Outline Discuss the Role of the Toxicologist Answer common - - PDF document

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Outline Discuss the Role of the Toxicologist Answer common - - PDF document

Oct 19, 2023 392 likes •631 views

7/17/19 Impairment: Its All in the Head THIS PRESENTATION MAY CONTAIN MATERIALS CREATED BY OTHERS. SUCH MATERIAL IS USED UNDER A CLAIM OF FAIR USE PURSUANT TO THE FAIR USE GUIDELINES IN FACE-TO-FACE INSTRUCTIONAL EDUCATION ACTIVITIES.

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Impairment: It’s All in the Head

THIS PRESENTATION MAY CONTAIN MATERIALS CREATED BY OTHERS. SUCH MATERIAL IS USED UNDER A CLAIM OF FAIR USE PURSUANT TO THE FAIR USE GUIDELINES IN FACE-TO-FACE INSTRUCTIONAL EDUCATION ACTIVITIES. ADDITIONAL USE OR DISTRIBUTION OF THAT MATERIAL IS PROHIBITED.

Outline

  • Discuss the Role of the Toxicologist
  • Answer common questions in regards

to lab testing results.

  • Understand Timelines of Impairment
  • Explain the importance of understanding

limitations in the testimony of a forensic toxicologist.

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0.06 0.065 0.07 0.075 0.073 0.069 0.065 0.06 0.05 0.07 0.073 0.07 0.067 0.06 0.058 0.05 0.045 0.04 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08 15 30 45 60 75 90 105 120

Alcohol Blood Levels & Subjective Effects

Alcohol (mg/dL) Alcohol (effects)

Adapted from: Sewell RA et al. The Effects of Cannabis Compared with Alcohol on Driving. Am J Addict. 2009

The Value of a Strong DRE Program

▰“The DRE program is the most effective tool currently available to law enforcement officers for the documentation of behavior and impairment in drug-impaired drivers.”

  • 2004 - National Toxicologists, DREs, and Prosecutors

(National Safety Council -Alcohol, Drug, and Impairment Division – NSC-ADID)

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What makes a good DUID case?

Solid Officer Solid DRE Solid Tox

Support

Solid

Prosecutor

What makes a good DUID case?

Officer DRE Tox

Support

Prosecutor

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ROLE OF THE TOXICOLOGIST

▰WHAT DOES A TOXICOLOGIST BRING TO COURT? ▰TERMINOLOGY DIFFERENCE? ▰TOLERANCE ▰SPECIMEN CHOICES ▰TESTIMONY LIMITS?

Analytical Chain of Custody Drugs Found

  • F. TOXICOLOGISTS TYPICALLY TESTIFY TO:

Joey Jones - RRQ

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What does the Toxicologist bring to court?

Administrative Documents:

  • Original Case File
  • Lab Reports /Receiving Sheet
  • Internal Chain-of-Custody
  • CV’s, Permits

Analytical Documentation

  • Raw Generated Analytical Data
  • Physical Evidence (Blood or Urine)
  • Validation Records

REFERENCES FOR THERAPEUTIC CONCENTRATIONS ▻*IMPORTANT* CONTEXT IS KING! ▻SINGLE DOSE vs. STEADY STATE? ▻PLASMA/SERUM vs. WHOLE BLOOD?

TIAFT THERAPEUTIC INDEX (2005) WINEK’S DRUG BLOOD LEVEL DATA (2001) BASELT – DISPOSITION OF TOXIC DRUGS AND CHEMICALS IN MAN MOLINA – HANDBOOK OF FORENSIC TOXICOLOGY FOR MEDICAL EXAMINERS

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Important Resource: Prescription Instructions

▰FDA Package Insert (Diazepam) ▰Warnings:

▻When diazepam is used with a narcotic analgesic, the dosage of the narcotic should be reduced by at least one-third and administered in small increments. In some cases the use of a narcotic may not be necessary. ▻As is true of most CNS-acting drugs, patients receiving diazepam should be cautioned against engaging in hazardous occupations requiring complete mental alertness, such as operating machinery or driving a motor vehicle.

TOXICOLOGISTS CANNOT TESTIFY TO:

Joey Jones - RRQ

IS THE DRIVER IMPAIRED? (ULTIMATE QUESTION) WHAT DRUG SYMPTOMS WOULD BE EXPECTED IN THE INDIVIDUAL DEFENDANT? IS THE DOSE PRESCRIBED APPROPRIATE FOR THE DEFENDANT?

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The Pharmacology Farm

THEN WHAT CAN WE DO?

SPECIAL TOPICS: TERMINOLOGY

IMPAIRMENT INTOXICATION VISIBLE/INVISIBLE SIGNS

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SPECIAL TOPICS: TERMINOLOGY

METABOLISM HALF LIFE CLEARANCE

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Source: Casarett & Doull, Chaps. 5 and 7, 1996

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Cannabinoid Distribution/Elimination

  • THC concentrations fall to about 60% of their peak within

15 min after the end of smoking

  • To about 20% of their peak within 30 minutes after the

end of smoking.

