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The Salt Lake Tribune (UT)
October 6, 1997 Author:
LEE SIEGEL THE SALT LAKE TRIBUNE
Who gets the call when dope addicts overdose and die, when drunken drivers cause fatal wrecks and when employers want to make sure workers aren’t high? Forensic toxicologists. These are folks who test urine, blood, saliva, sweat and hair for drugs and poisons. They help determine cause of death and ensure addicts and psychiatric patients take needed medications. They find fatal interactions among prescriptions. They look for drug abuse. They help jail intoxicated motorists. “We’re usually fighting with the attorneys in court,” joked Vickie Watts, president of the Society of Forensic Toxicologists (SOFT) and a 20-year veteran of crime labs and medical examiner offices in Montana and Arizona. Watts, now a consultant in Mesa, Ariz., is joining about 400 colleagues at Snowbird for SOFT’s annual meeting, which opened Sunday and runs through Thursday.
Among the more than 80 scheduled reports and studies: — Toxicologists from China and Switzerland compared hundreds of poisoning deaths. They found Swiss suicide victims prefer to inject an overdose of narcotics, while the Chinese tend to favor swallowing readily available farm pesticides. Meanwhile, French toxicologists analyzed suicidal overdoses of the malaria drug chloroquine. Eighteen healthy volunteers smoked marijuana or inhaled cocaine to reveal more about how blood levels of the drugs relate to behavior and symptoms. Stephen Heishman of the National Institute on Drug Abuse and Dennis Crouch of the University of Utah found marijuana raised volunteers’ heart rates and impaired performance on sobriety tests. Cocaine raised the heart rate and blood pressure but improved performance on field-sobriety tests.
Silicone breast-implant makers and many experts say implants pose no health hazard. Houston toxicologist Ernest Lykissa said his experiments suggest a potential threat. Lykissa and colleagues at Baylor College of Medicine showed silicone gels and platinum metal slowly leak from implants, and the leaking material injures rat and human cells — at least in the laboratory. Toxicologists from Roche Pharmaceuticals, which sells the sleeping pill Rohypnol overseas, assessed their ability to test blood and urine for the drug, which has been abused as a “date-rape drug.” The method might help in criminal cases. New Zealand’s Institute of Environmental Science tested marijuana seized by police over the years. It found that, contrary to many reports, marijuana there is not more potent than it was 20 years ago.
Wisconsin’s Marshfield Laboratories showed a common test falsely registers positive for amphetamine stimulant abuse if someone actually is taking fen-phen, the weight-loss combination of phentermine and the recently recalled fenfluramine. However, University of Utah researcher David Andrenyak modified a blood test for methamphetamine so it can detect fenfluramine. Death will be a common theme at the convention. “A lot of times it’s not obvious what caused a person to die,” said Capt. Kabrena Goeringer, a toxicologist at the U.S. Air Force Academy in Colorado. “Even if you measure very high concentrations of a drug in a person’s blood, it may or may not have caused their death.” Goeringer and Barry Logan of the Washington State Toxicology Laboratory reviewed deaths of 15 people with the antidepressant trazadone (Deseryl) in their bodies, and 20 others whose bodies contained Zoloft, another antidepressant. None of the deaths could be blamed solely on the antidepressants, but several were caused by interactions with other medications, Goeringer said. Other antidepressant problems on the program include a fatal interaction in Tennessee between Prozac and the schizophrenia drug Clozaril, and two overdose deaths on Paxil in Orange County, Calif. Some deaths pose mysteries. A 48-year-old alcoholic man was found dead at home, face down on a carpet, after he drank alcohol, rubbing alcohol and possibly nail-polish remover. Peter Singer of the medical examiner’s office in Edmonton, Canada, wondered why the man had high alcohol levels in his eyeball fluid and in the blood in his heart, but not in other blood or in urine. The answer: The man binged on booze so quickly that little reached his bladder before he died. In his death throes, he threw up, then inhaled some vomit, allowing alcohol to move from his lungs to heart. His eyes absorbed alcohol from vomit on the carpet.
A University of Tennessee report said 26 people taking fen-phen for weight loss came to a Memphis emergency room this year with abnormal heartbeats, hypertension, palpitations and other symptoms. Two had heart attacks and one died of an aortic aneurysm, or split aorta. Kari Blaho, emergency medicine research director, said doctors and toxicologists can’t prove fen-phen responsible, but the patients were otherwise healthy. Nine junkies came to a Detroit emergency room last year after overdosing on heroin mysteriously cut with scopolamine, which normally is prescribed to prevent spasms and motion sickness. After doctors neutralized the heroin, the scopolamine made patients agitated and violent, said Laureen Marinetti-Sheff of the Michigan State Police Crime Laboratory. She said the heroin-scopolamine combo – called “superbrick” – also caused problems in Philadelphia and Baltimore.
The Milwaukee County Medical Examiners’ Office reviewed the accidental death of a 36-year-old Wisconsin man with a history of opiate abuse and severe back pain. The man died when he gave himself a morphine overdose from a pump designed to deliver the drug directly to his spinal cord for pain. Toxicologists also analyze drug tests to make sure addicts in treatment programs stay on methadone or other heroin substitutes and stay off illegal drugs. French addicts are prescribed oral doses of buprenorphine as a heroin substitute. Marc Deveaux and colleagues from France’s Institute of Legal Medicine reviewed overdose deaths of 15 addicts who instead injected buprenorphine. Deveaux urged better supervision of the program. Physician-toxicologist Doug Rollins and others at the University of Utah’s Center for Human Toxicology are doing research on hair analysis as a way to detect drug abuse – a method Rollins doesn’t yet consider reliable. If and when it is, hair testing might be used to monitor addicts during treatment, said Rollins, the center’s director. Alan Spanbauer and others at the Utah center demonstrated a sensitive new method for testing blood for buprenorphine and Narcan when the two drugs are used together to treat addicts. Chemistry Professor Milton Lee said he and others at Brigham Young University devised a faster, more sensitive mass spectrometer to identify as little as one part drug in a trillion parts of blood. Lee said the patented device, now being developed by a Provo company, was tested on amphetamines, cocaine and heroin provided by the Utah State Crime Laboratory.
Some people try to beat drug tests that are required by many employers. Toxicologists study methods used to adulterate urine samples in hopes of learning to counteract them. Gregory Grinstead of Wisconsin’s Marshfield Laboratories found bleach, ammonia and strong alkalines can interfere with a common lab test for drugs. Vinegar, salt and Visine eye drops fouled urine tests to detect THC, the active ingredient in marijuana. Other studies showed products named THC Free and Klear can invalidate tests for marijuana and certain other drugs. But Francis Urry and colleagues at Salt Lake City’s Associated Regional and University Pathologists Laboratories showed Klear adds far more nitrites to urine than other nitrite sources, including some infections and certain breakdown products from medications. The difference in nitrite levels in urine could help labs detect adulterated samples.