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Using Forensic Toxicology to Enhance Medicolegal Death Investigations
Sara J Schreiber1, Brian L Peterson2
1From the Milwaukee County Medical Examiner's Office.
Summary
A review of natural deaths found 18 cases where drug toxicology testing changed the cause from natural disease to accidental or suicide. This highlights the importance of toxicology in determining accurate drug-related death classifications.
Area of Science:
- Forensic Toxicology
- Death Investigation
- Public Health
Background:
- Medical Examiner's Offices often certify natural deaths without autopsy or toxicology.
- Accurate determination of cause and manner of death is crucial for public health and legal purposes.
- Drug-related deaths can be misclassified if comprehensive testing is not performed.
Purpose of the Study:
- To review natural deaths certified without autopsy or toxicology.
- To identify drug-related fatalities misclassified as natural disease.
- To amend death certificates based on toxicological findings.
Main Methods:
- An evidence-based review of 315 natural deaths from 2020-2021.
- Blood samples screened using liquid chromatography-quadrupole mass spectrometry.
- Analysis of detected analytes to determine contribution to death, with confirmatory testing and forensic pathologist evaluation.
Main Results:
- 18 cases (approximately 5.7%) were reclassified due to significant drug detection.
- One case changed from natural to suicide; 17 cases changed to accidental.
- Drugs involved included both prescription and illicit substances.
Conclusions:
- Toxicology screening is essential for accurately classifying drug-related deaths.
- Re-evaluation of deaths initially certified as natural can uncover significant drug involvement.
- Amendments to death certificates are necessary when toxicology reveals drug-related causes.
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