Yale H. Caplan

Opiate analysis in cadaveric blowfly larvae as an indicator of narcotic intoxication.

Specimens of liver were collected from 40 cases in which the cause of death had been determined to be opiate intoxication. Rearings of Calliphora vicina larvae were then promoted on the decomposing liver. A control group of 10 decomposed liver specimens from non-opiate deaths was treated similarly. Analysis of larvae and liver for opiates (morphine) was conducted by radioimmunoassay. Good qualitative and quantitative correlation was observed in both the positive and negative groups. Regression analysis comparing the concentrations of opiates found in the larvae with those found in the liver in the positive group resulted in a correlation of r = 0.790.

Accidental Poisonings Involving Carbon Monoxide, Heating Systems, and Confined Spaces

Eleven incidents of carbon monoxide (CO) intoxication resulting in sixteen fatalities are reported. All of the cases involved heating systems as either the source or the means of distributing the CO. Blood samples were analyzed for ethanol and CO. Elevated blood CO saturations were found in 14 of the 16 victims while none of the victims had a blood ethanol concentration greater than 0.10% (w/v).

Drug and Chemical Related Deaths: Incidence in the State of Maryland???1975 to 1980

The incidence of drug and chemical related deaths was studied over a six-year period in the State of Maryland. Deaths were classified into the following categories: alcohol, carbon monoxide (CO), single drugs, multiple drugs, and narcotism. The last three categories were further subdivided as to the specific drugs or chemicals involved. Over the six-year period the number of alcohol and CO deaths remained steady, the number of barbiturate and propoxyphene deaths declined, while the number of tricyclic antidepressant drug deaths increased.

Phenol: Tissue Distribution in a Fatality

A case is reported where phenol, a disinfectant, was ingested and resulted in the death of a 40-year-old white female. Concentrations of phenol were determined in blood (130 mg/L), urine (47 mg/L), bile (187 mg/L), brain (486 mg/kg), kidney (331 mg/kg), muscle (204 mg/kg), liver (228 mg/kg), and stomach content (668 mg) and compared to other cases reported in the literature.

Incidence of cannabinoids in medical examiner urine specimens.

Cannabinoid use was studied in a nonspecific population of postmortem urine specimens in the State of Maryland. Of 500 sequential specimens screened for cannabinoids by enzyme multiplied immunoassay EMIT, 63 (13%) were initially positive and 58 (12%) were confirmed positive (92%). It was observed that geographic location and race did not correlate with cannabinoid prevalence. Cannabinoid use was observed to be strongly age related, with peak use by the 21- to 25-year-old age group where 22% of the cases were positive. Use of cannabinoids was also closely linked to homicides, which represented nearly half of the positive cases but only 13% of the total cases. When comparing manner of death, the greatest percent of confirmed positives was seen in homicide (26%) and drug-related (17%) deaths. The incidence of cannabinoid use was found to be more than 3 times as great in drug-related (17%) as compared to natural deaths (5%). The percent of cannabinoid-positive cases from vehicle-related accidents was low (6%) and that from nonvehicle-related accidents somewhat higher (10%). Other drugs appeared in cannabinoid-positive cases. Most prevalent was ethanol N = 18, followed by morphine (from heroin, N = 11), quinine N = 11, and cocaine N = 11. Phencyclidine (PCP) occurred twice and several other drugs were reported only once. Of the 25 homicide cases screened for drugs, 64% were positive for some drug including ethyl alcohol. Thus it appears that a high percentage of homicide cases are drug related. Males greatly outnumbered females (56:2) in positive cases, but the number of female specimens received was small.

A fatality involving phentermine.

A case is presented where phentermine, a sympathomimetic amine used as an anorectic drug, is believed to have significantly contributed to the death of an individual in whom other drugs were also found. Blood, urine, and tissue concentrations of phentermine are reported and compared to other cases in the literature.

Thiamylal: Review of the Literature and Report of a Suicide

A 28-year-old white male medical student was found hanging by the neck from the bathroom closet of a hotel room. An intravenous infusion line leading from a bottle of thiamylal sodium (an ultrashort-acting barbiturate) was inserted into the antecubital vein of the left arm. Blood was analyzed for alcohol and other volatiles and for acidic, basic, and neutral drugs. Only thiamylal was detected. Thiamylal was quantified by high-performance liquid chromatography with ultraviolet detection, and its presence was confirmed by gas chromatography/mass spectrometry. The tissue distribution of thiamylal was 29 mg/L in blood, 1.4 mg/L in urine, 16 mg/L in bile, 135 mg/kg in liver, 25 mg/kg in kidney, and 0.4 mg in the stomach contents. The uptake and distribution of thiamylal is similar to thiopental. The distribution of the drug in this case was compared to that of other fatalities involving ultrashort-acting barbiturates.

Drug Testing in Urine

Testing for drugs in the workplace has become commonplace as federal and private industry programs are developed. Effective use of laboratory results derived from testing urine specimens is a function of many factors including choice of specimen, testing modalities, specimen handling, and reporting. Since significant consequences can occur from positive test results, full understanding of the factors and the process is required.

A Review of Toxicological and Pathological Studies on Psychoactive Drug Involved Deaths

This book presents detailed summaries of pertinent information regarding 3004 deaths collected from nine metropolitan areas in the United States all involving psychoactive drugs. Toxicologists fundamentally are confronted with interpreting the results of analytical determinations and ascertaining the range of concentrations of psychoactive drugs in biological fluids and tissues that are associated with death. By presenting data such as drug concentrations, methadology, role of drug in death, route of administration, autopsy findings, and cause of death as well as other information in a uniform manner, the authors have presented the scientific community with a valuable registry. Too infrequently is a compilation of data presented in the literature that permits independent study and allows the toxicologist to derive his own conclusions.