Post-mortem formation of ethanol: Is 1-propanol a reliable marker? A proof-of-concept study using an in vitro putrefactive environment setup.

Ethanol is the psychoactive substance identified most frequently in post-mortem specimens. Unfortunately, interpreting post-mortem ethanol concentrations can be difficult because of post-mortem alcohol redistribution and the possibility of post-mortem alcohol neogenesis. Indeed, in the time interval between death and sample collection, the decedent may be exposed to non-controlled environments for an extended period, promoting microbial colonization. Many authors report that in the presence of carbohydrates and other biomolecules, various species of bacteria, yeast, and fungi can synthesize ethanol and other volatile substances in vitro and in vivo. The aim of this study was to study the impact of several variables on microbial ethanol production as well as develop a mathematical model that could estimate the microbial-produced ethanol in correlation with the most significant consensual produced higher alcohol, 1-propanol. An experimental setup was developed using human blood samples and cadaveric fragments incubated under strictly anaerobic conditions to produce a novel substrate, "cadaveric putrefactive blood" mimicking post-mortem corpse conditions. The samples were analyzed daily for ethanol and 1-propanol using an HS-GC-FID validated method. The formation of ethanol was evaluated considering different parameters such as putrefactive stage, blood glucose concentration, storage temperature, and storage time. Statistical analysis was performed using the Mann-Whitney non-parametric test and simple linear regression. The results indicate that the early putrefactive stage, high blood glucose concentration, high temperature, and time of incubation increase microbial ethanol production. In addition, the developed mathematical equation confirms the feasibility of using 1-propanol as a marker of post-mortem ethanol production.

3D-printed electrochemical pestle and mortar for identification of falsified pharmaceutical tablets.

Falsified medicines and healthcare supplements provide a major risk to public health and thus early identification is critical. Although a host of analytical approaches have been used to date, they are limited, as they require extensive sample preparation, are semi-quantitative and/or are inaccessible to low- and middle-income countries. Therefore, for the first time, we report a simple total analysis system which can rapidly and accurately detect falsified medicines and healthcare supplements. We fabricated a poly-lactic acid (PLA) pestle and mortar and using a commercial 3D printer, then made carbon black/PLA (CB/PLA) electrodes in the base of the mortar using a 3D printing pen to make an electrochemical cell. The pestle and mortar were able to crush and grind the tablets into a fine powder to the same consistency as a standard laboratory pestle and mortar. Using melatonin tablets to characterise the device, the 3D-printed pestle and mortar was able to detect the concentration of melatonin in the presence of insoluble excipients. The calibration plot showed a linear response from 37.5 to 300 µg/mL, where the limit of detection was 7 µg/mL. Electrochemical treatment was able to regenerate the CB/PLA working electrode allowing for repeated use of the device. In a blinded study, the device was able to accurately determine falsified melatonin tablets with recovery percentages between 101% and 105%. This was comparable to HPLC measurements. Overall, these findings highlight that our 3D-printed electrochemical pestle and mortar is an accessible and effective total analysis system that can have the ability to identify falsified medicines and healthcare supplements in remote locations.

Sociodemographic and clinical factors associated with transdermal alcohol concentration from the SCRAM biosensor among persons living with and without HIV.

