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The Invisible Killer: identifying new designer drugs in postmortem forensic toxicology

For the first time in Ireland, the State Laboratory have developed and implemented an analytical strategy allowing postmortem forensic toxicology samples to be screened for previously 'invisible' designer drugs outside the traditional scope of testing. This project has supported the Irish Coroners service in solving death investigations that previously could not have been satisfactorily concluded.

Innovation Summary

Innovation Overview

Novel psychoactive substances (NPS), more commonly known as designer drugs, have exploded onto the Irish market posing a significant public health challenge. Ireland is reported to have one of the highest levels of designer drug use in Europe thus creating a significant challenge for the human toxicology postmortem testing strategy where traditionally samples were only screened for a defined cohort of prescribed and illicit drugs. The primary challenge was accurately capturing a ‘snapshot’ of the rapidly evolving nature of the Irish drug market at any particular point in time to ensure the client received the most relevant and comprehensive toxicology screen available.

New drug products are easy to access online and now appear regularly, often in response to changes in legislative control e.g. in 2015 98 new European NPS alerts were issued. Very little is generally known about these new products, they often have very similar chemical structures and can be highly toxic in small amounts. Designer drugs are generally ‘invisible’ in traditional toxicology screens and are not available in commercially purchased databases. Additionally, there is very limited HRLCMS expertise in Ireland so collaborative analytical support was limited.

Finally, postmortem case history information was often limited, absent or incorrect (e.g. mislabeled products purchased online) adding to the overall analytical challenge. Our primary objectives were to:

• Develop an analytical approach that could tackle the rapid and continued emergence of new drug substances.

• Proactively monitor market trends and include new drugs as soon as feasible.

• Retrospectively analyze data in suspect toxicology cases.

• Provide our clients with a comprehensive world-class toxicology service.

Major beneficiaries of the innovation:

• With earlier identification of novel psychoactive substances now being achieved, relevant public health alerts can be issued in a more timely fashion.

• Due to our proactive monitoring of general population drug use trends, our toxicology screens accurately meet the evolving needs of the Irish Coroner’s Service and minimize cases where no satisfactory cause of death can be established.

• Retrospective analysis of data without physical re-analysis of the sample allows cases to be rapidly reassessed as additional NPS data comes to light. Additionally,
the sample volume is no longer an issue as we don't have to re-analyze limited sample cases.

• We regularly update and readily share all data with our wider network of toxicology laboratories and drug support services to support them in achieving their own goals.

Innovation Description

What Makes Your Project Innovative?

This project has revolutionized the national approach to postmortem forensic toxicology screening and more significantly has changed the traditional approach from a reactive to a proactive service where current market trends are monitored on an ongoing basis. This approach accurately reflects the current dynamic status of the Irish drug market and allows us to respond rapidly to change and provide our client with a world-class toxicology service. All information is readily shared with our wide network of colleagues in other government departments and we actively seek feedback from our peers both nationally and internationally.

What is the current status of your innovation?

• Initially identifying the gap in the forensic toxicology market created by the ‘invisibility’ of NPS drugs in traditional toxicology screens and recognizing the difficulty for the client in completing comprehensive death investigations when no obvious cause of death can be identified.

• Optimizing the relevant chemical methodology.

• Proactively keeping abreast of national and European drug alerts and trends. Assigning responsibility to the team for regularly updating and optimizing the NPS database.

• Effectively networking with the wider national and international toxicology community.

• Isolating suspect cases where the retrospective analysis was relevant based on the case history and/or unusual initial results.

• In toxicology cases where designer drugs were implicated in the cause of death, we liaised closely with the relevant coroners and pathologists to obtain a full case history. Additionally, we liaised with An Garda Siochana to ensure all relevant scene of death details were fully disclosed e.g. information about empty packets, bottles, etc.

• Our team is represented on the National Advisory Committee on Drugs and Alcohol Early Warning and Emerging Trends (NACDA EWET) subcommittee and we continued to liaise closely with this network in terms of gathering and sharing national NPS information and current trends.

• We continuously liaised with the EMCDDA (European Monitoring Committee for Drugs and Drug Addiction) to ensure all European drug alerts were included in our toxicology screen and to feedback national data and trends as required.

Innovation Development

Collaborations & Partnerships

1. In toxicology cases where designer drugs were implicated in the cause of death, we liaised closely with the relevant coroners and pathologists to obtain a full case history. Additionally, we liaised with the Irish police force to ensure all relevant scene of death details were fully disclosed e.g. information about empty packets, bottles, etc.

2. Our team is represented on the National Advisory Committee on Drugs and Alcohol Early Warning and Emerging Trends (NACDA EWET) subcommittee and we continued to liaise closely with this network in terms of gathering and sharing national NPS information and current trends.

3. We continuously liaised with the EMCDDA (European Monitoring Committee for Drugs and Drug Addiction) to ensure all European drug alerts were included in our toxicology screen and to feedback national data and trends as required.

Innovation Reflections

Results, Outcomes & Impacts

This project has revolutionized the national approach to postmortem forensic toxicology screening and more significantly has changed the traditional approach from a reactive to a proactive service where current market trends are monitored on an ongoing basis. This approach accurately reflects the current dynamic status of the Irish drug market and allows us to respond rapidly to change and provide our client with a world-class toxicology service. All information is readily shared with our wide network of colleagues in other government departments and we actively seek feedback from our peers both nationally and internationally.

Challenges and Failures

The primary challenge was accurately capturing a ‘snapshot’ of the rapidly evolving nature of the Irish drug market at any particular point in time to ensure the client received the most relevant and comprehensive toxicology screen available. New drug products are easy to access online and now appear regularly, often in response to changes in legislative control e.g. in 2015 98 new European NPS alerts were issued. Very little is generally known about these new products, they often have very similar chemical structures and can be highly toxic in small amounts. Designer drugs are generally ‘invisible’ in traditional toxicology screens and are not available in commercially purchased databases. Additionally, there is very limited HRLCMS expertise in Ireland so collaborative analytical support was limited. Finally, postmortem case history information was often limited, absent or incorrect (e.g. mislabeled products purchased online) adding to the overall analytical challenge.

Conditions for Success

In relation to this particular project, state of the art scientific instrumentation was essential at the initial development stage. We also required highly skilled scientific personnel and a modern analytical chemistry laboratory. As we work in a high throughput postmortem forensic toxicology environment, the support of senior management was critical in supporting this development work in parallel with routine testing. Finally, a highly motivated team with a common desire to achieve the final goal was critical in pushing the project to completion and this energy and enthusiasm are evident from the project's ongoing subsequent success.

Replication

1. Based on the success of our approach, other prominent national toxicology laboratories are currently assessing procuring relevant instrumentation to replicate our screening strategy.

2. As a result of the positive feedback given to our internal colleagues, other departments within the State Laboratory are currently proactively assessing our screening strategy for potential application within their own analytical areas.

3. Building on the expertise gained from the project, we are currently extending its application to other non-NPS analytes in relevant toxicology cases.

Lessons Learned

-Always think big and challenge current standards.

-Explore opportunities to develop and improve existing systems.

-Don’t reinvent the wheel.

-Ensure your team is aware of all current developments in your particular area of expertise.

-Create and utilize an extensive external network.

Year: 2015
Level of Government: National/Federal government

Status:

  • Diffusing Lessons - using what was learnt to inform other projects and understanding how the innovation can be applied in other ways

Innovation provided by:

Date Published:

21 May 2017

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