The postmortem redistribution phenomenon is an important factor in the interpretation of blood drug concentrations as a cause or factor in death. Intraosseous fluid (IOF) may serve as an alternative matrix for drug testing. Intraosseous fluid was collected from the left and right tibias and humerus of 29 decedents using the Arrow EZ-IO Intraosseous Vascular Access System. Standard autopsy specimens including blood were also collected at the same time during autopsy. Blood and IOF specimens were screened by immunoassay for opioids, fentanyl analogs, oxycodone, methadone, cocaine, methamphetamine, amphetamines, phencyclidine, tricyclic antidepressants, benzodiazepines and cannabinoids, using commercially available enzyme-linked immunosorbent assay (ELISA) kits. Correlation between cardiac/central blood ELISA and IOF ELISA results was mostly 100% for drug targets. Further blood confirmation analysis was performed by gas chromatography mass spectrometry also showed comparable correlation to IOF screen results. There was no significant difference between the IOF sites or sides of the body. This novel study supports the use of IOF as an alternative postmortem specimen for toxicological investigations as a potentially less-compromised tissue in decomposed or traumatized bodies. Preliminary data is provided for the screening of common drugs of abuse in IOF that may show to be subject to alternative rates of postmortem redistribution than to that of other biological specimens in future studies that quantitate IOF drug concentrations.

In recent years, a significant number of investigations have discovered up to 200 000 unsubmitted sexual assault kits (SAKs) in the US. While the public outcry was largely directed towards DNA analysis, the SAKs also contained biological specimens specifically designated for toxicological analysis. Due to the sensitivity of analytes in potential drug facilitated sexual assaults, the preservation and maintenance of the specimens is crucial in providing accurate toxicological measurements. The investigations into the unsubmitted SAKs have identified subjective law enforcement officer (LEO) rationale for the unsubmitted kits, however the impact on toxicological specimens has not been examined. This brief review of policies and guidelines with respect to forensic specimens has identified potential sources of evidentiary degradation, despite the use of chemical preservatives. With respect to temperature-controlled environments, the variation in SAK submission policies established throughout the US are potentially detrimental to the preservation of toxicological evidence. Degradation as a result of time-delayed collection and poorly maintained storage temperatures plays a crucial role for/in the interpretation of qualitative and quantitative toxicological results. This review finds these delays can be addressed through modernisation of facilities; electronic tracking of unsubmitted SAKs; mandated transfer of biological evidence within 72 h; and documentation of temperature within the chain of custody or other records. Without identifying the range of temperatures in which the evidence was exposed, forensic toxicologists may unintentionally provide erroneous interpretations of toxicological analyses -potentially casting doubt on the survivor's recall of events and negatively impacting future sexual assault investigations. KEY POINTS• Temperature-controlled conditions for biological evidence of sexual assault cases may be inadequate in the US. • Biological specimens collected in drug-facilitated sexual assault (DFSA) casework must be immediately preserved in optimal temperature-controlled temperatures. • If biological specimens are not stored at optimal temperatures, forensic toxicologists are likely to interpret values that do not reflect the specimen at time of collection. • It would benefit DFSA investigations and toxicological interpretations if temperature-related information was included with the chain of custody or other included documentation.

Cannabis intoxication in living and deceased drivers is an important medico-legal topic, but only a limited number of studies examine cannabinoids in living and deceased humans. This study compares cannabinoid concentrations (in ng/mL) in driving under the influence of drug (DUID) drivers with blood cannabinoids to those in drivers who died while driving with cannabinoids in their postmortem (PM) peripheral blood. From 2010 to 2013, there were 318 cannabis-positive DUID cases (mean, median THC: 4.9, 3); 88 had cannabis-only in their bloods (mean, median THC: 5.8, 4). In 23 DUID cases, Huestis' Predictive Models with 95% confidence intervals were applied and evaluated, demonstrating that the actual case time points in all 23 cases fell within the predicted time ranges. Among deceased drivers, 19 had cannabis-positive toxicology (mean, median THC: 11.7, 4.5) and 8 had cannabis-only (mean, median THC: 20.3, 19.5). Motorcyclists and bicyclists comprised the majority of deceased vehicle operators, with bicyclists averaging the highest mean and median THC concentrations overall. The analysis of variance between living and deceased drivers' cannabinoid concentrations showed that THC-OH and THC-COOH concentrations are not statistically different between the two groups, but that THC concentrations are statistically different, making it difficult to directly correlate PM with antemortem THC concentrations between living and deceased drivers.