BACKGROUND: Transdermal alcohol biosensors can objectively monitor alcohol use by measuring transdermal alcohol concentration (TAC). However, it is unclear how sociodemographic and clinical factors that influence alcohol metabolism are associated with TAC. The main aim of this study was to examine how sociodemographic factors (sex, age, race/ethnicity) and clinical factors (body mass index, liver enzymes: alanine aminotransferase [ALT] and aspartate transaminase [AST]), alcohol use disorder, and HIV status were associated with TAC while controlling for level of alcohol use. METHODS: We analyzed data from a prospective study involving contingency management for alcohol cessation among persons living with and without human immunodeficiency virus (HIV) that used the Secure Continuous Remote Alcohol Monitoring (SCRAM) biosensor. Forty-three participants (Mage  = 56.6 years; 63% male; 58% people living with HIV) yielded 183 SCRAM-detected drinking days. Two indices derived from SCRAM: peak TAC (reflecting level of intoxication) and TAC area under the curve (TAC-AUC; reflecting alcohol volume)-were the main outcomes. Self-reported alcohol use (drinks/drinking day) measured by Timeline Followback was the main predictor. To examine whether factors of interest were associated with TAC, we used individual generalized estimating equations (GEE), followed by a multivariate GEE model to include all significant predictors to examine their associations with TAC beyond the effect of self-reported alcohol use. RESULTS: Number of drinks per drinking day (B = 0.29, p < 0.01) and elevated AST (B = 0.50, p = 0.01) were significant predictors of peak TAC. Positive HIV status, female sex, elevated AST, and number of drinks per drinking day were positively associated with TAC-AUC at the bivariate level, whereas only self-reported alcohol use (B = 0.85, p < 0.0001) and female sex (B = 0.67, p < 0.05) were significant predictors of TAC-AUC at the multivariate level. CONCLUSIONS: HIV status was not independently associated with TAC. Future studies should consider the sex and liver function of the participant when using alcohol biosensors to measure alcohol use.

Levels of GHB in hair after regular application.

Gamma hydroxybutyrate (GHB) is a central nervous system depressant that is an approved drug for the treatment of narcolepsy with cataplexy and other syndromes. Due to its dose dependent stimulating, relaxing or sedative effects, illicit abuses include recreational use by young people and cases of drug-facilitated crime (DFC). Since GHB is also produced endogenously, for forensic questions, it is important to be able to differentiate between endogenous GHB and elevated levels due to additional intake. In this study, we measured GHB concentrations in hair of patients with narcolepsy receiving daily GHB treatment. The results were compared to endogenous concentrations and concentrations after chronic intake presented in several former studies. The aim of this study was to investigate whether a regular intake of a known dosage of GHB leads to elevated levels of GHB concentration in hair. We collected hair samples of 19 patients (14 female, 5 male) with narcolepsy under regular GHB treatment and examined the hair samples segmentally by digestion of the hair followed by liquid-liquid extraction and analysis using a Shimadzu LC20 UFLC system coupled with an AB Sciex API 4000 Qtrap tandem mass spectrometer. All volunteers received daily treatment with different doses of sodium oxybate (sodium salt of GHB) ranging between 3 and 9g per night. The observed mean value of GHB concentration in hair was 2.69ng GHB per mg hair for the 5 male participants, 1.56ng/mg for the 14 female participants giving an overall mean value of 1.86ng/mg for all participants. Our results showed no correlation between the daily dose or the duration intake of GHB and the measured concentration of GHB in hair. Although we did find a significant (p<0.01) difference between published endogenous levels of GHB in hair and GHB levels in hair of patients with regular daily GHB intake, the forensic relevance however is disputable. We hypothesise this narrow margin or even overlap to be the reason why analytical results from hair analysis in some cases fail to provide a reliable prove of a single exposition.

Investigation of patterns and dynamics of substance users: A long-term toxicology study on a sample of the Greek population between 2005 and 2019.

The purpose of the present study is to investigate dynamics underlying drug abuse and identify statistical correlations/patterns of forensic findings and sociodemographic factors in a population of illicit substance users. The following long-term studies were conducted: (a) a retrospective autopsy cohort study on autopsy incidents with available toxicological screening results (N = 482) in investigation of any possible forensic associations of exposure to illicit drugs; and (b) a cross-sectional study on a sample of arrested drug law offenders with available toxicological screening results (N = 195) as well as cluster analysis in order to possibly identify user profiles. Although outside the scope of the present study, ethanol was generally considered to be the main substance of abuse, as more than half of the premature deaths reported tested positive on the ethanol toxicology screen. Cannabis and opioid use was associated with unintentional causes of death, while an association of deliberate self-harm was noted with opioid and benzodiazepine use. Both cannabis and opioid use correlated with significantly younger ages (more than a decade) of premature death. Most frequently, an onset of substance use was reported in the early 20s with cannabis use. Although 65.3% of the subjects were diagnosed as dependent and unable to eliminate substance use on their own, only 7.7% of the subjects in the users' population had ever accessed appropriate support through rehabilitation programs.

