Forensic Laboratory Testing Methods

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Questions and Answers

In forensic toxicology, which of the following is NOT a part of the areas dealt with?

Impaired driving

Therapeutic drug monitoring (correct)

Workplace drug testing

Drug facilitated assault

In criminal cases, forensic toxicologists may be involved in which of the following?

Drug facilitated assault of assailants only

Impaired driving not limited to motor vehicles (correct)

Homicides of victims only

Impaired driving related to motor vehicles only

What is the role of a witness in court for a forensic toxicologist?

Provide opinion based on education and experience

Mainly involved in emergency screening

Only testify to facts and observations (correct)

Conduct lab work on the case

Which type of testing is usually done in clinical forensic toxicology if it is likely to influence treatment of the patient?

(GC/MS/MS) Signup and view all the answers

Which type of chromatography uses less solvent than liquid/liquid?

Gas chromatography (GC) Signup and view all the answers

What does LC-MS(MS) refer to?

Single MS or MS/MS Signup and view all the answers

What does UV/VIS stand for in the context of detectors?

Ultraviolet/visible detector Signup and view all the answers

What does ELISA stand for in the context of assays?

Enzyme linked sorbent immunoassay (96-well plates) Signup and view all the answers

What type of samples are primarily used for forensic toxicology testing?

Whole blood and tissue Signup and view all the answers

Which extraction method is increasingly used for LC-MS based assays?

Protein 'crash' extraction Signup and view all the answers

What are immunoassay designs optimized for in forensic work?

Diluted whole blood Signup and view all the answers

Which methods differ in their sample preparation requirements and effects on the analyte and matrix?

GC and LC chromatography methods Signup and view all the answers

What does the process of extraction involve in whole blood samples?

Denaturing proteins and peptides Signup and view all the answers

What is crucial in forensic testing to minimize interference and concentrate the analyte for improved sensitivity?

Sample processing and extraction Signup and view all the answers

Which substances influence the extraction process in forensic testing?

Amphoteric and zwitterion functions Signup and view all the answers

What does the extraction process aim to achieve in forensic testing?

To make the analyte more soluble in a solvent than the aqueous specimen Signup and view all the answers

Which type of extractions are common for GC-based assays?

Liquid-liquid or solid-phase extractions Signup and view all the answers

What influences the extraction scheme used in forensic testing?

Specimen type, available instrumentation, robustness, precision of the assay, and purpose of the test Signup and view all the answers

Which methods are employed to prepare samples for specific analytical methods?

Dilution, headspace analysis, and protein 'crash' Signup and view all the answers

What is the most likely reason for the elevated drug concentrations in blood taken at autopsy compared to blood collected at the hospital?

Postmortem redistribution Signup and view all the answers

Which factor can lead to low or near absent drug levels in cases involving depressants (narcotics, sedatives) with or without alcohol?

Resuscitation and hospitalization Signup and view all the answers

What is the primary reason for the delay in determining the cause of death in the case described?

Postmortem redistribution Signup and view all the answers

What can complicate the analysis of depressants (narcotics, sedatives) with or without alcohol in forensic toxicology?

Resuscitation and hospitalization Signup and view all the answers

What is the primary difference between the Medical Examiner system and the Coroner system?

The Medical Examiner system is headed by a forensic pathologist, while the Coroner system may or may not be headed by a physician. Signup and view all the answers

In postmortem toxicology, what is considered the manner of death?

Specific categories such as homicide, suicide, accident, natural, undetermined, and unclassified (MAID deaths). Signup and view all the answers

What is an example of determining the manner of death in postmortem toxicology?

A young woman with a long history of depression crossing into the oncoming lane and colliding with a semi-trailer head-on is classified as an accident. Signup and view all the answers

Why is it not usually possible to determine the time of death accurately in postmortem toxicology?

Due to the complex nature of toxicological analyses and their limited ability to provide precise timeframes for when toxins were ingested. Signup and view all the answers

Which bodily fluid is commonly used for postmortem toxicological analysis and provides unique insights into drug concentrations and effects?

Vitreous humor Signup and view all the answers

What is the primary purpose of chain of custody protocols in postmortem toxicology?

Both a and b Signup and view all the answers

In postmortem toxicology, which factor can significantly impact the interpretation of toxicological results?

Postmortem redistribution of drugs Signup and view all the answers

Which type of death can postmortem toxicology help rule out as the cause?

Natural disease Signup and view all the answers

Which bodily fluid is commonly used for postmortem toxicological analysis but has specific advantages and limitations in interpreting drug concentrations and effects?

Blood Signup and view all the answers

In cases involving drug overdoses or poisonings, which bodily fluid or tissue can provide valuable information for toxicological analysis?

Liver Signup and view all the answers

What is the primary reason for most forensic labs not measuring cannabidiol (CBD)?

It is a highly lipid soluble compound Signup and view all the answers

Which cannabinoid is pharmacologically 'active' and has higher concentrations after oral ingestion due to the first pass effect?

