The sentinel role of forensic toxicology laboratories to identify and act upon diverse drug threats by addressing toxicology and economic demands

Miller, Jeri D. Ropero; Mullen, Lawrance D.; Speaker, Paul J.

doi:10.1016/j.fsisyn.2022.100292

Cited by 4 publications

(6 citation statements)

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“…Balancing the operational needs of the laboratory while recognizing the need to continually develop and validate new methods is reliant on the laboratory having the necessary resources available to invest in the technology needed and the expertise of the forensic toxicology staff. Ropero Miller et al [39] recently published a detailed account of the challenges facing forensic toxicology laboratories and recognized that the demand for toxicological services is trending upward.…”

Section: Resultsmentioning

confidence: 99%

The rise and rise of fentanyl in postmortem casework

Cooper

2023

Journal of Forensic Sciences

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Forensic toxicology laboratories are navigating a period of time with increasing drug overdose deaths, an opioid epidemic, the impact of the COVID‐19 pandemic, and the illicit drug market flooded with novel psychoactive substances. In New York City, the Department of Forensic Toxicology has experienced a 56% increase in postmortem casework in the past decade with fentanyl detected in 80% of all overdose deaths. Over a period of 2.5 years, 15,638 postmortem cases were tested for the presence of fentanyl and fentanyl analogs using liquid‐chromatography tandem mass spectrometry (LCMSMS). Fentanyl was detected in approximately one third of cases and of these 4447 cases with femoral blood. A twofold increase in cases with high concentrations of fentanyl (>100 ng/mL) was observed between 2021 and 2022. The minor metabolite and precursor chemical, 4‐ANPP (4‐anilino‐N‐phenethylpiperidine) may help differentiate between illicit and licit fentanyl. 4‐ANPP blood concentrations were <10 ng/mL in 98% of the cases and the 4‐ANPP:fentanyl ratio was <0.67 for 99.1% of blood specimens. Only six cases had 4‐ANPP concentrations higher than the corresponding fentanyl blood concentration. This study also highlights, the changing fentanyl analogs found in postmortem cases since 2016 in NYC with the emergence of fluorofentanyl initially identified in 2020 and continuing to dominate in comparison with the prevalence of other analogs, many of which are no longer detected in casework. The detection of one of the latest drugs to be mixed with fentanyl, namely xylazine, has also increased in prevalence by 36.7% in 2022 compared with 2021.

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Section: Resultsmentioning

confidence: 99%

The rise and rise of fentanyl in postmortem casework

Cooper

2023

Journal of Forensic Sciences

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“…The Houston experience offers a similar contribution through the sentinel role that identification of emerging trends in impaired driving offers to public health and safety. The contributions may be measured through avoidance of accidents and the associated losses to death, injury, and property [40]. Ropero Miller et al [40] note that the liberalization of drug laws via legalization or decriminalization increases the expected number of drugrelated accidents.…”

Section: Discussionmentioning

confidence: 99%

“…The contributions may be measured through avoidance of accidents and the associated losses to death, injury, and property [40]. Ropero Miller et al [40] note that the liberalization of drug laws via legalization or decriminalization increases the expected number of drugrelated accidents. The corresponding average cost from additional accidents ranges from USD 12,521 for property damage to USD 98,998 for injury to USD 9,984,261 for fatalities.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly to the aforementioned articles, some considerations of forensic intelligence propose systems for implementation, while other considerations are specific to areas of investigation. Earlier studies tended to be concentrated in a few areas of investigation, including DNA [34][35][36][37][38], drugs-controlled substances [39][40][41], or firearms and ballistics [42][43][44].…”

Section: Recent Literature On Forensic Intelligencementioning

confidence: 99%

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Intelligence and the Value of Forensic Science

