ToxTalk EditorsYale Caplan, Ph.D., DABFTVickie Watts, M.S.

Section EditorsDaniel Anderson, M.S., FTS-ABFTMatthew Barnhill, Ph.D., DABFTDwain Fuller, B.S., DFTCBJ. Robert Zettl, MPA

SOFT 2008 Board of DirectorsPRESIDENT

Christine Moore, Ph.D., DABCCVICE PRESIDENT

Anthony Costantino, Ph.D., DABFTSECRETARY

Sarah Kerrigan, Ph.D.TREASURER

Bradford Hepler, Ph.D., DABFTDIRECTORS

Ashraf Mozayani, Ph.D., DABFTMarc LeBeau, Ph.D.Peter Stout, Ph.D., DABFTDan Anderson, M.S., FTS-ABFTDwain Fuller, B.S., DFTCB

ex officioPast President:

Diana Wilkins, Ph.D.Webmaster:

Bruce Goldberger, Ph.D., DABFTToxTalk Editors:

Yale Caplan, Ph.D., DABFTVickie Watts, M.S.

I N S I D E T H S I S S U E :President’s Message 22008 Annual Meeting Review 3-13Case Notes 14-19Drugs in the News 20-23New Drugs / ABFT News 24-25Bits & Pieces/Member News 26-27Back Cover—2009 Meeting Info

At the recent Business Meeting in Phoenix, the following individu-als were elected to serve as the new 2009 S.O.F.T. Board of Directors:

2009 President—Anthony Costantino, Ph.D., DABFT2009 Vice President—Bradford Hepler, Ph.D., DABFT

2009-2010 Treasurer—Marc LeBeau, Ph.D.2009-2011 Director—Adam Negrusz, Ph.D.2009-2011 Director—Fiona Couper, Ph.D.

Continuing members of the Board are:

2008-2009 Secretary—Sarah Kerrigan, Ph.D.2008-2010 Director—Peter Stout, Ph.D., DABFT

2008-2010 Director—Dan Anderson, M.S., FTS-ABFT2008-2010 Director—Dwain Fuller, B.S., D-FTCB

The above distinguished group will spend countless hours makingsure that this organization makes progressive, sound decisions to protect theintegrity and reputation of SOFT, as well as to ensure a stable, continuedsuccessful organization well into the future.

Six years is the average length of commitment when beginning arotation through the various Board positions. Current and past Board Mem-bers have much to be proud of. As the SOFT organization grows into anever larger entity, the more difficult the organizational issues become.Please appreciate the magnitude of involvement these folks accept on avolunteer basis. They are nominated and elected because they are knownby their peers as being dependable, ethical, and responsible individuals.Congratulations and grateful thanks to all of our SOFT Board Members.

C O N G R AT U L AT I O N S T O T H E S O F T 2 0 0 9B O A R D O F D I R E C T O R S

S U N S H I N E / R I E D E R S S I L E N T A U C T I O N

The 3rd annual “Sunshine /Rieders Silent Auction” at thePhoenix annual SOFT meeting net-ted $5,254. Donated merchandisewas bid on by meeting attendees.Not only is the auction a fun event,but complete proceeds benefit stu-dents interested in forensic toxicol-ogy through the SOFT Student En-richment Program. The late Dr.Sunshine and Dr. Rieders always

focused their energy on academicencouragement, and this event seemsto be an appropriate way to acknowl-edge their lifetime contributions inforensic toxicology.

Special thanks is extended toSOFT Member, Laurie Tobler andthe many volunteers who worked atthe 2008 Sunshine / Rieders SilentAuction to help raise funds for the2009 SSEP program.

®

Society of Forensic Toxicologists , Inc .Volume 32, Issue 4

December 2008

Greetings !

It waswonderful to see

many of you in Arizona – wecouldn’t have asked for better com-pany, weather, organization, foodor science. I often think of SOFTas a big family – and once againthat was apparent at the annualmeeting. I was particularly encour-aged by the many “First-Time At-tendees” to the conference, and bythe high number of young peoplewho were present.

Many thanks to our co-hosts, Vickie Watts and NormWade along with their team of vol-unteers and of course, our wonder-ful SOFT Administrator, BonnieFulmer. Ann-Marie Gordon, Scien-tific Chair, and Dan Anderson,Workshop Chair are to be com-mended for their exceptional workon the scientific content of themeeting.

The Special Issue of theJournal of Analytical Toxicologywas again a great success – manythanks to Dan Anderson for all hishard work. The Editor for 2009 willbe Jennifer Limoges – welcomeJennifer to a tough job. The inau-gural EDIT Award will be given in

2009 for the paper with the bestexperimental design and highestimpact on our field to be publishedin the Special Issue. Please note,the lead author of the selected pa-per must be a SOFT member sinceit is a SOFT Award, so start think-ing about your papers now – thedeadlines are in March.

It is with great sadness thatI tell the membership of the loss oftwo more esteemed colleagues in2008 – Drs. John Cody and Rich-ard Prouty. They will be sadlymissed, along with Dr. KarlaMoore, whose passing I reportedearlier this year, all having madetremendous scientific contributionsto our field. Our thoughts andprayers are with the families of ourcolleagues through this sad anddifficult time.

As I have previously men-tioned, the Board has begun to ad-dress ways to improve benefits forour members, with a view to ex-panding interest in our field byreaching out to other organiza-tions, whether it be by providingcontinuing education services, net-working opportunities, or hostingjoint meetings. For example, in2011 we will have a joint meetingwith the International Association

of Forensic Toxicologists (TIAFT)and the Society of Hair Testing(SoHT) in San Francisco, and in2013, Dr. Bruce Goldberger is ex-ploring the possibility of a jointmeeting with The National Asso-ciation of Medical Examiners(NAME) in Orlando, FL. Cur-rently Dr. Timothy Rohrig, is act-ing as liaison between SOFT andNAME to discuss a forward pathregarding potential educationalobjectives and benefits for eachsociety and Dr. Donald Frederickwill explore possibilities with theAmerican Academy of ClinicalToxicology (AACT). Other initia-tives are also being considered.

Finally, I thank you foryour loyalty and trust, and assureyou that it has been my absolutepleasure and privilege to be yourPresident for 2008. The support ofthe SOFT membership, as well asmy own family, faith and friendsare the most important gifts in mylife. I wish Dr. Anthony Costan-tino, incoming President, and allthe Board members the very bestfor 2009 and beyond.

Stay cool,

Christine

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P R E S I D E N T ’ S M E S S A G E

B Y C H R I S T I N E M O O R E , P H . D . , DA BC C

Volume 32, Issue 4

P H O E N I X 2 0 0 8 – A R E C O R D S U C C E S S I N T H E

B E A U T I F U L S O U T H W E S T

The mission ofSOFT is to promoteand develop the sci-ence of forensic toxi-cology, and the 2008program fulfilled that

mission providing an extensive week ofeducational opportunities includingworkshops, platform and poster ses-sions all in a relaxing southwestern re-sort atmosphere. The 2008 annualmeeting had an all-time record of over1000 meeting registrations and a soldout exhibit hall with 86 booths repre-senting 76 exhibiting companies. TheSOFT 2008 Meeting Co-Hosts, VickieWatts and Norman Wade providedattendees with a week of perfectweather, plentiful scientific content,diverse evening entertainment, goodfriends, delicious feasts, and more funpacked into one week than anyonethought possible.

Through the efforts of theWorkshop Coordinator Dan Anderson,the Scientific Program began with 12focus-oriented workshops. The work-shop attendees registered for an all timerecord of 1691 workshop units eligiblefor continuing education credit throughAACC. On Monday four full-dayworkshops including the Effects ofDrugs on Human Performance, Chem-station Productivity, Pharmacogenom-ics for Dummies, and Overview & Re-view of Forensic Toxicology alongwith three half day workshops on Sym-pathomimetic Amines and Tryp-tamines, Overview of Biomarkers ofAlcohol Testing and ISO 17025 Ac-creditation were offered. Tuesday’sworkshops included two full-day work-shops on Pain Management and Addic-tion, and Excel Spreadsheet Design/Statistics, and three half-day workshopson Critical Flicker Fusion Confusion,Applications of LC-MS in Human andVeterinary Toxicology and NaturallyOccurring Pharmacologically ActiveSubstances Native to the Southwest.

The Program Chair, AnnMarie Gordon, prepared a scientific

program that included 129 abstracts thatwere presented as 32 platform and 97poster presentations. Given our warmsouthwest weather SOFT attendees ex-perienced our first outdoor poster ses-sion on Wednesday afternoon.

Thanks to the efforts of the Co-ordinators, Jeri Ropero-Miller andAmanda Gallegos the SOFT StudentEducation Program (SSEP) provided 50Arizona College students with a fullday of activities designed to exposethem to two local toxicology laborato-ries, the Phoenix Crime Laboratory andthe Maricopa County Forensic ScienceCenter and to practicing forensic toxi-cologists.