Delta-9-tetrahydrocannabinol (∆9-THC) Signup and view all the answers

What is the main challenge in separating Delta-8-tetrahydrocannabinol (∆8-THC) analytically from Delta-9-tetrahydrocannabinol (∆9-THC)?

Similar side-effects to ∆9-THC Signup and view all the answers

Which cannabinoid is a positional isomer of Delta-9-tetrahydrocannabinol (∆9-THC) and is not usually present in Cannabis?

Delta-10-tetrahydrocannabinol (10-THC) Signup and view all the answers

Which cannabinoid is potentially up to 3 times more potent than ∆9-THC and is not naturally present in Cannabis?

O-Acetyl-delta-9-tetrahydrocannbinol (THC-O) Signup and view all the answers

Which cannabinoid is potentially comprising up to 40% of cannabis plant extract and studied for anxiety, cognition, movement disorders, pain, and epilepsy, with little psychoactivity?

Cannabidiol (CBD) Signup and view all the answers

What is the peak duration of the 'high' after smoking ∆9-THC?

2-6 hours Signup and view all the answers

In forensic cases involving THC, what has been revised regarding baseline blood THC levels?

<2 ng/mL in light smokers Signup and view all the answers

What does THC undergo in postmortem cases that affects blood levels?

Redistribution Signup and view all the answers

What has the Canadian Criminal Code set limits for regarding THC concentrations within 2 hours of driving?

<5 ng/mL Signup and view all the answers

What effect does THC have on heart rate?

Increased heart rate Signup and view all the answers

What is the half-life of THC in blood compared to the brain and body?

Longer in blood than brain and body Signup and view all the answers

In which bodily fluid can Cannabinol (CBN) be found?

Blood Signup and view all the answers

What do baseline blood THC levels typically measure in light smokers?

<2 ng/mL Signup and view all the answers

What does THC-P stand for?

Tetrahydrocannabiphorol Signup and view all the answers

What correlation exists between blood THC level and effect?

Positive correlation Signup and view all the answers

Which series of synthetic cannabinoids was funded by NIDA for medical research?

JWH Signup and view all the answers

Where are the cannabinoid receptors CB1 mainly located?

Central nervous system Signup and view all the answers

Which of the following is a potential adverse psychiatric effect of synthetic cannabinoids?

Psychosis Signup and view all the answers

What is a potential cardiovascular adverse effect of synthetic cannabinoids?

Hypertension Signup and view all the answers

What is a potential neurological adverse effect of synthetic cannabinoids?

Generalized seizures Signup and view all the answers

What makes the analysis of cannabimimetics difficult?

Very low blood concentrations Signup and view all the answers

Which country's federal drug laws control specific named substances and chemically related drugs with similar pharmacological effects?

Canada Signup and view all the answers

What act did the USA have in 1986 to control analogues of scheduled drugs?

Federal Analogue Act Signup and view all the answers

What is a downside for users of synthetic cannabinoids?

Don't know what you are getting Signup and view all the answers

What can complicate the analysis of synthetic cannabinoids?

They keep changing as regulations change Signup and view all the answers

Which country's federal rules are slow to add new substances, leading individual states to make individual drugs illegal?

USA Signup and view all the answers

Which of the following opioids is semi-synthetic?

Hydromorphone Signup and view all the answers

What is the primary mechanism of action of naloxone?

Competitive antagonist at mu-receptors Signup and view all the answers

What characterizes opioid tolerance?

Relative and absolute tolerance Signup and view all the answers

Which opioid exhibits cross-tolerance with heroin?

$C_22H_{28}N_2O$ Signup and view all the answers

Which of the following is a substituted and modified cathinone commonly found in 'Bath Salts' designer drugs?

Methylenedioxypyrovalerone (MDPV) Signup and view all the answers

In the USA, which federal agency has 'federal' rules regarding controlled substances?

DEA (Drug Enforcement Administration) Signup and view all the answers

Which of the following synthetic drugs is more potent and has more psychedelic activity compared to Khat?

'Bath Salts' designer cathinones Signup and view all the answers

Which series of synthetic drugs is known for being highly potent and toxic hallucinogens with LSD-like effects?

N-BOMe series Signup and view all the answers

Which of the following is a major abused stimulant that has experienced a resurgence?

Methamphetamine Signup and view all the answers

Which legislative body controls specific named substances and chemically related drugs with similar pharmacological effects in Canada?

$CDSA (Controlled Drugs and Substances Act)$ Signup and view all the answers

Which type of synthetic drugs are known for having stimulant plus psychedelic properties, along with being more potent than Khat?

'Bath Salts' Signup and view all the answers

What is the primary federal law for controlled substances in the USA?

DEA (Drug Enforcement Administration) Signup and view all the answers

Which of the following substances is mentioned in relation to causing potentially fatal excited delirium?