Speaker

2024

Forensic Sciences

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Recent research has seen a rapid expansion in the reference to front-end forensics as an indication of the untapped value of forensic science. While some of these contributions have centered on development of forensic intelligence from a single area of investigation, others call for a more fundamental change in the relationship between crime laboratories and policing, particularly relating early laboratory analysis with big datasets to provide leads to investigators. We highlight several recently implemented tactical strategies of crime laboratories that contribute to the body of forensic intelligence. Beyond the scientific gains from these tactical applications, the corresponding details on associated efficiencies, costs, time savings, and quality improvements offer insights towards patterns of success for the community of crime laboratories. Further details expand an interpretation of what constitutes success with an eye on the contributions of the crime laboratory towards public health, safety, and protection of the innocent in addition to societal gains from conviction of the guilty. The economic interpretation of the value provided by the forensic laboratory assists in the cost–benefit review of strategic and tactical decisions and supports the justification for laboratory public funding with measures of the return on investment from public support of the forensic laboratory. Examples of the cost savings from crimes avoided include the returns from testing the backlog of unsubmitted sexual assault kits with USD 81 of costs avoided for each USD 1 spent to high-efficiency laboratories achieving gains of USD 646 for each UD 1 spent on de novo case submissions.

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“…Seemingly limitless supplies of novel, inexpensive, highly purified, and potent substances [9][10][11][12][13][14][15][16] are aggressively marketed with near complete impunity throughout the United States [17][18][19] accompanied by drug-related violence within the United States [20][21][22][23][24] and south of its border in Mexico [25,26]. Confronted with burgeoning caseloads, death investigators and toxicology laboratories have been forced to adopt new operational strategies, sometimes forgoing autopsies and taking advantage of economies of scale by utilizing private toxicology laboratories instead of local ones [27][28][29][30][31]. Opportunities for adequate funding are constrained by limited public funding, paucity of grants for death investigation, and fierce competition for any funding [32].…”

Section: Introductionmentioning

confidence: 99%

Medical examiner response to the drug overdose epidemic in King County Washington: “Real‐time” surveillance, data science, and applied forensic epidemiology

Harruff

Yarid

Barbour

et al. 2023

Journal of Forensic Sciences

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As the overdose epidemic overwhelmed medicolegal death investigation offices and toxicology laboratories, the King County Medical Examiner's Office responded with “real‐time” fatal overdose surveillance to expedite death certification and information dissemination through assembling a team including a dedicated medicolegal death investigator, an information coordinator, and student interns. In‐house testing of blood, urine, and drug evidence from scenes was performed using equipment and supplies purchased for surveillance. Collaboration with state laboratories allowed validation. Applied forensic epidemiology accelerated data dissemination. From 2010 to 2022, the epidemic claimed 5815 lives in King County; the last 4 years accounted for 47% of those deaths. After initiating the surveillance project, in‐house testing was performed on blood from 2836 decedents, urine from 2807, and 4238 drug evidence items from 1775 death scenes. Time to complete death certificates decreased from weeks to months to hours to days. Overdose‐specific information was distributed weekly to a network of law enforcement and public health agencies. As the surveillance project tracked the epidemic, fentanyl and methamphetamine became dominant and were associated with other indicators of social deterioration. In 2022, fentanyl was involved in 68% of 1021 overdose deaths. Homeless deaths increased sixfold; in 2022, 67% of 311 homeless deaths were due to overdose; fentanyl was involved in 49% and methamphetamine in 44%. Homicides increased 250%; in 2021, methamphetamine was positive in 35% of 149 homicides. The results are relevant to the value of rapid surveillance, its impact on standard operations, selection of cases requiring autopsy, and collaboration with other agencies in overdose prevention.

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The sentinel role of forensic toxicology laboratories to identify and act upon diverse drug threats by addressing toxicology and economic demands

Cited by 4 publications

References 47 publications

The rise and rise of fentanyl in postmortem casework

The rise and rise of fentanyl in postmortem casework

Intelligence and the Value of Forensic Science

Medical examiner response to the drug overdose epidemic in King County Washington: “Real‐time” surveillance, data science, and applied forensic epidemiology

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