The SOFT Planning Committeesends a genuine and loud “Thank You”to the many exhibitors for their gener-ous financial sponsorships that fundedso many wonderful events enjoyed byall. The Evening events throughout theweek were designed with SOFT and thewarm hospitality of the southwesterndesert in mind. Monday evening high-lighted the Tier I Hospitality Receptionshosted by SOFT’s major meeting spon-sors in the resort’s beautiful patiosadorned by waterfalls and palm trees.The Tuesday evening Welcoming Re-ception showcased our favorite south-western foods with the attendees enjoy-ing the opening of the Exhibit hall,which flowed onto the outdoor patios.The Elmer Gordon Forum, attended byover 400 participants went long into thenight with many new and first timemeeting attendees voicing questions onforensic toxicology to the respectedaudience of pioneers in the field. Thisevent filled evening was followed bythe “Nite Owl Reception IX” hosted byCerilliant, at the nearby Rustler’sRooste, where guests could “attempt”their mechanical bull ride, play casinogames, eat, drink and mingle withfriends looking down on the lights ofthe Phoenix valley. Wednesday eve-ning began again in the exhibit hall witha “happy hour”, which was followed by“Sunset at the Oasis”, a poolside luau

experience with a steeldrum band providingan entertaining nightof Caribbean musicunder the moon andstars. Thursday eve-ning was the featured special event of themeeting, the President’s Banquet andMasquerade Ball. Attendees adornedelegant satin masks in all forms, colorsand the dance floor stayed crowded witha jubilant group of sleep deprived profes-sionals. Interspersed before and amongthe many other meeting events were theFun Run, held early Thursday morning,and the Sunshine Rieders Silent Auction,Tuesday through Thursday, the SOFTBusiness Meeting, Thursday afternoon,and many other organization meetings ofthe NLCP, NSC, CAT, ABFT, AAFS, aswell as various SOFT Committee meet-ings.

A special thanks goes out toThermo Scientific for sponsorship of theunique SOFT-2008 meeting bags as wellas the Internet Café, which was in con-stant use for the entire week. Our thanksalso to Agilent Technologies for sponsor-ship of the meeting lanyards and TinsleyPreston of Preston Publications for thecontinued support in providing the JATSpecial Issue to all the attendees of theSOFT annual meeting. The SOFT 2008Organizing Committee would like to gra-ciously thank all of the meeting volun-teers and the SOFT Board for their helpand support in making this a successfulmeeting.

Vickie Watts, Norm Wade: Meeting Co-HostsAnn Marie Gordon: Scientific Program ChairDan Anderson: Scientific Workshop Coor.Doug Kramer: SOFT-2008 Website DeveloperPeter Stout, Jeri Ropero-Miller:

Exhibitor Liaison SpecialistsBonnie Fulmer: Registration CoordinatorRobert Herndon: Events CoordinatorDiane Mertens-Maxham, Cindy Hogan:

PromotionsFrank Wallace, Dale Hart, Carl Horn: AVDeborah Denson, Diane Mertens-Maxham:

Volunteer CoordinatorsLaurie Tobler: Silent Auction CoordinatorDon Frederick: Continuing EducationJeri Ropero-Miller, Amanda Gallegos:

SOFT Student Enrichment Program

Page 3ToxTalk

12T H AN N U A L FU N RU NOver 95 individuals ran or

walked a course at the base ofSouth Mountain at the 2008 SOFTMeeting in Phoenix. Special thanksto Rob Herndon, the Fun Run Co-ordinator, who established the pathto follow, recruited the volunteers,and met the runners upon comple-tion of their run.

A note of appreciation isalso extended to the volunteers who

directed the participants along thecourse: Sue and Jenna Cooley,Ian Duffy, Amanda Gallegos,Donna Honey, Amy Lais, andNorm Wade.

The annual Fun Run hasgathered quite a following of fit-ness fans over the years. Partici-pants received the 2008 Fun Runtee shirt and three established win-ners each received an Apple iPod

Nano, generously donated by spon-sor, Agilent Technologies. Othergenerous sponsors of the Fun Runwere Cerilliant, OraSure Tech-nologies, Quality Assurance Ser-vice Corp., and Shamrock Glass.

This year’s 12th annual FunRun was dedicated to KarlaMoore, who passed away earlierthis year, and who began this FunRun tradition 12 years ago.

Page 4 Volume 32, Issue 4

Congratulations to all participants but especially the 1st Place Men’s Runner, Gordon Nelson (front row center inred/white) and the 1st Place Women’s Runner, Ilene Alford (front row fourth from left).

GBF Medical GroupGenTech Scientific, Inc.

GERSTEL, Inc.Grace Davison Discovery Sciences

Hamilton CompanyImmunalysis Corp.

Integrity Products, Inc.International Diagnostics Systems

JEOL USA, Inc.Justice Trax, Inc.

Lawyers & Judges PublishingLEAP Technologies

LECO Corp.Lin-Zhi International, Inc.

Lipomed, Inc.Microliter Analytical Supplies

Neogen Corp.NMS Labs

OraSure TechnologiesOrochem Technologies

Perkin ElmerPharmaceutical Press

PhenomenexPreston Publications (JAT)

Quality Assurance Service Corp.Randox Laboratories USA

Regis TechnologiesRestek Corp.

RocheRTI International

Rudolph Research AnalyticalSciteck Diagnostics, Inc.SGE Analytical Science

Shamrock Glass CompanyShimadzu Scientific InstrumentsSiemens Healthcare Diagnostics

Silver DreamSpeware Corp.

Springer USStandard Register

TASC, Inc.Thermo Scientific

United Chemical TechnologiesUTAK Laboratories, Inc.

Varian Inc.Venture Labs, Inc.

VertiQ Software, LLCWaters Corp.

XLINK Bioscience

Each year the list of com-panies exhibiting and sponsoringour annual meeting becomes moreimpressive. The financial commit-

ment from exhibitors is absolutelyessential in keeping meeting regis-tration fees low for attendees. The2008 exhibiting companies are

listed below. Those companieswho also have committed additionalfinancial sponsorship of the 2008meeting are in bolded print.

ToxTalk

Aegis Sciences Corp.Agilent Technologies

AIT LaboratoriesAlternative Biomedical SolutionsAmerican Solutions for Business

Applied BiosystemsAxiom Diagnostics, Inc.

Beckman CoulterBio Integrated Solutions, Inc.

Biochemical DiagnosticsBiotage

Branan Medical Corp.Bruker Daltonics

Caliper Life SciencesCampbell Science

Capitol VialCerilliant Corp.ChemWare, Inc.Chromsys, LLC

CMI, Inc.Data Unlimited Int’l., Inc.domnick hunter, a div ofParker Hannifin Corp.

DPX Labs, LLCExpress Diagnostics

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G R A T E F U L T H A N K S T O S. O. F. T.’ S G E N E R O U S E X H I B I T O R S

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Submitted by Section Editor, Matthew Barnhill, Ph.D., DABFT

Please send interesting “Case Notes” to Section Editor, Matthew Barnhill, Ph.D. atmbarnhilljr@worldnet.att.net

Introduction

Angel’s Trumpets is thecommon name for Brugmansiawhich is a genus of six species offlowering plants in the Solanaceaefamily. The name refers to thelarge, pendulous trumpet-shapedflowers, which can be white, yel-low, pink, orange or red. The plantcontains the tropane alkaloids, sco-polamine and atropine, which areboth classified as anticholinergicdrugs. In some cultures the plantsare ingested in shamanic rituals,and they are also abused recreation-ally, due to their hallucinogenicproperties. All parts of Brugmansiaare highly toxic and ingestion canbe fatal.

Case HistoryThis case involves a 19 year

old hispanic male with no knownmedical problems. He and a friendpicked 18 bell shaped flowers,boiled them in water and drank theresulting brown liquid. The subject

tongue, laryngeal and trachealmucosa, visceral pleura, epicar-dium and endocardium, gastricmucosa, right testis.

Mild hepatic pallor Minor traumaa. Facial abrasions and ecchymosesb. Right subgaleal hematomac. Abrasions on right forearm, back

and left knee

Toxicology Results

The biological samples werescreened by EMIT followed by GC/MS and were positive for the fol-lowing:

A flower identical to the onethe boys picked was analysed byGC/MS following a basic extractionand was positive for the following:

AntemortemUrine

Gastric

Atropine Phenytoin

Scopolomine

Cannabinoids

Lidocaine

Acetaminophen

Angel Trumpet Flower

Atropine

Apoatropine

Scopolamine

Methscopolamine

From the Miami Dade Medical Examiner Dept., Miami, FloridaMary E. Zaney, Toxicologist, Wilmo Andollo, Toxicologist, Emma O. Lew, M.D.