MDMA Signup and view all the answers

Which organization does not recognize excited delirium as a medical diagnosis unless clear diagnostic criteria are validated?

American Medical Association Signup and view all the answers

Which substances are mentioned as potentially lethal at higher doses, with PMMA causing a significant number of deaths in certain regions?

PMMA and N-Bombs Signup and view all the answers

Which organization recognizes excited delirium and notes its potential disproportionate effect on persons of color?

American College of Emergency Physicians Signup and view all the answers

'Substituted phenethylamines' are mentioned for their stimulant and psychedelic properties. What distinguishes these drugs?

$\text{Degree of psychedelic properties and overt toxicity}$ Signup and view all the answers

'N-Bomb' cases from the literature demonstrate the dangerous effects of these substances, including bizarre behavior, hyperthermia, and death. What type of substances are N-Bombs?

$\text{Synthetic phenethylamines}$ Signup and view all the answers

What is the potentially fatal state involving extreme agitation and delirium, often related to the acute abuse of stimulants such as cocaine and methamphetamine?

Excited delirium Signup and view all the answers

Which substances have potent hallucinogenic and toxic effects, making them difficult to detect in body fluids?

2C-X series and cocaine Signup and view all the answers

What distinguishes 'Substituted phenethylamines' in terms of their properties?

Psychedelic properties and overt toxicity Signup and view all the answers

What distinguishes 'N-Bomb' among other synthetic substances?

Belongs to synthetic phenethylamines category Signup and view all the answers

What is the estimated potency of isotonitazene compared to fentanyl?

Approximately as potent Signup and view all the answers

In which year was the first Alberta death due to carfentanil?

2016 Signup and view all the answers

Which substances have become major contributing factors in the opioid crisis?

Cocaine, amphetamines, and methamphetamine Signup and view all the answers

What is the potential adverse psychiatric effect of synthetic cannabinoids?

Paranoia and hallucinations Signup and view all the answers

Which bodily fluid is commonly used for postmortem toxicological analysis?

Blood Signup and view all the answers

Carfentanil abuse in Europe was discussed at which International Conference?

4th International Conference Novel Psychoactive Substances Signup and view all the answers

Which 'Novel' Psychoactive Substance was detected with isotonitazene being the first identified in an Alberta death in 2019?

Psychedelics Signup and view all the answers

What do benzodiazepines contribute to in the case report detailing the sudden death of an opioid addict?

Toxicity of opioids Signup and view all the answers

What are methods used to increase the success of finding more potent fentanyl and other opioid analogues?

All of the above Signup and view all the answers

Which 'Novel' Psychoactive Substance category includes cocaine, amphetamines, phenethylamines, and cathinones?

Stimulants Signup and view all the answers

What is the half-life range of naloxone as a reversing agent for fentanyl?

30-80 minutes Signup and view all the answers

What is the half-life range of fentanyl?

3-12 hours Signup and view all the answers

What is the typical route of medical administration for naloxone?

Intravenous or intramuscular Signup and view all the answers

For what purposes is fentanyl used?

Short-term anesthesia, acute surgical procedures, and chronic pain Signup and view all the answers

Who developed fentanyl and marketed it?

Dr. Paul Janssen and Janssen Pharmaceutica Signup and view all the answers

What has contributed to the popularity of fentanyl?

High addictiveness, ease of purchase, and potency compared to other drugs Signup and view all the answers

Which of the following substances is allowed in-competition only?

Caffeine Signup and view all the answers

In which category are glucocorticoids allowed both in-competition and out-of-competition?

Glucocorticoids Signup and view all the answers

Which of the following is not mentioned as a substance with sympathomimetic effects?

Morphine Signup and view all the answers

Which organization was established in 2002 to promote, coordinate, and monitor the fight against doping in sports?

World Anti-Doping Agency (WADA) Signup and view all the answers

What specific program is designed to monitor potentially abused drugs that are not banned outright but are subject to abuse?

Monitoring Program Signup and view all the answers

What is the purpose of Therapeutic Use Exemption (TUE)?

To allow medically justified medications that would otherwise be banned Signup and view all the answers

Who must apply to the WADA medical team for approval before an athlete can use specific medications for legitimate medical purposes?

The athlete's physician Signup and view all the answers

What substances were known to be used in the 1800s for doping in sports?

Strychnine and cocaine Signup and view all the answers

When did modern 'dope testing' start after a British cyclist collapsed and died after a grueling race?

Mid-1960s Signup and view all the answers

What was the initial focus of 'dope testing' when it started in the mid-1960s?

Stimulants Signup and view all the answers

Which regional event is mentioned as being under current regulation for drug testing in sports?

Pan American Games Signup and view all the answers

What was the concentration of chloroform in the wife's blood?

105 mg/L Signup and view all the answers

What was the concentration of chloroform in the husband's blood six hours after the event?

0.16 mg/L Signup and view all the answers

What method was used for the initial identification of chloroform to assist police with their investigation?

