Briefing: WhatisForensic Toxicology?

Preparedby:

TheForensicToxicologyCouncil,July2010

What is Forensic Toxicology?

benefits, risks and dangers associated with use and abuse of illicit and recreational drugs, medications andalcohol.Forensictoxicologyisgovernedthrough a professional certifying and accrediting board TheAmericanBoardofForensicToxicology(ABFT) and promotes professional development and education through major professional organiza tions, the Society of Forensic Toxicologists (SOFT), the American Academy of Forensic Sciences (AAFS), and international organizations such as The International Association of Forensic Toxicologists (TIAFT).

DeathInvestigationToxicology
Toxicology is the study of the adverse effects of (PostmortemToxicology): drugs and chemicals on Forensic toxicologists work biological systems. Forensic with pathologists, medical TheForensicToxicologyCouncil (FTC) toxicology deals with the examiners and coroners in wasformedin2009torepresentthe application of toxicology to helping to establish the interestsofthemajorprofessional cases and issues where role of alcohol, drugs and those adverse effects have organizationsinforensictoxicologyin poisonsinthecausationof administrative or medico theUnitedStates.TheFTCiscomprised death. The toxicologist legal consequences, and oftheseniorofficersand identifies and quantifies where the results are likely representativesoftheAmericanBoard the presence of drugs and to be used in court. Foren ofForensicToxicology(ABFT)*,the chemicals in blood and sictoxicologyisathorough tissuesamples.Thisisdone ToxicologySectionoftheAmerican lymodernscience,basedon using state of the art AcademyofForensicSciences(AAFS)*, published and widely chemical and biomedical andtheSocietyofForensic acceptedscientificmethods instrumentation capable of Toxicologists(SOFT)*.TheFTCwas and practices, for both detectingsmallamountsof formedspecificallytoprovide analysis of drugs in toxic materials, positively informationtogovernmentandpolicy biological materials, and identifying them, and ac interpretation of those makersregardingthisfield,andto curately measuring how results. Many of the promotetheadvancementand much is present. Accuracy, methods it employs have developmentofforensictoxicology. validity and reliability are been derived from innova essential, as this informa *TheFTCdoesnotspeakfor,oradvocatepolicyonbehalf tions in clinical medicine ofABFT,AAFS,orSOFT. tion is used in the deter and academic laboratories mination of cause and throughout the world. manner of death. Those Thousands of articles related to forensic toxicology determinations are the prerogative of the medical methods, instrumentation and interpretation are examiner or coroner; however, the toxicologist is a published in hundreds of peer reviewed journals keymemberoftheteamofexpertsthatassistinthat every year, and increase our understanding of the determination, consulting on pharmacology, drug Page1

 providesinterpretationoftheresultwithrespectto whetherthedoserepresentstypicaltherapeuticuse, recreationaluse,orpotentialabuse,andcanprovide opinionsaboutthelikelyeffectsofthesepatternsof use. This can include performance enhancement which occurs following the use of stimulants, and impairment from recreational or prescription medication use and misuse. Forensic toxicologists review and testify in cases of impaired driving involving alcohol and drugs, and address diverse issues such as transportation safety, drug facilitated crimes, competency, intoxication and diminished capacity. Forensic toxicologists frequently testify in court to both their findings and to their interpretation. This type of testing may occur in publiccrimelaboratories,butalsomaybeafunction HumanPerformanceToxicology: of a health department in some states. Many blood alcohol and drug testing Human Performance Tox cases are performed in icology deals with the Thefourdisciplines ofForensicToxicology: accredited private or effects of alcohol and academic forensic toxic drugs on human perform DeathInvestigationToxicology ology laboratories that ance and behavior, and (PostmortemToxicology) voluntarily observe the the medicolegal conse HumanPerformanceToxicology same standards in place quences of drug and DopingControl inthepublicsector. alcohol use. This may include investigations of ForensicWorkplaceDrugTesting Additionally, most states impaired driving, vehic have thousands of al ularassaultandhomicide, coholbreathtestingoperatorswhichfunctionunder drug facilitated crimes including sexual assault, and certification from a wide variety of state systems. aircraft, motor vehicle and maritime collision Alcohol breath calibration laboratories are also investigations. Forensic toxicologists perform beginningtobeaccreditedunderASCLDLABandISO analysis of drugs and alcohol in biological samples, 17025. Alcohol breath testing produces evidence in typically blood and urine, but increasingly in other DUI and impairment cases but is also integral in matricessuchasoralfluid,andhair,forthepurposes workplacedrugtesting. of determining the timing, extent, and impairment resultingfromdifferentpatternsofdrugandalcohol DopingControl: use. The toxicologist uses stateoftheart analytical Governing bodies of most competitive and methods, such as are found in many research and intramural sports have derived rules regarding hospital laboratories to isolate drugs from complex performance enhancing drug use to protect the biological samples, prepare them for analysis healthandwelfareoftheamateurandprofessional through extraction and purification, then determine athletes, to maintain a fair and even competitive the identity and amount of drug present. Following standard, and avoid wagering fraud. This applies to the analytical phase, the forensic toxicologist Page2 kinetics and interactions, metabolism, adverse and idiosyncratic reactions, drug tolerance, postmortem artifacts, drug stability, and other factors. The pathologistconsidersthisinformationinthecontext of the investigative and medical history of the case, and the findings of disease or other medical conditions at autopsy. Accurately establishing the appropriate cause and manner of death has serious implicationsforpublichealthandpublicsafety,and forensically reliable toxicology is an essential component of that process. Death Investigation toxicology is performed by both public and private laboratories and many private forensic laboratories provide specialized expertise and services not availableingovernmentlaboratories.

