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"Some of the tests take days, weeks, months," says Alan Hall, MD, a board-certified toxicologist and consultant in Laramie, Wyo. The final toxicology report, he says, draws not only from multiple test results and confirmation of the results, but also on the clinical experience of the toxicologists and pathologists involved in the investigation, as well as field work.
Here is what toxicology tests include, why they take so long, and why they can be tricky.
What is toxicology testing?
The toxicology testing performed after a person's death is known as forensic toxicology testing or postmortem drug testing.
That's different from clinical toxicology, according to the College of American Pathologists. This is the drug testing an emergency room doctor would be likely to order, for instance, if a patient shows up with signs and symptoms of drug overdose or abuse.
Other types of toxicology testing include workplace drug testing, which also screens for drugs of abuse, and athletic drug testing in sport programs, which detect banned substances or drugs that enhance performance.
The toxicology report that is eventually issued in forensic toxicology testing "is the result of the lab procedures identifying and quantifying potential toxins, which include prescription medications and drugs of abuse and interpretations of the findings," says Howard S. Robin, MD. He is the medical director of laboratory services at Sharp Memorial Hospital in San Diego and is a board-certified pathologist.
Toxicology testing is part of the autopsy report, Robin says. "A complete autopsy should have some level of toxicology studies."
How are forensic toxicology tests done?
At the time of the autopsy, collection of blood, urine, and tissue samples is done in preparation for the toxicology tests, says Barbarajean Magnani, PhD, MD, chairwoman of the Toxicology Resource committee for the College of American Pathologists. She is also vice-chair of the department of pathology and laboratory medicine at Tufts Medical Center, Boston.
"We collect blood from different areas, such as the femoral vein [in the leg] and heart blood," she tells WebMD. That's because the concentration of drugs can be different, she says, so comparing the concentrations can boost accuracy.
''We collect urine if there is any [in the body] and also use tissues [to test],” Magnani says.
Specimens taken for forensic toxicology testing routinely include, in addition to blood and urine, tissue samples from the liver, brain, kidney, and vitreous humor (the clear ''jelly" found in the eyeball chamber), according to information from the College of American Pathologists. Samples of the stomach contents and bile, a digestive juice secreted by the liver, are also collected routinely.