Toxicology Overview

Presented by

Deki Kelsang and Nghia Nguyen

Bureau of Forensic Toxicology• Conduct toxicological analyses for (1) the Medical

Examiner to help determine cause of death; and (2) law enforcement in DUI and other criminal investigations.

• Provide expert testimony and technical consultations on our test results.

Types of Samples Tested

Blood Urine Bile Liver Gastric Vitreous

Office of Medical Examiner

Blood Urine

Law Enforcement Agencies

Sample Collection• Use 10 mL gray top collection tubes for blood

samples.• Gray top tubes contain:

– 100 mg Sodium Fluoride (Preservative)– 20 mg Potassium Oxalate (Anti-coagulant)

Sample Collection Kits

• Due to budget cuts, BFT no longer supplies mailing kits.

• Any kit meeting the USPS regulations for biological specimens is acceptable.

• Contact information for our former vendors is posted on our website at: http://www.health.utah.gov/lab/toxicology/- Under Customer Resources

· Kit supplies

Sample Volume

• Minimum Sample Volume– Blood alcohol: 5 mL– Blood drug screen: 20 mL– Urine drug screen: 30 mL

Sample Submission• Ensure all evidence submission requirements are

met. Discrepancies in submission of samples will result in delays in testing or rejection of samples.

Sample Submission Reminders• To ensure your samples are processed without delays,

please verify that:– Each sample is labeled with the subject name and your agency case #– The tubes, containers, and packaging are sealed, initialed, and dated.– Include the typed and completed Toxicology Request Form with the

sample. – If the case has both blood and urine specimen, please secure the specimen

packages to each other to ensure they arrive at the lab together.

• Do not submit: – Needles– Consent form– Your internal chain of custody document

Delivery vs. Mail• Delivery: Evidence Intake Window is open Monday-

Thursday, 9 a.m.- 5 p.m. • Mailed specimens must meet blood borne pathogen

shipping requirements and be packaged to fully contain leakage/spillage in accordance with applicable federal laws (PHS 42 CFR Part 72, rule 173.199).

Sample Storage• Samples are stored in the Evidence Receiving fridge

upon receipt. • Samples are then transferred to the Evidence Fridge.• Toxicologists access the Evidence Fridge to retrieve

samples for analysis.

• After all testing is completed, samples are transferred to the Evidence Receiving fridge for return to the submitting agency.

Sample Return• Due to limited space and if no other additional

tests are requested, samples are returned to the submitting agency 6 weeks after a final report is issued.

• Samples are returned by mail or in person to agency personnel.

• To expedite returns, we recommend that you notify our evidence technicians before coming to the lab to pick up samples.

Types of Test Performed• Alcohol and other Volatiles• Illicit Drugs• Prescription Drugs

Order of Tests• Alcohol and other volatiles analysis

– For DUI cases, if the Alcohol result is >0.10 grams/100 mL of blood, no further testing is conducted.

– For non-DUI cases, all testing is performed as requested.

• Drugs of Abuse & Prescription Screens.• Drugs of Abuse and Prescription Confirmation Tests.

Volatiles Panel• Dual Headspace Gas

Chromatography (HSGC)• Volatiles Panel:

– Ethanol– Methanol– Isopropanol– Acetone

Illicit Drug Panel - Screen• ELISA (Enzyme Linked

Immunosorbent Assay)• Illicit Drug Panel

– Cocaine– Methamphetamine– Morphine– THC

Illicit Drug Panel - Confirmation• Gas Chromatography &

Mass Spectrometry (GCMS)

• Illicit Drug Confirmation Panel:– Cocaine/Benzoylecgonine– Amphetamine/

Methamphetamine & Other Amines

– Heroin/Morphine– THC/THC Metabolite

Prescription Drug Screen• Gas Chromatography &

Mass Spectrometry (GCMS)• Prescription Drug Panel

– Screening of over 40 prescription drugs

Prescription Drug Confirmation• Gas Chromatography &

Mass Spectrometry (GCMS)• Prescription Drug Panel

– Confirmation of 26 prescription drugs

• For drugs not included in our Prescription Panels, specimens may be sent to a reference laboratory at the expense of submitting agency.

• Alprazolam• Amitriptyline• Amphetamine• Butalbital• Carbamazepine• Carisoprodal• Chlordiazepoxide• Chlorpheniramine• Codeine• Clonazepam• Cyclobenzaprine• Dextromethorphan• Diazepam• Diphenhydramine

Prescription Drug Screen Panel• Doxepin• Doxylamine• Ephedrine• Fentanyl• Hydrocodone• Imipramine• Levorphanol• Meperidine• Meprobamate• Methadone• Mirtazepine• 6-Monoacetylmorphine• MDA• MDMA• Methylphenidate

• Nordiazepam• Norpropoxyphene• Nortriptyline• Olanzapine• Oxycodone• Phenobarbital• Phentermine• Phenytoin• Promethazine• Propoxyphene• Temazepam• Tramadol• Trazodone• Zolpidem

