Challenges of toxicology for the millennium

In meeting the challenges of toxicology, clinical and forensic toxicologists should expand their services and engage in research and development to meet changing needs. Expanding roles could potentially derive from the threat of terrorism, genotyping for interpretation of potential toxic drug interactions, and criminalistic testings. At the threshold of the next millennium, terrorism via weapons of mass destruction (WMD) has migrated from the war zones to civilian settings. These WMD may be in the form of nuclear, biological, and chemical devices (NBC). Recently, the possible use of chemical/biological weapons in the Middle East conflicts, the use of sarin in a Tokyo subway station, and the unregulated availability of nuclear fuel in some countries all have heightened the potential for international and domestic NBC. In preparation for NBC, both government and civilians in major American cities have been trained for safe handling of patients and casualties. Forensic and clinical toxicologists should be knowledgeable about the clinical pharmacology, safe samples processing, and possible screening and/or analysis of samples exposed to or containing: vesicants; cyanide; and nerve, riot control, and pulmonary agents. These samples may be transported for further analysis and confirmed by designated central laboratories. In criminal/correctional settings, toxicologists should engage in quality assurance and consultation with attorneys, judges, and correctional professionals. With the emergence of pharmacogenetics, genotyping may enhance rational drug therapy for enhanced patient care, and may explain adverse or fatal drug reactions in postmortem analysis.