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....

This Webinar describes multiple, acute drug intoxications with 25I-NBOMe, a synthetic designer drug which resulted in two fatalities with negative initial toxicology screening, occurring over a two-week period in the summer of 2012 in Grand Forks, North Dakota and East Grand Forks, Minnesota. The presentation describes the circumstances surrounding the deaths and intoxications with autopsy results of the decedents and medical record review of survivors along with toxicology results. This webinar discusses the law enforcement and local hospital collaborations necessary to investigate sudden, suspected drug deaths due to novel synthetic drugs which inexplicably occur in the background of the multiple other drug deaths which inundate every hospital emergency department and medical examiner’s office....

Loperamide (trade name Imodium) is a synthetic opioid derivative that is used to decrease the frequency of bowel movements in patients with diarrhea. Once dispensed only by prescription, it has been available as an over-the -counter medication for over three decades. Loperamide was thought to have low abuse potential but there have been several fatalities due to this drug reported since 2015.

CFSRE’s NPS Discovery is an open-access drug early warning system (EWS) operating in the United States. NPS Discovery’s evidence-based approach leads the development of high impact reports for real-time action. We are working in collaboration with law enforcement, public health, and public safety agencies to rapidly identify emerging drugs associated with intoxications and adverse events....

The United States has strict requirements for firearm manufacturers and importers regarding serial numbers and other required markings. New technologies such as 3D printing, and different interpretations of the laws surrounding firearms, have resulted in the rise of un-serialized firearms, commonly referred to as “ghost guns.” Of great importance is a controversial “80% rule,” which asserts that a firearm does not fall under US federal guidelines unless its receiver is more than 80% complete....