C A S E N O T E S #1 : P R E T T Y B U T D E A D LY

complained of feeling hot, hadslurred speech and began behavingerratically (hallucinogenic in na-ture). He said he had blurred vi-sion and a lack of saliva.

Later that same day the po-lice were dispatched to a burglaryin process involving this man. Thesubject resisted arrest and wascombative towards an officer (triedto kick and bite him). The officerpunched him repeatedly in the faceand handcuffed him. While travel-ing in the back of the police car herepeatedly banged his head againstthe window. He was transportedto the hospital where he arrivedwith altered mental status and hy-perthermia (temperature of 106 °F). His blood pressure was 60/40with a heart rate of 200. He haddilated pupils and bleeding frommultiple sources. He was admittedto the ICU with a diagnosis of anti-cholinergic intoxication, dissemi-nated intravascular coagulation,status post assault. His conditiondeteriorated and he died the fol-lowing day.

Autopsy Findings Generalized edema with hydro-

thoraces and hydroperitoneum Bilateral marked pulmonary

edema Cerebral swelling Hemorrhagic diathesis with

petechiae/ecchymoses in

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C A S E N O T E S

Volume 32, Issue 4

Specimen Analyte Result

AM Blood AtropineScopolomine

Detected < 0.005 mg/L (LOQ)Not Detected

AM Serum AtropineScopolomine

Not DetectedNot Detected

AM Urine AtropineScopolomine

2.3 mg/L0.13 mg/L

Brown Liquid(Brew)

AtropineScopolomine

12.5 mg/L14.2 mg/L

Tropane Alkaloid Quantitationwas performed by GC/MS on the ante-mortem samples and the brown liquid theboys drank (see adjacent chart).

Conclusion

The cause of death was deter-mined to be Acute Atropine Toxicity andthe manner of death was Accidental.

C A S E N O T E S #2 : S U I C I D E O R H O M I C I D E ?

IntroductionEthanol is a central nervous

system depressant, but at low dosescan act as a stimulant by depressionof inhibitory centers. It is used pri-marily in social settings and rarelyused for medicinal purposes (1).Ethanol is very water soluble anddistributes evenly throughout thehuman body. This allows ethanolconcentrations to be estimatedbased upon a subject’s sex, weight,and degree of adiposity (2). Ethanolis typically absorbed quickly fromthe stomach, small intestine, andcolon. Maximal ethanol blood con-centrations can be obtained between30 to 90 minutes after the last drink(1). The behavioral effects of etha-nol depend on the dose. Thegreater the dose, the more intensethe behavioral effects. At bloodalcohol concentrations of 0.21-0.30a person may experience aggres-sion, reduced sensations, depres-sion, and stupor. Behavioral effectsat 0.31-0.40 BAC, a person mayexperience unconsciousness, coma,and possible death. At blood alco-hol concentrations of 0.41 andgreater, death is a possibility (3).

Oxycodone is a semi-synthetic narcotic analgesic that is

gument with her boyfriend over hispossible infidelity. The boyfriendleft for work as a TSA agent andreceived an email a short while laterfrom the deceased saying goodbye.Upon receiving the email, the boy-friend rushed home to find the de-cedent in bed with a self-inflictedgunshot wound to the head and thegun still in the decedent’s hand.Upon further inspection a suicidenote was found. When fire rescueresponded to the scene, the de-ceased was pronounced dead.The boyfriend was questioned andfound to have gunshot residue onhis hands. Supposedly the gunshotresidue was due to his job as a TSAagent. Videotapes were taken fromsurveillance cameras around thedecedent’s residence to confirm theboyfriend’s story. Review of thevideotapes proved to be consistentwith the accounts of his enteringand leaving the residence. Emailsfrom the boyfriend to a friend andthe decedent were taken into cus-tody for review. The emails to afriend were consistent with possiblespeculations of infidelity. Themother of the deceased was inter-viewed by the police also. Accord-ing to the mother, she had

often distributed in combinationwith other drugs (acetaminophen,aspirin, ibuprofen, phenacetin orcaffeine). It is available as 2.5-10mg normal-release and 5-160 mgextended-release capsules and tab-lets typically but is also distributedas liquid (1-20 mg/mL), rectal sup-pository (15 mg), and parenteralinjection (10 mg/mL) (2). Oxy-codone is prescribed for treatmentof acute pain especially in the post-operative period (1). Some of theadverse effects experienced by sub-jects undergoing oxycodone painmanagement are: nausea, somno-lence, dizziness, asthenia, diaphore-sis, constipation, and urinary reten-tion. In cases of overdose a subjectmay experience any of the follow-ing effects: stupor, coma, muscleflaccidity, severe respiratory de-pression, hypotension, and cardiacarrest. In one study, two adultscommitted suicide using oxy-codone, their postmortem bloodlevels were 4.3 and 14 mg/L (2).

Case HistoryA 22 year old black woman

was discovered by her live-in boy-friend with a self-inflicted gunshotwound to the right temple. Prior toher death, the decedent had an ar-

From the Miami Dade Medical Examiner Dept., Theresa Hippolyte, M.S., Toxicologist, George Hime, M.S.,Toxicologist, Bruce A. Hyma, M.D.

ToxTalk Page 15

C A S E N O T E S #1 ( C O N T I N U E D )

spoken to her daughter an hourprior to the incident. She describedthe decedent as upbeat and lucid notconsistent with a person intendingto commit suicide. The deceaseddid not suffer from any knownmedical conditions and had neverhad any suicidal ideations in thepast.

Postmortem ToxicologyPostmortem aorta blood,

mixed heart blood (serum), bloodcells, bile, gastric lavage, and vitre-ous humor were submitted for toxi-cological analysis. The analysisincluded a blood EIA screen, vola-tile screen by GC-FID, basic drugscreen by GC-NPD, confirmationof opiates by GC-MS, and OpiateQuantitation by GC-MS. The toxi-cology results reported below arefrom the final toxicology report.

Ethanol GC-FIDAorta Blood 0.41%Vitreous Humor 0.03%Bile 0.56%Serum 0.34%Gastric 0.61%

Opiate Quantitation (Oxycodone)Aorta Blood 12.3 mg/LVitreous Humor 0.08 mg/LBile 10.3 mg/LBlood Cells 6.1 mg/LSerum 9.0 mg/LGastric 40 mg Total

DiscussionBased upon the levels of

ethanol and Oxycodone in the dece-dent’s body at the time of death, shewould have more than likely diedfrom an overdose based upon litera-ture cited above. The decedenthowever was able to hold a lucid

conversation one hour prior to herdeath, without her mother detectingany impairment in her daughter’sspeech or thought processes. Shewas then able to hold a gun steadyto her right temple and perfectlyexecute her suicide.

The level of ethanol in thedecedent’s blood should have lefther in an incapacitated state or un-conscious. The ethanol concentra-tion in the vitreous humor is notconsistent with the findings in theother samples analyzed. This couldbe explained by the decedent cut-ting off circulation to the vitreoushumor and not allowing equilibra-tion to occur after she shot herselfin the head.

In addition, the levels ofOxycodone in all the specimensanalyzed excluding the vitreous hu-mor were at toxic levels which aretypically seen in overdose cases.The negative adverse effects causedby overdose like stupor, coma,muscle flaccidity, severe respiratorydepression, hypotension, and car-diac arrest should have preventedthe decedent from being able toshoot accurately and precisely.

The mystery of this death ishow could the deceased carry outher suicide with an acutely toxiclevel of ethanol and oxycodone?Absorption and distribution of theethanol and oxycodone took sometime; why did she not succumb tothese drugs before she was able tocommit suicide? Could the de-ceased be able to consume andachieve these levels after the con-versation with her mother approxi-mately one hour before her death?And; what is the significance of theocular fluid results relative to theblood?

Suicide or homicide? Yourtheories and suggestions would beappreciated. Please send commentsto: olsentm@miamidade.gov.

References

1. J.G. Hardman, L.E. Limbird,P.B. Molinoff, R.W. Ruddonand A.G. Gilman. Goodman &Gilman’s The PharmacologicalBasis of Therapeutics, 9th ed.McGraw-Hill, New York, 1996.

2. R.C. Baselt. Disposition ofToxic Drugs and Chemicals inMan, 8th ed. Biomedical Publi-cations, Foster City, CA, 2008.

3. http://science.education.nih.gov/supplements/nih3/alcohol/guide/info-alcohol.htm

C A S E N O T E S #2 : (C O N T I N U E D )

Page 16 Volume 32, Issue 4

2009 AN N UA L

ME M B E R S H I P

DU E S

Enclosed with this mailing ofToxTalk is the annual membershipdues notice. In 2009, there will be a$10 increase, from $50 to $60, thatwas unanimously approved at theSOFT annual business meeting inPhoenix. The last dues increase wasin 1996 when dues changed from $35to $50 per year.

