Forensic Toxicology: The Science and Law

Abstract

The harming of living things takes two structures, unplanned and deliberate, with both bringing about possibly shocking results. Whether harming brings about abnormal practices, hospitalizations, or deaths, the field of forensic toxicology plays a key figure relating logical discoveries to connection of impacts. As a "forensic" science, forensic toxicology utilizes the standards of expository science to recognize conceivably causative operators and toxicology to offer unthinking purposes behind debilitation, disease, or death with the particular pertinence of these sciences to matters of the law. In these regards, the rehearsing forensic toxicologist must comprehend the requirement for strong science that is research and observationally based as the centre so as to meet the perpetually expanding requests set on the expert in the medico-lawful setting.

Keywords

Hospitalizations, Forensic toxicology, Science, Mass spectrometry, Toxicology

Introduction

The four ranges of impact of Forensic toxicology include [1-4]:

Human Performance Toxicology

The recognizable proof and understanding of substances that debilitate an individual's capacity to play out an undertaking, e.g., driving a vehicle or games.

Post-mortem Toxicology

The recognizable proof of substances in the body, that guide in the assurance of cause and way of death [5].

Workplace Testing

The screening of body liquids or tissues from people identifying with business or disability while utilized, e.g., applying for an occupation.

Drug Courts/Probation and Parole

Court-requested testing identified with people who, as a feature of some program, must remain tranquilize free.
Despite the application, the Forensic toxicologist must utilize forms that can withstand unforgiving investigation both from different researchers and legitimate procedures.

The Science

The expository period of legal toxicology has experienced unlimited change since its initiation in the mid-nineteenth century. Never again are nonspecific tests, e.g., shading responses, adequate for motivations behind logical verification of the nearness of some substance of concern. As scientific instruments have advanced, so have the desires of the field. Today, the sign of a decent scientific toxicological recognizable proof is predicated on the utilization of two diverse systematic procedures utilizing two distinctive physicochemical standards wherever conceivable, with no less than one of the methods utilizing some kind of molecular identification [6-10].

The most well-known sub-molecular based devices in play at present in the lion's share of scientific toxicology labs are hyphenated mass spectrometric methods [11-14]. While gas chromatography-mass spectrometry (GC-MS) was the pillar through a large portion of the 1980s for investigation of natural substances, including drugs, a move to fluid chromatography-mass spectrometric (LC-MS) methods has happened [15-20]. For metals, inductively coupled plasma-mass spectrometry (ICP-MS) and optical discharge spectroscopy (OES) are genuinely regular devices, and different methods, e.g., particle chromatography, are likewise utilized for sundry different substances of toxicological concern [21,22]. In regard to LC-MS, single-stage innovations have offered approach to multistage (LC-MS/MS) or time-of-flight (LC-TOF) forms, both requiring moderately less complex example planning while giving enhanced affectability and specificity contrasted with more seasoned diagnostic apparatuses.

The transformation of LC-MS in the most recent 20 years has been noteworthy. A decent case of the adjustments in this method can be found in the Waters Corp. (Milford, MA) beginning of bench top LC-MS instruments [23-29]. In just roughly 20 years, this gathering experienced a progression of changes from its Platform single-stage LC-MS, to its Micro LC-MS-MS, to enhanced couple gadgets (Premier, TQD, TQS) and TOF instruments, each giving upgrades in specificity, affectability, roughness, usability, programming, and issue-based arrangements.

With the coming of new medications (both licit and illegal) and other compound exposures and new administrative desires, the difficulties confronting the Forensic toxicologist today are as considerable as ever some time recently. Strategy approval necessities, stringent ID criteria, and the capacity of instruments today to recognize low centralizations of substances (the "vanishing zero") facilitate add to the diagnostic difficulties in forensic toxicology [30-34].

Translating explanatory discoveries in regard to relationship to impacts extending from disability to death can be amazingly testing. Factors, for example, contrasts in digestion system, anatomical wellspring of a given example, after death development of chemicals in the body, and so forth., all make instabilities in any translation without extra data, e.g., conditions, perceptions, etc. All things considered, explanatory plans and interpretive exactness must be founded on a comprehensive way to deal with any given case that considers such things as case history, example gathering data, medicinal history, and timing of occasions.

