Forensic Toxicology

Drug Use and Misuse

Susannah Davies, Atholl Johnston, David Holt

• Publisher: Royal Society of Chemistry
• Year: 2019
• eBook ISBN: 9781788018104
• Edition: 1
• Topic: Medicine
• Subtopic: Forensic Medicine

New designer drugs, access to databases, and changing availability of samples for analysis have changed the face of modern forensic toxicology in recent years. Forensic Toxicology: Drug Use and Misuse brings together the latest information direct from experts in each sub-field of the discipline providing a broad overview of current thinking and the most innovative approaches to case studies.
The text begins with an in-depth discussion of pharmaco­epidemiology, including information on the value of nationwide databases in forensic toxicology. The use and abuse of drugs in driving, sport and the workplace are then discussed by industry experts who are conducting case work in their field. Not only are new drug groups discussed (NPS), but also their constantly changing impact on drug legislation. Synthetic cannabinoids, khat and mephodrone are discussed in detail. Following a section devoted to legislation and defence, readers will find comprehensive chapters covering sample choice reflecting the increasing use of hair and oral fluid, and also the less commonly used sweat and nail analysis. New and old case examples are compared and contrasted in the final part of the book, which will enable readers to understand how drugs impact on each other and how the interpretative outcome of a case are dependent on many aspects.
From use of pharmaceutical drugs in a clinical setting, through smart drugs to new psychoactive drugs, this book documents the wide range in which drugs today are abused. This book will be an essential resource for postgraduate students in forensic toxicology, and for researchers in forensic toxicology laboratories who need the latest data and knowledge.

1Introduction to Forensic Toxicology and the Value of a Nationwide Database

Alan Wayne Jones

Linköping University, Linköping, Sweden
Email: [email protected]

1.1 Introduction

Forensic toxicology, formerly known as forensic chemistry, is a multidisciplinary subject concerned with various aspects of chemistry, physiology, pharmacology and toxicology, as well as other branches of science and technology.^1,2 Forensic toxicology practitioners are first and foremost trained in analytical chemistry because their principal task is extraction, detection, identification and quantitative analysis of a plethora of drugs and poisons in biological specimens.^3,4 Another important duty of the forensic toxicologist or forensic pharmacologist is to provide expert testimony in criminal and civil cases involving the use and abuse of drugs in society and also in drug-related crimes, such as when drunk and drugged drivers are prosecuted.⁵

Knowledge about the disposition and fate of drugs in the body and how psychoactive substances alter normal functioning of the brain are important considerations when forensic toxicologists interpret their analytical findings in a legal context.⁶ The relationships between the various clinical signs and symptoms of impairment and the concentrations of psychoactive substances in blood is other relevant information available from TOXBASE, a forensic toxicology database.

The various sub-disciplines of forensic toxicology and the types of information stored in TOXBASE are listed below:

• Unnatural death investigations involving poisoning and overdosing with drugs.
• Driving under the influence of alcohol and/or other drugs.
• Drug facilitated crimes (incapacitation), such as date-rape.
• Control of illicit drugs in society, especially by people detained in prisons and other sectors of the criminal justice system.
• Child welfare and custody cases where suspicion arises that the parents or care-givers abuse drugs or administer drugs to the infants or elderly for which they are responsible.
• Monitoring the use of banned drugs by people enrolled in treatment and rehabilitation programs for substance abuse disorder.
• Drug testing in the workplace.
• Use of doping agents in sports.

Forensic pharmacovigilance is a subject of increasing interest and importance when it comes to the safety of medicines and the dangers of prescribing certain combinations of drugs to patients.^7,8 The information in TOXBASE can help to flag for the emergence of new recreational drugs of abuse (designer drugs), and help to decide whether these should be banned or classified as controlled substances. Other information stored in TOXBASE deals with the drugs commonly encountered in poisoning deaths.^9,10 By cross-linking information in TOXBASE with other databases (e.g. prescription registers) or safety of medicines records the potential dangers of certain drugs and drug combinations become easier to document.¹¹ The post-mortem section of TOXBASE can be complemented with information about the cause and manner of death (e.g. suicide, homicide, accident) according to findings at autopsy and the official death certificate.¹²

1.2 Forensic Toxicology in Sweden

Geographically, Sweden is roughly the same size as California or twice the size of the UK. However, the population of Sweden is only 9.5 million (2014), which means that one central forensic toxicology laboratory provides analytical services for the whole country. This centralization has several advantages when it comes to the choice of analytical methods and the availability of modern state-of-the-art equipment, quality assurance procedures and laboratory accreditation.

The annual workload in terms of numbers and types of forensic cases submitted for analysis to the Swedish National Laboratory of Forensic Toxicology are summarized in Table 1.1. Official records show that the number of forensic autopsies has remained remarkably constant, averaging 5000 per year over the past 20 years. The laboratory workload is strongly influenced by new government legislation dealing with abuse of alcohol and drugs in society, as exemplified by enactment of a zero-tolerance law for driving under the influence of drugs (DUID) in 1999.¹³ The forensic toxicology database available in Sweden contains information about hundreds of drugs and their metabolites and the concentrations in blood and other biological specimens from living and deceased persons.¹⁴ Senior scientists at the Swedish National Laboratory of Forensic Toxicology are closely associated with the faculty of medicine at the University of Linköping, particularly clinical pharmacology. A good collaboration between these two organizations has resulted in considerable research activity and many joint publications.¹⁵

Table 1.1 Number and type of cases submitted to the Swedish Board of Forensic Medicine for toxicological analysis during the years 2012, 2013 and 2014.

Type of investigation	Year 2012	Year 2013	Year 2014
Post-mortem toxicology	5051	5084	5310
Traffic cases (drun...

Table of contents

• Cover
• Title Page
• Copyright Page
• Preface
• Contents
• 1 Introduction to Forensic Toxicology and the Value of a Nationwide Database
• 2 Forensic Pharmacology
• 3 The Role of Amnesty Bins in Understanding the Pattern of Recreational Drugs and Novel Psychoactive Substances Being Used Within a Locality
• 4 Contamination of Water with Drugs and Metabolites
• 5 Understanding the Utility of Analysis of Anonymous Pooled Urine from Standalone Urinals in Detecting and Monitoring Recreational Drug Use
• 6 Mephedrone and New Psychoactive Substances
• 7 Novel Psychoactives in New Zealand
• 8 Cannabis and Synthetic Cannabinoids
• 9 Khat – Chewing it Over: Continuing “Cultural Cement”, Cardiac Challenge or Catalyst for Change?
• 10 Role of Analytical Screening in the Management and Assessment of Acute Recreational Drug Toxicity
• 11 Workplace Drug Testing
• 12 Current Issues in Human Sport Drug Testing: Clenbuterol, Erythropoietin and Xenon
• 13 Drugs and Driving
• 14 Alcohol Technical Defences in Road Traffic Casework
• 15 New Psychoactive Substances and the Criminal Law
• 16 Scheduling of Drugs in the United States
• 17 Drug Legislation in New Zealand
• 18 Use of Reference Materials in Toxicology
• 19 Nail Analysis in Forensic Toxicology
• 20 Hair Testing in Forensic Toxicology
• 21 Drugs in Oral Fluid
• 22 Sweat as an Alternative Biological Matrix
• 23 Smart Drugs
• 24 Substandard and Counterfeit Medicines
• 25 Detection of Drugs and Drug Metabolites from Fingerprints
• 26 Investigating Drug Metabolism of New Psychoactive Substances Using Human Liver Preparations and Animal Studies
• 27 Case Examples and Discussion
• Subject Index