Headspace GC/FID Signup and view all the answers

What were the signs of struggle observed in the wife?

Broken dentures and facial abrasions Signup and view all the answers

What is the primary reason that cardiac glycosides cannot be detected or measured by GC-based methods?

They are not volatile enough and undergo thermal breakdown before transforming into the gas phase Signup and view all the answers

Why was it fortunate that an astute cardiac resident ordered a digoxin test in the case mentioned in the text?

The symptoms were similar to 'digoxin' toxicity Signup and view all the answers

What was the outcome of the suspicion that the husband was the poisoner despite lack of evidence?

He was never charged by the police Signup and view all the answers

What method was used to analyze cases involving pancuronium and/or unique metabolites found in patients who were not prescribed the drug?

LC-MS/MS method Signup and view all the answers

'N-Bomb' cases from the literature demonstrate dangerous effects including bizarre behavior, hyperthermia, and death. What type of substances are N-Bombs?

Substituted phenethylamines Signup and view all the answers

In which year did Saldivar confess to murdering 50 patients on NBC Dateline?

March 1998 Signup and view all the answers

What substance was involved in the case where a husband was accused of killing his wife with alcohol, alprazolam, and cadmium?

Alcohol, Alprazolam, and Cadmium Signup and view all the answers

What substance's concentrations were found to be elevated in blood taken at autopsy compared to blood collected at the hospital?

Cadmium Signup and view all the answers

What did Lawrence Livermore National Laboratory develop a method for extracting and analyzing in toxicology testing?

Pancuronium Signup and view all the answers

What did Saldivar retract on ABC 20/20 and Extra in April 1998?

His confession of murdering patients on NBC Dateline Signup and view all the answers

What type of death can postmortem toxicology help rule out as the cause?

Accidental death due to poisoning or overdose Signup and view all the answers

In the case of homicidal administration of digitoxin, what was the concentration of digitoxin in the postmortem blood sample?

395 ng/ml Signup and view all the answers

What was the range of chloroform concentration found in the victim's body in the case involving Dr. Samson Dubria?

17-43 mg/L Signup and view all the answers

What did the accused, Dr. Samson Dubria, suggest as a possible explanation for the presence of chloroform in the victim's body?

Inhaled it when they drove past a truck hauling the chemical on the freeway Signup and view all the answers

What was the mean concentration of chloroform associated with homicide?

33 mg/L Signup and view all the answers

In the case of homicidal administration of digitoxin, what was the therapeutic range for serum digitoxin concentration?

10 - 35 ng/ml Signup and view all the answers

What was the outcome of the suspicion that the victim might have self-administered an overdose of chloroform to relieve headache pain in the case involving Dr. Samson Dubria?

'Almost impossible' according to experts due to lack of evidence left behind Signup and view all the answers

What was the mean concentration of chloroform associated with suicide?

32 mg/L Signup and view all the answers

What was identified as a potentially abused drug in the case involving homicidal digitoxin poisoning?

Cannabinol (CBN) Signup and view all the answers

What is the GCS (Glasgow Coma Scale) score of the 25-year-old female in Case #2?

3 Signup and view all the answers

In Case #1, what is the calculated respiratory rate in breaths per minute?

30 Signup and view all the answers

What is the body temperature (in degrees Celsius) of the unknown male in Case #1?

$T 40$C Signup and view all the answers

What is the heart rate (in beats per minute) of the unknown male in Case #1?

$HR 149$ Signup and view all the answers

What is the difference between 'Fever' and 'Hyperthermia'?

Fever is a regulated increase in body temperature, while hyperthermia is an unregulated increase in body temperature. Signup and view all the answers

What should be done about the elevated temperature in cases of hyperthermia?

Aggressively cool the patient using methods like body bag with ice/water, fanning and misting, and cooled IV fluids. Signup and view all the answers

What is the primary reason for sedation in managing 'Hot & Bothered' patients?

Rigidity and hyperactivity can be fatal, so sedation with medications like benzodiazepines is essential. Signup and view all the answers

When should cooling of hyperthermic patients be stopped?

Cooling should be stopped when the patient's body temperature reaches a safe level and stabilizes. Signup and view all the answers

Which residency programs in Canada are entry points for the Clinical Pharmacology & Toxicology Training (CPT) fellowship?

Emergency Medicine, Internal Medicine, Anesthesia, and Pediatrics Signup and view all the answers

What is a key aspect of PADIS roles?

Toxicovigilance involving identifying and evaluating toxic risks in the community Signup and view all the answers

What does the toxicologic exam involve?

Assessing head, eyes, ears, nose, throat, skin, central nervous system, gastrointestinal system, and cardiovascular system Signup and view all the answers

What may be included in the toxicologic workup?

'Tox panel,' urine tox screens, electrolytes, creatinine, urea, VBG/ABG, serum osmols Signup and view all the answers

What is a qualitative test for various substances that may not directly correlate with the patient's signs and symptoms?

