[PDF] Criminal Law Section: Toxicology and the Courts

41169_76thspringconf_tox_science_law.pdf

Toxicolog

y and the Courts:

Understandin

g and Inter p retin g the gpg

Scientific Evidence

~

Jennifer WilsonJennifer

Wilson

Program Coordinator, Toxicology Unit

Forensic Sciences DivisionMichigan State PoliceMichigan State

Police

T oxicologyoxicology • Toxicology:the study of the adverse effects of chemicals on or g anisms. g •Primary Tenet "All substances are poisons; there is none that is not a poison.

The dose differentiates a poison from a remedy".

PlP arace l sus Fiil ild h d fhdi ii • F orens i c tox i co l ogy i nc l u d es t h e stu d y o f t h e di spos i t i on of drugs in the body and their effects on function. PP urpose To analyze biological samples (blood, urine, breath) for alcohol and drug content and tobreath) for alcohol and drug content , and to assist courts and medical examiners to establish their likel y effects on the sub j ect. yj MttM arque tt e

Grayling

Bridgeport

Sterling Hts

Lansing

Grand Rapids

Sterling

Hts

Northville

MSP Toxicology UnitMSP

Toxicology

Unit

Lansing Laboratory

Analysis of blood, urine and other biological samples for alcohol and drugs of abuse. Anal y sis of bevera g es for alcohol content. yg

Toxicology Supervisor:Mr. Geoffrey French

Toxicology Program Coordinator:Ms. Jennifer Wilson

Staff of 10 forensic scientists and 1 technician

> 16,000 alcohol and 5,000 drug analyses per year.

Si dLS

c i ence an d L aw

Scientific World

View

Scientific

World - View The data is what it is.

R.A. Ludwig

Legal World

- View Legal World View It depends on what the definition of "is" is.

W. Clinton

Drugs Analyzed by MSP Toxicology

•Alcohol •Amphetamines•GHB •Hallucinogens•Antidepressants •Benzodiazepines •

Barbiturates

•Inhalants •Muscle Relaxants •

Narcotic Analgesics

Barbiturates

•Cannabinoids •Carbon Monoxide

Narcotic

Analgesics

•Non-prescription drugs •Opiates hl •Cocaine & metabolites •K2 or Spice •Bat h sa l ts •Other prescription and street drugs

MSP Laboratory OperationsMSP

Laboratory

Operations

1.Samples collected in cases of OUIL/OUID, CSC,

ME requests, other felonies or suspicious circumstances.2.All samples analyzed for alcohol content. Alcohol report issued (2-3 weeks).3.If requested, drug analysis performed.Dru

g toxicolo gy re p ort issued (

2-8 months

) . ggyp ( )

4.Samples will be discarded no less than two years after

receipt of samples.receipt of samples.

Number of Alcohol Cases AnalyzedNumber

of

Alcohol

Cases

Analyzed

Alcohol Cases Per Year

160001700014000150001200013000

Per Se OWI law passed

1000011000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Y ea r A lcohol Gas Chromatograph

Alcohol Gas Chromatograph:Alcohol

Gas

Chromatograph:

Autosampler

Alcohol Testing MethodsAlcohol

Testing

Methods

Gas Chromatography

MSP Toxicology Laboratory.

Used for blood, urine, biological and beverage samples. Procedure: blood heated, ethanol evaporates, air (headspace) sampled. Advantages: clean, only volatiles will be detected. Specific: discriminates ethanol from isopropanol, etc.

State of the art for forensic labs.

Anal y st Techni q ue yq It is standard lab practice for all analysts always to: • Check the tube labels a g ainst the case file to be sure the ri g ht sam p le ggp was used; also check dates, times, spelling of names, etc. • Label all glassware. • Double-check all numbers and labels when removing sample from one tube to another.• Rinse or change pipettors and tips between samples. • Handle onl y one sam p le at a time. yp • Record anything unusual about the sample or its handling.

Kim Doing Alcohol AnalysisKim

Doing

Alcohol

Analysis

Blood and Urine Alcohol Analysis

Procedures:• Each sample is analyzed twice, once each on two separate instruments• The results must agree within 0.01 •

The lower number is reported.The

lower number is reported. • The instruments are calibrated weekly and multiple controls are run with every batch of samplescontrols are run with every batch of samples .

