FORENSIC TOXICOLOGY - Bio Medical Forensics

AMP BZE OPI PCP THCA ADULT INV SUBS Total
Screened (+) 14 4 6 0 6 0 15 0 45
Confirmed (+) 8 4 6 NA 6 NA 15 NA 39
Of these 63 donor specimens, seven donors provided specimens
with multiple results: multiple presumptive drug positives, multiple
unacceptable validity test results, or a combination of presumptive drug
positive and unacceptable validity test results. Confirmatory testing of
these seven specimens yielded the following results:
Positive ADULT/ AMP/ AMP/ AMP/ BZE/ BZE/ OPI/
Screening Test INV BZE OPI THCA DIL THCA THCA
Confirmatory pH too high AMP NEG AMP AMP BZE BZE NEG MOR
Test
Results
MAMP NEG MAMP MAMP NEG COD
Abnormal BZE COD THCA DIL THCA THCA
Creat&SpGr MOR
Only 13 of the 478 specimens reported as Rejected for Testing were
collected under Post-Accident or Reasonable Suspicion/Cause
conditions. One of those 13 donors provided a dilute specimen.
Specimens from three of these 13 donors (23.1%) provided drug positive
results: two donors were positive for THCA, and one donor was positive
for both BZE and THCA. Of the specimens provided by the 478 donors,
9.6 % (46) provided specimens with drug positive and/or unacceptable
specimen validity results (not including the 11 dilute specimens) as
compared to 2.2% of all Federal & federally regulated specimens tested
and reported by all SAMHSA certified laboratories during the same time
period that were also tested for drugs and specimen validity (not
including dilute results).
Conclusions: Of the 478 specimens reported as Rejected for
Testing, 353 were rejected for insufficient volume (< approximately
30mL), with only 18 of these 353 specimens having leaked in transit
resulting in their insufficient volume. This suggests that the minimum
volume requirement for specimen rejection may need to be re-evaluated.
Rejected Specimens, Federal Employees, Non-Negative Incidence
K3 Alcohol, Drugs, and Homicide
Xiang Zhang, MD*, and Ling Li, MD, Office of the Chief Medical
Examiner, 111 Penn Street, Baltimore, MD 21201; Ping Yan, MD,
Department of Forensic Medicine, Wuhan University, Wuhan, Hubei
430072, China; Barry S. Levine, PhD, and David R. Fowler, MD,
Office of the Chief Medical Examiner, 111 Penn Street, Baltimore,
MD 21201
After attending this presentation, attendees will better understand
the role of alcohol and drug abuse in violent deaths.
This presentation will impact the forensic community and/or
humanity by providing additional support that alcohol and drug users are
at greatly increased risk of being victims of homicide.
In the United States, homicide is the third leading cause of death for
persons 15-24 years of age and the leading cause of death for black
males 15-34 years of age. It has been estimated that one out of ten
homicide victims are drug-related.
A retrospective study of homicide victims in the State of Maryland
was conducted for 2003, 2004, and 2005 to determine alcohol and/or
illicit drugs use among homicide victims. During the past three years, a
total of 1,674 homicides occurred in Maryland, with an average rate of
10.1 homicides per 100, 000 individuals. Males were six times more
likely to become homicide victims (85.7%) than were females (14.3%).
Blacks were 5.9 times more likely than whites to be victimized. Black
males were at the greatest risk, to become victims. Of homicide victims,
71 % (1187/1674) were black males, with an average rate of 53.5 per
100,000 populations.
* Presenting Author
Comprehensive alcohol and drug testing were performed on all of
the homicide victims. Alcohol and /or drugs were found in a significant
portion of homicide victims. Of this group, 739 out of 1,674 homicide
victims (44%) showed some form of recent illicit drug and/or alcohol
use. Alcohol was positive in 33% of the cases. Among illicit drugs,
cocaine was the most common drug detected in the homicide victims
(15%), followed by Narcotics (6%), Phencyclidine (PCP) (3%), and
Methylenedioxymethamphetamine (MDMA) (1%). More male victims
(46%) were positive for alcohol and/or drugs than were female victims
(22%). Blacks (45%) were slightly more likely than whites (41%) to be
positive for alcohol and/or drugs.
The most common cause of homicide in Maryland was firearm
injury (77%), followed by sharp force injury (10%), blunt force injury
(8%), suffocation/strangulation (2%). Among victims caused by firearm
injury, 34% were positive for alcohol, 10% for cocaine, 7% for narcotics,
4% for PCP, and 1% for MDMA. The victims from sharp force injury
were 33% positive for alcohol, 7% for cocaine, 2% for narcotics, and 1%
for PCP. Alcohol, cocaine, and narcotics were detected in 25%, 6%, and
6% respectively among victims of blunt force injury, and in 36%, 3%,
and 11% respectively among the victims from suffocation/strangulation.
Forensic Toxicology, Drugs, Homicide
K4 Gamma-Hydroxybutyrate (GHB) -
Withdrawal With Severe Rhabdomyolysis,
Hyperkalemia, and Cardiac Arrest
David M. Benjamin, PhD*, 77 Florence Street, Suite 107, Chestnut
Hill, MA 02467
After attending this presentation, attendees will learn about the
presentation of severe GHB withdrawal.
This presentation will impact the forensic community and/or
humanity by informing the forensic community that severe GHB
toxicity leading to death can occur in the absence of proper treatment.
Gamma-Hydroxybutyrate (GHB) is well known to the forensic
toxicology community for its euphoric, soporific, and intoxicating
properties. Fatalities have occurred from recreational use of GHB at
clubs or “Raves,” and when GHB has been added surreptitiously to
anther person’s beverage, usually to facilitate a sexual assault (Drug
Facilitated Sexual Assault, DFSA). However, chronic use of GHB
produces a dependence similar to that of ethanol, and a withdrawal
syndrome very similar to ethanol-related delirium tremens (DTs) has
been reported in the literature.
In this case, the decedent was a 28-year-old a male with a longterm,
high dose dependence on GHB. In order to ensure his supply of
GHB, the man distributed GHB. At the time of his cardiac arrest, the
decedent was in police custody for possession and trafficking of GHB.
During the booking process, the decedent complained of symptoms of
GHB withdrawal. Over a further two-day period of abstinence, the
decedent became disoriented, agitated, began to hallucinate and injure
himself. To prevent further injury, he was restrained in a “pro-straint”
chair with restraints at the wrists, chest, and ankles. The next day, he
was less combative but continued to have hallucinations and exhibit
rambling speech. After 22.5 hours, he was released from restraints and
transferred to a soft-walled cell equipped with video monitoring. He
subsequently was observed walking around the cell, but by the end of the
second hour, he was observed slumped in the corner of his cell. Guards
entered the cell and found him unresponsive, pulse less and apneic.
EMS personnel were summoned and also reported him as pulse less and
apneic, with a cardiac monitor indicating pulseless sinus tachycardia.
CPR was started, the patient was intubated and given naloxone and
dopamine, and he was transported to the hospital emergency room (ER).
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