Comparison of urine to sweat patch test results in court ordered testing.

A former cocaine and methamphetamine abuser was continuously monitored with both sweat patch and urine testing for approximately 6 months. Thirteen sweat patches were applied and collected, five were positive for cocaine and/or methamphetamine, but all the urine specimens collected were negative at the analytical cut-off levels. The high incidence of false positive sweat patch tests in relation to the sensitivity, specificity, and efficiency of the sweat patch assay is discussed. Possible mechanisms, which can lead to false positive results, are presented. The results of our study raise further questions about the preferential use of the sweat patch in detecting new episodes of drug use in formerly chronic drug users.

Drugs in postmortem adipose tissues: evidence of antemortem deposition.

INTRODUCTION: Drug concentration measured in postmortem adipose tissue may or may not reflect antemortem concentration. To examine the possibility of whether the presence of basic drugs in adipose tissue is the result of postmortem change, we examined: tissues with and without livor mortis, concentration gradients within the adipose layer, and the stability of drug concentrations during the postmortem period. CASE REPORTS: Five drug-related deaths with case histories and analytical data are presented. Adipose tissues with and without livor mortis from the thigh area of the same decedent were analyzed for cocaine. The cocaine concentration of the tissue exhibiting 4+ livor was equivalent to the concentration observed in tissue without livor. Analyses of cross sections of adipose tissues containing cocaine and methamphetamine disclosed that drug concentrations were equally distributed throughout the layer, from just beneath the dermis to directly above the muscle. When morphine and temazepam concentrations were measured in adipose tissues collected from similar sites, but at different times, from the same cadaver, they remained essentially the same over 3 days (approximately 80 h). CONCLUSIONS: Since concentrations were the same in areas with and without livor mortis, the possibility of redistribution into adipose from blood or vascular channels is eliminated. The absence of a concentration gradient within the adipose layer rules out diffusion or permeation from muscle into the adipose layer, and the failure of morphine or temazepam concentration to change over time indicates that drugs in the adipose tissue are stable during the postmortem interval. Our findings support the notion that drugs identified in postmortem adipose tissue are there because of antemortem deposition and not because of any postmortem change or event.

Drug deposition in adipose tissue and skin: evidence for an alternative source of positive sweat patch tests.

In a series of licit and illicit drug-related deaths, qualitative and quantitative analyses on extracts of adipose tissue and skin were performed by GC/MS. In all cases, the adipose tissue was found to contain drugs at concentrations lower than, approximately equal to, or even greater than the concentrations of the same analytes found in the blood, which may reflect a consequence of long-term chronic exposure, or acute intoxication, or some combination of both. Approximately one cubic inch of skin with adipose tissue was removed from the mid to lower abdominal region adjacent to the midline incision during autopsy. The drugs were recovered from the specimens following incubation and alkaline, acidic, and alkaline chloroform back extraction of one to three grams of tissue. Deuterated analogs of the analytes were added to the matrix at the beginning of the incubation period. Cocaine and free morphine (from heroin) were readily identified in several cases. The presence of these illicit drugs in adipose tissue raises significant forensic questions, especially the use of 'sweat patches' to monitor recent cocaine or heroin use in chronic drug users.

A solid phase enzyme immunoassay (ELISA) for the detection and quantitation of anticardiolipin antibody.

A solid-phase enzyme-linked immunoabsorbent assay (ELISA) is described for the detection and quantitation of anticardiolipin antibodies (ACAs) IgG and IgM in sera. In these assays, non-specific binding was controlled by using antigen-negative wells for all serum dilutions tested. Quadruplicate 100-microliters serum samples diluted 1:20 for ACA-IgG and 1:40 for ACA-IgM were incubated for two hours, after which alkaline phosphatase-conjugated antihuman IgG or IgM was added. A standard serum was used on each plate to provide reproducibility of the assay. Upper limits of normal for ACA-IgG and IgM were established by testing 161 sera from normal persons. Sixty-one selected patients with SLE were tested; and, from these results, categories of positivity were defined from negative to 4+. All screen-positive sera (greater than or equal to 1+) were assayed in a quantitative ELISA assay for ACAs, using multiple dilutions of the unknowns. These data were fit on a standard curve generated with dilutions of a reference serum on each plate using a computerized data reduction system based on the 2 Plus 2 model. The standard curves were compared with the international standards for IgG and IgM anticardiolipin. The ability to quantitate ACA concentrations allows better definition of positive sera, as well as the opportunity to accurately evaluate and follow this antibody in a variety of patient groups.

Datura stramonium: a fatal poisoning.

A case report of death caused by ingestion of Datura stramonium, also referred to as jimsonweed, thorn apple, or Jamestown weed, is presented. Mass spectral data on urine extracts of a 20-year-old male showed the molecular ions and principal fragment ions of scopolamine and atropine, present in Datura stramonium.

Mass spectrometric identification and confirmation of 16-methylprednisone acetate in Mexican pills.

The identification and confirmation of an unusual corticosteroid, 16-methylprednisone acetate, in Mexican pills is described. Identification is based on molecular structure illucidation from the electron impact fragmentation pattern. Characteristic m/e peaks at 121 (base peak), 241, 256 and 414 (molecular ion) are observed. Fragmentation pathways leading to these ions are presented. Confirmatory studies, employing NMR are also presented.

Premature deaths in persons with seizure disorders--subtherapeutic levels of anticonvulsant drugs in postmortem blood specimens.

Eleven autopsy cases from a Colorado coroner's service are presented in which postmortem levels of anticonvulsant drugs were subtherapeutic. Scene investigation or medical history, or both, revealed evidence of epilepsy in all eleven cases. Five of the deaths (three drowning and two with aspiration of gastric contents) occurred during a suspected seizure. The six remaining deaths were attributed to asphyxia associated with terminal seizures. Because anatomic evidence of epilepsy is often minimal and nonspecific, the authors think that levels of anticonvulsant drugs should be determined in cases of sudden unexpected death with a history of epilepsy. It is probable that these eleven deaths were preventable with better patient motivation and compliance with the physicians' orders. Many epileptic patients fail to take their medications as directed because of the undesired side effects. Lower doses of anticonvulsant drugs could reduce the degree and number of unwanted side effects and encourage patient compliance. Therefore, careful monitoring of serum anticonvulsant levels during the life of the patient might permit lower but still adequate drug levels with fewer adverse effects and hence encourage the epileptic to comply with the doctor's orders, take his medication, and live.

Electron impact mass spectrometric detection of Freon in biological specimens.

Freons from an aerosol spray can were detected in the blood, liver, brain, and lung of a 14-year-old girl who died after intentional inhalation. A headspace mass spectrometric analytical technique was employed to detect the fluorocarbons. The spectra from the specimens showed the presence of m/e peaks at 101, 103, and 105 from the ion (CFCL2)+ which arises from fragmentation of trichlorofluoromethane (Freon 11) and dichlorodifluoromethane (Freon 12), and peaks at 85 and 87 from the ion (CF2Cl)+ which arises from fragmentation of dichlorodifluoromethane (Freon 12). The technique presented here provides greater specificity than previously reported analytical procedures for the identification of these volatile toxic chemical compounds in biological specimens.