Urine drugs of abuse screen Signup and view all the answers

What are the ABCs of toxicology?

Airway protection, breathing assessment, circulation Signup and view all the answers

What are key processes in managing toxicology cases?

Decontamination and enhanced elimination Signup and view all the answers

What is PADIS elective open to?

Residents from any specialty Signup and view all the answers

What is the role of the Alberta Centre for Toxicology in drug testing?

Provides oversight and accreditation for workplace drug testing labs in Alberta Signup and view all the answers

What distinguishes regulated and non-regulated workplace drug testing?

Mandatory status and adherence to specific rules Signup and view all the answers

What is the main focus of the learning objectives for the Employment Related Drug Testing overview?

Emphasizing quality and accuracy in drug testing Signup and view all the answers

What distinguishes the types of workplace drug testing based on their regulatory status?

$Mandatory status and specific rules Signup and view all the answers

What is the primary purpose of drug screening in the workplace?

To ensure job safety and government regulations are met Signup and view all the answers

Which industry is NOT mentioned as commonly using drug screening?

Healthcare Signup and view all the answers

What are the important pharmacokinetic considerations in drug testing?

Absorption, distribution, metabolism, and elimination Signup and view all the answers

Which drug is described as having unpredictable strength and contamination?

Amphetamines Signup and view all the answers

What is a significant health risk associated with opioids?

Respiratory depression Signup and view all the answers

What are the effects commonly associated with cannabinoids?

Euphoria and relaxation Signup and view all the answers

What is the primary purpose of ethanol testing in urine samples?

To determine recent alcohol consumption and potential impairment Signup and view all the answers

What is the main reason for the disqualification of the snowboarder in the given scenario?

The snowboarder's claim of passive inhalation was not considered credible Signup and view all the answers

What is the significance of SAMHSA accreditation in drug testing?

It ensures accurate screening methods and confirmation of all positives Signup and view all the answers

In forensic toxicology, what is the significance of poppy seeds in relation to opioids/opiates?

They are metabolized into codeine and morphine in the body Signup and view all the answers

What is a key factor to consider about interpreting positive cannabinoid results?

$17.8$ ng/mL THC level indicates recent marijuana use within hours Signup and view all the answers

What distinguishes 'Inca tea' positives from other cocaine metabolite results?

They are more likely to be false positives due to their rarity Signup and view all the answers

What is a key consideration regarding interpreting positive drug test results?

Positive results may not necessarily imply impairment or recent use Signup and view all the answers

What distinguishes 'Inca tea' positives from other cocaine metabolite results?

They are more likely to be false positives due to their rarity Signup and view all the answers

What is the primary purpose of Immunoassay (IITF) in workplace drug testing?

To provide rapid preliminary testing for drugs Signup and view all the answers

What is the main responsibility of Medical Review Officers (MROs) in workplace drug testing?

Determining 'reportable' positives and reporting results to companies Signup and view all the answers

Which method is used for confirmation testing involving the extraction, clean up, concentration, derivatization, chromatography, and detection of drugs?

GC/MS Signup and view all the answers

What are the potential drawbacks of non-laboratory based testing (POCT) in workplace drug testing?

False positives and negatives, lack of confirmation, and user dependency Signup and view all the answers

What can influence drug test results in workplace drug testing?

Donors' drug history including prescription medications and alcohol consumption Signup and view all the answers

What are the potential methods of specimen adulteration in workplace drug testing?

Internal dilution, external dilution, substitution, contamination, or tampering Signup and view all the answers

Which bodily fluid is NOT mentioned as a specimen type for drug testing in the workplace?

Tears Signup and view all the answers

What are alternate confirmation methods mentioned in workplace drug testing?

LC/MS/MS, LC/TOF, GC/MS/MS, GC/TOF Signup and view all the answers

What is a potential disadvantage of non-laboratory based testing (POCT) in workplace drug testing?

Lack of confirmation of results Signup and view all the answers

What are some potential methods of specimen adulteration mentioned in workplace drug testing?

Internal dilution, external dilution, substitution, contamination or tampering Signup and view all the answers

What are some potential drawbacks of non-laboratory based testing (POCT) in workplace drug testing?

False positives and negatives, lack of confirmation and user dependency Signup and view all the answers

What are the effects of alcohol, also known as Ethanol?

Drowsiness and loss of consciousness Signup and view all the answers

What were the rulings in the Entrop Case regarding drug testing at the Sarnia Imperial Oil refinery in Canada?

Denied random drug testing but allowed random alcohol testing Signup and view all the answers

What was the focus of Canadian courts regarding drug testing in the workplace?

Focusing on the ability to perform the job and individual rights Signup and view all the answers

What are the analytical considerations for drug testing in the workplace?

Sample collection, chain of custody, and drug testing procedures Signup and view all the answers

What is involved in sample collection for drug testing in the workplace?