 bothhumanandanimalsports.Internationalgroups such as the International Olympic Committee (IOC), the World AntiDoping Agency (WADA), and the International Federation of Horseracing Authorities (IFHA) work to update and maintain these lists as patterns of drug use change. Enforcing these rules requires periodic offseason random and event focused drug testing for performance enhancing drugs, and other medications that appear on the organizations prohibited substances lists. Forensic toxicologistsinthisfieldusemanyofthesamehigh performance analytical methods to detect current and historical use of banned substances, including stimulants,anabolicsteroids,anddiuretics.Thistype oftestingoccursincommercialandpublicaccredited laboratories around the world, though there is also testing of highschool, college and other athletes thatoccursinprivatelaboratories. scientists employ highly uniform and welldefined techniques and methods to minimize the risk of errors,andensurethatemployeesaretreatedfairly and that testing is done to the highest forensic standards.Themajorityofworkplacedrugtestingis not covered directly by accreditation programs however. These unregulated programs can perform tests using other matrices such as oral fluid, sweat andhair. A related subset of workplace testing is for parole and probation both at the state and federal levels. Thistestingisoftenconductedwithmethodssimilar to workplace samples but is applicable to the criminal system in the management of parolees. Outside of the military, almost all of this testing occursincommerciallaboratories.

ForensicWorkplaceDrugTesting:
Use of drugs by people in the workplace has significant safety and economic consequences. Consequently,intheUnitedStates,workersinsafety sensitive positions are prohibited from using rec reationaldrugsortakingcertainmedicationswithout a prescription. Enforcing these standards requires preemployment, random, and forcause drug testing, such as following an accident or a trans portation collision. Members of the US military, employees working for the Federal Government, or their contractors are also required to comply with thesestandardssetforthintheDrugFreeWorkplace Act adopted by Congress in 1988. Forensic toxic ologists perform testing of urine samples in these laboratories regulated and inspected on behalf of the Federal Government in a program managed by the Substance Abuse and Mental Health Services Administration (SAMHSA). Testing for five major classesofabuseddrugsandtheirmetabolites,these

Promoting Scientific Excellence and Professional Standards in Forensic Toxicology

In 2009, the FTC established a scientific working group in forensic toxicology (SWGTOX) to organize efforts to advance and standardize the practice of forensic toxicology in US laboratories. The activities of SWGTOX are discussed below. The FTC received fundingsupportfromtheNationalInstituteofjustice (NIJ) to launch SWGTOX which had its inaugural workgroupmeetingsinFebruary2009. SOFT and the AAFS Toxicology Section developed a guidance document in the 1990s to identify good practices in forensic toxicology related to quality controlandqualityassurance,methodselectionand operation, instrument and equipment maintenance, staff qualifications and training, documentation of results, and laboratory management and safety. These guidelines became the basis for the develop

TheSOFT/AAFSLaboratoryGuidelinesareavailableat: http://www.softtox.org/?pn=publications&sp=Laboratory_Guidelines
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 ment of a laboratory accreditation program imple mented by ABFT in 1996. Currently 26 forensic toxicologylaboratoriesareaccredited. The National Laboratory Certification Program (NLCP) currently accredits 38 regulated workplace laboratories. These laboratories are inspected and evaluated under federal guidelines. Again these guidelines address good practices for forensic toxicologyandqualitycontrolandassurance. The SOFT/AAFS Laboratory Guidelines committee has continued to review and update the guidelines, and the most recent version was updated in 2006. ABFT continues to work with the SOFT/AAFS com mittee in its revisions to the ABFT inspection checklisttoaccountfordevelopmentsintechnology, instrumentationandstandardsofpractice. In 2009, ABFT began the process of aligning its lab oratory accreditation program with ISO/IEC stand ards. Both ISO 17025 (Testing and Calibration Laboratories), and ISO 15189 (Clinical Laboratories) wereevaluated,andABFTispursuingISO15189asa templateforthisISOaccreditation. andregulationsalreadyexist(e.g.,FederalDrugFree Workplace Program and the World AntiDoping Agency). These committees conduct business through estab lished subcommittees and task groups to focus on specific aspects of the SWGTOX mission. The objectivesoftheSWGTOXaretoestablishminimum standards for the practice of forensic toxicology in thefollowingareas1)Standards,practice,protocols including quality assurance and quality control, 2) Educational requirements, 3) Accreditation (laboratory compliance with standards of practice), and 4) Certification (individual compliance with educational and experience standard to practice forensic toxicology). SWGTOX will also establish a uniform Code of Ethics for forensic toxicologists, identify areas of research and development in the field of forensic toxicology, and promote public awarenessofthefieldofforensictoxicologythrough outreach.