A clinical investigation into the ability of subjects with lung disease to provide breath specimens using the EvidenzerIRL evidential breath analyser in alcohol intoxicant driving in criminal justice evidence.

The EvidenzerIRL instrument has been in use as an evidential breath analyser in the application of drink driving laws in the Republic of Ireland since 2011. The result of the analysis is used as evidence in prosecutions before the Courts in per se offences of driving under the influence of alcohol as distinct from screening results at the roadside. This study aims to assist doctors, lawyers and judges in assessing drivers' failure to provide valid evidential breath specimens. Since the introduction of the EvidenzerIRL, approximately 10% of evidential breath tests annually result in failure or refusal to provide a successful breath specimen, this is an offence under Irish road traffic laws. The presence of lung disease has been given as a reason for the driver failing to provide evidential breath specimens. The aim of this study is to assess the ability of subjects with lung disease to provide breath specimens using the EvidenzerIRL. Pulmonary function tests (PFT) were carried out on volunteers from outpatients of the pulmonary laboratory in St Vincent's University Hospital, Dublin (n = 58) and a control group with no underlying lung disease (n = 19). After the PFTs all volunteers were asked to provide breath specimens using the EvidenzerIRL. Fourteen (24%) out of 58 lung disease volunteers failed to provide a breath specimen, no one from the control group was unsuccessful. Thirteen females and one male volunteer could not successfully provide. Female volunteers were more likely to fail to provide than male volunteers. A significant difference was found between the median age of successful (62.2 years) and unsuccessful (69.2 years) lung disease volunteers. Only one PFT, percentage predicted of Forced Expiratory Volume in 1 second (FEV1), had a significant difference between the mean of successful (86.6%) and unsuccessful (66.5%) lung disease volunteers. A subject with lung disease was more likely to be successful than unsuccessful. Drivers' effort and operators' guidance through the process were found to be crucial parts to a successful outcome.

Hip-flask defense: An experimental study in the Hungarian population.

Toxicology tests and medical expert opinions are part of routine work in drunk driving cases in both domestic and international practice. The greatest challenge to forming an opinion is that the perpetrator claims to have consumed alcohol after the act of driving. To determine the time of consumption, it is essential to establish whether the alcohol in the body was in the absorption phase or in the elimination phase when the sample was collected. In domestic practice, breath alcohol content can be measured several times, two blood samples can be collected, and both blood and urine samples can be taken almost simultaneously. A recent Swedish study showed that taking a single blood sample and two urine samples allows for a more accurate examination of consumption after the fact. This study aimed to examine the applicability of such model to the domestic environment. We conducted a controlled drinking experiment involving 15 Hungarian casual drinker volunteers aged 18-25 years who consumed different amounts of alcohol at specified times while providing regular breath alcohol measurements as well as blood and urine samples. These measurement results provided accurate information about the changes in alcohol metabolism compared to the time of drinking and allowed us to draw the necessary conclusions, offering further evidence that alcohol metabolism can vary significantly between different ethnic groups. The results showed that the absorption and excretion of ethyl alcohol in the volunteers were much faster than those in the current Hungarian standards used in practice. In conclusion, the comparison of blood and urine samples collected between 60 min and 120 min cannot be considered suitable for establishing the fact of drinking after driving in Hungarian practice, and a local model is needed.

Drug-facilitated sexual assault and other crimes: A systematic review by countries.

