Postmortem diagnosis and toxicological validation of illicit substance use
| Autor: | Marilyn A. Huestis, Elin Lehrmann, William D. Darwin, Amy Deep-Soboslay, Mary M. Herman, Thomas M. Hyde, William J. Freed, Zoan R. Afanador, Jean Lud Cadet, Ross H. Lowe, Allan J. Barnes, Gloria Gallegos, Joel E. Kleinman |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Phencyclidine Abuse
Drug Marijuana Abuse medicine.medical_specialty Substance-Related Disorders media_common.quotation_subject Medicine (miscellaneous) Sensitivity and Specificity Article Cocaine-Related Disorders Cerebellum medicine Humans Medical History Taking Psychiatry Oligonucleotide Array Sequence Analysis media_common Pharmacology Postmortem Diagnosis biology Illicit Drugs business.industry Addiction Medical examiner Opioid-Related Disorders medicine.disease biology.organism_classification Body Fluids Substance abuse Psychiatry and Mental health Opioid Autopsy Cannabis business Coroners and Medical Examiners Hair medicine.drug |
| Zdroj: | Addiction Biology. 13:105-117 |
| ISSN: | 1369-1600 1355-6215 |
| DOI: | 10.1111/j.1369-1600.2007.00085.x |
| Popis: | The present study examines the diagnostic challenges of identifying ante-mortem illicit substance use in human postmortem cases. Substance use, assessed by clinical case history reviews, structured next-of-kin interviews, by general toxicology of blood, urine, and/or brain, and by scalp hair testing, identified 33 cocaine, 29 cannabis, 10 phencyclidine and 9 opioid cases. Case history identified 42% cocaine, 76% cannabis, 10% phencyclidine, and 33% opioid cases. Next-of-kin interviews identified almost twice as many cocaine and cannabis cases as Medical Examiner (ME) case histories, and were crucial in establishing a detailed lifetime substance use history. Toxicology identified 91% cocaine, 68% cannabis, 80% phencyclidine, and 100% opioid cases, with hair testing increasing detection for all drug classes. A cocaine or cannabis use history was corroborated by general toxicology with 50% and 32% sensitivity, respectively, and with 82% and 64% sensitivity by hair testing. Hair testing corroborated a positive general toxicology for cocaine and cannabis with 91% and 100% sensitivity, respectively. Case history corroborated hair toxicology with 38% sensitivity for cocaine and 79% sensitivity for cannabis, suggesting that both case history and general toxicology underestimated cocaine use. Identifying ante-mortem substance use in human postmortem cases are key considerations in case diagnosis and for characterization of disorder-specific changes in neurobiology. The sensitivity and specificity of substance use assessments increased when ME case history was supplemented with structured next-of-kin interviews to establish a detailed lifetime substance use history, while comprehensive toxicology, and hair testing in particular, increased detection of recent illicit substance use. |
| Databáze: | OpenAIRE |
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