Postmortem diagnosis and toxicological validation of illicit substance use

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 Hyde, Joel Kleinman, William J. Freed

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)105-117
Number of pages13
JournalAddiction Biology
Volume13
Issue number1
DOIs
StatePublished - Mar 2008
Externally publishedYes

Fingerprint

Cocaine
Toxicology
Cannabis
Hair
Phencyclidine
Opioid Analgesics
Coroners and Medical Examiners
Interviews
Neurobiology
Scalp
History
Urine
Sensitivity and Specificity
Brain
Pharmaceutical Preparations

Keywords

  • Addiction
  • Biological matrix
  • Drug abuse
  • Hair toxicology
  • Postmortem Substance Abuse Assessment Questionnaire
  • Substance use disorders

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Pharmacology
  • Psychiatry and Mental health

Cite this

Lehrmann, E., Afanador, Z. R., Deep-Soboslay, A., Gallegos, G., Darwin, W. D., Lowe, R. H., ... Freed, W. J. (2008). Postmortem diagnosis and toxicological validation of illicit substance use. Addiction Biology, 13(1), 105-117. https://doi.org/10.1111/j.1369-1600.2007.00085.x

Postmortem diagnosis and toxicological validation of illicit substance use. / Lehrmann, Elin; Afanador, Zoan R.; Deep-Soboslay, Amy; Gallegos, Gloria; Darwin, William D.; Lowe, Ross H.; Barnes, Allan J.; Huestis, Marilyn A.; Cadet, Jean L.; Herman, Mary M.; Hyde, Thomas; Kleinman, Joel; Freed, William J.

In: Addiction Biology, Vol. 13, No. 1, 03.2008, p. 105-117.

Research output: Contribution to journalArticle

Lehrmann, E, Afanador, ZR, Deep-Soboslay, A, Gallegos, G, Darwin, WD, Lowe, RH, Barnes, AJ, Huestis, MA, Cadet, JL, Herman, MM, Hyde, T, Kleinman, J & Freed, WJ 2008, 'Postmortem diagnosis and toxicological validation of illicit substance use', Addiction Biology, vol. 13, no. 1, pp. 105-117. https://doi.org/10.1111/j.1369-1600.2007.00085.x
Lehrmann E, Afanador ZR, Deep-Soboslay A, Gallegos G, Darwin WD, Lowe RH et al. Postmortem diagnosis and toxicological validation of illicit substance use. Addiction Biology. 2008 Mar;13(1):105-117. https://doi.org/10.1111/j.1369-1600.2007.00085.x
Lehrmann, Elin ; Afanador, Zoan R. ; Deep-Soboslay, Amy ; Gallegos, Gloria ; Darwin, William D. ; Lowe, Ross H. ; Barnes, Allan J. ; Huestis, Marilyn A. ; Cadet, Jean L. ; Herman, Mary M. ; Hyde, Thomas ; Kleinman, Joel ; Freed, William J. / Postmortem diagnosis and toxicological validation of illicit substance use. In: Addiction Biology. 2008 ; Vol. 13, No. 1. pp. 105-117.
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