Drug Testing in Alternate Biological Specimens (Forensic Science and Medicine)

200 Pages·2008·1.28 MB·English

by  Amanda J. Jenkins

Drug Testing in Alternate Biological Specimens
F O R E N S I C
SCIENCE MEDICINE
AND
Drug Testing in Alternate Biological Specimens,
edited by AMANDA J. JENKINS, 2008
Herbal Products: Toxicology and Clinical Pharmacology, Second Edition,
edited by RICHARD L. KINGSTON and TIMOTHY S. TRACY, 2007
Criminal Poisoning: Investigational Guide for Law Enforcement, Toxicolo-
gists, Forensic Scientists, and Attorneys, Second Edition,
by JOHN HARRIS TRESTRAIL, III, 2007
Forensic Pathology of Trauma: Common Problems for the Pathologist,
by MICHAEL J. SHKRUM and DAVID A. RAMSAY, 2007
Marijuana and the Cannabinoids,
edited by MAHMOUD A. ElSOHLY, 2006
Sudden Deaths in Custody,
edited by DARRELLL. ROSS and THEODORE C. CHAN, 2006
The Forensic Laboratory Handbook: Procedures and Practice,
edited by ASHRAF MOZAYANI and CARLA NOZIGLIA, 2006
Drugs of Abuse: Body Fluid Testing,
edited by RAPHAEL C. WONG and HARLEYY. TSE, 2005
A Physician’s Guide to Clinical Forensic Medicine, Second Edition,
edited by MARGARET M. STARK, 2005
ForensicMedicineoftheLowerExtremity:HumanIdentificationandTrauma,
Analysis of the Thigh, Leg, and Foot,
by JEREMYRICH, DOROTHYE. DEAN, and ROBERT H. POWERS, 2005
Forensic and Clinical Applications of Solid Phase Extraction,
by MICHAEL J. TELEPCHAK, THOMAS F. AUGUST, and GLYNN CHANEY, 2004
Handbook of Drug Interactions: A Clinical and Forensic Guide,
edited by ASHRAF MOZAYANI and LIONEL P. RAYMON, 2004
Dietary Supplements: Toxicology and Clinical Pharmacology,
edited by MELANIE JOHNS CUPP and TIMOTHY S. TRACY, 2003
Buprenorphine Therapy of Opiate Addiction,
edited by PASCAL KINTZ and PIERRE MARQUET, 2002
Benzodiazepines and GHB: Detection and Pharmacology,
edited by SALVATORE J. SALAMONE, 2002
Drug Testing
in Alternate
Biological
Specimens
Edited by
Amanda J. Jenkins
LakeCountyCrimeLaboratory,Painesville,OH
Foreword by
Yale H. Caplan
NationalScientificServices,Baltimore,MD
Editor
AmandaJ.Jenkins
LakeCountyCrimeLaboratory
Painesville,OH
ISBN:978-1-58829-709-9 e-ISBN:978-1-59745-318-9
LibraryofCongressControlNumber:2007940757
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This work is dedicated to the global community of toxicologists,
analytical chemists, and other scientists who have contributed to the body
of knowledge in the field of forensic toxicology.
Amanda J. Jenkins, 2007
We must not forget that when radium was discovered no one knew that it
would prove useful in hospitals. The work was one of pure science. And this
is a proof that scientific work must not be considered from the point of view
of the direct usefulness of it. It must be done for itself, for the beauty of
science, and then there is always the chance that a scientific discovery may
become like the radium a benefit for humanity.
Marie Curie (1867–1934)
Lecture at Vassar College, Poughkeepsie, NY, USA
May 14, 1921
Foreword
Forensic toxicology encompasses the analysis for drugs and chemicals including the
mostcommondrugsofabuseandalsofocusesontheinterpretation,thatis,theunder-
standing and appreciation of the results of this testing in a medical–legal context.
The same methods and principles can also be applied to clinical situations. Tradi-
tionally,forensictoxicologyfocusesonpostmorteminvestigation,workplacedruguse
assessment,andhumanperformanceevaluation,butinmanyinstances,clinicaltesting
becomes forensic when treatment is associated with a court order or family situations
leadtocustodystruggles.Theresultsoftoxicologytestingareoftenpresentedtocourts
for the adjudication of an issue but are very often misunderstood or worse misrepre-
sented.Weneedtorememberthatatestisnotatest.Atestresultisonlyasgoodasthe
question it is asked to answer. Toxicology test results must, therefore, be introduced
by qualified toxicologists.
The traditional specimens used in testing include blood or its component parts,
that is, plasma or serum, and urine. This is in part because these are the easiest
to collect. In addition, in the case of blood, or its components, it represents the
dynamic state of drug distribution in the body with the best relation to the state
of the individual’s pharmacologic condition (therapeutic, impairment, and death). In
the case of urine, we have a static fluid that generally does not correlate with the
pharmacological effects in an individual, rather it represents high concentrations of
drugs and metabolites and demonstrates prior use. Thus, the ready accessibility and
knowledge of the pharmacokinetics and distribution of drugs caused toxicologists to
focus on these specimens. Further they were within the limits of the known analytical