$pH$ and creatinine (or $s.g.$) testing, chain of custody verification, and donor drug history Signup and view all the answers

What did the rulings in the Trimac Case involve regarding pre-employment and random drug testing for drivers working in Canada?

Allowed pre-employment testing but denied random testing due to invasion of privacy Signup and view all the answers

What did various legal cases uphold or deny regarding pre-employment drug testing?

Upheld pre-employment drug testing but denied accident/incident testing Signup and view all the answers

What is important for toxicologists in forensic drug testing regarding court testimony?

Both interpretation of drug test results and training for being an expert witness Signup and view all the answers

What is included in sample collection considerations for forensic toxicology?

Collection protocol only Signup and view all the answers

What does alcohol testing measure?

Impairment from alcohol only Signup and view all the answers

What is recommended to minimize interference and concentrate the analyte for improved sensitivity in forensic toxicology?

Crucial measures during sample collection to minimize interference Signup and view all the answers

In what context is non-laboratory-based testing relevant for workplace drug screening?

For initial screening purposes before sending samples to a laboratory Signup and view all the answers

Study Notes

Forensic Laboratory Testing Overview

Forensic labs use extraction and chromatography methods for whole blood and tissue testing, as opposed to clinical labs.
Forensic testing covers a wide range of substances, including drugs, poisons, and chemicals at varying concentrations.
Most forensic toxicology testing is done on whole blood or tissue, which presents more difficulty and interference compared to serum or plasma.
Sample processing and extraction are crucial in forensic testing to minimize interference and concentrate the analyte for improved sensitivity.
Immunoassay designs vary for forensic and clinical testing, with ELISA plates being optimized for diluted whole blood in forensic work.
Chromatography methods such as GC and LC differ in their sample preparation requirements and effects on the analyte and matrix.
Specific extraction methods like liquid-liquid or solid-phase extractions are common for GC-based assays, while protein 'crash' extracts are increasingly used for LC-MS.
Techniques like dilution, headspace analysis, and protein 'crash' are employed to prepare samples for specific analytical methods.
The process of extraction involves denaturing proteins and peptides in whole blood, forming a clear supernatant for analysis after centrifugation.
The extraction process aims to make the analyte more soluble in a solvent than the aqueous specimen, often involving the adjustment of pH.
The extraction scheme used depends on the specimen type, available instrumentation, robustness, precision of the assay, and the purpose of the test.
Factors like amphoteric and zwitterion functions in analytes, as well as the presence of specific substances, influence the extraction process.

Importance of Postmortem Toxicology in Forensic Investigations

The Alberta Office of the Chief Medical Examiner handles around 6,500 cases annually, with a total of 32,000 deaths in the province, including 80-100 homicides per year.
Cases in Alberta have substantially increased over the past 6-10 years, covering various categories such as homicidal, suicidal, accidental, undetermined, and natural deaths.
Other forensic laboratories, such as RCMP labs in Vancouver, Edmonton, and Ottawa, handle criminal cases, DNA, trace evidence, documents, and firearms investigations.
Toxicology in Ontario and Quebec is managed by their own labs and provincial police services, while other provinces have different arrangements, such as local hospitals, provincial laboratories, and U.S. private laboratories.
Postmortem toxicology is crucial as it can rule out natural disease or trauma as the cause of death and sometimes identify contributory factors.
Different bodily fluids and tissues, including blood, vitreous humor, urine, liver, and stomach contents, are used for toxicological analysis, with each providing unique insights into drug concentrations and effects.
Postmortem blood, vitreous humor, and urine are commonly used for toxicological analysis, with each having specific advantages and limitations in interpreting drug concentrations and effects.
The presence and concentrations of drugs in the liver, stomach contents, and other bodily fluids and tissues can provide valuable information for toxicological analysis, especially in cases involving drug overdoses or poisonings.
Postmortem toxicology can also involve the analysis of other specimens such as bile, cerebrospinal fluid, solid tissues, injection sites, and exhibits like syringes, drinking glasses, and bottles.
Chain of custody protocols are essential in postmortem toxicology to track exhibits from collection to disposal, ensuring the integrity and security of the specimens and analysis process.
Postmortem toxicology is critical for investigating deaths related to carbon monoxide poisoning and can reveal less obvious sources of toxic substances, such as postmortem fermentation leading to false alcohol levels.
Postmortem redistribution of drugs in the body, influenced by factors like pH changes and protein binding, can significantly impact the interpretation of toxicological results, highlighting the complexity of postmortem toxicology.

