Postmortem Toxicology of Abused Drugs

214 Pages·2007·3.59 MB·English

by  Steven B. Karch MD FFFLM

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Half Title Page
Postmortem
Toxicology
of
Abused Drugs
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Title Page
Postmortem
Toxicology
of
Abused Drugs
Edited by
Steven B. Karch, MD, FFFLM
Consultant Pathologist and Toxicologist
Berkeley, California
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
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CRC Press
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Library of Congress Cataloging-in-Publication Data
Postmortem toxicology of abused drugs / [edited by] Steven B. Karch.
p. ; cm.
“A CRC title.”
Includes bibliographical references and index.
ISBN-13: 978-1-4200-5451-4 (alk. paper)
ISBN-10: 1-4200-5451-1 (alk. paper)
1. Forensic toxicology. 2. Drugs of abuse--Toxicology. 3. Autopsy. I. Karch, Steven B.
[DNLM: 1. Autopsy--methods. 2. Forensic Toxicology--methods. 3. Street Drugs--poisoning. W 825
P858 2007]
RA1228.P67 2007
614’.13--dc22 2007008111
Visit the Taylor & Francis Web site at
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Contents
Chapter 1 Introduction to Postmortem Toxicology....................................................................1
W. Lee Hearn, Ph.D. and H. Chip Walls, B.S.
Chapter 2 Specimen Selection, Collection, Preservation, and Security..................................13
Bradford R. Hepler, Ph.D. and Daniel S. Isenschmid, Ph.D.
Chapter 3 Common Methods in Postmortem Toxicology........................................................31
W. Lee Hearn, Ph.D. and H. Chip Walls, B.S.
Chapter 4 Strategies for Postmortem Toxicology Investigation...............................................67
Edited and Revised by Henrik Druid, M.D., Ph.D.
Chapter 5 Quality Assurance in Postmortem Toxicology........................................................95
Wilmo Andollo, B.S.
Chapter 6 Interpretation of Postmortem Drug Levels............................................................113
Graham R. Jones, Ph.D., DABFT
Appendix I Glossary of Terms in Forensic Toxicology...........................................................131
Compiled by H. Chip Walls, B.S.
Appendix II Common Abbreviations........................................................................................137
Compiled by H. Chip Walls, B.S.
Appendix III References for Methods of Drug Quantitative Analysis.....................................141
Appendix IV Sample Calculations............................................................................................181
Barry K. Logan, Ph.D. and Alan Wayne Jones, D.Sc.
Appendix V Predicted Normal Heart Weight (g) as a Function of Body Height in
392 Women and 373 Men......................................................................................185
Index..............................................................................................................................................187
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Preface
Because of the continuous increase in availability and use of pharmaceuticals and illicit drugs,
postmortem toxicology has become more and more important in death investigations. The intro-
duction of new substances to the market requires a high awareness among pathologists and toxi-
cologists and necessitates the development of methods that encompass the newcomers. Fortunately,
many important achievements have been made in methodology, and the application of novel
techniques, such as modifications of solid phase extraction and LC/MS techniques, now offers
better conditions for efficient and sensitive analyses of numerous substances.
Many important contributions regarding the impact of various postmortem changes that may
influence the toxicological results have been published. Pharmacogenetic analyses, e.g., to identify
poor metabolizers, may now be applied on postmortem material and assist in the determination of
the manner of death, and studies on postmortem redistribution of drugs have resulted in a widespread
appreciation of the influence of the specimen type on the drug concentrations.
In recent years, the specific detection of many compounds and their metabolites in various
matrices has improved substantially. However, the interpretation of their concentrations remains a
difficult task. Hence, despite the progress in postmortem toxicology, information about previous
drug use and the circumstances surrounding death, and the autopsy findings are still very important
in order to arrive at correct conclusions when interpreting the analytical results. An intimate
collaboration between toxicologists and pathologists is therefore desirable.
Traditionally, teachers of forensic science have always emphasized that the proper investigation
of a drug-related death involves three elements: scene investigation, autopsy, and toxicological
examination. The traditional approach is no longer valid because it assumes that the autopsy was
complete. We now know that it has never been complete. Heart disease is not ruled out just because
25 sections of myocardium look normal. Poisoning is not proven just because blood morphine
concentrations are very high. We now live in the age of the DNA microarray. Chips for measurement
of CYP2D6 polymorphisms are already available commercially. Arrays for the measurement of the
hundreds of genes involved in hypertrophic cardiomyopathy already exist in development labs. The
sooner these new technologies are incorporated into forensic toxicology, the sooner the justice
system will benefit.
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The Editor
Steven B. Karch, M.D., FFFLM, received his under-
graduate degree from Brown University. He attended grad-
uate school in anatomy and cell biology at Stanford Univer-
sity. He received his medical degree from Tulane University
School of Medicine. Dr. Karch did postgraduate training in
neuropathology at the Royal London Hospital and in cardiac
pathology at Stanford University. For many years he was a
consultant cardiac pathologist to San Francisco’s Chief
Medical Examiner.
In the U.K., Dr. Karch served as a consultant to the
Crown and helped prepare the cases against serial murderer
Dr. Harold Shipman, who was subsequently convicted of
murdering 248 of his patients. He has testified on drug
abuse–related matters in courts around the world. He has a
special interest in cases of alleged euthanasia, and in episodes where mothers are accused of
murdering their children by the transference of drugs, either in utero or by breastfeeding.
Dr. Karch is the author of nearly 100 papers and book chapters, most of which are concerned
with the effects of drug abuse on the heart. He has published seven books. He is currently completing
the fourth edition of Pathology of Drug Abuse, a widely used textbook. He is also working on a
popular history of Napoleon and his doctors.
Dr. Karch is forensic science editor for Humana Press, and he serves on the editorial boards
of the Journal of Cardiovascular Toxicology, the Journal of Clinical Forensic Medicine (London),
Forensic Science, Medicine and Pathology, and Clarke’s Analysis of Drugs and Poisons.
Dr. Karch was elected a fellow of the Faculty of Legal and Forensic Medicine, Royal College
of Physicians (London) in 2006. He is also a fellow of the American Academy of Forensic Sciences,
the Society of Forensic Toxicologists (SOFT), the National Association of Medical Examiners
(NAME), the Royal Society of Medicine in London, and the Forensic Science Society of the U.K.
He is a member of The International Association of Forensic Toxicologists (TIAFT).