FORENSIC TOXICOLOGY - Bio Medical Forensics

4, and 7; median concentrations were 1.6 (range 0.8 - 7.3), 1.4 (range 0.5 -
7.5), and 1.2 (range 0.3 - 5.5) ng/mL, respectively. Fewer specimens were
positive for 11-OH-THC; median concentrations were 2.4 (N = 3, range 2.1
– 3.3), 1.2 (N = 2, range 0.73 – 1.75) ng/mL, and not detected (N = 16) on
days 2, 4, and 7, respectively. Median THCCOOH concentrations in these
16 participants’ specimens were 25.9 (range 7.2 – 189.4), 19.4 (range 4.3 –
88.3), and 11.5 (range 2.8 – 45.6) ng/mL, on days 2, 4 and 7, respectively.
Interpretation of plasma and whole blood cannabinoid concentrations
is important in DUID and other forensic cases. For the first time, we present
evidence of the presence of THC in plasma for multiple days during monitored
abstinence, suggesting that its detection in plasma may not indicate
recent use in individuals consuming cannabis on a daily basis. Bioaccumulation
of THC in deep tissue compartments and gradual release from tissue
stores into the bloodstream during cannabis abstinence may explain this
prolonged seven day THC detection window.
THC, Plasma, Cannabis
K47 The Z Drugs: An Update for Forensic
Toxicologists in Light of DUID Cases
H. Chip Walls, BS*, Forensic Toxicology Laboratory, University of Miami,
Department of Pathology, 12500 SW 152nd Street Building B, Miami, FL
33177; Laura J. Liddicoat, BS, Wisconsin State Laboratory-Toxicology
Section, PO Box 7996, Madison, WI 53707-7996; and Jeri D. Ropero-
Miller, PhD, RTI International, 3040 Cornwallis Road, PO Box 12194,
Building 3, Room 116, Research Triangle Park, NC 27709
After attending this presentation participants will have a greater
understanding of the Z drugs, how they produce the effects commonly seen
in DUID cases and metabolism and excretion profiles that affect the forensic
toxicologist abilities to detect the drug or metabolites. In addition, recent
pharmacological research will be summarized concerning such issues as
sleep driving and other aberrant behavior.
This presentation will influence the forensic science community who
support suspected DUID and drug facilitated sexual assault cases by
enhancing their understanding of the drug mechanisms and current
challenges to interpretive issues.
The “Z-drugs” are non-benzodiazepine sedative hypnotic available in
standard release and extended release formulations. Zolpidem (Ambien) has
consistently finished in the “Top 20” of the 200 most prescribed medications
over the last seven years. Zolpidem is commonly prescribed for treatment
of insomnia. Lunesta (Eszopiclone) has been approved by the U.S. Food and
Drug Administration for long term treatment of insomnia since 2004.
Eszopiclone is a nonbenzodiazepine hypnotic that is a pyrrolopyrazine
derivative and is a steroisomer of zopiclone (Imovane, Noctitrex, Ximovane,
Zimovane), which is not currently available in the U.S. Zaleplon (Sonata) is
also a nonbenzodiazepine hypnotic from the pyrazolopyrimidine class.
Zaleplon interacts with the GABA receptor complex and shares some of the
pharmacological properties of the benzodiazepines. Although not a
benzodiazepine, zaleplon can cause similar effects: anterograde amnesia
(forgetting the period during the effects) as the most common side effect.
Multiple cases will be presented highlighting some of the analytical and
interpretation challenges presented by the “Z-drugs”. Zolpidem blood
concentrations in a few selected cases ranged from 190 to greater than 4,000
ng/mL. Clearly some of these drivers’ blood concentrations dramatically
exceed those expected from single oral dosing for night time hypnotic effect.
A typical case of Zolpidem impaired driving is presented: A law enforcement
officer observed a subject crash into the rear of a parked car. The officer
also noted “bizarre driving” with the subject driving in reverse for one
block, then stopping in the line of traffic for one minute (one vehicle had to
swerve to avoid crash). The officer pulled up behind & activated emergency
lights; however the subject didn’t notice the officer and started driving forward.