testing methodology.
Althoughdrugtestingincludesmanyhundredsofprescriptiondrugs,illicitdrugs,
or other chemicals, five classes of drugs are common to all forensic arenas. These are
theamphetamines(includingamphetamineandmethamphetamine),cocaine,marijuana,
narcotics (including morphine, codeine, and others), and phencyclidine.
TestingmethodologyhascontinuallyevolvednowincludingGCMS,GCMSMS,
LCMS,andLCMSMSimprovingsensitivityandreducingsamplesizes,thuspermitting
effective analysis of additional specimens that were previously inaccessible. These
non-traditional materials may be summarized into three groups:
1. Clinical ante mortem specimens including amniotic fluid, breast milk, and
meconium.
ix
x Foreword
2. Postmortemspecimenstofacilitatedeathinvestigationsincludingvitreoushumor,
brain tissue, liver tissue, bones, bone marrow, hair and nails.
3. Workplace testing enhancement including oral fluid (saliva), hair, and sweat.
Thechaptersinthisbookfocusontheselesstraditionalspecimensandparticularlythe
applicationoftheseareasofpracticetothedrugsofabuse.Theuseofthesespecimens
enhances the forensic investigation and leads to a more complete understanding of
the drug-related event. The sum purpose of all toxicological testing is to insure the
determination of the cause of drug deaths, the impairment of individuals by drugs,
and/oranindividual’sprioruseofdrugs.Allspecimenshaveaspecificformationand
timeline.Theincorporationofdrugsintooroutofaspecimenisafunctionofthedrugs
chemicalstructure,pharmacokinetics,andthenatureofthetimelineforthespecimen.
Specimens have similarities and differences, hence, strengths and limitations. Each
providesauniquehistoricalpicture.Resultsbetweenallspecimensdonothavetoagree
(i.e., they all need not be positive at the same time). Understanding the differences is
essential to interpretation and one of the purposes of this book.
Thetermalternatematricesconnotesthatspecimensinadditiontothetraditional
matrices may be useful in diagnosis, particularly if and when the traditional matrices
arenotavailableorarecontaminated.However,morefrequentlythespecimensshould
be considered “complimentary,” that is, they can confirm, enhance, or facilitate inter-
pretationoftheresultsfromthetraditionalmatrices.Asforalldrugsandspecimens,the
processofinterpretationshouldincludeconsiderationofallaspectsoftheinvestigation,
including the analysis of multiple specimens.
For example:
• Testing vitreous humor particularly in alcohol cases may overcome the issue of
postmortem redistribution.
• Testing brain, liver, and hair or nails may be useful in decomposed bodies where
blood and urine are not available.
• Testing oral fluid and hair in the workplace may contribute to evaluating the
frequency of use and/or to overcome adulteration of urine.
• Testing maternal specimens and meconium may allow assessment of substance
abuse against newborns where sufficient volumes of traditional specimens are
unavailable.
Some highlights of the book include:
• The liver is the largest organ in the human body and is relatively unaffected by
postmortem redistribution as compared with blood.
• Brain is useful in the interpretation of time intervals between administration of
drug and death.
• The composition of amniotic fluid and breast milk and the mechanisms known to
effect drugs of abuse transfer to these matrices are reviewed.
• Salivaororalfluidisdiscussedwithregardtotheeffectofrouteofadministration,
collectionprocedures,andsaliva:plasmaratiosontheamountofdrugdeposited.
Foreword xi
• Sweat as a biological matrix is described including an overview of the structure
of the skin, the composition and production of sweat, and the approaches used to
collect sweat.
• Boneandbonemarrowarefacilitatedasspecimensfollowingextractionbysoaking
bone in organic solvent and subjecting to routine drug assays.
• Meconium may provide a history of in utero drug exposure. Although easy to
collect,smallsamplesizes,lackofhomogeneity,differentmetabolicprofiles,and
the requirement for low-level detection present analytical challenges.
• The utility of nails is examined reviewing the basic structure of the nail, mecha-
nismsofdrugincorporation,analyticalmethodologies,andinterpretationofresults.
• Vitreoushumorisreviewedconsideringpertinentstudiesthathaveexamineddrug
depositionintothespecimen.Discussionincludestheincreasedstabilityofcertain
drugs in this matrix and its amenability to analysis with little or no pretreatment.
• Thechaptersofferwindowsintothewiderworldofdrugtesting.Theyprovidethe
chance to go further to unfold new forensic mysteries and answer new questions
for the criminal justice system.
Yale H. Caplan, Ph.D., D-ABFT
National Scientific Services, Baltimore, MD, USA