2012
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Abstract: The forensic pathologist interprets the toxicology results in the setting of the entire death investigation. This review focuses on potential errors by the forensic pathologist with regard to toxicology analysis encountered with death investigation. These include mistakes of determining the cause of death based solely on the drug concentration and failure to consider the postmortem nature of the specimen when interpreting results. The forensic toxicologist does analytical toxicology; i.e., determining what dru… Show more

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“…The accurate completion of death certificates needs to improve, especially with regard to the names of substances implicated in the cause of death, not only in the UK but internationally. To overcome such shortcomings, consideration should be given to including toxicological results on the death certificate only where they have made a pathological contribution and stating the generic names of the chemicals causing death . In turn, this posits the need for mortality registers to be provided with detailed toxicological and pathological data on a routine basis.…”
Section: Current Needs and Recommendationsmentioning
“…The accurate completion of death certificates needs to improve, especially with regard to the names of substances implicated in the cause of death, not only in the UK but internationally. To overcome such shortcomings, consideration should be given to including toxicological results on the death certificate only where they have made a pathological contribution47 and stating the generic names of the chemicals causing death.48 In turn, this posits the need for mortality registers to be provided with detailed toxicological and pathological data on a routine basis.Collaborating and agreeing on approaches to defining NPS and NPS-related deaths, how to identify such events more accurately, and what statistics and other information regarding them is very important. There needs to be stronger communication between data suppliers (such as Coroners, Medical Examines and Procurators Fiscal) and both GMRs and, more particularly, SMRs.…”
mentioning
“…The medical certification section describes the causal chain of events leading to death, from the initiating condition or injury (the “underlying cause of death” [UCOD]) to the immediate cause of death, describing also other significant conditions contributing to death, and the manner of death (e.g., natural, accident, suicide, homicide, undetermined) [ 9 •, 23 ]. Multiple studies have reported that common ME/C errors in death certification can affect the accuracy of death certificate data for public health action [ 9 •, 13 , 25 30 ]. Hanzlick provides an excellent review on the important role of ME/Cs in generating MDI data for epidemiological research and the public health impact of MDIs in the USA [ 11 ••].…”
Section: Investigation and Classification Of Overdose Deathsmentioning
“…Drug overdose mortality surveillance relies on the ability of the medicolegal death investigation (MDI) system to generate death certificates with complete and specific information on drugs that are responsible for or contributed to overdose deaths [ 9 •, 10 ••, 11 ••]. However, lack of routinely performed comprehensive toxicology testing, analytical challenges to detection and quantification of novel synthetic opioids, and errors in death certificate completion can introduce bias in quantifying the involvement of specific drugs in drug overdose mortality [ 12 ••, 13 , 14 , 15 ••]. This review discusses the MDI system and certification of overdose deaths, death certificate coding using the International Classification of Diseases, Tenth Revision (ICD-10), approaches to drug overdose mortality data quality assessment, and epidemiological tools for improved identification of specific drugs to improve population estimates for opioid-related drug overdose mortality.…”
Section: Introductionmentioning
“…Particularly with instances of chronically used (methadone) and abused (heroin) substances, tolerance and other variables produce a wide range of drug concentrations that often overlap in the living and the dead [20]. Postmortem redistribution and the postmortem interval also may affect these concentrations [21][22][23][24][25]. Postmortem redistribution is the change that occurs in drug concentrations after death with the redistribution of drugs, for example, into the blood from the lungs, liver, or myocardium.…”
Section: Death Certificationmentioning