Postmortem diagnosis and toxicological validation of illicit substance use.

Abstract

The present study examines the diagnostic challenges of identifying ante-mortem illicit substance use in human postmortem cases. Substance use, assessed by clinical case history reviews, structured next-of-kin interviews, by general toxicology of blood, urine and/or brain, and by scalp hair testing, identified 33 cocaine, 29 cannabis, 10 phencyclidine and nine opioid cases. Case history identified 42% cocaine, 76% cannabis, 10% phencyclidine and 33% opioid cases. Next-of-kin interviews identified almost twice as many cocaine and cannabis cases as Medical Examiner (ME) case histories, and were crucial in establishing a detailed lifetime substance use history. Toxicology identified 91% cocaine, 68% cannabis, 80% phencyclidine and 100% opioid cases, with hair testing increasing detection for all drug classes. A cocaine or cannabis use history was corroborated by general toxicology with 50% and 32% sensitivity, respectively, and with 82% and 64% sensitivity by hair testing. Hair testing corroborated a positive general toxicology for cocaine and cannabis with 91% and 100% sensitivity, respectively. Case history corroborated hair toxicology with 38% sensitivity for cocaine and 79% sensitivity for cannabis, suggesting that both case history and general toxicology underestimated cocaine use. Identifying ante-mortem substance use in human postmortem cases are key considerations in case diagnosis and for characterization of disorder-specific changes in neurobiology. The sensitivity and specificity of substance use assessments increased when ME case history was supplemented with structured next-of-kin interviews to establish a detailed lifetime substance use history, while comprehensive toxicology, and hair testing in particular, increased detection of recent illicit substance use.

• Authors: Elin Lehrmann, Zoan R Afanador, Amy Deep-Soboslay, Gloria Gallegos, William D Darwin, Ross H Lowe, Allan J Barnes, Marilyn A Huestis, Jean L Cadet, Mary M Herman, Thomas M Hyde, Joel E Kleinman, William J Freed
• Journal: Addiction biology (Addict Biol) Vol. 13 Issue 1 Pg. 105-17 (Mar 2008) ISSN: 1369-1600 [Electronic] United States
• PMID: 18201295 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural)

Chemical References

• Illicit Drugs

Topics

• Autopsy
• Body Fluids (chemistry)
• Cerebellum (chemistry, pathology)
• Cocaine-Related Disorders (diagnosis, pathology)
• Coroners and Medical Examiners
• Hair (chemistry)
• Humans
• Illicit Drugs (analysis)
• Marijuana Abuse (diagnosis, pathology)
• Medical History Taking
• Oligonucleotide Array Sequence Analysis
• Opioid-Related Disorders (diagnosis, pathology)
• Phencyclidine Abuse (diagnosis, pathology)
• Sensitivity and Specificity
• Substance-Related Disorders (diagnosis, pathology)