The MSP alcohol

p ro g ram has been described as pg one of the strongest in the country.

Analytical Procedures: AlcoholAnalytical

Procedures:

Alcohol

What's the "error rate" of your method?

What's the variability of your result?

Nhhi iill" "

• N o suc h t hi ng, stat i st i ca ll y, as " error rate " . • The variability allowed between instruments is 0.01 • The standard deviation between duplicate samples

run on the same instrument is 0.002What's the limit of detection of your method?• .001.• The third digit is truncated (.009 reported as .00)

Uncertainty in Tox Measurements

Soon we will be required by ASCLD to report ourSoon we will be required by ASCLD to report our "uncertainty measurement" on our alcohol reports. •Will be a +/- value followin g the blood alcohol result. g •Takes into account all possible error in our method. •Is available for defense attorneys and prosecutors at this time upon request. •It is likely that it will eventually be reported on the alcohol report for every casereport for every case . •Already is being reported for drug cases as a +/- percentage .

Blood vs SerumBlood

vs Serum What is the difference between blood and serum?What is the difference between blood and serum? Whole Blood: As it is drawn from the body; contains cells, water, p roteins. Red, more viscous than water or serum. Serum:Cells, most proteins removed; water fraction of blood

Clear yellowish Most hospitals analyze serumClear

, yellowish . Most hospitals analyze serum . Serum has more water per volume than blood, so the alcohol content will be higher in serum. The amount by which it will be higher dd hh i( fhbldhihill)d epen d s on t h e h ematocr i t ( percentage o f t h e bl oo d w hi c h i s ce ll s ) .

MSP uses a conversion factor of 16%, or 0.116:

0.116

g /dL serum ~ 0.100 d/dL whole bloo d g R etro g rade Extra p olation gp

Definition:Cl l i f bl d l hll l li iC

a l cu l at i on o f a bl oo d a l co h o l l eve l at an ear li er t i me from that of a blood sample taken at a later time.

Information Required:Information

Required:

• Times when subject began and finished drinking •

What and how much subject drankWhat

and how much subject drank • Food eaten • Weight • Drinkin g ex p erience gp Resultsare given as a range of possible values and are often challenged by defense experts.

Blood Alcohol Challenges:Blood

Alcohol

Challenges:

Procedural

A nalyst and Instrumentation • What ' sthe " error rate " of your method? Whats the error rate of your method? •Too many (or not enough) entries in maintenance logs •Calibration and/or controls not used enough or correctly

I t t tti i d t

• I ns t rumen t se tti ngs i na d equa t e •Repeat analyses mean you make a lot of mistakes •Blood tube may have been contaminated •Stopper may have been dried out •Chain of custody inadequate: who knows what the

Post Office did to the kit en route?Post

Office

did to the kit en route? •How well is the analyst really trained?

Alcohol Challen

g es: Inter p retation gp

My client...

- drank all the alcohol right before leaving the bar - drank after the accident - took an hour to absorb one beer - only had one drinkonly had one drink - wasn't the driver SS o: - the lab report is wrong - the lab report doesn't matter - s/he was below 0.08 at the time of the stop.

Til UiD TiT

ox i co l ogy U n i t D rug T est i n g

Purpose:

To discuss the different types of drug tests

available , and the stren g ths and limitations ,g of each.

To determine how to interpret the

information each t yp e of test p rovides. yp p

What Difference Does

SlMk? a S amp l e M a k e ?

Blood: indicates what is currently in the system

- what the central nervous system is being exposed to. - indicates possible or probable impairmentindicates possible or probable impairment .

Urine:indicates prior exposure

- may or may not correlate with impairment - drugs can show up in urine after they have been cleared from the blood - no magic threshold for "recent" vs "residual" urine level.

Which Test Was Done?Which

Test Was Done?

Hospital Lab •

If from patient treatment regimen most likely immunoassay only • If from patient treatment regimen , most likely immunoassay only . •Results (blood or urine): "Cannabinoid Positive"

MSP Lab•

Immunoassay screen, GC/MS confirmation.

