title: Postmortem diagnosis and toxicological validation of illicit substance use.
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.
authors.affiliation: Cellular Neurobiology Research Branch, National Institute on Drug Abuse (NIDA IRP), National Institutes of Health, Baltimore, MD 21224, USA. elehrman@intra.nida.nih.gov
authors.forename: Elin
authors.initials: E
authors.lastname: Lehrmann
authors.forename: Zoan R
authors.initials: ZR
authors.lastname: Afanador
authors.forename: Amy
authors.initials: A
authors.lastname: Deep-Soboslay
authors.forename: Gloria
authors.initials: G
authors.lastname: Gallegos
authors.forename: William D
authors.initials: WD
authors.lastname: Darwin
authors.forename: Ross H
authors.initials: RH
authors.lastname: Lowe
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Barnes
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Huestis
authors.forename: Jean L
authors.initials: JL
authors.lastname: Cadet
authors.forename: Mary M
authors.initials: MM
authors.lastname: Herman
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Hyde
authors.forename: Joel E
authors.initials: JE
authors.lastname: Kleinman
authors.forename: William J
authors.initials: WJ
authors.lastname: Freed
mesh_terms: 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*
chemical_list: D013287:Illicit Drugs