Dues payments may be madeby check and mailed to the SOFTAdmin. Office, 1 N. Macdonald St.,Suite 15, Mesa, AZ 85201 or paidon-line by charge card at the SOFTwebsite, www.soft-tox.org or bytelephone toll free, 888-866-7638 tothe SOFT Admin. Office, M-F,9 am—1 pm MT. Please be sure tonotify the office of any changes incontact information with your duespayment.

vealed that both victims werenegative for ethanol, but an addi-tional suspected analyte found inboth replicate blood alcohol analy-sis of both victims suggested thepresence of a volatile compound.Both cases were then tested forcommon volatiles and found tocontain 1,1-difluoroethane. Thedriver also tested positive for nor-flurane (another propellant). Nor-flurane could not be confirmed inthe blood of the passenger.

Another postmortem caseconcerns a 23 year old male whodrowned after being seen with acan of “computer dust cleaner.”The can of “computer dustcleaner” was found in the waternear the vicinity where the victimwas last seen by a family memberwho rendered aid to the victim.Later at the victim’s home twomore cans of “computer dustcleaner” were found under the vic-tim’s pillow. The victim’s bloodtested positive for 1,1-difluoroethane.

In the officer submittedpaperwork for a suspected DUIcase, the officer indicates the sub-ject was “huffing paint”. This casewas analyzed and contains tolueneat 2.0 mg/L. Officer submittedpaperwork for another suspectedDUI case requested a test for“paint thinner”. Subsequent con-versation with the officer revealedthe subject was suspected of huff-ing paint thinner. The case wastested and was negative for tolu-ene; however, a significant amount(0.057 g/100mL) of acetone, an-other constituent of paint thinner,

C A S E N O T E S 3 : V O L AT I L E S T E S T I N G AT T H E G E O R G I A

B U R E A U O F I N V E S T I G AT I O N , D I V . O F F O R E N S I C S C I E N C E S

By: Leigh Champion and Kasey Wilson

IntroductionIn April 2008, the Georgia

Bureau of Investigation Divisionof Forensic Sciences (GBI DOFS)Toxicology Section resumed ana-lytical testing for volatile com-pounds after several years of notperforming the service. Volatilecompounds are chemicals such asaerosols and solvents which can beabused and may lead to legal con-sequences such as a DUI or evenresult in death. Many commonhousehold products are abused byinhaling the chemical directly froma container (snorting or sniffing),by “huffing” (inhaling from a ragsoaked with the chemical) or by“bagging” (spraying the chemicalin a bag and then placing the bagaround the head or face).

The GBI DOFS Toxicol-ogy Section is currently testing fora wide range of volatile com-pounds. These compounds in-clude, but are not limited to, pro-pellants such as 1,1-difluoroethanewhich is commonly used in aerosoldust removers (aka keyboardcleaners) and solvents which in-clude toluene, hexane and methyl-ene chloride which are ingredientsin paints, paint thinners and glues.Volatile determinations are per-formed when requested by the offi-cer in a suspected DUI case orwhen requested by a medical ex-aminer in a postmortem case. Ad-ditional cases have also been ana-lyzed for volatile compounds afterinadvertently finding an unknownsuspected analyte during routineheadspace gas chromatography(HSGC) for blood alcohol analy-

sis. Compounds reported fromblood alcohol testing include: etha-nol, methanol, acetone and isopro-panol.

Case HistoriesFrom April through August

2008, GBI DOFS has performedvolatiles testing on twenty-ninecases. Twenty-one of these casesare antemortem cases and the othereight are postmortem. Of thetwenty-nine cases, nineteen arepositive for one or more volatilecompounds. The other ten cases arenegative for common volatile com-pounds.

Seventeen of the nineteenpositive cases contain 1,1-difluoroethane. Thirteen of thecases that are positive for 1,1-difluoroethane involve motor vehi-cle accidents, three are suspectedDUIs and one is a drowning relatedto inhalant abuse. Of the MVAs,five involve injuries, five are with-out injuries, one does not indicate ifthere are any injures and two arefatalities from the same accident.

The paperwork submitted bythe medical examiner for the twoMVA fatality cases indicates that a27 year old male driver and a 19year old female passenger left aparty to get something to eat whenthey were involved in a single carMVA resulting in a fire. Onlookerswere unsuccessful in attempting toremove the two individuals becauseboth victims were pinned in the ve-hicle. Witnesses advised that boththe driver and passenger were con-scious and talking after the acci-dent. Blood alcohol testing re-

ToxTalk Page 17

phy mass spectrometry using anAgilent 7694 headspace autosam-pler with an HP 6890 Series GC and5973 Mass Selective Detector. Allcases suspected of containing vola-tile compounds are screened by alow molecular weight method usingan Agilent J&W GS-GASPRO col-umn and a high molecular weightmethod using an Agilent J&W HP-5MS column. Some compounds,such as toluene, may be identifiedon both the low and high molecularweight methods. Other compounds,such as 1,1-difluoroethane, onlyshow up using the low molecularweight method. Any cases foundpositive for compound(s) foundonly by one method are then reana-lyzed in order to have two inde-pendent tests for reporting purposes.

Most compounds are reported asqualitative only; however, tolueneis routinely reported quantitativelydue to possible occupational expo-sure. Other solvents may also bereported quantitatively if the needarises.

DiscussionOn average the GBI DOFS

Toxicology Section is currently per-forming approximately six volatiledeterminations per month. Thevolatile compound with the highestnumber of reported positive cases is1,1-difluoroethane and most ofthese cases are related to peopledriving a motor vehicle. Submis-sion paperwork for the majority ofthe positive 1,1-difluoroethanecases indicate that the subject in-haled an aerosol and many specifi-cally identify “difluoroethane”.Conversations with law enforce-ment reveal that many subjects havethe aerosol containers in their vehi-cle at the time of the accident ortraffic stop. Some of the aerosolcontainers indicate that the dust re-mover contains a “bitterant/deterrent” to deter inhalant abuse;however, based on the number ofpositive cases reported, individualsare still abusing aerosols despite theadditives.

Results for Volatiles Testing

April - August 2008

1,1-difluoroethane

1,1-difluoroethane andnorfluranebutane and other shoepolish ingredientstoluene

acetone found in BAtestnegative for commonvolatiles

S I N C E R E T H A N K S

Sincere thanks to long time SOFTmember, Tinsley Preston of Preston Publi-cations for his continued alliance w/ SOFTin providing the annual Journal of Analyti-cal Toxicology Special Issue to all attendeesof the SOFT annual meetings. Mr. Prestonalso regularly donates an annual subscrip-tion of JAT to the Sunshine/Rieders SilentAuction event (valued over $500) which

really helps to bump the fundraiser bot-tom line.

Last but not least, Tinsley haskindly contributed hundreds of photo-graphs over the last few years to sharewith ToxTalk recipients that make read-ers smile and re-live good times.

Tinsley’s dedicated support ofSOFT is so appreciated by all.

was found and reported during theblood alcohol analysis.

In one postmortem case, a15 year old female was found in abedroom with her head “buried in atowel” and “her nostrils and facecovered in shoe polish”. A can ofshoe polish was located near thevictim. The victim’s blood and thecan of shoe polish were submitted.The blood was analyzed and foundto contain butane, cyclohexane,heptane, 2-methylhexane and 3-methylhexane. A follow-up testwas performed on the can of shoepolish and found to be consistentwith the blood results.

ExperimentalGBI DOFS tests for vola-

tiles by headspace gas chromatogra-

Page 18

C A S E N O T E S #3 : (C O N T I N U E D )

Volume 32, Issue 4

BloodMorphine (Free) 0.20 mg/LKetamine 0.32 mg/LNorketamine 0.18 mg/L

LiverKetamine 0.24 mg/KgNorketamine 0.72 mg/Kg

Stomach ContentsTotal weight received: 244 gmsKetamine 62.0 mg/KgNorketamine 46.8 mg/Kg

We present a post-mortemcase analysis of a 24 year old singlemale who imbibed ketamine andheroin. The decedent had a historyof recreational use of ketamine, butnot heroin.

The decedent was discov-ered by his parents in their resi-dence. Investigation found bottlesof unknown pills of various sizes,

All submitted tissues and evi-dence (pills) were subject to standardanalytical screening and mass spec-trometry confirmation protocols.Positive findings of the analysis areas follows.

The Medical Examiner ruledthe death accidental.

some empty and others near-full,located at the scene. Autopsy didnot reveal any medically signifi-cant findings.

Comprehensive analysiswas performed on various post-mortem tissues, including femoralblood, urine, stomach content andliver.

