Postmortem diagnosis and toxicological validation of illicit substance use.
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.
Lehrmann
Elin
E
Cellular Neurobiology Research Branch, National Institute on Drug Abuse (NIDA IRP), National Institutes of Health, Baltimore, MD 21224, USA. elehrman@intra.nida.nih.gov
Afanador
Zoan R
ZR
Deep-Soboslay
Amy
A
Gallegos
Gloria
G
Darwin
William D
WD
Lowe
Ross H
RH
Barnes
Allan J
AJ
Huestis
Marilyn A
MA
Cadet
Jean L
JL
Herman
Mary M
MM
Hyde
Thomas M
TM
Kleinman
Joel E
JE
Freed
William J
WJ
D001344:Autopsy; D001826:Body Fluids / Q000737:chemistry; D002531:Cerebellum / Q000737:chemistry / Q000473:pathology; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000473:pathology; D003334:Coroners and Medical Examiners; D006197:Hair / Q000737:chemistry; D006801:Humans; D013287:Illicit Drugs / Q000032:analysis*; D002189:Marijuana Abuse / Q000175:diagnosis / Q000473:pathology; D008487:Medical History Taking; D020411:Oligonucleotide Array Sequence Analysis; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000473:pathology; D010623:Phencyclidine Abuse / Q000175:diagnosis / Q000473:pathology; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000473:pathology*
D013287:Illicit Drugs