Amanda J. Jenkins

Detection of drugs of forensic importance in postmortem bone.

There is a paucity of literature detailing the disposition of drugs in bone and bone marrow. Infrequently, in deaths involving skeletonized remains, fragmentation, decomposition, and exsanguination, traditional specimens may be unavailable for toxicological testing. This study examined the utility of bone for the detection of benzodiazepines, opiates, cocaine and metabolites, and basic drugs in 39 cases. Cases were identified on the basis of a positive blood result. After specimen preparation, samples were assayed by liquid-liquid or solid phase extraction with gas chromatographic and gas chromatographic mass spectrometric detection. The majority of decedents were white males with 28% of individuals between the ages of 41 to 50 years. The cause of death was drug intoxication in 22 cases. The most prevalent drugs detected in the blood males and females were opiates and bases. Morphine, codeine, and oxycodone were detected in bone, whereas 6-acetylmorphine and hydrocodone were absent. For alkaline extractable drugs, in only 57% of blood positive specimens, the corresponding bone was also positive. These included antidepressants and antihistamines. Diazepam and nordiazepam were detected in the bone of all blood positive cases. Bone concentrations were higher than blood levels. Benzoylecgonine was the most common cocaine analyte detected in bone. These data demonstrated that drugs may be detected in bone using current technologies and that in general concentrations were higher than those observed in corresponding blood specimens. A negative result in bone, however, should be interpreted with caution because multiple factors determine the deposition of a drug in this matrix.

Screening for cocaine metabolite fails to detect an intoxication.

Testing for the presence of cocaine (COC) is common in postmortem and clinical laboratories. COC use may be detected by screening urine specimens for COC metabolite. In the forensic arena, screening positive results are confirmed by a more specific and sensitive technique, such as gas chromatography-mass spectrometry. This article reports the case of an individual who died of COC intoxication but whose immunoassay screen (EMIT) for COC metabolite was negative. Gas chromatography-mass spectrometry analysis of the urine detected benzoylecgonine (BE) at a concentration of 75 ng/mL and COC at 55 ng/mL. These concentrations explain the negative screening result since the cutoff concentration of the assay was 300 ng/mL for BE. The reported cross reactivity with COC was 25,000 ng/mL. However, heart blood concentrations of COC and BE were 18,330 and 8640 ng/mL, respectively. The results from this case provide evidence that an EMIT test alone may fail to detect COC use. Individuals utilizing results of drug screening by immunoassay must be aware of the limitations of this testing methodology.

The prevalence of drugs in carbon monoxide-related deaths: a retrospective study, 2000-2003

The objective of this study was to review demographic characteristics and drugs detected in carbon monoxide (CO)-related deaths from cases received by the Office of the Cuyahoga County Coroner in Cleveland, Ohio, from 2000–2003. Postmortem reports were reviewed, and decedents for which CO was listed as the cause of death were included. The data were compiled into 3 groups according to the official coroners verdict as to the manner of death: accident, suicide, and homicide. Included in this study were 122 cases: 84 (69%) accidental, 31 (25%) suicide, and 7 (6%) homicide. Accident decedents were typically white males, aged 40–59 years, residing in Cleveland. Suicide decedents were also middle-aged, white males but residing in the suburbs. Homicide decedents under the age of 6 were characteristically black (N = 2), while decedents over the age of 39 were predominately white (N = 3). Carboxyhemoglobin (COHb) levels in suicide cases were higher than concentrations measured in accidental deaths. The highest percentage of suicide decedents (36%) had a COHb level >70% saturation, accident decedents (36%) between 50% and 69% saturation, and homicide decedents (71%) below 50% saturation. Ethanol (N = 34) was detected in 28% of deaths, and therapeutic and/or abused drugs (N = 50) were detected in 41% of deaths. Illicit drugs were detected in 11% of cases (cocaine/metabolites; THC/metabolites), other drug positives were therapeutic medications. The most common drugs detected were antidepressants and antihistamines in suicides and pain medications and antihistamines in accidents.

Homicidal ethylene glycol intoxication: a report of a case.

