To Test or Not To Test?: The Value of Toxicology in a Delayed Overdose Death

Abstract

A case demonstrating the necessity of thorough death investigation processes where toxicology plays an active role is presented. A 33-year-old white man presented to the emergency room in respiratory distress after an overdose episode where he was revived on the scene by fire rescue. His condition continued to deteriorate and he expired 6 days after the initial incident. No admission specimens were available for testing; however, there were specimens drawn 4 and 5 days after the incident. Drug paraphernalia from the scene was obtained by the laboratory through collaboration with local law enforcement. Drug paraphernalia was initially tested in the laboratory and after obtaining the results, the antemortem and postmortem specimens were tested identifying mitragynine and U-47700, among other drugs. These results indicate the value in obtaining and testing drug paraphernalia, and the value of testing antemortem specimens even in the event of a delay.

A Forensic Diagnostic Algorithm for Drug-Related Deaths: A Case Series

“…History and death scene investigation alone is not sufficient to predict a drug intoxication. The toxicology laboratory can identify and measure drugs in biological samples assisting the forensic pathologist and the medical examiner in their work [5,6]. The recommendations regarding the investigation, evaluation, and certification of deaths related to drugs misuse were recently updated by the National Association of Medical Examiners and an expert panel of medical toxicologists [1,7].…”