Toxicology: What is Routine for Medicolegal Death Investigation Purposes?

Drugs, whether illicit, prescription, or over-the-counter, cause or contribute to death in many cases falling under medical examiner or coroner jurisdiction. Thus, toxicological analysis often plays a critical role in the determination of the cause and manner of death. There is significant variability, however, between medicolegal death investigation systems with respect to standards of practice for the performance of “routine” toxicological analysis. Depending on a multitude of variables, including the size of the office, caseload, population base, budget, laboratory testing panel, pathologist philosophy, and personnel availability, routine toxicological analysis may range from no testing at all, to minimalistic urine screening, to complete quantification of all potential toxins identified on screening assays. As physicians, forensic pathologists are trained to search for the correct diagnosis in every case, every time. When establishing protocols and defining routine toxicological analyses, however, the pathologist is often forced to consider the pros of thoroughness and accuracy, versus the cons of cost and diminished timeliness of results. A rational approach to forensic toxicology is offered in an attempt to combine efficiency and frugality with acquisition of essential medicolegal data.