The presentation examines a tragic hospital death reported to the MEO as natural, for which the family initially refused an autopsy. It serves as an ideal springboard to examine the difficulties of pain management, basic pharmacology of both narcotics and of naloxone, and how pathologist and tox lab can work together to arrive at the correct cause of death as well as prevent future deaths.

This presentation will review the recent history of the opioid crisis, with a focus on the impact of various scheduling strategies on attempts to control proliferation of new drugs and the emergence of potent novel opioid substances in new chemical classes, including the nitazenes (isotonitazene, metonitazene, and N-pyrrolidino etonitazene), brorphine, and cinnamypiperazines (AP-237, AP-238).

The International Alliance of Clinical and Forensic Toxicologists (IACFT), your free, virtual, and multilingual association, is welcoming you to attend its 3-day, Spring 2022 Virtual Meeting.

The presentation will use three real case examples to highlight and explain what the main points of interest are when trying to determine if postmortem redistribution is a factor in the interpretation of postmortem toxicology results. The presentation will aim to keep the topic and presentation simple, clear, and concise. The presentation will not be able to cover all aspects of this very broad and complicated subject. However, with the 3 case examples and general background information that will be provided, the expectation is that the audience will have a very good fundamental understanding of how to decide what is and is not relevant and how to work through a case so that a reasonable opinion can be rendered. The importance of understanding the context of any case and why, regardless of where you are in the investigation chain, you must have all the information before you can reasonably provide an interpretation and how the sample site(s) also provide important fundamental information.

Chronic pain and hospice patients often have elevated levels of pain medications in their system due to prolonged use at high doses. Interpretation of these levels can be problematic for the forensic pathologist trying to determine whether these drugs contributed to the cause of death. The goal of this talk is to discuss the issues at play and provide recommendations for toxicologic interpretation.

Level: Introductory concepts for support team members and death scene responders

Target audience: Medicolegal death investigators, coroners, medical examiners, law enforcement, toxicologists, introduction for persons interested in careers in medicolegal death investigation.

Content: This is an introductory module concerning the investigation of death scenes with a focus on drug overdose and drug related deaths. Its primary purpose is to introduce new death investigators, coroners, and law enforcement personnel to best practices of drug death scene investigation and documentation. It will introduce major drug categories encountered in drug deaths, and their effects, personal protection from potential drug exposure at scenes, medication/prescription records review, an overview of laboratory practices that assists in evaluation of drug involvement causing death and working with toxicologists to order appropriate testing and result interpretation. An extensive glossary of toxicology related terms including common and illicit drugs will be provided.

In this event, a series of cases will be discussed where methamphetamine made its guest appearance on the toxicology reports and have the Medical Examiner (Mary Sens) and the Toxicologist (Nikolas Lemos) discuss how easy or difficult it was for it to be included on the Death Certificate. The webinar will then conclude with a brief overview of the drug's pharmacology....

Immunoassays (IA) have offered sufficient sensitivity in toxicology for many decades. However, it lacks specificity and introduces technical challenges associated with identifying a growing number of new psychoactive substances (NPS). In contrast, mass spectrometry (MS)-based techniques can be used to simultaneously identify a broader scope of compounds with multiple data acquisition modes and retrospective data analysis. Many complex biological matrices are encountered in these investigations, although blood is the most encountered biofluid. The extraction of multiple drugs with different physicochemical properties using a single protocol can be challenging. As such, many MS-based screening methods do not include cannabinoids, and laboratories still rely on IA-based detection....

Certification of deaths in custody, especially those in the pre-arrest phase, can be difficult in the setting of significant natural disease with or without positive toxicology findings. Should these be included on the death certificate? As with child death and drug-related fatality review committees, deaths in custody should be reviewed, if not at the state level, at the local/county level. Establishing a multidisciplinary review team/committee will help effectively prevent future fatalities....

Join NMS Labs for “Navigating Testimonial Hearsay: Key Insights from Smith v. Arizona for Legal and Forensic Experts,” an informative online session about the Smith v. Arizona Supreme Court ruling and its impact on forensic laboratories. This ruling impacts the right to confront witnesses in criminal matters, but the weight of the impact is still to be determined. During the event, MJ Menendez, Esq, and Donna Papsun, MS, D-ABFT-FT, will translate the Smith v. Arizona decision and how it applies to forensic testing. In addition, they will review the proposed framework of linking steps in the testing process to quality practices, accreditation, and licensing standards, a process desired to satisfy the “primary purpose” condition. This is a must-attend for forensic stakeholders seeking to stay informed on evolving law related to forensic testing....