Forensic Toxicology

The Forensic Toxicology course provides an overview of the problems faced by the Forensic Toxicologist during forensic investigations for medical and legal purposes.

The investigations performed involve the examination of a wide range of biological and non-biological specimens to ascertain which substance(s) may have been involved in the underlying pathology, as a cause of death or in the commissioning of a crime.

Substances for which analyses are requested include legal and illegal drugs, over the counter and prescription medications, classic poisons, metals and plant materials. The course is presented by professionals working in the field and covers the whole process that may impact upon toxicological findings.

In the living the process starts from the admission to police stations or accident & emergency departments where individual’s symptoms and signs may be recorded and treatment may be initiated. For the deceased the findings at autopsy may provide valuable information for the toxicologist, the pathologist, the coroner, police officers or those involved in criminal or civil defence work. For both the living and the deceased the pre-analytical considerations, such as sample collection and documenting chain of custody are critical, and are set in the context of the analytical problems.

The course then goes on to focus upon particular areas such as drug facilitated crime, recreational drugs and the ever evolving designer drug market. The strengths and limitations of the analytical tools the toxicologist have available to them are discussed, together with the impact of the Human Tissue Act on clinical research studies.

Finally the interpretation of toxicological findings is discussed, with particular emphasis on the limitations imposed by sparse information on the toxicity of drugs in overdose and the complexities resulting from cases in which multiple drugs are involved.

Modules

Pre-Analytic Considerations in Post-Mortem Toxicology

This module incorporates key aspects which should be taken into consideration prior to sample submission for toxicological analysis. Analysis can often provide us with the answers we are searching for, however the likihood of obtaining these answers is dependent on the pre-analytic phase. Therefore, a strong understanding of these pre-analytic phases are vital for ensuring the best conditions possible for toxicological analysis.

Pathology of Drug Abuse

In this module the pathological aspects of drugs, including alcohol, as seen at autopsy are discussed.

Furthermore, the basic gross and microscopical aspects of these various effects, both acute and chronic, are demonstrated.

The Investigation of Drug-Facilitated Crime

Drug-Facilitated Sexual Assault (DFSA) is a term used to refer to all forms of non-consensual sexual activity, whether it involves forced or covert administration of an incapacitating or disinhibiting substance or taking advantage of someone profoundly intoxicated by his or her own actions (ACMD, 2007).

The amnesic effect of candidate drugs results in delayed presentation and loss of associated evidence. The investigation is further complicated by the high potency, low dose and short detection window of these drugs.

Furthermore, the chemical instability of commonly implicated drugs and their poor response to immunoassay present additional challenges for toxicologists.

The classic ‘date rape’ drugs – flunitrazepam (Rohypnol®), GHB (gammahydroxybutyrate) and ketamine – as portrayed in the media, are very uncommon findings in these cases. Most published data suggests that alcohol and not drugs appears to pose the biggest date rape risk.

Deliberate Self-Poisoning

This module provides an overview of Deliberate Self-Poisoning (DSP) from a clinical toxicology perspective.

This module reviews the epidemiology and demographics of DSP together with the common agents ingested. This is followed by a step-by-step guide to the assessment and management of the patient with DSP.

Recreational Drug Toxicity

This module focuses on toxicity (acute harm) associated with the use of recreational drugs, including novel and emerging recreational drugs.

The module will cover the prevalence of recreational drug use, both at a population and sub-population level, and describes the clinical classification of recreational drugs based on their pattern of acute toxicity and clinical effects.

This classification system will then be used to discuss particular patterns of acute harm and their management for commonly used recreational drugs from within each clinical group.

Finally, we will focus on GHB/GBL withdrawal and cocaine-related myocardial ischaemia and the management of these conditions.

New Designer Drug Trends in the United Kingdom

Recreational drugs have long been associated with modern dance culture. Illicit stimulants such as ecstasy, other amphetamine-like drugs and cocaine as well as recently reclassified cannabis are common amongst clubbers in the UK.

The widespread use of the Internet and the constant search for new legal and illegal highs has lead to an increase in the production of new designer drugs. These new stimulants may be derivatives of the ecstasy/amphetamine group of drugs, but recently a group of mild stimulants called piperazines have emerged on Internet sales sites. These drugs are promoted as a safe and legal alternative to illicit drugs.

It is the analysis of these licit and illicit drugs that reveals the true extent of what is being consumed, often by young and vulnerable clubbers in the UK and worldwide.

We have shown that tablets and powders recovered from dance venues or purchased from Internet sites may not contain what is expected.

In this presentation, findings from drug amnesty bins at clubs and festivals in the UK are discussed, focusing on the drugs seen most frequently. Cases involving new designer drugs associated with clinical presentations at A&E departments will also be shown, together with examples of unusual findings in tablets, capsules and even food products that contained more, or less, than was bargained for.

Analytical Limitations – Not As Easy As You Might Think

This module aims to highlight the analytical challenges faced by the forensic toxicologist in a (bio)analytical laboratory.

The media hype surrounding forensic toxicology analysis portrays the common misconception that one can detect any drug or poison in any specimen. This is not the case due to the “Analytical Limitations” we face on a daily basis.

This module discusses the factors to consider when selecting a (bio)analytical method, what (bio)analytical methods are available and the main analytical challenges.

It will focus on the theory, strengths and limitations of immunoassay, chromatography and hyphenated mass spectrometry methodology, using were possible example from the laboratory. It really is not as easy as you might think!

Interpretation of Drug Concentrations

This module aims to highlight the challenges faced by the forensic toxicologist in the interpretation of toxicological data for the living and the dead. Interpretation is complicated by simple factors such as correct sample collection to the more complex factors such as inter-individual pharmacokinetic and pharmacodynamic variability. This module will focus on the factors to consider for the interpretation of drug data in samples from the living and the dead, including interpretation of alcohol measurements, the presence of metabolites and the use of alternative matrices. Specific case studies will also be presented.

The Human Tissue Act

For anyone working with tissues taken from humans in England, Wales or Northern Ireland needs an undersrtanding of the the Human Tissue Act 2004 (Scotland has a separate act – Human Tissue (Scotland) Act 2006). This module outlines the provisions of the Human Tissue Act 2004 and introduces students to their responsibilities under the law.

The unit discusses why it was felt by Government that the Act was necessary and the incidents that lead to its enactment. The purpose and objectives of the act are described. The issues surrounding consent are outlined and the differences that exist when using tissue from the living or the dead are explained.

The key provisions for consent to use “relevent material” for “scheduled purposes” are explained. An explanation of what constitutes “relevent material” and what “scheduled purposes” are is given.

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