ii. Toxicology as a tool

Drug Induced Homicide Defense Toolkit

ii. Toxicology as a tool

With or without an autopsy, toxicology testing should be performed to identify and

quantify any substances in the body. Some coroner or ME offices may rule a death an

overdose based on the results from a rapid drug test. However, screening tests alone

provide incomplete evidence, as these types of screens are subject to both false positives

and false negatives --especially for opioids and benzodiazepines.123 124 Follow-up

toxicology is incredibly valuable, particularly in a state requiring but-for causation.

Toxicology results are essential in determining the cause of death, and counsel are

highly recommended to consult a competent expert because toxicology results must be

interpreted in the context of the circumstances surrounding death, the medical history, the

scene of the death, and the autopsy findings.125 Knowledge of “human physiology and

123 Manon Ceelen et al., Post-mortem Toxicological Urine Screening in Cause of Death Determination, 30 Hum Exp Toxicol. 1165, 1171 (2011), https://pubmed.ncbi.nlm.nih.gov/21084528/.

124 Gary M. Reisfield et al.,

'False-positive' and 'False-Negative' Test Results in Clinical Urine Drug Testing, 1 Bioanalysis, 937-52 (2009), https://pubmed.ncbi.nlm.nih.gov/21083064/.

125 Jonathan G. Thompson et al., Free Oxycodone Concentrations in 67 Postmortem Cases from the Hennepin County Medical Examiner ’ s Office, 32 Journal ofAnalytical Toxicology 673, 679 (2008), https://pubmed.ncbi.nlm.nih.gov/19007520/; See also HilkeAndresen et al., Fentanyl: Toxic or Therapeutic? Postmortem and Antemortem Blood Concentrations After Transdermal Fentanyl Application, 36 Journal ofAnalytical Toxicology 182, 188 (2012), https://academic.oup.com/jat/article/36/3/182/887968.

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Disclaimer: All content is provided for informational purposes only and does not constitute legal advice

Drug Induced Homicide Defense Toolkit

pharmacology can provide useful clues for making this determination.” NAME

accordingly recommends consulting with a pathologist or toxicologist.126

Questions of interpretation arise frequently because many factors can complicate a

toxicology report.

● The exact panel ordered by the coroner or medical examiner (ME)

provides parameters for its findings. A coroner or ME’s suspicions will

determine what toxicology panel to run, but a complex drug combination

or specific fentanyl analog may not be revealed in its entirety if a simpler

panel is ordered for analysis versus an expanded toxicology screen.

● Not all labs are the same, and understanding a particular lab’s capabilities

can be critical to interpretation. Depending on the capabilities of the lab,

as well as the panel ordered, a toxicology report may or may not produce

expected results.

● Not all labs have the ability to keep up with the science on identifying

novel substances. Some novel compounds will remain unidentified if

126 See Gregory G. Davis et al., National Association of Medical Examiners Position Paper: Recommendations for the Investigation, Diagnosis, and Certification of Deaths Related to Opioid and Other Drugs, 41Am J Forensic Med Pathol 152, 156 (2020), https://pubmed.ncbi.nlm.nih.gov/32404634/.

Version Date July 2021 – Check https://ssrn.com/abstract=3265510 for most current edition

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Drug Induced Homicide Defense Toolkit

methods have not yet been developed to determine the entirety of its

chemical makeup.127

● Lack of specificity may leave room to question what drugs were

consumed by the decedent unless the metabolites can be compared directly

to results of tests on unconsumed drugs at the overdose scene. For

example, the presence of morphine in a toxicology report may indicate

consumption of morphine, heroin, codeine, or a combination of the three.

On the contrary, a more specific finding of 6-monoacetyl morphine

(6-MAM) would indicate heroin use only. 128

For these reasons--which may not be an exhaustive list--consultation with a

toxicologist is incredibly valuable. A coroner or an attorney without a scientific

background may struggle to interpret the findings of a toxicology report. An expert can

help to evaluate the report and guide further investigation. To help ensure your expert has

127 Justin Brower, Ph.D., Forensic Toxicologist, Drug Identification for Suspected Overdoses: Special Emphasis on Opioids, Medicolegal Death Investigation Seminar (Nov. 10, 2018), https://www.wakeahec.org/courses-and-events/56769/medicolegal-death-investigation-seminar-approved-fo r-ama-pra-category-1-credits™ .

128 See Mia von Euler et al., Interpretation of the Presence of 6-Monoacetylmorphine in the Absence of Morphine-3-glucuronide in Urine Samples: Evidence of Heroin Abuse, 25 Therapeutic Drug Monitoring 645, 647 (2003), https://pubmed.ncbi.nlm.nih.gov/14508389/.

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Disclaimer: All content is provided for informational purposes only and does not constitute legal advice