Drug-facilitated sexual assault (DFSA) and drug-facilitated crime (DFC) constitute a mode of violence that is generally unknown to the population and may go unnoticed by health professionals. The aim of this systematic review was to analyze the victims of DFC, compiling their sociodemographic characteristics, the toxic substances used and their biological matrices and modes of action, in order to identify the substances that are commonly put to criminal use. The aim would be to establish political and health strategies that inform and warn people about possible criminal social behaviors consequent danger to health. This systematic review was conducted following the PRISMA guidelines. Alcohol, benzodiazepines and cocaine were among the most commonly detected substances. In most of the hospitals, immunoassays, liquid chromatography (LC-MS), or gas chromatography-mass spectrometry (GC-MS) analyses were used to identify the substances, while the most frequently used biological matrices were blood and urine. From a judicial point of view, the instrumental protocols and techniques followed for the detection of toxics in different biological matrices must guarantee the reliability and validity of the results for use in a court of law. The recommendations of international organizations should be followed and must be called upon to strengthen their respective national laws against this chemical submission (CS) phenomenon.

Ethyl glucuronide and ethanol concentrations in femoral blood, urine and vitreous humor from 117 autopsy cases.

BACKGROUND: Vitreous humor (VH) is a specimen of great value in forensic investigations and is being used for evaluating possible post-mortem formation of ethanol. Ethyl glucuronide (EtG) is an ethanol metabolite that has found interest for the same purpose. Both compounds can be measured in VH and because of differences in rate of distribution and elimination they may offer complementary information. METHODS: VH, femoral blood (FB) and urine were collected from 117 autopsy cases for forensic investigation. Ethanol was measured with headspace gas chromatography, while EtG was measured with liquid chromatography - tandem mass spectrometry. RESULTS AND CONCLUSION: Ethanol was detected in all matrices in 39 cases, while EtG was present in 62 cases. The VH-FB and the VH-urine ethanol concentrations in the 39 cases were statistically correlated (p < 0.00001). In one case with an ethanol concentration of 0.11 g/L in FB, no ethanol was detected in VH and urine, and no EtG in any specimen, indicating a possible post-mortem formation. EtG was present in VH in more cases than in FB and urine. The correlation between the EtG concentrations in VH and FB was statistically significant (p < 0.0003) as was the case also for VH and urine (p < 0.001). The combined information on ethanol and EtG concentrations in the three matrices can be used to interpret alcohol drinking habit before death. This study confirms the value of using VH as a specimen in forensic investigations regarding recent exposure to ethanol. EtG can be used not only for investigating post-mortem ethanol formation but also for estimating recent alcohol drinking.

Critical Analysis of Laboratory Testing Methodologies When Interpreting Conflicting Results at Autopsy.

ABSTRACT: Toxicological analysis is an important diagnostic component of a postmortem examination and may involve both antemortem and postmortem specimens. Here, we present a case in which an antemortem specimen, when reanalyzed in the forensic toxicology laboratory, resulted in values that contradicted the reported values from the medical record and required further investigation. This case involves a 51-year-old man decedent with a medical history of chronic alcohol abuse. His antemortem urine drug screen, performed upon admission to an emergency department, was negative. His serum blood alcohol level at presentation was reported as 0.960 g/dL and, repeated 4 hours later, was 0.500 g/dL with a comment indicating that there was significant lipemia interfering with the results. At autopsy, the antemortem blood sample collected from the hospital, postmortem blood, and vitreous humor samples were analyzed and all 3 samples were found to be negative for ethanol. The hospital laboratory used an enzymatic assay for ethanol detection, which is known to be impacted by lipemia, and the forensic laboratory used head-space gas chromatography, which is not impacted by lipemia. This highlights the need to critically analyze laboratory testing methodologies when interpreting conflicting results at autopsy.

Simultaneous detection of salivary Δ9-tetrahydrocannabinol and alcohol using a Wearable Electrochemical Ring Sensor.