From George F. Jackson, Ph.D., William A. Dunn, M.S., Lyla Perez, MD of the E.H.A. Institute of ForensicScience, State Toxicology Laboratory and Regional Medical Examiner’s Office, Newark, NJ

UrineKetamine 3.00 mg/LNorketamine 5.20 mg/LCodeine 0.45 mg/LMorphine (free) 4.40 mg/L6-mono-acetyl-morphine 1.35 mg/L

PillsPositive for acetaminophen and alprazolam

SE E K I N G WO RK S H O P OP T I O N S F O R 2009Please consider chairing a

workshop or suggesting a specifiedkind of workshop that would be in-teresting to attend.

Please discuss any work-shop ideas with the 2009 Work-shop Coordinator, John Soper,Ph.D., jwsoper@integrity.com (orcall 405-954-6265).

The posted deadline to sub-mit a workshop proposal isMarch 1, 2009 so please give thissome immediate thought to perhapshelp provide educational opportuni-ties to fellow SOFT members atfuture SOFT meetings.

The Planning Committee forthe 2009 annual meeting is seekingWorkshop Proposals. Includedwith this mailing of ToxTalk is de-tailed information that gives com-plete instructions how to submit aproposal for consideration.

Workshops could be full orhalf day in length; targeted at ad-vanced, intermediate, or novicelevel of audience knowledge.Workshops should qualify for Con-tinuing Education units of credit, befocus oriented and promote or de-velop the science of forensic toxi-cology.

ToxTalk Page 19

C A S E N O T E S #4 : K E TA M I N E & H E R O I N D R U G D E AT H

Dr. John Soper,2009 Workshop Coordinator

Page 20 Volume 32, Issue 4

D R U G S IN T H E N E W S

Methadone: Old Drug, New Challenges

By Dwain C. Fuller, D-FTCB, TC-NRCC

ber of methadone-related deaths hasskyrocketed.

Those of us who have inves-tigated or studied many of thesedeaths can probably recite the cir-cumstances surrounding the deatheven before reading the report: Thedecedent usually has begun usingmethadone within the last 5 to 7days, was observed to be sleepingand “snoring loudly” prior to beingfound dead with, often profuse, pul-monary edema. There is also agood chance that a benzodiazepinewas involved as well.

To be quite candid, I amafraid toxicologists may be some-what reticent to speak publiclyabout this trend for fear that ourwords will be taken out of contextby some attorney the next time wetestify about a methadone death.This fear is not unfounded. I toohave been called upon to testify indisputes involving both sides of thecivil litigation arising from thesedeaths. It is for this reason that Ifeel it prudent at this point to issuethis disclaimer:

Every case is different, with differing:dose, patient tolerance, co-morbidities,drug interactions, physical circum-stances, etc. No attempt has beenmade by the author of this article toprovide an exhaustive treatise on thecomplex subject of methadone, phar-macology, use, abuse, toxicity, ordeath.

HistoryMethadone was first synthe-

sized by German scientists duringWorld War II after the United

IntroductionThe late Professor Randy

Pausch began his Last Lecture withthe statement, “My father alwaystold me, ‘If there is an elephant inthe room, introduce them.”’ Withthat in mind, I would like to intro-duce you to the toxicological ele-phant in the room, the fact thatthere has been a huge increase inmethadone-related deaths over thepast ten to fifteen years. No intro-duction is really necessary, is it?Forensic toxicologists are quiteaware of this trend, but for the mostpart, we haven’t discussed it much,at least publicly. The media hasreported on these deaths at length,but as they often do, fail to actuallyunderstand them, and more oftenthan not, they simply cloud the is-sue. I read an article recently withthe following quote: “(Methadone)is killing people at therapeuticdoses!” I want to ask, “Therapeuticfor whom? Obviously not the pa-tient who died.” Or perhaps thequestion, “What exactly is thetherapeutic range versus toxic oreven lethal range for any opioid?”As forensic toxicologists we knowwe must consider many issueswhen interpreting opioid concentra-tions surrounding a death: Whatwas the goal of the opioid therapy;analgesia, narcotic replacement?What was the likely tolerance of thepatient? Did the patient have anyco-morbidities? Was the patienttaking other medications? To namebut a few. These issues notwith-standing, the fact remains, the num-

States and their allies cut off theopium supply to Germany. Thesynthetic opioids meperidine andpropoxyphene were also developedduring this time. Methadone wasgiven the trade name, “Dolophine”.A common misconception, or urbanlegend, about Dolophine, was that itwas named in tribute to Adolf Hit-ler, evolving from the originalname, “Adolphine”. This is untrue.The name Dolophine was derivedfrom the Latin root "dolor," mean-ing pain, and was actually namedby the American branch of EliLilly, after the war.

Methadone was brought intothe United States in 1947, and forthe most part, until recently, hasbeen used primarily as a treatmentfor narcotic addictions, mostly in-volving heroin.

PharmacologyMethadone has much the

same effects as morphine but differsin some very important ways whichwe will discuss in more detail later.Although in most countries the drugis administered as the racemic mix-ture of (R)- and (S)- isomers, (R)-methadone accounts for most, if notall, the opioid effects. Methadoneprimarily acts at the µ opioid recep-tor. According to one source,methadone has a bioavailabilityranging from 36 – 100% and aTmax of 2.5 – 5 hours. Its volumeof distribution ranges from 2 – 13L/kg and its half-life ranges from 4– 130 hours, with the half-life of the(R)-enantiomer being somewhatlonger.

(I have purposely avoided the use ofmean values in this citation. The sub-jects and conditions of the studies fromwhich these data were drawn are sodiverse, that any attempt to distill themto mean values would be misleading atbest.)

Methadone is metabolizedby the cytochrome P450 systemwith CYP3A4, and to a lesser ex-tent, CYP2D6 being the main iso-forms involved.

AvailabilitySince the late 90’s there has

been a marked increase in metha-done related fatalities as practitio-ners seeking alternatives to oxy-codone and hydrocodone began toprescribe methadone for pain man-agement. Contributing to the rise inthe popularity of methadone as ananalgesic is its low price and longhalf-life. The quantity of metha-done being supplied to hospitals,pharmacies and practitioners hasincreased 350% between 2001 and2006.

DeathsIn a study by the U.S. De-

partment of Health and Human Ser-vices, National Center for HealthStatistics that studied the increase ofpoisoning deaths, including metha-done, between 1999 and 2004, thenumber of all poisoning deaths in-creased 54% to 30,308 over the1999-2004 period, while the numberof poisoning deaths mentioningmethadone increased 390% to 3,849(Figure 1). Poisoning deaths men-tioning methadone increased from4% of all poisoning deaths to 13%of all poisoning deaths. Most re-

D R U G S I N T H E N E W S (C O N T I N U E D )

cently, all poisoning deaths in-creased 6% from 2003-04, whilethose mentioning methadone in-creased 29%.

Of all narcotics mentionedin poisoning deaths, methadone hadthe largest relative increases.The relative increase in methadone-related poisoning deaths from 1999

to 2004 was greater than for anyindividual substance.

AgeAge specific rates of metha-

done death are higher for personsage 35-44 and 45-54 years than forthose younger or older. This patternhas been true for most of the 1999-

Correction: In the last Drugs in the News (Vol. 32,Issue 3), the graphic at the top of page 13 labeled asethylene glycol is actually diethylene glycol. Weapologize for any confusion this may have caused.

Please send your interesting contributionsfor “Drugs In The News” to Section Editor,Dwain Fuller, at Dwain.Fuller@va.gov

Page 21ToxTalk

2004 period (Figure 2). Amongthose age 55-64 years, the rate in2004 was seven times the rate in1999; for those in each of the 10-year age groups covering the span25-54 years, the rates in 2004 were3-5 times the rates in 1999. Thelargest increase, however, is notedfor young persons 15-24 years; therate in 2004 was 11 times that in1999.

RegionalityMethadone-related deaths

appear to be highly regional in char-acter. The following two graphicsare illustrative of this fact:

D R U G S I N T H E N E W S (C O N T I N U E D )

State 1999 2000 2001 2002 2003 2004%

Increase

WV 4 3 25 52 67 99 2,400

OH 7 14 30 48 62 122 1,650

LA 4 4 19 34 47 64 1,500

KY 8 28 46 72 122 121 1,400

NH 2 7 11 26 32 29 1,350

FL 29 47 117 195 255 400 1,300

OR 5 18 24 60 66 68 1,250

PA 7 17 14 36 67 88 1,150

TN 8 10 14 37 58 99 1,150

WI 6 16 18 34 35 63 950

Top 10 States with the Highest Percent of Increasein Methadone Poisoning Deaths, 1999-2004

Potential Causes of DeathThere are several factors that contribute to the increase

in methadone related deaths. Perhaps the first and most obvi-ous, as mentioned previously, is the increased availability ofmethadone. Practitioners are at an increasing rate prescribingmethadone for pain management, as they look for replacementdrugs for, the much-maligned and often abused, oxycodoneand hydrocodone. Furthermore, practitioners often wish toexploit the long half-life of methadone for their chronic painpatients, allowing them less frequent dosing, and to help them

avoid chronic exposure to high doses ofacetaminophen, often compounded withmore traditional pain medications. Alsoweighing heavily in prescribing decisionsis the fact that methadone is inexpensiveas compared to many of the other painmedications available today.