Cannabis and THC: Key Facts and Forensic Implications

Tetrahydrocannabiphorol (THC-P) is around 30 times more potent than ∆9-THC and is not naturally present in Cannabis
O-Acetyl-delta-9-tetrahydrocannbinol (THC-O) can be up to 3 times more potent than ∆9-THC and is not naturally present in Cannabis, with potential hallucinogenic effects at high doses
Over 100 cannabinoids are naturally present in cannabis, with Cannabidiol (CBD) potentially comprising up to 40% of cannabis plant extract, studied for anxiety, cognition, movement disorders, pain, and epilepsy, with little psychoactivity
Cannabinol (CBN) is mildly psychoactive but is present in only small amounts in cannabis, being a metabolite of delta-9-THC
∆-9-Tetrahydrocannabinol (THC) has various psychoactive effects including relaxation, euphoria, increased heart rate, and impaired motor skills, reducing nausea and vomiting
Correlation between blood THC level and effect is poor, except in the early stages of smoking
The peak ∆9-THC represents cessation of smoking, with a duration of the 'high' lasting 2-6 hours, much longer than the elevated blood THC concentration
Canadian Criminal Code has set limits for THC concentrations within 2 hours of driving, recognizing the effects of combined marijuana and alcohol consumption
THC has a relatively short half-life in blood, but a longer half-life in the brain and body, leading to complexity in civil cases
Accepted facts about THC levels and postmortem changes have been revised, with baseline blood THC levels typically being <2 ng/mL in light smokers and 1.2-5.5 ng/mL 7 days after last use
THC undergoes postmortem redistribution, with concentrations in muscle tissue and fat affecting postmortem blood levels
Forensic cases involving THC include a pilot with THC in blood at the time of a fatal crash, an ATV accident with postmortem THC levels, and a stabbing victim with elevated femoral blood THC likely due to contamination from past smoking

Drug-Related Delirium and Deaths

Case #1: Police shot and killed a man who threatened them with a firearm after they found him sleeping in his vehicle by the side of the road
Autopsy and toxicology revealed multiple gunshot wounds and high levels of methamphetamine, amphetamine, and other substances in the man's blood
Case #2: A driver with methamphetamine in his blood crashed into a tree, resulting in the death of a passenger
Toxicology testing found significant levels of methamphetamine and amphetamine in the driver's blood, despite him appearing to have fallen asleep while driving
Case #3: A man exhibiting excitable and erratic behavior died suddenly while being transported to the emergency department after being restrained by police and paramedics
Excited delirium is a potentially fatal state involving extreme agitation and delirium, often related to the acute abuse of stimulants such as cocaine and methamphetamine
Methamphetamine, MDMA, and PMMA can be lethal at higher doses, with PMMA causing a significant number of deaths in certain regions
Other toxic phenethylamines, such as 2C-X series and N-Bombs, have potent hallucinogenic and toxic effects and can be difficult to detect in body fluids
N-Bomb cases from the literature demonstrate the dangerous and sometimes fatal effects of these substances, including bizarre behavior, hyperthermia, and death
The American Medical Association does not recognize excited delirium as a medical diagnosis unless clear diagnostic criteria are validated
Recognized by NAME and the American College of Emergency Physicians, excited delirium may involve heavy police restraint and disproportionately affect persons of color
Substituted phenethylamines have stimulant and psychedelic properties, with the degree of psychedelic properties and overt toxicity distinguishing these drugs

Fentanyl: Key Facts and Figures

Naloxone is a reversing agent for fentanyl, with a half-life range of 30-80 minutes
Fentanyl has a half-life of 3-12 hours, requiring repeat naloxone injections
Medical administration of naloxone is typically intravenous or intramuscular
Fentanyl is used for short-term anesthesia, acute surgical procedures, and chronic pain
Fentanyl was developed in 1960 by Dr. Paul Janssen and marketed by Janssen Pharmaceutica
Fentanyl abuse is a concern, with the drug being highly addictive and potent
Illicit fentanyl abuse has seen a rapid increase in cases, particularly in non-patch related forms
The number of apparent unintentional non-prescribed opioid poisoning deaths has increased significantly
Fentanyl poisoning deaths are often associated with other substances such as cocaine and methamphetamine
The estimated fatal dose of fentanyl for non-medical use ranges from 0.5-1.0 mg, with higher doses for tolerance
Fentanyl's popularity is due to its high addictiveness, ease of purchase, and potency compared to other drugs
Carfentanil, estimated to be 100x more potent than fentanyl, has become an abused drug and poses a significant risk