Driving under the influence of cannabis and alcohol represents a major safety concern due to the synergistic or additive effect of these substances of abuse. Hence, rapid road-site testing of these substances is highly desired to reduce risks of fatal accidents. Here we describe a wearable electrochemical sensing device for the simultaneous direct, decentralized, detection of salivary THC and alcohol. The new ring-based sensing platform contains a voltammetric THC sensor and an amperometric alcohol biosensor on the ring cap, along with the wireless electronics embedded within the ring case. Rapid replacement of the disposable sensing-electrode ring cap following each saliva assay is accomplished by aligning spring-loaded pins, mounted on the electronic board (PCB), with the current collectors of the sensing electrodes. The printed dual-analyte sensor ring cover is based on a MWCNT/carbon electrode for the THC detection along with a Prussian-blue transducer, coated with alcohol oxidase/chitosan reagent layer, for the biosensing of alcohol. THC and alcohol can thus be detected simultaneously in the same diluted saliva sample within 3 min, with no cross talk and no interferences from the saliva matrix. The new wearable ring sensor platform should enable law enforcement personnel to screen drivers in a single traffic stop and offers considerable promise for addressing growing concerns of drug-impaired driving.

An 8-Year Retrospective Study on Suicides in Washington, DC.

The suicide rate in the United States has been increasing steadily over the previous 10 years. In DC, these results are not mirrored. The suicide rate has a tendency to be lower than the rest of the country. During this retrospective review of suicides in DC, factors such as medical history and toxicology results were examined.In this study performed over 8 years (2009-2016), 394 suicides occurred. It was found that decedents committed suicide mostly by hanging (31.2%), firearms (20.3%), or drug intoxication (15.7%). The average age was 44.5 years. Similar to national statistics, male individuals committed suicide at a higher rate (77.9%) than did female individuals (22.1%). The toxicology data showed that ethanol (26.4%), antidepressants (20.1%), opioids (14.9%), and benzodiazepines (12.9%) were the drugs most frequently involved, although the finding of no drugs was most common (33.7%). Ethanol was present in 5 methods of suicide that include death by hanging, drowning, firearm, suffocation, and poisoning.This research provides information that may be useful for public health officials when confronting the issue of suicide. It is hoped that it will encourage other medical examiner offices to perform toxicological analysis and autopsy of all suicide cases.

Ethanol levels in legally autopsied subjects (2016-2017): Update of data and epidemiological implications in relation to violent deaths in Canary Islands (Spain).

The aim of this study was to analyze the prevalence of ethanol in individuals (277) subjected to a mandatory medico-legal autopsy in the Institute of Legal Medicine of Las Palmas (Canary Islands, Spain) during 2016-2017, comparing the results with data published in 2015. Blood and/or vitreous humor samples were analyzed by gas chromatography. 31.8% of the individuals were positive to ethanol. We observed a decrease in the prevalence of ethanol among males (p = 0.002). While the prevalence of ethanol was reduced, the concentration among those positive subjects has increased. 11.9% of the series died in a traffic accident and the percentage of positive to ethanol decreased in relation to 2015 (64.3, 25.0, and 35.3%). The number of suicides remains constant, although the age of the suiciders has been significantly reduced (p = 0.022). The results of this study indicate that ethanol is still heavily involved in non-natural deaths.

Forensic entomotoxicology: Current concepts, trends and challenges.

The application of forensic entomotoxicology in investigations of death by poisoning has gained popularity as insects serves as an alternative specimen (evidence) when conventional toxicological samples have degraded or are no longer available. Successful detection, identification, and quantification of drugs and toxic substances from insects have been demonstrated through various research experiments. In the present review paper, role of insects as toxicological sample, its collection and preservation, analysis using various instrumental techniques, and trends in the use of analytical techniques have been discussed. Limitations hindering the growth of this field and the way forward for future studies have been highlighted. In addition, the effect of poisons on insects used for postmortem interval estimation has been described.

The Outbreak of Fentanyl-Related Deaths in Cook County, Illinois, Between October 2015 and December 2017: A Retrospective Study and a Comparison with Previous Data.