What professional groups represent Forensic Toxicology?

TheAmericanAcademyofForensicSciences (AAFS)ToxicologySection www.aafs.org

SWGTOX www.SWGTOX.org

SWGTOX was constit AAFS is a multi ThethreecommitteesofSWGTox: uted by the FTC in disciplinaryorganization October 2009, at the Standards,Practice,ProtocolsandAccreditation representing forensic annual SOFT meeting sciences in the United in Oklahoma City. The Education,Ethics,OutreachandCertification States. AAFS has over mission of the Research,Development,TestingandEvaluation 6000memberswhoare SWGTOX is to investi engaged in the practice gate, analyze, develop of forensic science or in training in this field. AAFS and disseminate consensus in standards of practice promotes professional development, research, for forensic toxicology. The scope of SWGTOX sharingofinformation,professionalnetworking,and activities includes postmortem and human perfor recognitionofleadershipandserviceintheforensic mancetoxicology.Whilethestandardsdevelopedby sciencecommunity.AAFSpublishesapeerreviewed SWGTOXareconsideredgoodstandardpracticeinall JournaltheJournalofForensicSciences.TheAAFS forensictoxicologydisciplines,thescopeofSWGTOX Toxicology Section provides training and education activities does not necessarily include those activities for its members, governs committees specialized areas where mandated, codified rules Page4

 dedicatedtotheadvancementofforensictoxicology subdisciplines and promotes the advancement of knowledgeinthefield. leading developments in the field. SOFT also maintains committees charged with the develop ment of standards for analytical toxicology laborat ories,whichcollaborateswithABFTandAAFS.SOFT and AAFS have jointly prepared a document on Laboratory Guidelines designed to promote consist entminimumstandardsofpractice.Theseguidelines becamethebasisfortheABFTLaboratoryAccredita tionchecklist.

TheAmericanBoardofForensicToxicology (ABFT) www.abft.org

Established in 1975 as a pro fessional certi fication Board for the disci plineofforensic toxicology, ABFT certifies appropriately qualifyied individuals as professional toxicologists. The criteria forcertificationareeducation,experience,successful completion of an examination, and documented continuing professional education. Certification is awarded at the Diplomate (PhD) level and Forensic ToxicologySpecialist(nonPhD)level.Currentlythere are 220 Board certified forensic toxicologists in the United States and internationally. ABFT maintains and enforces a code of ethics for its certificants. ABFT also offers accreditation to forensic toxicology laboratories, based on compliance with a comprehensivechecklist,participationinproficiency testing programs, and onsite inspections and re inspections. ABFT is accredited by the Forensic SpecialtiesAccreditationBoard(FSAB).

ForensicToxicologyCouncil(FTC)
The FTC was formed in 2009 to coordinate the efforts of the leadership of the three organizations described above, to ensure consistency in plans for professionaldevelopmentofthefield,aunifiedvoice forforensictoxicologyonmattersrelatedtolegisla tive or regulatory action governing forensic toxic ology laboratories, and to manage projects that require the joint efforts of the three organizations specifically the development of a SWGTOX. The FTC membership is comprised of the ranking officers of SOFT, ABFT and the AAFS Toxicology section along with the representatives of SOFT and ABFT to the Consortium of Forensic Science Organizations (CFSO).

Other
Various regional forensic science and forensic toxic ology groups exist around the United States, and have local meetings and trainings. The membership of these regional groups overlaps significantly with theaboveorganizations.

SocietyofForensicToxicologists(SOFT) www.softtox.org
SOFT is a professional membership organization for forensic toxicology professionals with more than900members.Itholds an annual meeting for the presentation of research andcasereports,newanal ytical methods and data analysis. Its abstracts are peer reviewed. SOFT publishes annually a special issueoftheJournalofAnalyticalToxicologyfeaturing

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Forensic Toxicology Statistics

SOFTrecentlysurveyedthetoxicologycommunityto better understand the nature of the profession. These figures represent preliminary results of these efforts.