A second factor in the increasingdeath rate is that the pharmacology ofmethadone can be quite unpredictable. Adetailed discussion of the pharmacoki-netic variability of methadone was au-thored by Eap, Buclin, and Baumann in2002. Among some of the more impor-tant factors contributing to this variabilityare a long Tmax, a long and highly vari-able half-life, and the effect of co-ingested medications.

Due to the long Tmax of metha-done, the respiratory depressing effects

Below: MethadoneRelated Deaths in 2004

Source: National Centerfor Health Statistics

Page 22 Volume 32, Issue 4

CNS depression or unpredictableeffects on methadone metabolism,as well as poor patient compliance,further obfuscate methadone ther-apy. Methadone is a powerful toolin the physician’s arsenal for use incombating pain or fighting addic-tion, however, like everything pow-erful, it must be understood and itmust be respected.

AcknowledgementsA special thanks to Troy

Merrick who sent me the article,Killer or Cure, by David Hurst.

References

1. Killer or Cure. David Hurst, TheAltoona Mirror, Altoona, PA

2. http://web1.caryacademy.org/chemistry/rushin/StudentProjects/CompoundWebSites/2001/Methadone/history.htm, retrievedon 11/2/08

3. http://en.wikipedia.org/wiki/Methadone, retrieved on 11/2/08

4. Eap CB, Buclin T, Baumann P, In-terindividual Variability of theClinical Pharmacokinetics ofMethadone. Clinical Pharmacoki-netics 2002:41 (14): 1153-1193.

5. Increases in Methadone-RelatedDeaths: 1999-2004. Lois A.Fingerhut, Office of Analysis andEpidemiology. U.S. Department ofHealth and Human Services, Cen-ters for Disease Control and Pre-vention, National Center forHealth Statistics, Hyattsville, MD20782, http://www.cdc.gov/nchs/products/pubs/pubd/hestats/methadone1999-04/methadone1999-04.htm#fig2, re-trieved on 11/3/08

6. Caplehorn JRM, Drummer OH, Fa-tal methadone toxicity: signs andcircumstances, and the role of ben-zodiazepines. Australian and NewZealand Journal of Public Health,2002,Vol.26,(4), 358-362

abusers. However, it is often this“delayed onset” of analgesia andlack of psychotropic effects thatlead patients to overmedicatethemselves. Patients who areswitched to methadone from oxy-codone, hydrocodone, or the like,may feel that their medication isnot working, since they may notachieve the analgesia they seek inthe time period they have come toexpect, therefore they take addi-tional doses. Similarly, those pa-tients seeking or expectingeuphoric effects from methadone,may also take additional doses inan attempt to achieve those effects.Additionally, as discussed previ-ously, patients may use other po-tentially interfering medications,even against medical advice.

Lastly, one cannot ignorethe role of “therapeutic misadven-ture”. As one can readily discernfrom the forgoing discussion,methadone therapy can be quiteunpredictable. Many doctors whoare not routinely involved in addic-tion medicine or pain managementpractices may not adequately un-derstand the difference in the phar-macology of methadone as com-pared to the more traditional opioidanalgesics. This may lead to overprescribing, too rapid an escalationin dosage, or a lack of patient edu-cation and proper warnings, espe-cially for new methadone patients.

SummaryThe incidence of metha-

done-related deaths has grown rap-idly over the past 10 to 15 years.High variability in volume of dis-tribution, bioavailability, half-life,and a long Tmax contribute to thedifficulties in the management ofmethadone therapy. Furthermore,drug interactions, causing additive

of methadone may develop severalhours after the last dose, often afterthe patient has gone to bed, makingthe loss of respiratory drive evenmore dangerous.The half-life of methadone is quitelong as compared to most otheropioids and its respiratory depres-sant effects often last much longerthan its analgesic effects. Adding toits unpredictability is the fact thatstudies have indicated that metha-done induces CYP3A4 and there-fore enhances its own metabolismafter a period of use.

Co-ingested medicationsmay also play a role in methadonetoxicity. There appears to be astrong correlation between the con-comitant use of benzodiazepinesand methadone fatality. Caplehornand Drummer, 2002, postulated thatthis may be primarily due to thebenzodiazepine-induced relaxationof the upper airway, causing airwayobstruction which in turn exacer-bates the loss of respiratory drive, aspreviously mentioned.

Beyond the additive effectsof co-ingested CNS depressants,many medications have been showneither to induce or inhibit CYP3A4.Inhibition of CYP2D6 has also beenindicated by some of the SSRImedications, in particular. This un-predictable induction and/or inhibi-tion of methadone’s metabolizingenzymes contributes to its unpre-dictable half-life.

Yet a third factor is patientcompliance, or rather, a lackthereof. Methadone has been foundeffective as a narcotic replacementmedication for opioid addicts pri-marily for two reasons: Its longhalf-life allows for infrequent andclinic-controlled dosing and its longTmax minimizes or eliminates theeuphoric effects sought by opioid

D R U G S I N T H E N E W S (C O N T I N U E D )

ToxTalk Page 23

Page 24 Volume 32, Issue 4

DrugHeart Blood

(ug/ml)Dextromethorphan 0.46

Promethazine 0.44

Hydrocodone 0.46

Levorphanol PresentAmbroxol *0.44

Ambroxol, active ingredientof Mucosolvan® or Mucoanginis®,has local anesthetic properties and isa systemically active mucolytic agentused for decades in the treatment ofrespiratory disorders associated withexcessive mucus, chronic inflamma-

tory pulmonary conditions, bron-chitis, and/or pneumonia. The onsetof action occurs after 30 minuteswhen administered orally. Thedrug works by breaking acid muco-polysaccharide fibers causing thesputum to be thinner and less vis-

cous, therefore more easily re-moved by coughing. AlthoughAmbroxol has been on the marketfor numerous years, this was thefirst encounter our ToxicologyLaboratory has had with the drug.

N E W D R U G S - A M B R O X O L

Submitted by Jaime Lintemoot and Dan Anderson, Los Angeles County Department of Coroner1104 N. Mission Road, Los Angeles, CA 90033

Please send interesting “New Drugs” articles to Section Editor, Dan Andersonat danderson@coroner.lacounty.gov

General Information:Common Name: AmbroxolTrade Names: Mucosolvan®, Mucoangin®

Chemical Name: trans-4-(2-Amino-3,5-dibrombenzylamino)-cyclohexanolChemical Formula: C13H18Br2N2OFormula Weight: 414.56 (Ambroxol HCl)Molecular Weight: 378.10CAS Number: 18683-91-5Administration: Tablets - 30 mg

Syrup - 5 ml containing 15 mgSigma Aldrich Catalog No. A9797

Toxicology:Extraction: n-butylchloride basic liquid/liquid drug extraction with an acid back extractionDetection: GC/NPD - Linearity (r2=0.99) from 0.10-2.0 ug/ml utilizing Carbinoxamine as IS

(*method not fully validated)GC/MS - 264, 279, 114, 319, 378 m/z

Elution Order: Paroxetine, Metoclopramide, AMBROXOL, Fentanyl, OlanzapineUV-VIS: Experimentally determined - Molar Absorptivity Coefficient at 244 nm in 0.1 N HCl

averaged 255 (10 mg/ml)

Case Study:In May 2008, a thirty-five year

old female with a recent diagnosis ofpneumonia, a history of depression, anda past suicide attempt (18 years ago byDrano® ingestion) was found unrespon-sive at home and subsequently diedupon arrival at the hospital. The au-

topsy results were inconclusive, there-fore, the cause and manner of death wasdeferred for Toxicology. The Toxicol-ogy results are represented in the adja-cent table. The Medical Examiner de-termined the cause of death to be Multi-ple Drug Intoxication with a mode ofdeath as Undetermined.