The National Institute on Drug Abuse has observed an increase in fentanyl deaths in the United States. One epidemic related to the abuse of fentanyl happened in Cook County in 2005-2007 (350 deaths). Another outbreak of fentanyl deaths occurred in 2015-2017 in the same area. The database of the Cook County Medical Examiner's Office was searched for cases of fentanyl deaths between 2015 and 2017: 1244 deaths were found. A comparison was performed with the previous data: an increase in the number of females was observed in 2015-2017. Also, in 2005-2007, the majority of deaths occurred among African American, while in 2015-2017, Caucasians were more involved. Within our population, some drug combinations were more common in specific demographic subgroups (male/females; Caucasian/African American; and certain age groups). The epidemiology and the most significant drug associations found at the toxicology are discussed, highlighting the usefulness of the knowledge about this outbreak for public health.

Detection of fentanyl and fentanyl analogues in biological samples using liquid chromatography-high resolution mass spectrometry.

BACKGROUND: Fentanyl and analogues such as butyrylfentanyl, carfentanil, 4-fluorobutyrylfentanyl, and furanylfentanyl may be either added to, or sold as, heroin. Fentanyl and carfentanil have approximately 100 and 10,000 times the potency of morphine, respectively, and there is thus a high risk of death with the use of these drugs. METHODS: We looked for fentanyl/fentanyl analogues using liquid chromatography-high resolution mass spectrometry (LC-HRMS) in selected biological samples obtained post-mortem February 2017-end January 2018. Suspicion of fentanyl poisoning arose from the circumstances of death, a history of heroin use, and the geographical area in which the deceased was discovered, supplemented by drugs intelligence data. RESULTS: Of the 84 deaths investigated, fentanyl and/or a fentanyl analogue were detected in 40 (48%). The fentanyls encountered were carfentanil (N = 17), fentanyl (9), carfentanil and fentanyl together (12), and fentanyl, carfentanil, 4-fluorobutyrylfentanyl, and butyrylfentanyl together (2). The median (range) post-mortem blood fentanyl concentration was 2.66 (0.21-107) µg/L and the median (range) carfentanil concentration was 0.24 (0.03-1.66) µg/L. The most prevalent compounds present together with fentanyls were ethanol [N = 28, median (range) post-mortem blood concentration: 44 (<10-249) mg/dL)], benzoylecgonine [N = 22, 0.64 (<0.05-3.17) mg/L] and free morphine [N = 20, 0.05 (<0.05-0.34) mg/L]. Deaths in hospital excluded, median blood free morphine, and ethanol concentrations were significantly lower in deaths where fentanyl/fentanyl analogues were present, but there was much overlap with the blood concentrations of these analytes in the non-fentanyl related deaths. A routine drugs of abuse assay using LC-HRMS identified fentanyl with 100% sensitivity and carfentanil with 89% sensitivity. CONCLUSIONS: Given their potency, misuse of fentanyl and its analogues is likely to cause severe toxicity. A simple LC-HRMS method detected all cases in which fentanyl was identified post-mortem and most of the cases in which carfentanil was detected.

Price of Four Loko in Large U.S. Cities, 2018.

BACKGROUND: Supersized alcopops are flavored alcoholic beverages that contain up to 5.5 standard alcoholic drinks in a single can. Limited research suggests Four Loko-the most commonly consumed supersized alcopop by underage drinkers-is among the least expensive ready-to-drink alcohol products on the U.S. market. This is a public health concern because alcohol prices are inversely associated with consumption and related harms, particularly among youth. This study investigated Four Loko's retail price per volume of alcohol in large U.S. cities. METHODS: This study used multistage random sampling to collect data in the largest city of each state and Washington, DC. A simple random sample of 5 ZIP codes from each city was selected and entered into Four Loko's website product locator. Within ZIP codes, up to 4 stores were randomly selected and contacted by telephone. Retailers were interviewed about Four Loko in regard to: availability, volume, alcohol by volume (abv), price for 1 can, and discounts for purchasing more than 1 can. RESULTS: The sample included 344 retail stores with Four Loko in stock. Average price per standard alcoholic drink (i.e., 14 g of absolute alcohol) was $0.54 for Four Loko products. Taking into account volume, price, and discounts, an average of 17 standard alcoholic drinks could be purchased via Four Loko with $10. Adjusted analysis using linear regression showed that availability of bulk price discounts and higher abv (14% vs. 12%) were associated with lower price per drink. CONCLUSION: This study verifies that Four Loko is among the least expensive ready-to-drink alcohol available for purchase in the United States. Given that consuming a single supersized alcopop constitutes binge drinking and is therefore unsafe, regulatory agencies should consider a variety of steps to reduce the availability and abv of these products and increase their retail price in order to reduce and prevent unsafe alcohol consumption.