The Law

Science has a tendency to be truth looking for, while one capacity of the law is to settle debate. This polarity does not generally make for good partners. It is occupant, be that as it may, upon the scientific researcher to comprehend that he or she is not a backer, while that is the part of a lawyer, i.e., to advocate for his or her customer [34-38].

In the antagonistic legal framework inside the United States, difficulties to the science utilized as a part of criminal and common cases can be disagreeable, frequently with doubt on both sides. That lawyers are distrustful of Forensic science is fairly grounded in truth with complex cases of scientific science examinations gone awry [39-44]. For their part, in any case, the lion's share of Forensic researchers are persevering, committed, essentially instructed, and prepared people who play out their occupations with the most extreme of care and alert.

In 2009, the National Academy of Sciences issued a report entitled on “Strengthening Forensic Science in the United States: A Path Forward”. This report was dispatched by the U.S. Congress. While there were numerous discoveries depicted in the report, the basic concentration was on scientific controls where design coordinating is the essential principle of distinguishing proof, e.g., fingerprinting, chomp marks, shot correlations, and so forth [45-51]. The real reactions depended on an absence of logical standards supporting cases. A couple of Forensic sciences were praised for solid logical legitimacy, including Forensic toxicology. All things considered, it was perceived that all branches of legal science must be saturated with science, have a solid logical research part, and be measurably stable. As of now, activities from both the official and authoritative branches of the U.S. Government are being considered to help the legal sciences to achieve these objectives.

In 1997, with redesigns in 1997, 2002, and 2006, the Toxicology segment of the American Academy of Forensic Sciences (AAFS) and the Society of Forensic Toxicologists built up rules for the act of Forensic toxicology. Prior to this time, scientific toxicology research centers were pretty much left to their own particular gadgets in regard to quality activities. This previous endeavor at self-control was comparatively radical and solidly settled this train as one of the pioneers in advancing quality models. Sadly, determined as "rules," research facilities were not committed to take after these proposals, in this manner rendering no general acknowledgment for this record.

In October 2009, the Scientific Working Group in Toxicology (SWGTOX) was established. Scientific working gatherings in the legal sciences are long-remaining, with every train having its own particular working gathering, e.g., SWGDAM for DNA examination. The capacity of these gatherings is to characterize the benchmarks of practice and best practices inside every train. These gatherings were at first bolstered fiscally and basically by the U.S. Bureau of Justice and now by the National Institute of Standards and Technology (NIST). It is the expectation of NIST to allude to these gatherings as Guidance Groups with points of interest of structure capacity still to be resolved. Notwithstanding their title, partially, these gatherings are intended to fortify the legal sciences because of the worries raised by the NAS report and different perceptions.

SWGTOX is involved Forensic toxicology professionals, scholastics, and other topic specialists regarded important, speaking to legislative, private, and not-revenue driven concerns [52-55]. Models advancement includes a procedure that permits all partners influenced by such norms to survey and remark before reception of the standard. To date, principles seeing such issues as a code of expert lead, technique approval, explore, improvement, testing, and assessment have been embraced. Close term, extra benchmarks on quality control, mass spectrometry, work force necessities, and accreditation will be embraced [55-60]. Different parts of scientific toxicology, e.g., distinguishing proof measures, will be anticipated. While there is no authorization component as of now doled out to the SWGs, it is foreseen that the disappointment of research centers to receive such measures will be risky as these offices are stood up to with them in the court.

Forensic toxicology professionals and labs can be guaranteed and authorize, individually. As in the field of solution, where board affirmation does not ensure greatness in the clinician, confirmation and accreditation don't ensure unrivaled practices by a Forensic toxicologist or lab; be that as it may, they do show negligibly worthy learning and practices. In entirety, however, adherence to SWGTOX models and affirmation/accreditation ought to give certainty to the overall population and the legitimate framework that any given individual or research center is addressing the necessities of a quality-based scientific toxicology framework.

