeletal muscle and blood concentrations with a lack of predictability. The authors conclude that thigh skeletal muscle may be used for qualitative identification of morphine; however, interpretation of quantitative results should not be made as there does not seem to be a clear correlation between femoral blood and skeletal muscle concentrations for morphine.