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....

Potency testing in edibles is challenging, as each edible has a unique consistency, and each suffer from distinctive analytical challenges. During this time, you will learn tips and tricks to optimally extract cannabinoids and get the cleanest samples....

The focus of this Grand Round presentation is to demonstrate best practices for sample collection for blood and vitreous fluid and juxtapose these practices with techniques that can cause alteration of drug concentrations within the collected samples....

This talk aspires to begin the process of creating illness scripts and diagnostic reasoning models for chemical and simple asphyxiant deaths. Highlighting historical context, scene investigation findings, pathophysiology, societal and forensic context, toxicology and laboratory date will begin to creating schemas for cause and manner of death investigation and determination....

Level: Expert level detail for individuals familiar with death investigation practices for professionals involved in complex medicolegal investigation of drug caused and related death

Target audience: Forensic pathologists, medical examiners, coroners, medicolegal death investigators, forensic toxicologists, forensic pathology fellows and residents.

Content: This is an advanced course designed specifically for forensic pathologists and toxicologists with moderate the extensive experience in medicolegal death investigation casework. It is recommended that Module II “The Evaluation and Certification of Drug Caused and Related Deaths for Forensic Pathologists, Toxicologists and Death Investigators” be completed prior to taking this course (see above). The main topics covered will include expert level review of the current analytical approaches and workflows employed in the postmortem laboratory such as immunoassay and mass spectrometry, and interpretation of toxicology results for specialized circumstances to include drug-delivery-resulting-in-death (“but-for”), drug use with restraint, hospital, and pediatric and palliative care deaths, exhumations, US Drug early warning systems, and other emergent topics.