•Results:

Blood:THC and THC-COOH present or

THC-COOH only present

Ui THC

COOH l t

U r i ne: THC - COOH on l y presen t .

What Dru

g s Tested f or? gf •Dipsticks: panel only. •

Immunoassay: panel onlyImmunoassay:

panel only •GC/MS: Most drugs, depending on the procedure used.BUT WILL h l bl kf d ? BUT : WILL t h e l a b l oo k f or most d rugs ?

Private labs

: you get only what you pay for.

If did 't k f S th ll 't t ti ll l k f itIf

you did n 't as k f or S oma, th ey usua ll y won 't au t oma ti ca ll y l oo k f or it .

Crime labs:

MSP will generally look for anything the assay can detect.

Caveat: may take longerCaveat:

may take longer . D ru g Anal y sis gy

Samples are analyzed twice by two different techniques:Screening Test (Randox Immunoassay BiochipArray)Screening

Test (Randox

Immunoassay

Biochip

Array)

••Detects classes of drugs• Disting ishes negati e from pres mpti e positi e samples •

Disting

u ishes negati v e from pres u mpti v e positi v e samples Confirmatory Test (GC/MS)••Sensitive: detects very small amounts of drug in a sample •

Specific: distinguishes individual drugsSpecific:

distinguishes individual drugs •State of the art, standard for forensic laboratories.

Testin

g Basics g

3 Steps in Drug Testing:3

Steps in Drug

Testing:

•Sample preparation •Conducting the test•Analyzing the data

Solid Phase ExtractionSolid

Phase

Extraction

Solid-phase extraction: removal of drugs from sample matrix by binding to absorbent material in the extraction column. Rest of sample discarded.

GC/MSGC/MS

•GC/MS: versatile and specific. Many different applications (environmental, academic, forensic).•Different procedures exist per drug or type of drug: -THC GHB - GHB - Most street/Rx drugs - Benzodiazepines (Valium, Xanax, Ativan) - Opiates, cocaine metabolites, amphetaminesOpiates, cocaine metabolites, amphetamines •Confirmation of all the drugs in a sample can require 3 or 4 procedures de p endin g on the needs of the case. pg

Gas Chromatograph/Mass SpectrometryGas

Chromatograph/Mass

Spectrometry

Confirmatory Tests (GC/MS)Confirmatory

Tests (GC/MS)

••Sensitive: detects very small amounts of drug in a sample (< 1 ng/ml).•Specific: distinguishes individual drugs and their metabolites.

•State of the art, standard for forensic laboratories.•Procedure: - Drug extracted from the blood/urine sample - Extract injected into the GC/MS - The sample is bombarded with an electron beam which breaks the drug molecule into pieces. - Pieces = mass spectra, or molecular "fingerprint" unique to each drug. •Spectra compared to databases: NIST, reference books, in-house libraries.

Gas Chromatograph/Mass SpectrometerGas

Chromatograph/Mass

Spectrometer

GC/MS:A

utosam p le r p I denti f ication o f Dru g s ffg Identification of DrugsGC/MS generates a molecular " fingerprint " of a drug that GC/MS generates a molecular fingerprint of a drug that can be matched to a database of mass spectral data: 477

Mass spectrum

of THC-COOH (PFP derivative,SIM mode MSP 477
489
625
640
SIM mode , MSP protocol).

Molecular

" fingerprint " of THC COOH

Molecular

fingerprint of THC - COOH .

Nothing else looks like this!

I denti f ication o f Dru g s ffg

Identification of Drugs

GC/MS

g enerates a molecular "fin g er p rint" of a dru g that ggpg can be matched to a database of mass spectral data: 8282
182

303Mass spectrum

of cocaine.

Molecular

" fingerprint " of cocaine

Molecular

fingerprint of cocaine .

Nothing else looks like this!

I nter p retation: Dru g s pg

Misidentification of Drugs: You mistook Tylenol for THC!Drug identification is NOT subjective! Based on:1. Database match of mass spectral data.

2. Agreement between screening and confirmatory tests.3. Presence of metabolites.4. Training, experience and proficiency of analyst.

I nter p retation: Dru g s pg

Misidentification of Drugs2.