Future Developments in Forensic Toxicology

The interest for toxicological examinations will keep on growing, outpacing the capacity of every nation's Forensic toxicology research facilities to process them [61-65]. This solicitation intends to build the measure of research, advancement, refinement, as well as change of expository procedures utilized by forensic labs to accumulate information on complex synthetic substances and their metabolites [66-74]. It additionally looks for research into instruments and innovations that will advance speedier, generally relevant, rough, less expensive, and less work concentrated types of gear for recognizable proof, gathering, protection, as well as investigation of natural examples for controlled substances and different poisons [75], to grow new logical systems, and non-ruinous methods. To the extent innovation progression is concerned, organizations will contend with each other to deliver an instrument or arrangement that will decrease investigation times, increment affectability of the instrument, and lessen test readiness. With such a large number of chemicals and medications in presence, new psychotropic substances and the different lattices, there will in all probability be an interest for toxicologists [76-80]. In light of this, they will require productive yet careful techniques.

Without a doubt, the future may give more prominent and more prominent toxicological data [81-85], however it is not an assurance that this will include interpretive clarity for the forensic toxicologist [86-89].

Later on, the Forensic toxicologist will remain the individual who inspects blood, body liquids, and tissue tests of the casualty to check whether the reason for death was a medication or toxic substance; when a forensic pathologist can't locate a conspicuous reason for death after a post-mortem examination, the scientific toxicologist will bear on deciding particularly the majority of the medications and toxins introduce alongside the amounts at the season of death, and shaping if any metabolites are available, and also any medication associations, and looking at any history of medication use by the casualty [90-95]. To stay qualified as a scientific toxicologist, she/he will dependably have and enhance her/his experience in expository science or toxicology. The explanatory systems, natural grids, after death thinks about, restorative medication administration or checking, driving disability, working environment tranquilize testing, pharmacodynamics observing, and toxicogenetics/toxicogenomics studies will keep being a portion of the objectives of forensic toxicology [96-98].

Conclusion

Forensic toxicology assumes a noteworthy part in both general wellbeing and open security. At the establishment of this train are two built up sciences, explanatory science and toxicology? At the point when drilled accurately, Forensic toxicology helps medicinal inspectors, law authorization, lawyers, clinicians, and others by setting up the recognizable proof of potential harming or impeding operators and related interpretive esteem to these discoveries. Adherence to sound quality practices addresses the issues of the train, as well as permits utilization of the discoveries in matters of the law. Through selection of existing and future quality guidelines, questions in regards to the legitimacy of legal toxicology as a connected science are tended to in an experimentally stable way. All things considered, whether it is for reasons for the law or unadulterated research, nothing beats the logical procedure.