A M E R I C A N B O A R D O F F O R E N S I C T O X I C O L O G Y ( A B F T ) N E W S

ToxTalk Page 25

At the ABFT annual meeting in February 2008, thefollowing Directors were elected to a three-year term:

Yale Caplan, Ph.D., D-ABFT Daniel Isenschmid, Ph.D., D-ABFT Joseph Manno, Ph.D., D-ABFT Elizabeth Spratt, MS, D-ABFT

The above re-elected and newly elected Directors jointhe following Directors currently serving their respectiveterms:

Frederick W. Fochtman, Ph.D., D-ABFT Graham R. Jones, Ph.D., D-ABFT Barry K. Logan, Ph.D., D-ABFT H. Horton McCurdy, Ph.D., D-ABFT J. Rod McCutcheon, B.S., D-ABFT Robert J. Osiewicz, Ph.D., D-ABFT Theodore F. Shults, J.D., M.S, Public Member

The Board Officers elected in February 2008 to a one-year term are:

President, Marina Stajic, Ph.D., D-ABFT Vice Pres., Bruce Goldberger, Ph.D., D-ABFT Secretary, Daniel Isenschmid, Ph.D., D-ABFT Treasurer, Robert Middleberg, Ph.D., D-ABFT

It is a great honor and privilege to serve as the fourthPresident of the ABFT. In its first 33 years of existence, theABFT had only three presidents: Dr. Kurt Dubowski, Mr.Robert Cravey and Dr. Yale Caplan. Dr. Caplan was electedto the Board in 1984 and, after serving as Secretary/Treasurer,was elected President in 1989. He held this position until June30, 2008, longer than the combined terms of the first twopresidents and, most likely, longer than any other presidentever will. President Caplan led the Board to many significantaccomplishments. Most notably, the ABFT Laboratory Ac-creditation Program was developed with the goal to enhanceand maintain standards of practice of post mortem forensictoxicology and human performance forensic toxicology;ABFT has been among the first boards to be accredited byThe Forensic Specialties Accreditation Board (FSAB), formedin 2000 as an entity to objectively assess, recognize, andmonitor various professional boards that certify individualforensic scientists and other forensic specialists; the ForensicToxicology Specialist certification was established to includetoxicologists who have not met educational requirements forDiplomate certification; ABFT certification, originally limitedto the United States and Canada, has been extended interna-tionally.

Dr. Caplan retired from the office of President, butgraciously agreed to remain a member of the Board. The

Board has traditionally acknowledged outstanding ser-vices to the Board by presenting a plaque to the outgo-ing Director. In Dr. Caplan’s case, this plaque was pre-sented while he still serves on the Board, not only tocommemorate past distinguished service, but also in an-ticipation of future invaluable contributions. On behalfof all the Directors – THANK YOU, Yale!

The annual Certificant ceremony and receptionwas held during the SOFT meeting in Phoenix. Certifi-cants who passed the exam in Phoenix were introducedand certifications were presented to those who recentlyqualified and re-qualified, as well as to representativesof laboratories accredited by ABFT. There are cur-rently 24 laboratories participating in the ABFT Labora-tory Accreditation Program – 23 in the United Statesand one in Canada.

CONGRATULATION to eighteen toxicologistswho have successfully met all the requirements andjoined the ranks of ABFT certificants since March 2008:

By Marina Stajic, Ph.D., D-ABFTPresident, ABFT

Ilene K. Alford, FTS-ABFTDiane Boland, D-ABFTChris W. Chronister, D-ABFT

Timothy C. Fassette, FTS-ABFTMichele A. Glinn, D-ABFT

Veronica M, Hargrove, FTS-ABFTWilliam R. Johnson, FTS-ABFTJames C. Kraner, D-ABFTCarrol R. Nanco, FTS-ABFT

Daniel K. Richardson, FTS-ABFTJinee D. Rizzo, D-ABFT

Colleen E. Scarneo, FTS-ABFTJohn L. Stevenson, FTS-ABFTSaeed Touserkani, FTS-ABFTTara J. Valouch, FTS-ABFT

James H. Watterson, D-ABFTCarolyn M. Whitney, FTS-ABFT

Donna B. Zittl, FTS-ABFT

The ABFT Board has restructured the certifica-tion application, re-certification application and continu-ing education fees. Effective January 1, 2009, a non-refundable fee of $150 will be applied to all new appli-cations, replacing the previous $ 300 fee. The re-certification fee of $300 will no longer be required everyfive years. Instead, a fee of $ 100 will be required withthe annual submission of continuing education credits.Certificants will still need to submit a re-certificationapplication every five years in order to remain in goodstanding.

A . A . F. S . / S . O . F. T.J O I N T D R U G S &

D R I V I N G

C O M M I T T E E

N AT I O N A L S A F E T Y

C O U N C I L — C O M M I T T E E O N

A L C O H O L A N D O T H E R

D R U G S

A . A . F. S .N E W S

—T O X I C O L O G Y S E C T I O N

The Executive Board of the NSC/CAODmet Friday, October 31st at this years’ SOFTConference in Phoenix. Current committee offi-cers are: Jerry Landau, Chair; Mack Cowan ,Vice Chair; and Laura Liddicoat, Secretary.

The Executive Board announced thatLaurel J. Farrell will be the next recipient of theRobert F. Borkenstein Award. This distinguishedhonor will be presented at a banquet and cere-mony to be held Monday evening, February 16th

during the AAFS Annual Meeting in Denver.The recipient of the Borkenstein award

is one who has a minimum tenure of 25 years ofactive service in the area of alcohol/drugs andtraffic safety, has contributed to that field to a

degree that their achieve-ments are nationally recog-nized and has a minimum of10 years of active and pro-ductive involvement as avolunteer with the NationalSafety Council. SOFTmembers are well aware ofLaurel’s many contributionsand commitment to ourorganization. She has heldseveral offices within SOFTand spent countless hoursbehind the scenes at mostevery meeting doing a hostof duties in support ofSOFT as well as chairingworkshops and presenting.

The next meetingof the NSC ExecutiveBoard will be Sunday, Feb-ruary 15th and the FullCommittee will meet onMonday, February 16th.Exact time and locationdecided later. To access theCAOD policies, previousBorkenstein Award recipi-ents or learn more about thecommittee go towww.nsc.org and type inCommittee on Alcohol andOther Drugs under thesearch engine.

The AAFS / SOFT JointDrugs & Driving Committee willmeet again at the AAFS Meeting inDenver, on Wednesday, Feb. 18,2009, from 12:00 pm—2 pm. Thetime was changed so the meetingwould not conflict with the Borken-stein Award Dinner. The Drugs &Driving Special Session will be onThursday, February 19, from 8:30am—12:00 pm, and will feature nineplatform presentations. The com-mittee continues to focus on theDUID website project, which isnearing completion.

If you are interested in assistingwith the February 09 AAFS meeting inDenver, please contact Ken Ferslew(ferslew@mail.etsu.edu) or Phil Kemp(p_kemp@ocmeokc.state.ok.us).

The theme of this years’ AAFSmeeting is “Forensic Science: Envisioningand Creating the Future”.

The Tox Section will have specialsessions on Drugs and Driving and one onPediatric Toxicology. This year’s Tox.Section lectureship will feature Dr. DanielPiomelli, a prominent Professor of Phar-macology at U-Cal-Irvine. He will focuson the endocannabinoid signaling system.You don’t want to miss this.

Adam Negrusz reported that adatabase CD of all Tox Section abstractsfrom 1991 to 2008 is now available free ofcharge to AAFS Tox members.

The AAFS Toxicology Sectionwelcomes new members. Those existingmembers needing to update their member-ship to Fellow should see one of the Sec-tion Officers.

TO X I C O L O G Y - B I T S & P I E C E SSubmitted by Section Editor, J. Robert Zettl, MPA

Page 26 Volume 32, Issue 4

Serving as the Editor of the JAT Special Edition2008 was absolutely a wonderful opportunity for profes-sional development, personal growth, and it would nothave been possible without the confidence provided byPresident Christine Moore Ph.D., Tinsley Preston, JulieWeber-Roark, and Bruce Goldberger, Ph.D.

As you read this today, the holiday season iswell upon us and I can reflect back and finally say,“Whew, it’s over!” What a whirlwind it was, managingand finalizing twenty-nine manuscripts in a little overthree-month period. Yes, it was a lot of work, but I lovedevery minute of it, especially my Spring Break in CaboSan Lucas, Mexico critiquing manuscripts by the pool!(There’s a visual – NOT!) All fun aside, the success ofthis Journal could not be possible without the significantcontributions of all the SOFT Authors and the very timelyreviews by my wonderful colleagues and friends. Again,I cannot thank you all enough for having the trust in meto represent the SOFT organization as the 2008 SpecialEdition JAT Editor. Have a great 2009 New Year!

Dan Anderson

2 8 T H S P E C I A L E D I T I O N O F J O U R N A L

O F A N A L Y T I C A L T O X I C O L O G Y

F A R E W E L L S

LtCol. John Thomas Cody, Jr. Ph.D.(Ret) D-FTCB

Long time SOFT member, LtCol. John ThomasCody Jr. Ph.D. (RET) passed away in October after a threeyear battle with colon cancer on October 3, 2008 in SanAntonio, Texas. He is survived by his daughters Catherineand Elizabeth Claire of San Antonio; a brother DanielCody of Atlanta, GA.; two sisters Kathleen Cecil ofLivingston, NJ and Lenore Monks of Jackson, PA. Johnearned a BS in Biology from Iowa Wesleyan College, anMS in Science Education and a PhD in Biochemistry fromthe University of Iowa. He served in the USAF for over 27years and was the Consultant to the Air Force SurgeonGeneral on Drug Testing for the majority of those years.John retired as the Commander of the Drug Lab at BrooksCity-Base. John was an original officer and co-founder andan active member of the Chromosome 18 Registry & Re-search Society. John served as Chair of the SOFT MS/MSGuidelines Committee and was a frequent contributor toJAT. He authored several articles on the excretion profileof amphetamines. He was immediate past President of theForensic Toxicologist Certification Board, Inc. (FTCB)and was chairman of the Forensic Drug Toxicology Exami-nation Committee of the FTCB at the time of his death.His contributions and presence will be sorely missed.