Agreement between screening and confirmatory tests. 2.

Agreement

between screening and confirmatory tests. If the two didn't agree, the sample would automatically be re-analyzed.

3. Presence of metabolites.

Metabolites arise only within the body after ingestion4. Training, experience and proficiency of analyst.

MSP l t t k 1

2ffltii tt

MSP ana ly s t s t a k e 1 - 2 y ears o f f orma l t ra i n i n g , cons t an t proficiency testing. Defense experts we know don't do mass spectral analysis.

Mass Spectrometers

Number of Drug Cases AnalyzedNumber

of Drug Cases

Analyzed

Toxicology Cases Per Year

55006000650040004500500055002500300035004000

Blood THC analysis instituted

in Dec 2001

Per Se OWI law passed

Oct 1, 2003

1500

20002500

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

in Dec . 2001
Year Dru g s Found b y MSP ( 2011
) gy() Drug %ofCases Drug %ofCases Drug % of Cases Drug % of Cases

THC56Clonazepam4

Alprazolam24Zolpidem2Hydrocodone16Cyclobenzaprine 2

Cocaine 10Methamphetamine 2

Morphine12Trazodone 2S

10 Fl ti 2 S oma 10 Fl uoxe ti ne 2

Diazepam8Butalbital1

Diphenhydramine 7Phenobarbital1Codeine

6

Venlafaxine

1

Codeine

6

Venlafaxine

1

Methadone 5Propoxyphene1

Amphetamine5Sertraline1Citalopram

4 MDMA < 1

Citalopram

4 MDMA 1

Oxycodone4Fentanyl<1

Tramadol3

Drug ConsumptionDrug

Consumption

Absorptioninto the blood stream.

Distributionto organs and tissues.

Metabolismto inactive compounds.

Eliminationfrom the body.

Drugs and ImpairmentDrugs

and

Impairment

CNS Depressants

CNS Stimulants

CNS

Depressants

CNS

Stimulants

alcoholcocainebdii ht i b enzo di azep i nesamp h e t am i nes barbiturates hallucinogens opiates narcotic analgesics

GHBcarisoprodolcarisoprodol

marihuana inhalants All depressants share some symptoms of intoxication, as do all stimulants.

AntidepressantsAntidepressants

Common Antidepressants:Fl ti (P )

Nf d (S )

Fl uoxe ti ne (P rozac ) N e f aza d one (S erzone )

Sertraline (Zoloft) Paroxetine (Paxil)

Imipramine (Tofranil) Quetiapine (Seroquel)Risperdone (Risperdal) Doxepin (Sinequan)Bupropion (Wellbutrin) Amitriptyline (Elavil)Trazodone (Desyrel)

Nortriptyline (Aventyl)

Trazodone

(Desyrel)

Nortriptyline

(Aventyl) Citalopram (Celexa) Venlafaxine (Effexor)P ibl Sid Eff tP oss ibl e Sid e Eff ec t s: dizziness, drowsiness, confusion, disorientation, ataxia

Other Prescription DrugsOther

Prescription

Drugs DrugPossible Side Effects Medical UsesOlanzapine (Zyprexa) dizziness drowsiness schizophrenia

Olanzapine

(Zyprexa) dizziness , drowsiness schizophrenia Valproic Acid (Depakote) nausea, sedation bipolar disorder Methylphenidate (Ritalin) agitation, hallucination ADD/ADHD Chlor p romazine (

Thorazine

) drowsiness , confusion anti p s y chotic p() , py Thioridazine (Mellaril)drowsiness, confusion antipsychotic

Clozapine (Clozaril)seizuresantipsychotic

Phentermine (Adipex)agitation, confusion obesityCarbamazepine (Tegretol) seizuresanticonvulsant Cyclobenzaprine (Flexeril) drowsiness, dizziness muscle relaxant Buspirone (Buspar)drowsiness, dizziness anxiety disorders lid (A bi ) di i hi Zo l p id em (A m bi en ) se d at i on, amnes i a h ypnot i c

Doxylamine (Unisom) sedation hypnotic

Non-Prescri

p tion Dru g s pg

Caffeine, nicotine:not usually reporte

d

DrugPossible EffectsUsesIbuprofen,

Acetaminophen liver toxicity, pediatric overdose pain, fever reliefDiphenhydramine sedationantihistamine

Pseudoephedrine dizziness, agitation, tremor decongestantGuaifenesin

CNS depression

cough suppressant

Guaifenesin

CNS depression cough suppressant

Dextromethorphan sedationcough suppressant

I li id f h i ifi t t f th l

• I n li qu id f orm, many h ave s i gn ifi can t amoun t s o f e th ano l . • Growing abuse by minors for amphetamine or sedative properties. • May potentiate CNS-depressant actions of other drugs.