References

1. McIntyre IM, et al. Postmortem fentanyl concentrations: a review. J Forensic Res. 2012;3:157.
2. Santos C, et al. Development of a medical toxicology curriculum in spanish with content informed by a population survey for medical trainees in the dominican republic. J Clin Toxicol. 2016;6:311.
3. Durisova M. Opinion: Journal of drug metabolism and toxicology. J Drug Metab Toxicol. 2016;7:e128.
4. Kendall RJ. Wildlife toxicology: where we have been and where we are going. J Environ Anal Toxicol. 2016;6:348.
5. Baniak N, et al. Vitreous humor: a short review on post-mortem applications. J Clin Exp Pathol. 2015;5:199.
6. Vasquez S, et al. Biochemical and molecular identification of type V MRSA among students at a small southern university. J Bacteriol Parasitol. 2015;6:216.
7. Zargar MH, et al. Molecular identification of intron 2 splice mutation and 8bp deletion in CYP21 gene for congenital adrenal hyperplasia (CAH) patients in Kashmir (North India). J Mol Genet Med. 2016;10:205.
8. Sharma M, et al. Molecular identification of forensically important indian species of flesh flies (Diptera: Sarcophagidae) by using COI gene of mitochondrial DNA. J Forensic Res. 2015;6:316.
9. Fahmi AI, et al. Leaf rust resistance and molecular identification of Lr 34 gene in egyptian wheat. J Microb Biochem Technol. 2015;7:338-343.
10. El–Zanaty AF, et al. Molecular identification of rhizobium isolates nodulating faba bean plants in egyptian soils. J Bioprocess Biotech. 2014;5:194.
11. Ali A, et al. Electrospray tandem mass spectrometric study of a furo-furan Lactone inHeliotropium eichwaldi. J Chromatogr Sep Tech. 2015;6:307.
12. EL-Maali NABO and Wahman AY. Gas chromatography-mass spectrometric method for simultaneous separation and determination of several pops with health hazards Effects. Mod Chem appl. 2015;3:167.
13. Maddi A, et al. Mass spectrometric analysis of whole secretome and amylase-precipitated secretome proteins fromStreptococcus gordonii. J Proteomics Bioinform. 2014;7:287-295.
14. Krappmann M, et al. Achroma software-high-quality policy in (a-)typical mass spectrometric data handling and applied functional proteomics. J Proteomics Bioinform. 2014;7:264-271.
15. Salvatierra-Stamp VC, et al. Supercritical-fluid chromatography with diode-array detection for emerging contaminants determination in water samples. Method Validation and Estimation of the Uncertainty. J Chromatogr Sep Tech. 2015;6:291.
16. Mahendra Kumar T, et al. Evaluation of the isotopic abundance ratio in biofield energy treated resorcinol using gas chromatography-mass spectrometry technique. Pharm Anal Acta. 2016;7: 481.
17. Arnoldi S, et al. Validation study of analysis of 1-phenyl-2-propanone in illicit methamphetamine samples by dynamic headspace gas chromatography mass spectrometry. J Chromatogr Sep Tech. 2016;7:322.
18. Nimmanwudipong T, et al. Determination of intramolecular 13C isotope distribution of pyruvate by headspace solid phase microextraction-gas chromatography-pyrolysis-gas chromatography-combustion- isotope ratio mass spectrometry (HS-SPMEGC-Py-GC-C-IRMS) Method. J Anal Bioanal Tech. 2015;7:293.
19. Chen Z, et al. Utilization of a matrix effect to enhance the sensitivity of residual solvents in static headspace gas chromatography. J Chromatogr Sep Tech. 2015;6:289.
20. Bokhart M, et al. Determination of Organochlorine Pesticides in Wildlife Liver and Serum Using Gas Chromatography Tandem Quadrupole Mass Spectrometry. J Chromatogr Sep Tech. 2015;6:286.
21. Ojochenemi AD, et al. Mycotoxicological concerns with sorghum, millet and sesame in northern Nigeria. J Anal Bioanal Tech. 2016;7:336.
22. Kurunthachalam SK. Asbestos and its toxicological concern. Hydrol Current Res. 2013;4:e110.
23. Pupke D, et al. Optimization of an enrichment and LC-MS/MS method for the analysis of glyphosate and Aminomethylphosphonic Acid (AMPA) in saline natural water samples without derivatization. J Chromatogr Sep Tech. 2016;7:338.
