Drug-Related Deaths

Forensic toxicology involves the study of the adverse effects of drugs, alcohol and poisons on biological systems in a medicolegal context. Toxicology testing is an important ancillary test required in many death investigations, for example in suspected drug overdoses, toxicology will play an integral part in the investigation. In addition, toxicology testing has an important role in determining the role of drugs or alcohol in traumatic deaths (e.g. motor vehicle collisions), and some cases may require testing to exclude the contribution of toxicology in sudden unexpected deaths in infancy. Collection of appropriate samples is a critical part of toxicology testing. Blood and urine samples are the most frequently tested samples, but other samples such as liver, vitreous fluid and gastric contents may also be useful, depending on case history, available tissues in the decedent and laboratory capabilities. The impact of the opioid crisis and the proliferation of novel psychoactive substances has highlighted the critical role of toxicology and the importance of understanding the many factors that influence the interpretation of drug findings for people working in death investigations. This chapter will provide an overview of forensic toxicology and explore some of the unique challenges that arise when dealing with postmortem drug testing and the interpretation of results.