Post-mortem toxicology in violent fatalities in Cape Town, South Africa: A preliminary investigation.

BACKGROUND: In South Africa, violence-related injury and mortality contributes highly to the nation's burden of injury. Drug abuse, which is also reported to be rife across the county, has been associated with violence, resulting injury, and death. While post-mortem toxicological investigations are comprehensive and routine in violent fatalities internationally; this is not currently the case in South Africa. OBJECTIVES: To conduct a post-mortem toxicological investigation on a cohort of violent fatalities in the West-Metropole of Cape Town, Western Cape. METHODS: The study included a prospective toxicological analysis and a retrospective review of the corresponding blood alcohol results on a small cohort of victims of violent death (whether homicidal, non-overdose suicidal, or accidental) admitted to the Salt River State Mortuary in Cape Town. Biological specimens were collected from the victims following informed consent from the next-of-kin, and a targeted screening approach using liquid chromatography coupled to tandem mass spectrometry was used for the qualitative toxicology analysis. At the Forensic Chemistry National Laboratory, blood alcohol testing was conducted using a headspace gas chromatography with flame ionisation detector according to national standards. Data was analysed with regards to demographics, circumstances of death, and toxicological results. RESULTS: Consent was obtained for 104 violent death cases, autopsied between August-October 2015, most were male victims of homicide (n = 92, 88%). Volatiles analysis for ethanol was performed on 98% of cases, with 41% testing positive (>0.01 g/100 mL). Other drugs of abuse were detected in 63 (61%) cases and more than one substance were present in 51 (49%) cases. The most commonly detected substances were combinations of methamphetamine, diphenhydramine, and methaqualone. CONCLUSIONS: A high prevalence of drugs of abuse was identified in a cohort of victims of violent death. Objective drug trends observed were consistent with national self-reported rehabilitation centre data and research on self-reported drug user. This study was limited by the sampling strategy, including challenges associated with obtaining consent and the rapid turnover of violent fatalities. Despite this - and to the authors' knowledge - this study provided the first prospective post-mortem toxicological investigation into violent death in South Africa. Contextually, it highlights the need for routine and comprehensive toxicology in these cases to strengthen research and service provision, so as to better understand the role of drugs in violent death.

Toxicological findings in 1000 cases of suspected drug facilitated sexual assault in the United States.

The purpose of this study was to identify the extent and types of drugs found in alleged drug facilitated sexual assaults (DFSA) in 37 states and 1 territory of the United States. In total, 1000 cases were reviewed. Between the cases that gender was provided (613), most of the victims (91.68%) were woman, mean age of 26.8 years old. Blood and/or urine samples were tested. Twenty-one point six percent of the cases were negative for intoxicating substances. A hundred and one different substances were detected. Overall, ethanol was the most prevalent substance, detected in 30.9% of the cases (309 cases), followed by cannabinoids (THC/THCCOOH/11-OH-THC) (28.8% of cases), amphetamine/methamphetamine (16.5% of cases), cocaine/metabolites (10.4% of cases), and clonazepam/metabolite (7.6% of cases). The mean, median and range concentrations of ethanol in blood (n = 309) were 98.6 mg/dL, 82.0 mg/dL and 9.2-366 mg/dL, respectively. Ethanol and cannabinoids were the most frequent combination found. The absence of alcohol and drugs in some cases may represent delay in collecting samples.