24. Benkessou F, et al. Quantification of dimethylacetamide and its primary metabolite monomethylacetamide in plasma using robust LC-MS method. J Anal Bioanal Tech. 2016;7:327.
25. Roda E, et al. Evaluation of two different screening ELISA assays for synthetic cathinones (Mephedrone/Methcathinone and MDPV) with LC-MS method in intoxicated patients. J Clin Toxicol. 2016;6:302.
26. Saha A, et al. High throughput LC-MS/MS method for simultaneous estimation of 9-cis-retinoic acid and its metabolite 4-Oxo-9-cis-retinoic acid in human plasma and its application to a bioequivalence study. J Anal Bioanal Tech. 2015;S13:001.
27. Gobburi ALP, et al. Heterogeneous ganglioside standards in LC-MS/MS: sensitive method for quantifying the major molecular components in mono-sialo ganglioside standards. J Anal Bioanal Tech. 2015;S13:009.
28. Alves ANL, et al. Analytical performance of LC-MS/MS method for simultaneous determination of five steroids in serum. Mass Spectrom Purif Tech. 2015;1:107.
29. Dar SA, et al. An introduction about genotoxicology methods as tools for monitoring aquatic ecosystem: present status and future perspectives. Fish Aquac. 2016;J 7:158.
30. Durisova M. Model based description of the pharmacokinetic behavior of pentobarbital in fasted male volunteers after oral administration of 10 mg of pentobarbital. Clin Exp Pharmacol. 2016;6:200.
31. Saganuwan AS. Toxicology: the basis for development of antidotes. Toxicol open access. 2015;1:e101.
32. Misra H, et al. Toxicology and safety determination for a novel therapeutic dual carbon monoxide and oxygen delivery Agent. J Clin Toxicol. 2014;4:205.
33. Colombo ML. Some observations on the toxicology of natural products. J Pharmacovigilance. 2014;S1:e001.
34. Babita B, et al. Auditory and acoustic features from clue-words sets for forensic speaker identification and its correlation with probability Scales. J Forensic Res. 2016;7:338.
35. Khairkar SR, et al. Forensic discrimination potential of video spectral comparator and micro spectrophotometer in analyzing question document and fraud cases in India. J Forensic Res. 2016;7:329.
36. Tuladhar BS. Trends of clinical toxicology cases in Nepal. J Forensic Res. 2014;5:217.
37. Kalougivaki JJVP. Medico-legal death investigation systems in the pacific and creating a stronger pacific disaster victim identification network. J Forensic Res. 2015;6:255.
38. Gallello G, et al. Chemical element levels as a methodological tool in forensic science. J Forensic Res. 2015;6:264.
39. Verma K. Role of diatoms in the world of forensic science. J Forensic Res. 2013;4:181.
40. Kshemada K, et al. Forensic sciences and growth of cardiology. J Forensic Res. 2013;5:e115.
41. Khajja BS, et al. Forensic study of indian toxicological plants as botanical weapon (BW): a review. J Environment Analytic Toxicol. 2011;1:112.
42. Wilde LW. Introduction of new DNA marker sets in australian forensic laboratories. J Forensic Res. 2012;3:e109.
43. Singh JP and Singh K. Fiber examination in forensic science. J Textile Sci Eng. 2013;3:e116.
44. Stickel L. The unwritten laws of american fingerprinting. J Civil Legal Sci. 2016;5:210.
45. Yukihiro S, et al. Quality control of natural products by fingerprinting of eastern blotting. Pharm Anal Acta. 2016;7:494.
46. Schmidt EM, et al. Characterization of royal jelly by electrospray ionization mass spectrometry fingerprinting. Mass Spectrom Open Access. 2015;1:105.
47. Iqbal SA, et al. DNA fingerprinting of rice lines for salinity tolerance at reproductive stage. Adv Crop Sci Tech. 2015;S1:006.
48. Mishra A, et al. Application of DNA fingerprinting in an alleged case of Paternity. Biochem Anal Biochem. 2015;4:165.
49. Vinayak V, Mishra V, Goyal MK (2013) Diatom fingerprinting to ascertain death in drowning cases. J Forensic Res 4:207
50. Guerrini A and Sacchetti G. Chemical fingerprinting of medicinal and aromatic plant extracts: HP-TLC bioautographic assays as preliminary research tool to match chemical and biological properties. Med Aromat Plants. 2014;3:e152.