Clinical Toxicology Fellowship Training Program Overview

Clinical toxicology fellowship training is a 2-year program in the US, typically pursued after a 3-5 year Emergency Medicine residency.
In Canada, the Clinical Pharmacology & Toxicology Training (CPT) is a 2-year Royal College Fellowship, and entry residency programs include FRCPC Emergency Medicine, Internal Medicine, Anesthesia, and Pediatrics.
The PADIS (Poison and Drug Information Service) elective is open to residents from any specialty and involves bedside consults, information specialist training, and exposure to drugs, chemicals, or toxins via various routes.
PADIS roles include day-to-day activities such as patient care, telephone and bedside consultation, education, research, surveillance, and prevention.
Toxicovigilance is a key aspect of PADIS roles, involving the active process of identifying and evaluating toxic risks in the community.
The PADIS team assesses risks of public health concern, including poisoning outbreaks due to contamination, new drugs, mass chemical exposures, or unusual patterns.
The telephone risk assessment by PADIS involves evaluating the patient's clinical status, history, physical exam, initial investigations, and toxin specifics.
The toxicologic exam includes assessing head, eyes, ears, nose, throat, skin, central nervous system, gastrointestinal system, and cardiovascular system, along with a complete set of vitals.
The toxicologic workup may include a "tox panel," urine tox screens, electrolytes, creatinine, urea, VBG/ABG, serum osmols, LFTs, transaminases, and ECG.
Urine drugs of abuse screen is a qualitative test for various substances, and its results may not directly correlate with the patient's signs and symptoms.
The ABCs of toxicology involve airway protection, breathing assessment, circulation, decontamination, enhanced elimination, and finding and initiating specific therapies.
Decontamination and enhanced elimination are key processes in managing toxicology cases, including methods such as SDAC, hemodialysis, and intra-lipid (IV fat emulsion).

History and Types of Drug Testing

Drug testing has a history dating back to the 1970s, with various developments in the 1980s and 1990s, including the introduction of different testing methods such as hair and oral fluid testing.
Arguments for drug screening include job safety, absenteeism, and government regulations, while arguments against include legal concerns, opposition to enforcement, and questioning the accuracy of testing.
Industries using drug screening include transportation, petroleum, mining, pulp and paper, and other industrial operations, as well as financial, commercial, security, sports, and service industries.
Various types of drug testing methods include pre-employment, random, reasonable suspicion/cause, post-accident, return to duty, and follow-up testing.
Pharmacokinetic considerations such as absorption, distribution, metabolism, and elimination, as well as urine variables and limitations, are important factors in drug testing.
Workplace drug screening includes mandatory tests for substances such as amphetamines, cannabinoids, cocaine metabolites, opioids, phencyclidine, and ethanol, with additional non-regulated tests for benzodiazepines, barbiturates, methadone, methaqualone, and LSD.
The elimination times for drugs vary, ranging from 1-30 days for cannabinoids and 1-2 days for amphetamines.
Phencyclidine, also known as PCP, is a hallucinogen with unpredictable and variable effects, and is rarely seen in Western Canada.
Amphetamines, a CNS stimulant, can have unpredictable strength and contamination, and can lead to various adverse effects including psychosis and cardiac arrest.
Opioids, including heroin and prescription drugs, can lead to physical dependence, withdrawal symptoms, and serious health risks, such as respiratory depression and potential lethal effects.
Cannabinoids, including marijuana, have various effects such as euphoria and relaxation, and synthetic forms can have toxic effects, as well as links to psychiatric disorders and carcinogenic properties.
The text also discusses the appearance, class, dose, and effects of various drugs, including amphetamines, opioids, cannabinoids, and phencyclidine, as well as the implications of their use and testing.

Drug Testing in the Workplace: Legal and Analytical Considerations

Cocaine, also known as Coke, Nose Candy, or Snow, is a CNS stimulant and local anesthetic, with effects including rapid shallow breathing, increased heart rate, and euphoria.
Alcohol, also known as Ethanol, is a CNS depressant, causing drowsiness, slurred speech, and loss of consciousness, and is the most abused drug.
Entrop Case involved legal challenges related to random drug testing at the Sarnia Imperial Oil refinery in Canada, with rulings against random drug testing but allowing for random alcohol testing for safety-sensitive employees.
The T.D. Bank Case also faced legal challenges related to drug testing, with the Canadian Civil Liberties Association claiming that testing deprived handicapped persons of employment.
The Trimac Case involved a union challenge against pre-employment and random drug testing for drivers working in Canada, with rulings against pre-employment testing and random testing due to invasion of privacy.
Various legal cases have upheld or denied pre-employment drug testing, with the Alberta Human Rights Commission focusing on the treatment of employees disabled through drug or alcohol dependency.
Drug testing is not illegal in Canada, but random testing is not accepted, while accident/incident testing and pre-employment testing are allowed.
Alcohol testing measures impairment, while drug testing is not a measure of impairment, and the focus of Canadian courts is on the ability to perform the job and individual rights.
Court testimony and interpretation of drug testing results are important for toxicologists in forensic testing, and training for being an expert witness is recommended.
Analytical considerations for drug testing in the workplace include sample collection, drug testing procedures, and non-laboratory-based testing.
Sample collection involves collection supplies, chain of custody, collection protocol, donor drug history, specimen adulteration, and elements of chain of custody.
Drug testing procedures include specimen log-in, chain of custody verification, and pH and creatinine (or s.g.) testing, with a focus on maintaining security and preventing tampering.

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Test your knowledge of forensic laboratory testing methods, including extraction, chromatography, and sample processing for whole blood and tissue analysis.