CannabinoidsCannabinoids

Detectable in Blood:12 - 18 hoursDetectable in Urine: 1

2 days in infrequent

Detectable

in

Urine:

1 - 2 days in infrequent users, up to 30 days in chronic users

Cannabis sativa

• Most common drug seen in MSP Lab: 1/2 of all cases • Linked to impaired driving and long-term damage to

Cannabis

sativa memory and learning. • N o overdoses re p orted (y et ) due to cannabinoids alone , p(y), but a common factor in auto fatalities, especially in young people.

Retrograde?Retrograde?

DMTDatamaster

THC C COO

0040.060.080.1

rAC TH C - COO H 00.02 0 . 04

68 122 201 262 319

B minutes after the end of drinking

THC M b li

Al h l M b li

THC M eta b o li sm Al co h o l M eta b o li sm A Short Histor y o f Cannabinoid Testimon y yfy

2004: P vs Derror (Grand Traverse Co.), P vs. Kurtz (Jackson Co.)•

Derror:

Fatal/serious PI accident only THC

COOH present

•

Derror:

Fatal/serious

PI accident , only THC - COOH present . • Subject acknowledged smoking marihuana earlier in the day. • Charged with per seOWI causing death/injury. •

Defense: THC

COOH not Schedule I

•

Defense:

THC - COOH not

Schedule

I . 2006
• MI Supreme Court affirms THC-COOH is a Schedule I compoun d .

2010 P vs Feezel

(

Washtenaw Co.

) () • MI Supreme Court reverses itself, overturns Derror. • Declares THC-COOH not a Schedule I compound.

How Are Things Different Now?How

Are

Things

Different

Now?

Pre-Derror (pre-per se)•

THC COOH presented as evidence of ingestion of controlled substance • THC - COOH presented as evidence of ingestion of controlled substance . • Not disputed that THC-COOH means ingestion of THC. • Not required to show THC present at time of stop (no retrogrades). •

Testimony on impairment generally required

•

Testimony

on impairment generally required .

Post-Feezel

• Cannot prosecute under MCL 257.625(8) with any amount of THC-COOH (p. 26). • Need to show THC itself present in system at time of stop • If a lab report doesn't list THC or distinguish THC from THC-COOH, can it be used as evidence? • Must a lab report show THC itself to be admissible? If so....

Controlled Substances

Controlled Substances (State of Michigan)

Public Health Code 333.7211-333. 7215

Schedule I.

No medical uses, high abuse potential.

THC (marihuana)MDMA(Ecstasy)MDMA

(Ecstasy) Designer amphetamines: MDA, DMA, PMA, DMT, DET, etc. Hallucinogens: PCP, LSD, mescaline, peyote, psilocin HeroinHeroinGHBA nd others.

Controlled Substances

Controlled Substances (State of Michigan)

Public Health Code 333.7211-333. 7215

Schedule II.Approved medical uses, high abuse potential - morphine, hydrocodone, oxycodone, codeine - methadone, Marinol (medicinal THC) h i h h i h l h id ( i li ) -amp h etam i ne, met h amp h etam i ne, met h y l p h en id ate ( R i ta li n ) and others AND " Coca leaf extracts and any salt preparation of derivative thereofCoca leaf extracts and any salt , preparation of derivative thereof .. including cocaine, salts, stereoisomers..." (333.7214.a.iv)

Controlled SubstancesControlled

Substances

Schedule III.Schedule

III. •Approved medical uses, lesser abuse potential than II. • Most barbiturates, ketamine, preparations with defined t f d i hi dih d d i

Schedule IV.amoun

t s o f co d e i ne, morp hi ne or dih y d roco d e i ne •Approved medical uses, abuse potential less than II

• Most benzodiazepines (Valium, Xanax), phentermineSchedule V.•Approved medical uses, abuse potential less than IV.•

Some preparations of ephedrine codeine morphine dih drocodeine • Some preparations of ephedrine , codeine , morphine , dih y drocodeine . • OTC ephedrine excepted.