51. Tu VA, et al. Development of a chromatographic fingerprint for the quality control of Mallotus apelta by using HPLC-DAD-FLD-ELSD with Mallo apelta B as marker compound. Nat Prod Chem Res. 2016;4:234.
52. Ziaka M, et al. The accuracy and reliability of non-invasive haemoglobin measurements in the emergency room: a small prospective observational quality control study from a swiss university hospital ED. Emerg Med (Los Angel). 2016;6:324.
53. Nevis IF, et al. Quality control tool for screening titles and abstracts by second reviewer: QCTSTAR. J Biomet Biostat. 2015;6:230.
54. Bargańska Ż, et al. Development of a gas chromatography - tandem mass spectrometry procedure for determination of pesticide residues in honey and honeybee samples. J Chromatograph Separat Techniq. 2015;S6:002.
55. Trivedi MK, et al. Investigation of isotopic abundance ratio of biofield treated phenol derivatives using gas chromatography-mass spectrometry. J Chromatograph Separat Techniq. 2015;S6:003.
56. Florio W, Morici P, Rizzato C, Barnini S, Tavanti A, et al. (2015) Diagnosis of bloodstream infections by mass spectrometry: present and future. Mass Spectrom Open Access 1:106.
57. Jia RZ, et al. Identification and classification of rhizobia by matrix-assisted laser desorption/ionization time- of-flight mass spectrometry. J Proteomics Bioinform. 2015;8:098-107.
58. Milosavić N, et al. MALDI MS imaging-molecular mapping of biological samples by MALDI mass spectrometry. J Microb Biochem Technol. 2015;7:e122.
59. Klein DM, et al. Determination of drugs and metabolites in raw wastewater using liquid chromatography-mass spectrometry. J Forensic Res. 2015;6:268.
60. Sunjida SB, et al. Assessing the quality of household and drinking water in tongi industrial zone of bangladesh and its toxicological impact on healthy sprague dawley rats. J App Pharm. 2016;8:224.
61. Oluwole OB, et al. Nutritional properties and toxicological assessment of high nutrient biscuit developed from blends of some cereals and legume. J Nutr Disorders Ther. 2015;5:176.
62. Pawar HA and Lalitha KG. Toxicological evaluation of gum (Galactomannans) isolated from senna tora seeds. J Drug Metab Toxicol. 2015;6:193.
63. Geleta B, et al. Toxicological evaluations of the crude extracts and fractions of moringa stenopetala leaves in liver and kidney of rats. J Cytol Histol. 2015;7:383.
64. Ayadi I, et al. Chemical synonyms, molecular structure and toxicological risk assessment of synthetic textile dyes: a critical review. J Develop Drugs. 2016;5:151.
65. Varghese RS, et al. Assessment of GC-MS in detecting changes in the levels of metabolites using a spike-in experiment in human plasma. Metabolomics. 2016;6:175.
66. Luque de Castro MD. Could metabolomics clarify the multiple sclerosis–vitamin D metabolites relationship? J Mult Scler (Foster City). 2016;3:1710.
67. Lubobi SF, et al. Isolation of bioactive secondary metabolites from seaweeds amphiroa anceps against chicken meat associated pathogens. J Antimicro. 2016;2:113.
68. Guo WR, et al. Simultaneous detection method for mycotoxins and their metabolites in animal urine by using impurity adsorption purification followed by liquid chromatography-tandem mass detection. J Chromatogr Sep Tech. 2015;6:308.
69. Nagalaxmi V, et al. (2015) UV-B exposure increases the activity of indoleamine 2, 3-dioxygenase (Ido) and alters the levels of tryptophan metabolites in indian ground squirrel (Funambulus Palmarum) Lens. J Diabetic Complications Med. 2015;1:102.
70. Jannone BSG, et al. Utility of monitoring azathioprine metabolites in the management of children with autoimmune hepatitis. J Hepatol Gastroint Dis. 2016;2:114.
71. Butnariu M. Secondary metabolites (Pterosin F and B) from Pteridium aquilinum. J Ecosys Ecograph. 2015;5:e123.
72. Campos S, et al. Simultaneous quantification of propofol and its non-conjugated metabolites in several biological matrices using gas chromatography/ion trap – mass spectrometry method. J Anal Bioanal Tech. 2014;5:195.
