SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

C27
PHARMACEUTICAL IDENTIFICATION AND QUALITY CONTROL TESTING AT A MAJOR
MEDICAL CENTER
Carl E. Wolf* and Alphonse Poklis. Department of Pathology, Medical College of Virginia Campus at
Virginia Commonwealth University, Richmond, VA 23298-0165.
Clinical Toxicology laboratories are often presented with the problem of identifying the contents of
pharmaceutical products. These preparations come into question in a variety of situations: the preparation is
found outside of it's "controlled" environment, the inappropriate or wholly unexpected response of a
patient to the administration of the preparation, or suspicions of drug diversion or abuse by a health care
provider. Medical institutions generally address the issue of drug abuse by health care workers through preemployment
urine drug testing, random drug testing, and/or "for cause" drug testing after an incident has
occurred. However, such programs seldom, if ever address issues of pharmaceutical compounding or
tampering.
We have developed a simple HPLC method to routinely identify and quantitate pharmaceutical
preparations for over 15 different drugs, including opiates, synthetic opiates, local anesthetics, and
midazolam. The method uses a Beckman ODS column (4.6 x 250 mm), and an isocratic mobile phase
consisting of acetonitrile: perchloric acid: water (33:0.134:67) for drug separation. Drugs are detected and
quantitated using a UV detector at either 206 or 280 nm. In the past 6 years, we have analyzed thousands of
pharmaceutical products for content and concentration. Most of these products were analyzed for
concentration, to verify proper compounding by our hospital pharmacy or local pharmacies.
Several cases will be presented of typical findings from products that have not been tampered with, as well
as, instances of mistaken compounding and drug. diversion. Cases include: preparations from patient
controlled anesthesia, IV bag solutions, rescue squad drug boxes, and improper compounding of pediatric
preparations for c1onidine, and hydromorphone.
Keywords: Drug Diversion, Pharmaceutical Testing, Narcotics
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