Courtesy Marilyn Huestis, Borkenstein Drug Course, 2009 20 40 60 80 100 120 140 160 180 15 30 45 60 75 90 105 120

THC Blood Levels & Subjective Effects

THC (ng/mL) THC (effects)

Adapted from: Sewell RA et al. The Effects of Cannabis Compared with Alcohol on Driving. Am J Addict. 2009

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Common Questions

  • Why were drugs not detected?
  • Possible explanation(s)
  • Drug ingestion was outside of the detection time frame

(blood vs. urine)

  • Liability à Time for arrival and evaluation completion.

12 12 1 2 3 4 5 6 7 8 9 10 10 11 11

12:20 AM – Initial Drug Use (~250ng/mL) 1:00 AM – Blood {50ng/mL}

Traffic Stop: 1:30 AM – Blood {<10ng/mL} DRE Evaluation 2:00 AM – Blood {<5ng/mL}

Specimen Collection 2:40 AM None Detected

Key Point: Every Second Counts

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THC Levels in Whole Blood – Smoked vs. Oral

Journal of Analytical Toxicology, Vol. 28. September 2004 Relationship of Delta 9-Tetrahydrocannabinol Concentrations in Oral Fluid and Plasma after Controlled Administration of Smoked Cannabis. Marilyn Huestis, Edward Cone. Clinical Chemistry 55:12 2180–2189 (2009) Delta 9-Tetrahydrocannabinol (THC), 11-Hydroxy-THC, and 11-Nor-9-carboxy-THC Plasma Pharmacokinetics during and after Continuous High-Dose Oral THC. Eugene W. Schwilke, David M. Schwope, Erin L. Karschner, et. al.
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Effects and Uses of Marijuana

  • SFST performance!!!
  • Absence of HGN & VGN
  • Increased HR
  • Increase BP

“It is concluded that it is unsafe to operate a vehicle or other complex equipment while under the influence of cannabis, due to the increased risk of death or injury to the

  • perator and the public.”

“It is further concluded that due to rapid changes in blood THC concentrations

  • ver time, there is no minimum safe

threshold blood concentration below which a driver can be considered to have been unaffected while driving following recent cannabis use. Consequently, there is no scientific basis for the adoption of THC per se laws for driving.”

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Common Questions

  • Why were other drugs detected than what the subject stated

they took?

  • Metabolism – all drugs are transformed in the body to

facilitate their utilization or elimination.

  • *An important step that your toxicologist can assist you with over the phone.

Morphine, Heroin or Codeine? ▰Morphine can arise in the blood and urine through the administration of morphine itself or through the metabolism of heroin or codeine

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Common Questions

  • Why were drugs not detected?
  • Possible explanation(s)
  • The subject didn’t take (or know what they took)

the drug.

What is the best sample?

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What is the best sample? There is no clear correlation between urine drug concentrations and impairment.

  • Alcohol (good)
  • Urine is only indicative of prior use

What is the best sample - Urine?

“Urine is a specimen best suited to demonstrate prior drug use or exposure (e.g., preemployment or workplace testing) rather than impairment proximate to the time of

  • driving. In a DUID context, a positive urine drug test result

could reflect use some time distant from the actual driving and beyond the duration of effect, or impairment”

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Then it has to be Blood Right?

It is very difficult to draw (on the spot) a clear correlation between blood drug concentrations and impairment for many drugs.

  • Alcohol (good)
  • Drugs à Researchers cannot ethically administer the doses of drugs typically taken by

regular users

  • Rare à one single drug on board
  • Many Drugs have different effects in the acute phase from the later / withdrawal phase.
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What is the best sample - blood?

“Blood and oral fluid are the preferred matrices for DUID

  • investigations. Blood is preferred because drug and metabolite

concentrations can be evaluated within the context of therapeutic, toxic or recreational use. Although in any given case, issues related to tolerance and individual sensitivity must be considered, reference concentrations in blood provide useful interpretive context. ”

▻ What does therapeutic mean to you?

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What are some FACTS about your lab?

  • Your lab cannot test for every known drug
  • Each laboratory has its own policy for testing DUID cases.
  • Ex: DUID/FATAL/DRE
  • Some labs may screen samples for only common classes of drugs

– excluding other, less common drugs.

  • Other labs may be more extensive.
  • Some labs have been neglected for decades…
  • Equipment & Personnel

Conclusion

  • Get to know you lab and toxicologists
  • When you start seeing things they need to know.
  • Have them come to a DRE Cert, Recert, Etc.
  • Bullet proof the front end of the case (Officer

Observations, Narrative)

  • Consider setting up a lab liaison.
  • See if the lab can supply you with “Scope” Cards
  • Understand the time frame issues with sample

collection & preservation.

  • Get the sample as quickly as possible
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TESTIMONY LIMITATIONS

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“ Toxicological analysis of a biological specimen is the final step in the process and provides a nexus for the

  • fficer’s observations.”
  • Farrell, Kerrigan, and Logan. Recommendations of Toxicological Investigation of Drug Impaired Driving. Journal of Forensic Sciences. 2007.
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DUID Case

DRE Evaluation Driving & SFSTs

Toxicology

Arresting Officer Observations

Contact Information

Joseph O. Jones, MS

13 Children’s Way, R2109 Little Rock, AR 72202 O: 501.364.2670 C: 302.345.8206 jojonestox@gmail.com

Questions?

@THEREALJOJONES