73. Birandra KS and Mason RP. Is metabolic activation of topoisomerase ii poisons important in the mechanism of Cytotoxicity? J Drug Metab Toxicol. 2015;6:186.
74. Verma KL, et al. Analysis and detection of precursor chemicals used in preparation of narcotic drugs and psychotropic substances – a forensic perspective. J Forensic Res. 2015;6:274.
75. Olajide A, et al. Psychotropic drug prescription practice in psychiatric in-patients in saskatchewan, Canada. J Neuropsychopharmacol Mental Health. 2016;1:114.
76. Chavez OH. Some children do need psychotropic medication. J Psychiatry. 2015;19:344.
77. Oliveira L and Santos Z. Use of psychotropics and drug-drug interactions in oncology: reflections from a study in a portuguese psycho- oncology unit. Adv Pharmacoepidemiol Drug Saf. 2015;4:194.
78. Wurtman JJ. Weight gain on psychotropic drugs: has the obesity community been paying attention? J Obes Weight Loss Ther. 2015;5:271.
79. Poklis A. Fentanyl: a review for clinical and analytical toxicologists. J Toxicol Clin Toxicol. 1995;33:439-447.
80. Kuhlman JJ Jr, et al. Fentanyl use, misuse, and abuse: a summary of 23 postmortem cases. J Anal Toxicol. 2003;27:499-504.
81. Stanley TH. Fentanyl (proceedings of the symposium “updates of the clinical pharmacology of opioids with special attention to long-acting drugs”). Journal of Pain Symptom Management. 2005;29:67-71.
82. Baselt RC. Disposition of toxic drugs and chemicals in man. (9th edn), Biomedical Publications, Foster City, California. 2011.
83. Kornick CA, et al. Benefit-risk assessment of transdermal fentanyl for the treatment of chronic pain. Drug Saf. 2003;26:951-973.
84. Henderson GL. Fentanyl-related deaths: demographics, circumstances and toxicology of 112 cases. J Forensic Sci. 1991;36:422-433.
85. Flannagan LM, et al. Fentanyl patches left on dead bodies-potential source of drug for abusers. J Forensic Sci. 1996;41:320-321.
86. Booth JV, et al. Substance abuse among physicians: a survey of academic anesthesiology programs. Anesth Analg. 2002;95:1024-1030.
87. Centers for Disease Control and Prevention (CDC). Nonpharmaceutical fentanyl-related deaths--multiple states, April 2005-March 2007. MMWR Morb Mortal Wkly Rep. 2008;57:793-796.
88. US Department of Justice, National Drug Intelligence Center (2006) Fentanyl: situation report (SR-000001).
89. Ripple M, et al. Cluster of fentanyl-tainted heroin deaths in a three-week period in Maryland. Proceedings of the American Academy of Forensic Sciences Annual Meeting, 2007.
90. Isenschmid DS, et al. A rapid increase in fentanyl related deaths in Detroit: a twelve month review. Proceedings of the Annual Meeting of the American Academy of Forensic Sciences, 2007.
91. Joranson DE, et al. Trends in medical use and abuse of opioid analgesics. JAMA. 2000;283:1710-1714.
92. Jumbelic MI. Deaths with transdermal fentanyl patches. Am J Forensic Med Pathol. 2010;31:18-21.
93. Moore TJ, et al. Serious adverse drug events reported to the Food and Drug Administration, 1998-2005. Arch Intern Med. 2007;167:1752-1759.
94. Edinboro LE, et al. Fatal fentanyl intoxication following excessive transdermal application. J Forensic Sci. 1997;42:741-743.
95. Anderson DT and Muto JJ. Duragesic transdermal patch: postmortem tissue distribution of fentanyl in 25 cases. J Anal Toxicol. 2000;24:627-634.
96. DeSio JM, et al. Intravenous abuse of transdermal fentanyl therapy in a chronic pain patient. Anesthesiology. 1993;79:1139-1141.
97. Marquardt KA and Harratt RS. Inhalation abuse of fentanyl patch. J Toxicol Clin Toxicol. 1994;32:75-78.
98. Kramer C and Tawney M. A fatal overdose of transdermally administered fentanyl. J Am Osteopath Assoc. 1998;98:385-386.
99. Coppola M and Mondola R. Bromo-dragonfly: chemistry, pharmacology and toxicology of a benzodifuran derivative producing LSD-like effects. J Addict Res Ther. 2012;3:133.
100. Ding WX. Autophagy in toxicology: defense against xenobiotics. J Drug Metab Toxicol. 2012;3:e108.