By Kevin G. Shanks, M.S., D-ABFT-FT
I always had an interest in science and math at a young age. And for some reason, I was enamored with drugs and poisons too. Some of my favorite television shows as a teenager were Murder She Wrote and Quincy, M.E. – yes, I know I’m showing my age there. I also watched the now dreaded CSI television shows, including ever sunglasses-wearing Horatio in Miami. I also was a big fan of Agatha Christie or any work that involved poisons. Yes, I was (and still am) a big nerd.
My first role in the laboratory years ago was doing the analytical testing on a pharmaceutical drug: a urinary tract medication that had three active ingredients (methenamine, phenylsalicylate, and hyoscyamine). The pharmaceutical company had outsourced the regulated testing to my former lab and we had to test the tablets for regulatory compliance, which included content uniformity and testing for excipients and degradation in simulated gastric and intestinal fluids. It was very boring, monotonous work, but I learned a lot during that first year including how to make simulated gastric and intestinal fluid, which was quite interesting. I operated HPLC, flame photometers, and UV-VIS instruments. I also learned I didn’t like GMP testing very much. Just think of all the documentation you have to do in your job every day (it’s a lot, I know) and then multiply that by 1,000,000. I’m not joking. It was actually pretty stressful work too as it was all FDA-regulated work so we had multiple instances of FDA inspectors in the lab to watch us do the testing. And those FDA inspectors (at least the ones I’ve met) aren’t the nicest of people. After a year, an opportunity arose in method development and validation and I jumped at it. A few years went by and I got my hands on a LC-ToF in 2006 and I was hooked at that point. We became the first production forensic toxicology lab in the country to utilize an LC-ToF in screening. Around that time I also acquired the duty of handling the non-routine casework in the lab – things like syringes, tablets, liquids, drug paraphernalia, seized drug evidence, and foodstuffs. Also, another duty was developing methods for drugs that neither we nor a reference lab had a method for. A few more years later and a forensic toxicologist position opened up and I happily took it and as they say, that’s all she wrote. I’ve been in an official forensic toxicologist position for the last 12 years. If you ever want to know more, I’d gladly tell you more, but that’s enough about me in particular.
I’ve been lucky to see a lot of change in this field over the last 20 years. Firstly, instrumental analysis is quite different than it was a couple of decades ago. When I first was on the job we were using Thin Layer Chromatography, GC-MS, and immunoassay for screening. We had HPLC with UV and fluorescence detectors, GC-MS, and LC-single quadrupole MS instruments for confirmation testing – LC-triple quadrupole MS wasn’t really a thing yet in forensic toxicology. And no one inside of toxicology had even dreamt of using high resolution accurate mass instruments such as single stage time of flights or quadrupole time of flight mass spectrometers for anything at that point. But you look around the lab today and all you see is LC-QToFs and LC-MS/MS. It’s wild how much change has occurred in a relatively short amount of time.
Secondly, the sheer breadth of available drugs has substantially increased as well. In the early 2000s, novel psychoactive substance (NPS) wasn’t a term that was familiar. No one spoke about them. But sometime around 2008, NPS such as substituted cathinones, designer benzodiazepines, fentanyl analogs, synthetic opioids, and synthetic cannabinoids changed the toxicology landscape. We can no longer just worry about the classical drugs of abuse (such as methamphetamine or heroin or cocaine) or prescription medications (such as oxycodone, hydrocodone, or alprazolam). A challenge we face in forensic toxicology is what substances do we need to include in our scope of testing? In the early 2000s, most labs weren’t even testing for fentanyl. Can you imagine that? Illicit fentanyl is by far and away the most important drug that is driving overdoses in the United States these days and has been for the last several years. The next question after scope is how do we analyze them in the effective and efficient way as possible? And finally, after all that, the most pressing issue is the arduous challenge of results interpretation and expressing a scientific opinion in courts of law – how does the substance play a role in a medical-legal death investigation or human impairment? Does it play a role? Is it an incidental finding? Someone much smarter than me used to say, “Never practice toxicology in a vacuum”. And it’s truer today than it has ever been.
There’s that old adage that the only constant in life is change. It’s a saying for a reason. If this was social media, I’d end the sentence with #truth. That saying exactly describes the last 20 years of forensic toxicology.