Controlled Substances

Prescri

p tion Dru g s: pg •

• If not scheduled, not a controlled substance.• Considered to have little to no abuse or dependency

potential, but patient must be monitored for harmful effects.• Examples: antidepressants, antipsychotics, muscle relaxants. .

What Does It Mean?What

Does It Mean?

Schedule I:

Any drugs listed on CS Schedule IM t THC E t (N t THC

COOH!)

M os t common: THC , E cs t asy (N o t THC -

COOH!)

Section 7214(iv)(a):Coca leaf extracts and related compounds: cocaine So:any amount of THC, Ecstasy, cocaine or other Schedule I drugs in any body fluid is per seevidence of OUID

Charging OWI?Charging

OWI?

Still OWI!

- Schedule II - V drugs are still Controlled Substances.

V li X M b t A bi t

- V a li um, X anax, M epro b ama t e, A m bi en, e t c: prosecutor can still charge OWI although they are not Schedule I. - Schedule II - V: impairment must be proven, not a given.

Charging OWI?Charging

OWI?

Not OWI (?):

- Prescription drugs that are NOT controlled substances (e.g. Prozac, Effexor) - Over-the-counter drugs (Robitussin)- Inhalants (Dust-Off) or solvents (paint thinner)

Not controlled substances can

' t be charged under

257.625(8).

Not controlled substances , can t be charged under

257.625(8).

Independent TestsIndependent

Tests A second laboratory got different results. Why?Possible reasons: - Performed a different type of test

Screening test vs GC/MS; type of GC/MS done

-Test had different specificity

Dididbidjbid?D

etects ac idi c an d b as i c d rugs or j ust b as i c d rugs ? -Instrumentation had different sensitivity

What type of instrument detector?What

type of instrument detector?

Independent TestsIndependent

Tests A second laboratory got different results. Why?Possible reasons: - Different analyst performing the test

Trained in the detection of that drug?

- Laboratory has different cutoffsLab 1: c toff 1 ng/mlLab 1: c u toff = 1 ng/ml

Lab 2: cutoff = 10 ng/ml

Sample = 5 ng/ml.Lab 1: positive result Lab 2: negative resultLab 1: positive result . Lab 2: negative result .

Independent TestsIndependent

Tests A second laboratory got different results. Why?Possible reasons: - Samples tested at different times

Some drugs degrade in storage (i.e. cocaine)

- Samples may have been drawn at different sites on the bodyPostmortem distrib tion: femoral s thoracic bloodPostmortem

distrib u tion: femoral v s thoracic blood . - Interassay variability

Yields not always the same assay to assayYields

not always the same assay to assay .

Court ActivitiesCourt

Activities

Major Areas of Court Testimony:Analytical Procedures:

Analyst assigned the case

Analytical

Procedures:

Analyst

assigned the case

Expert Testimony:Toxicologist (usually Ph.D.)

• Interpretation of results •

Impairment issuesImpairment

issues • Blood alcohol calculations (retrograde extrapolation) • Rebuttal of defense experts (breath and blood cases)

Court CaseloadCourt

Caseload

SubpoenasSubpoenas~ 500 per person per yearO1 fldO R 1 per every f our cases comp l ete d

OR 2 per day, every day

20 -

40 court a

pp earances/ y ear

Video Testimony

pp y

Greatly reduces time spent on the road by scientists.Still not widely used due to defense objections andStill

not widely used due to defense objections and desire of prosecution to have witness appear in person.

ToxicologyToxicologyToxicologyToxicology

All substances are poisons; there is none

All substances are poisons; there is none

that is not a poison. The dose that is not a poison. The dose differentiates a poison from a remedy. differentiates a poison from a remedy.

ParacelsusParacelsusParacelsusParacelsus