Forensic Toxicology

This module will focus on toxicity (acute harm) associated with the use of
recreational drugs, including novel / emerging recreational drugs.
The module will cover the use prevalence
of recreational drugs, both at a populuation and sub-population level and
describe a clinical classification of recreational drugs based on their
pattern of acute toxicity / 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, in addition we will focus on GHB / GBL withdrawal and
cocaine-related myocardial ischaemia and their management.

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 will discuss the factors to consider when selecting a (bio)analytical method(s), 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!

Recreational drugs have long been associated with modern dance culture. Illicit stimulants such as ecstasy, other amfetamine-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/amfetamine group of drugs, but a group of mild stimulants called piperazines has spread throughout Internet sales sites recently, 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 I shall discuss findings from drug amnesty bins from clubs and festivals in the UK, discussing 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.

This module will provide an overview, from a clinical toxicology perspective, of deliberate self-poisoning. The epidemiology and demographics of DSP together with the common agents ingested will be reviewed. This will be followed by a step by step guide to the assessment and management of the patient with DSP.

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. Chemical instability of commonly implicated drugs and their poor response to immunoassay pose yet further 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 suggest that alcohol, and not drugs, appears to pose the biggest date rape risk.

The pathological aspects of drugs, including alcohol,as seen at autopsy, are discussed. The basic gross and microscopical aspects of the various effects both acute and chonic are demonstrated.

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.