By George S. Behonick, Ph.D. F-ABFT
In recognition of National Forensic Science Week (NFSW), September 18-22, 2023, I am putting pen to paper to capture some thoughts on what this means to Axis Forensic Toxicology. The euphemism, “Dead men tell no tales”, is oft used as a metaphor. To be certain, it is an exaggerated phrase, but it does get a point across. Similarly, medical examiners (ME), forensic pathologists and coroners hold as a credo, “We speak for the dead”. It is a creed extending to other members of the medico-legal death investigation team, chiefly the men and women who comprise the ranks of the various disciplines within the field of forensic science. We at Axis Forensic Toxicology are part of that team and we are charged with the responsibility of trying to provide answers and context to what often are the final moments, or acts, of a person before departing this planet. Forensic postmortem toxicology is uniquely set apart from the other forensic science specialties. Think about this for a moment, it is the only branch within forensic science that provides the ME, coroner or forensic pathologist with explanation for, or reason for a decedent’s demise; that is, a cause of death (COD). All of the other forensic science disciplines may provide supporting evidence integral to unraveling the circumstances and details of a death. For example, DNA and latent fingerprint scientists provide definitive proof in establishing a decedent’s identity, or likewise may be able to establish the identity of a subject who may have had close contact with the decedent before or at the time of death. Criminalist analysts may categorize and document trace evidence such as hairs and fibers, for eventual comparison to known materials from a death scene or decedent. Firearms examiners provide weapon function tests in cases of suicide by suspected self-inflicted gunshot wound (that is, was it an accident or was it self-intentional?). Projectile fragments and bullets recovered at autopsy can be matched to a specific weapon. Note however, that none of these examples provide potential for COD. Postmortem forensic toxicology can offer plausible reason and evidence for the pathophysiological mechanisms to cause one’s death (e.g. the respiratory depression and accompanying apneic and anoxic pathology associated with an opioid poisoning or intoxication).
The past quarter century has borne witness to rapid change and advancement in the field of forensic toxicology. Toxicologists and analysts were at the forefront of the nationwide epidemic of prescription drug abuse and misuse which ignited in the mid to late 1990s with OxyContin® (dubiously dubbed “Hillbilly Heroin” because of its scourge inflicted to middle Appalachia) and then morphed to other opioids such as methadone and prescription derived fentanyl. Within the first decade of the new millennium, the United States experienced a re-emergence in heroin. Heroin-related deaths surged for a brief period 2010-15, to be followed by the nationwide infiltration of illicitly manufactured fentanyl (IMF) into the street drug supply chain. The synthetic modification and manipulation of IMF then resulted in the proliferation of potent fentanyl analogs such as carfentanil and furanylfentanyl. More recently, other designer opioids, novel psychoactive substances, and clandestinely manufactured psychotropic substances such as synthetic cannabinoids (‘K2 Spice’), cathinone compounds (‘bath salts’), nitazene compounds and designer benzodiazepines such as bromazolam and flualprazolam have come to make their mark in the United States. Not to mention, mitragynine (‘kratom’) and the adulterant drug xylazine (‘Tranq’). Fortuitously, forensic toxicology has enjoyed a golden age in the last twenty-five years with respect to technology. This encompasses not only new and improved methods for the extraction and recovery of drugs and drug metabolites from postmortem blood and other fluids and tissues, but also a robust cavalcade of sophisticated instrumentation and automation. Utility and versatility of high-resolution mass spectrometry (HRMS) which empowers laboratories with the ability to detect and identify, in real time fashion, literally hundreds of drug compounds and drug metabolites of interest is astounding. Liquid Chromatography-Quadrupole Time of Flight HRMS imbues laboratories with a tool to meet the challenges of an ever-changing illicit drug landscape. Indeed, working as a forensic scientist, technician, or analyst in a modern forensic toxicology laboratory is both exciting and rewarding; moreover, it is imperative we also acknowledge all of the actors in this play. It is not an exaggeration in stating that it takes a village to do what we do day to day, so it is we recognize during this NFSW 2023 the executive and administrative clerical staff, the logistics staff, the IT support, managers and supervisors, the accessioning staff, and everyone associated with Axis Forensic Toxicology.
In closing, I leave you with the sage words of a grizzled ME whom I had the pleasure of working with in Virginia. His name is Dr. William Massello III, recently retired in the last several years as the Chief Medical Examiner for the state of North Dakota. He once posited to me, “Someone has to make sense out of all of this mess”. Words I have never forgotten, but still echo today. Despite some of the most horrific, tragic circumstances that can befall a human being, we are called upon to do our jobs. Be proud of what you do, realize the essential contributions you make to the public at large, the criminal justice system and to the decedent families and next of kin we indirectly serve. Be proud to work in forensic science!