Arising Opioid Issues in Toxicology Laboratories


Since 2014, there has been a significant increase in the number of drug overdose deaths because of the widespread emergence of NPS in the U.S. According to the American Academy of Forensic Sciences, these deaths are often attributed to the ingestion of illegally manufactured novel and emerging drugs, including designer benzodiazepines, opioids, and stimulants, as well as fentanyl and its analogs. This increase in decedents poses a significant challenge to medical examiners, coroners, and overwhelming forensic toxicology laboratories as their caseload increases, as they often cannot provide the required expanded scope of analysis for NPS promptly. This is partly due to insufficient qualified staff and the lack of appropriate instrumentation to conduct critical analyses. Added to these, numerous laboratories don’t have access to state-of-the-art equipment and struggle to meet demanding turn-around times and expanded scope of analyses.

The techniques to identify and quantify NPS require comprehensive validation as mandated by new national standards for performing analyses and laboratory accreditation. In some cases, validation takes weeks or months to complete. An accredited laboratory will require personnel with expertise in analytical toxicology to implement new instrumentation.

A forensic toxicology laboratory goes through many steps when examining drugs, including a screen and confirmation, followed by quantitative analysis when needed. It can be time-consuming and costly to include the analysis of emergent drugs using these well-established methods. In addition, the staff might not have the proper training on the most up-to-date instrumentation to do a thorough analysis. Furthermore, technologically advanced instrument systems used in forensic toxicology labs are often complex and require extensive validation before implementation.

The testing method is evolving from a strictly qualitative (presence/absence of a substance) approach to a more quantitative approach (concentration of a substance) to acquire definitive data concerning NPS and their role in the cause of death. The quantitative approach is costly, more difficult to achieve, and requires extensive validation to meet national standards.

Toxicological testing has been proven to be an essential tool that supports the ME/C community in death investigations and provides certification of the cause and manner of death. The enhanced scope of testing by the forensic toxicology laboratory will streamline the precise certification of deaths caused by these novel drugs. Moreover, when information is needed to support the cause and manner of death certification, laboratories and ME/C offices can share critical electronic data, ensuring timely information transfer.

Presently, forty percent (40%) of ME/C offices cannot share data electronically with other ME/C offices or toxicology laboratories due to a lack of a computerized data management system. Toxicology laboratories and the ME/C must establish a steady communication to prompt the investigation of emerging drugs, as a vital part of investigating potential overdose or drug-related deaths. The federal MDI-DATA-Working Group focuses on data sharing between ME/C and other stakeholders. Therefore more funding must be directed to this critical function.

The lack of comprehensive toxicology data also impacts our public health partners and constrains the policymakers’ ability to comprehend current drug trends in their communities, as well as their ability to form prompt and appropriate guidelines and action plans to save lives. Public safety standards, including education, interdiction, treatment, recovery, and even counteraction drugs, cannot be effective without the expanded toxicology analysis for early detection of these new drugs.

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