Eventually the subject stopped. The subject was wearing a fur lined
winter cap over a baseball cap and sunglasses over the top of prescription
eyeglasses even though it was night time at the time of the incident. The
subject exhibited delayed responses to the officer’s questions, slow slurred
speech and seemed confused. The subject was unsteady and needed to brace
on the car to attempt Standardize Field Sobriety Tests (SFST). The subject
exhibited multiple clues on all 4 SFSTs. The subject was arrested and taken
in for a blood sample. Throughout the examination the subject was unable
to recall any of the recent incidents. The subject stated: “I’m confused, lost
and out of it”. Toxicological analysis of the blood revealed zolpidem at 500
ng/mL and less than 50 ng/mL of citalopram.
As this case report demonstrates, “Z-drugs” have the potential to
significantly impair the driving abilities of an individual. Dissemination of
toxicological findings for cases such as these will assist forensic toxicologists
in their own case interpretations.
DUID, Zolpidem, Zaleplon and Zopiclone
K48 Medical Devices and Their Impact
on Death Investigations
Alberto Gutierrez, PhD*, Office of In Vitro Diagnostic Device Evaluation
and Safety, 9200 Corporate Boulevard, Rockville, MD 20850; Alphonse
Poklis, PhD*, Medical College of Virginia, Box 98-165, Virginia
Commonwealth University/Medical College of Virginia Hospitals Station,
Richmond, VA 23298; Joseph A. Prahlow, MD*, South Bend Medical
Foundation, 530 North Lafayette Boulevard, South Bend, IN 46601;and
Ruth E. Winecker, PhD*, Office Chief Medical Examiner, Campus Box
7580, Chapel Hill, NC 27599-7580
After attending these presentations participants will understand how
medical devices such as blood glucose monitors, insulin pumps, patient
controlled analgesia, intrathecal pumps, and defibrillators can impact death
investigation by providing information about the events surrounding a death.
The presentation will impact the forensic community by providing
information about medical devices, their evaluation, and assignment of cause
and manner of death.
Introduction: There are a variety of medical conditions in which
medical devices including blood glucose monitors, insulin pumps, patient
controlled analgesia, intrathecal pumps, and defibrillators are employed and
these devices are encountered with increasing frequency in forensic death
investigations. Questions concerning the proper operation and potential
tampering of these devices as well as historical information contained in
them is of concern to a variety of forensic professionals.
Topics Covered: This special session will cover regulatory,
pathological, toxicological, and safety issues related to medical devices.
A historical overview of these devices, their in vitro diagnostic
evaluation and safety by the Food and Drug Administrations Center for
Devices and Radiological Health (CDRH) as well as basic information on
device regulation will be discussed. More than 20,000 companies worldwide
produce over 80,000 brands and models of medical devices for the U.S.
market. These devices rang from contact lenses and blood sugar monitors to
implanted hip joints and heart valves. The CDRH makes sure that new
medical devices are safe and effective before they are marketed. The center
is also responsible for monitoring these devices throughout the product life
cycle, collecting, analyzing, and acting on information about injuries and
other experiences in the use of medical devices and radiation-emitting
electronic products, setting and enforcing good manufacturing practice
regulations and performance standards for medical devices, monitoring
compliance and surveillance programs for medical devices.
A synopsis of techniques that might be used during autopsy when
encountering an in vitro device as well as case studies in which the interaction
of pathology and these devices played a role in the death will be included.
Special procedures used during and following an autopsy can help with a
diagnosis of device performance. These procedures can help when deciding
on a cause and manner of death.
Toxicological case studies focused mainly on chronic pain treatment
involving fentanyl patches and continuous analgesia infusion devices will
be discussed. Aggressive treatment of chronic pain in recent years has lead
111 * Presenting Author