The following memorial was written by long time friend, Bill Ander-

son.

In October of this year a long-standing memberof SOFT, Richard W. Prouty, passed away. Dick, as hewas known to everyone, was a long-standing member andPast President of SOFT. He obtained his initial trainingin toxicology while attending Auburn University. Aftergraduation he entered the United States Army and servedas a toxicologist while stationed in Japan. After leavingactive duty, he attended the University of Maryland inBaltimore. From there, he traveled to North Dakota andassumed the position of State Toxicologist and adjunctprofessor of Toxicology and Pharmacology at North Da-kota State University. He subsequently served as theChief Toxicologist for the Office of the Chief MedicalExaminer for the State of Oklahoma. During his career,Mr. Prouty authored several papers, but he is especiallyremembered for his pioneering work concerning the post-mortem redistribution of drugs. He actively participatedin several professional organizations. He served as Presi-dent or Section Chair of AAFS, SOFT, and SAT and hewas actively involved in ABFT. Dick was an avid sports-man and outdoor enthusiast; he pursued these activitiesup until his death. He enjoyed people and he never met astranger. He will be missed by all, but his legacy contin-ues via the many toxicologists that he helped train andmentor.

Richard W. Prouty, B.S., D-ABFT

NE W BO O K SOn Site Drug Testing, edited by BruceGoldberger and Amanda Jenkins

Today on-site drug testing is usedwidely in the workplace, the justice system(probation and parole), hospital emergencyrooms, physician offices, and rehabilitationprograms. Scientists and forensic toxicolo-gists critically evaluate the on-site devicescurrently available and share their valida-tion studies. For each device, the expertcontributors discuss its principles, materi-als and reagents, procedures, interpretation,and performance. Sample collection, adul-teration, standards, and legal requirementsare addressed. This book provides a firmbasis for choosing the best test device andtechnique most suited to their purpose.

Published by Humana Press @$115 (Hardcover, 304 pages).

Garriott’s Medicolegal Aspects of Al-cohol, 5th Edition, edited by JamesGarriott

Alcohol related investigationand litigation typically pertains to ar-rests of drinking drivers, but also in-cludes industrial accidents, public trans-port accidents, and violent crimes. Themedicolegal aspects of alcohol are com-plex topics because so many differentcomponents are present in alcohol-related criminal and civil cases. This5th Edition provides updated sciencewith specialized expertise and expandednew sections including prosecution anddefense of DUI cases.

Available from Lawyers &Judges Publishing @ $139(Casebound 536 pages, 8-1/2”x11”,Copyright August 2008).

ToxTalk Page 27

Special thanks to Dr. Leo Dal Cortivo who hasmade a generous donation to the SOFT ERA fund inmemory of Richard Prouty.

Future S.O.F.T. Meeting Info

2009: Oklahoma City, OK………Oct. 18-23, 2009…………..Phil Kemp, Dennis McKinney

2010: Richmond, VA……………Oct. 18-22, 2010….…..Michelle Peace, Lisa Tarnai Moak

2011: San Francisco, CA………...Aug. 29-Sep. 2, 2011………….………….Nikolas Lemos

2012: Boston, MA……………….June 30-July 6, 2012….……….……...…Michael Wagner

2013: Orlando, FL……………….to be determined……………………….Bruce Goldberger

Committee Committee Chair

Nominating…………………………Diana Wilkins, Ph.D.Membership……………………..….Sarah Kerrigan, Ph.D.Strategic Planning…………………..Bradford Hepler, Ph.D., DABFTBudget, Finance, and Audit………...Robert Turk, Ph.D., DABFTToxTalk Co-Editors………....……...Yale Caplan, Ph.D., DABFT

Vickie Watts, M.S.ByLaws……………………...……..Yale Caplan, Ph.D., DABFTPublications (JAT Special Issue) ….Dan Anderson, M.S., ABFTAwards...…………………………...Philip Kemp, Ph.D., DABFTDrugs & Driving…………...………Jennifer Limoges, M.S., DABCMeeting Resource…………...……..Anthony Costantino, Ph.D., DABFTPolicy and Procedure…………...….William Anderson, Ph.D.SOFT Internet Web-Site……...……Bruce Goldberger, Ph.D., DABFTContinuing Education………...……Ann Marie Gordon, M.S.Laboratory Guidelines…...………...W. Lee Hearn, Ph,D.Ethics………………………...…….Aaron Jacobs, Ph.D.Drug Facilitated Rape &

Sexual Assault………...………..Marc LeBeau, Ph.D.MS/MS Guidelines………………...Anthony Costantino, Ph.D.

February 1 for March Issue

May 1 for June Issue

August 1 for September Issue

November 1 for December Issue

Phil Kemp, Co-Hostp_kemp@ocmeokc.state.ok.us

Dennis McKinney, Co-Hostdmckin321@aol.com

John Soper, Workshop Chairjwsoper@integrity.com

Jesse Kemp, Workshop Comm.jkemp@arlok.com

Dave von Minden,Scientific Program Chairdvonminden@uco.edu

Robert Bost, Registrationrbost@uco.edu

2 0 0 8 S . O . F. T. C O M M I T T E E C H A I R S

ToxTalk Deadlines for Contributions

S.O.F.T. Administrative OfficeOne Macdonald Center1 N. Macdonald St., Suite 15Mesa, AZ 85201

Phone: 888-866-SOFT (7638)Fax: 480-839-9106E-mail: ToxTalk@soft-tox.org

Society of ForensicToxico logists , Inc.

ToxTalk is the official publication of the Society of Forensic Toxicologists, Inc., mailed quar-terly (bulk mail) to its members. It is each member’s responsibility to report changes ofaddress to the SOFT Administrative Office. Non-members may receive ToxTalk for $15 percalendar year. Checks payable to SOFT may be mailed to the SOFT Administrative Office.To submit articles or address ToxTalk issues please email to ToxTalk@soft-tox.org.

The Renaissance Hotel is ready to begin acceptingreservations. The on-line link is:

http://www.marriott.com/hotels/travel/OKCBR?groupCode=socsoca&app=resvlink&fromDate=10/16/09

&toDate=10/24/09

Mark you calendars forSOFT 2009 in Oklahoma City, Okla-homa! From October 18th throughOctober 23rd, the capitol city of Okla-homa will be at your feet, combiningthe best of scientific environmentswith the unique and lively entertain-ment that Oklahoma City is knownfor. The selected venue for the 2009annual meeting in Oklahoma City isthe Cox Convention Center. The offi-cial meeting hotels are the Down-town Renaissance Hotel and theCourtyard by Marriott.

Phil Kemp and DennisMcKinney, our 2009 meeting co-hosts, welcome the SOFT member-ship to another science packed, funfilled week of special events. Within

a block of the meeting site and hotelsis the historic Bricktown district, withshopping and restaurants galore allconnected by a mile-long canal. Afleet of water taxis provide a means ofseeing the sites. A city trolley alsoruns through the downtown districtconnecting popular attractions for$0.25. In addition, there are horse andbuggy rides through the middle ofBricktown.

Oklahoma City is geographi-cally located near the center of ourcountry and easily accessible by auto,air, and Amtrak service. The popula-tion of the metro area is 1.1 million.Visitors can expect a mild climateduring the week of the SOFT meeting,October 19 – 23, 2009. Temperatures

range from the upper 40’s at night tothe 60’s during the day.

If the old west trips your trig-ger, then Oklahoma City is the rightplace for you. The National Cowboyand Western Heritage Museum has oneof the most complete collections ofWestern art in the world. It combinesthe influences of the American cowboyand Native American cultures to pre-sent a fantastic picture of the Okla-homa heritage. Take a stroll around thehistoric Stockyards City district neardowntown that features a variety ofshops and eateries.

The SOFT 2009 committee isin full swing planning a great meetingso we look forward to seeing you inOklahoma City!

Tom Kupiec, Events &Scientific Program Comm.tkupiec@arlok.com

Laurel Farrell, Treasurerljfarrellco@msn.com

Jeri Ropero-Miller,Exhibitor Liaisonjerimiller@rti.org

Peter Stout,Exhibitor Liaisonpstout@rti.org

Bruce Goldberger,SOFT Webmasterbruce.goldberger@ufl.edu

SOFT 2009 Planning Committee