Volumeofsamples(Monthlyworkload)
It is very difficult to get accurate numbers that reflect the total workload in toxicology due to the variability in how cases and samples are counted. However,approximately6.5millionworkplacesam ples are tested under federal regulation and an additionalestimated50millionnonregulatedwork place samples are tested annually. Of the lab oratoriesresponding,thereisabroaddistributionof workloadsfromonly1casepermonthtothehighest reporting260,000samplespermonth.

Selfreportedtypeoflaboratory
Laboratorieswereaskedhowtheywouldcharacter ize their laboratory. It should be noted that many laboratorieshandlemultipletypesofwork.Thisisas a percentage of laboratories not as a percentage of thework.

8% 28%

28%

Forensicdrugtesting Postmortemtoxicology Humanperformance

35%
Independentconsultant

Lessthan1%ofresponsesindicateddopingcontrol.

LaboratoryAccreditation
Only a few states (New York, Texas and Oklahoma) and Federal programs require laboratory accredita tion. Not all forensic toxicology laboratories are accredited; however on a largely voluntary basis accreditation is well established in the field under a number of programs. Many laboratories participate inmorethanoneprogram.
Percentageoflaboratoriesreportingparticipationin accreditationprograms 24% AmericanBoardofForensicToxicology(ABFT) 15% ISO17025 1% ISO15189 0% ISO17011 NationalLaboratoryCertificationProgram(NLCP) 20% 18% ASCLDLAB(legacy) 21% CLIA 30% CollegeofAmericanPathologists(CAP) Stateprograms(includingalcoholaccreditations) 22% 3% DepartmentofDefense(militarydrugscreening) 12% Noaccreditation

Fundingorbusinessmodeloflaboratory
Laboratories were asked how they are funded. Again, laboratories may have multiple sources of funding. This also indicates 41% of toxicology laboratories responding are other than publicly funded.

4% 2% 3% 10% 22% 5% 27% 18% 7%

CountyFunded Federallyfunded Statefunded CityorMunicipalityfunded Commerciallyfunded Hospitalnotforprofit Univeritynotforprofit Independentnotforprofit Other

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Contact Information
Additionalinformationcanbeobtainedfrom membersoftheFTC,SWGTOX,andtheirrelated organizationsbycontacting:
Officers: BarryKLogan,PhD,DABFT(Chair) AAFSVicePresident NMSLabs 3701WelshRoad WillowGrove,PA18901 (267)6153516 barry.logan@nmslabs.com BruceAGoldberger,PhD,DABFT(Secretary) ABFTVicePresident DeptofPathology,Immunology&LaboratoryMedicine UniversityofFloridaCollegeofMedicine 4800S.W.35thDrive Gainesville,FL32608 (352)2650680x72001 goldbeba@pathology.ufl.edu Members: YaleHCaplanPhD,DABFT ABFTrepresentativetoCFSO NationalScientificServices 3411PhillipsDrive Baltimore,MD21208 (410)4867486 fortox@aol.com KennethEFerslewPhD,DABFT AAFSToxicologySectionChair EastTennesseeStateUniversity ToxicologySection,Box70422 JohnsonCity,TN37614 (423)4396424 ferslew@etsu.edu BradfordRHelper,PhD,DABFT SOFTPresident WayneCountyMedicalExaminersOffice 1300EastWarrenAvenue Detroit,MI48207 (313)8332552 bhepler@co.wayne.mi.us

PhilipKemp,PhD,DABFT AAFSToxicologySectionSecretary ARLOKLaboratories 840ResearchParkway,Suite.546 OklahomaCity,OK73104 (405)2711144 pkemp@arlok.com SarahKerrigan,PhD SOFTVicePresident SamHoustonRegionalCrimeLaboratory 8301NewTrailsDrive,Suite125 TheWoodlands,TX77381 (936)2942503 sarah.kerrigan@shsu.edu MarinaStajic,PhD,DABFT ABFTPresident OfficeofChiefMedicalExaminer 520FirstAvenue NewYork,NY10016 (212)4472637 MStajic@ocme.nyc.gov PeterRStoutPhD,DABFT SOFTrepresentativetoCFSO RTIInternational 3040CornwallisRoad POBox12194 ResearchTrianglePark,NC27709 (919)3163450 pstout@rti.org SWGTOXCoChairs: DanielSIsenschmid,PhD,DABFT WayneCountyMedicalExaminersOffice 1300EastWarrenAvenue Detroit,MI48207 (313)8332552 Disensch@co.wayne.mi.us RobertAMiddlebergPhD,DABFT NMSLabs 3701WelshRoad WillowGrove,PA18901 (267)6153516 robert.middleberg@nmslabs.com BruceAGoldberger,PhD,DABFT

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