• Alprazolam• Amphetamine• Amitriptyline• Butalbital• Carbamazepine• Carisoprodol• Chlorpheniramine• Codeine• Cyclobenzaprine• Dextromethorphan

Prescription Drug Confirmation Panel

• Diazepam• Diphenhydramine• Doxylamine• Ephedrine• Hydrocodone• Meperidine• Methadone• Meprobamate• MDA• MDMA

• Methylphenidate• Nordiazepam• Nortriptyline• Oxycodone• Phenobarbital• Phentermine• Phenytoin• Promethazine• Propoxyphene• Tramadol• Trazodone• Zolpidem

Batch & Case Review• Batch Review

- Data Results Verified- Method & Reporting criteria are met- Standards & Reagents traceability documented

• Case Review- Case Information Verified- Chain of Custody Verified- All requested tests performed & final data reviewed.- Issuance of Final Toxicology Report.

• Blood vs. Urine• Blood analysis: – Used to establish impairment and recent use. Drugs in the blood

can affect performance.

• Urine analysis:– Can only be used to establish use of drug but not impairment. Due to the

variability of absorption, distribution, metabolism, excretion and elimination of drugs between individuals, no correlation can be made between the presence of drug in the urine and levels of that drug in blood.

Interpretation of Drug Results

• With the exception of alcohol, there is insufficient scientific data relating the blood levels of many drugs to the degree of impairment.

• In accordance with DRE training, Toxicologist testimony is based on the 3 legged-stool approach.- Observation of poor driving. - Poor field sobriety test performance.- The presence of a drug or metabolite consistent with subject’s symptomology.

Interpretation of Drug Results

Toxicology Staff

Tim AlexanderToxicologist I

Lexi DavisToxicologist I

Mary ParksLab Technician

Alyssa GulrajaniLab Technician

Marcel BibeaultSection Chief

Russell ShamoToxicologist II

Deki KelsangToxicologist II

Nghia NguyenToxicologist I

Othman JaberToxicologist I

Tiffany BerardiSr. Toxicologist

Gambrelli LaycoToxicology

Bureau Director

Roles• The Lab Technicians receive and return evidence.• The Forensic Toxicologists perform all analytical work

and provide technical consultations.• The Section Chief and Sr. Toxicologist oversee the

forensic toxicologists, review analytical work, and issue reports.

• The Bureau Director oversees the bureau and establishes and maintain policies and procedures for the laboratory.

CaseloadNumber of Tests Conducted and Toxicology Funding (FY2005-FY2010)

0

10,000

20,000

30,000

40,000

50,000

60,000

Fiscal Year

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$5.00

$10.00

$15.00

$20.00

$25.00

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Tests conducted per year 36,442 44,333 35,641 44,647 42,024 51,089

Funding per test $24.29 $21.73 $28.85 $25.33 $24.95 $20.30

FY2005 FY2006 FY2007 FY2008 FY2009 FY2010

Analytical Rotations• Rotations:

- Ethanol- Other Volatiles- Drugs of Abuse- Prescription Drug Screen- OME Prescription Drug Confirmation (Weak Base)- LE Prescription Drug Confirmation (Weak Base)- Prescription Drug Confirmation (Weak Acid)- THC/THC Metabolite Confirmation- Amphetamines/Meth/Other Amines Confirmation- Cocaine/ Metabolite Confirmation- Morphine Confirmation

Staff Training• For each analysis, the

trainee must read the required reading materials.

• The trainee will observe a certified analyst, then be observed while conducting a practice analysis.

• The analyst must complete a written test.

Staff Training• Training of Toxicology

Staff involves:- Reading Materials- Hands-on practice and observations- Competency Tests

Competency Testing• Once the training is completed, the competency of the

trainee will be checked by assigning blind samples to be tested.

• The trainee will also complete accuracy and precision testing as part of the competency testing.

• Blind sample results will be evaluated by Sr. Toxicologist and if the results agree with the expected result, then the trainee will begin the rotation.

Certification and Proficiency Testing

• The Bureau of Forensic Toxicology is certified by the Bureau of Lab Improvement of the Utah Department of Health to perform ethanol analysis.

• The Bureau of Forensic Toxicology ensures quality by participating in external proficiency testing programs of:– The US Department of Transportation and National Highway

Traffic and Safety Administration (US DOT & NHTSA)• Alcohol & Other Volatiles

– The College of American Pathology (CAP)• Drugs & Alcohol

Professional Development

• Attend meetings and conferences related to the field of Toxicology.

• Participate in outreach programs and offer lectures at local colleges and universities.

• Read journal articles and when time allows, conduct our own research.

Staff Memberships• The International Association of Forensic

Toxicologists (TIAFT)• Society of Forensic Toxicologists (SOFT)• American Society of Crime Lab Directors (ASCLD)• American Chemical Society (ACS)• American Society of Clinical Pathology (ASCP)