We report a case of a 75-year-old hypertensive, diabetic man who presented to the emergency room with symptoms and signs of nausea, acute intoxication, significant alteration in mental status with rapid neurologic deterioration, and blunt impact injuries sustained during a recent altercation with a 36-year-old female companion-caretaker. He denied a history of ethanol abuse or other recent toxic ingestion and had not been diagnosed with or treated for depression. Hospital laboratory tests revealed a metabolic acidosis and a negative urine toxicology screen. He was diagnosed with toxic encephalopathy with metabolic acidosis secondary to metformin. Despite treatments including hemodialysis, he expired after approximately 28 hours of hospitalization. A postmortem anatomic examination revealed recent blunt-impact injuries and cardiac and renal pathology. A subsequent histologic examination revealed the presence of calcium oxalate crystals in the kidneys and brain, in addition to cardiac and renal pathology. Comprehensive forensic toxicologic testing was performed on antemortem and postmortem samples and revealed lethal levels of ethylene glycol. The cause of death was as a result of acute intoxication by ethylene glycol with another condition of multiple blunt impacts to the head, trunk, and extremities. The manner of death was ruled as homicide. A trial by jury, involving the female companion-caretaker, resulted in her conviction, and she was sentenced to 23 years to life in prison. In this report, we present an unusual case of homicidal ethylene glycol intoxication in which legal proceedings have occurred.

Cross-Reactivity of Naloxone with Oxycodone Immunoassays: Implications for Individuals Taking Suboxone®

In 2002, the US Food and Drug Administration approved the use of the sublingual tablet, Suboxone® (Reckitt Benckiser Pharmaceuticals), to treat opioid dependence. The formulation is available at 2 doses, 2 or 8 mg (free base) buprenorphine hydrochloride and 0.5 or 2 mg (free base) naloxone hydrochloride dihydrate (1). The combination product is designed to decrease the potential for intravenous abuse, since parenteral administration may precipitate opioid withdrawal(2). To monitor compliance, physicians request urine testing of buprenorphine and often additional testing to ensure no illicit drug use. A client recently requested multianalyte testing of patients taking Suboxone. Initial testing suggested a response with the oxycodone assay. We hypothesized this response was due to the presence of naloxone. To test this hypothesis, we ( a ) assayed a 40-μg/L buprenorphine calibrator with the oxycodone assay and ( b ) assayed drug-free urine samples that had been supplemented with increasing concentrations (100–10 000 μg/L of naloxone (Cerilliant Corporation) and naloxone glucuronide (Sigma–Aldrich). We evaluated 2 enzyme immunoassays: the homogeneous enzyme immunoassay (HEIA) oxycodone (Immunalysis Corporation) and the DRI® …

Drugs of Abuse

The misuse/abuse of drugs is a serious problem in our community. In 2006, the Drug Abuse Warning Network (DAWN) estimated that 1,742,887 emergency room visits in the USA were drug related and that 958,164 were due to the use of an illicit drug [1]. Drugs are classified by the US Controlled Substance Act into categories based on abuse potential and acceptable medical use. Schedule I drugs have a high abuse potential with no currently approved medical uses. The remaining schedules are lesser variations with the abuse potential decreasing with acceptable medical uses. Drugs are abused based on their pharmacological properties which may include euphoria, increase in mood or energy. The use of some drugs causes an activation of the dopamine reward pathway which increases the likelihood of abuse.

Formation of Benzoylecgonine Isopropyl Ester Following Solid-Phase Extraction

In forensic toxicology general alkaline drug screens typically utilize liquid liquid [LLE] or solid phase extraction [SPE] sample preparation techniques. It is expected that different drugs will be detected when a laboratory changes techniques. In this study, when the authors switched from LLE to SPE they were able to detect benzoylecgonine [BE]. Benzoylecgonine isopropyl ester [BEIE] was also detected. Further investigation demonstrated that the BEIE was formed during sample elution with methylene chloride/isopropanol/ammonium hydroxide. BEIE was not detected if methanol/ammonium hydroxide was used as the elution solvent. Analysts should be aware that BEIE is formed in the presence of BE if elution solvents comprise isopropanol and a strong base. Therefore, use of BEIE as an internal standard in such assays will result in inaccurate quantitation of BE.