TECHNICAL REPORT An analysis of post-mortem toxicology practices in drug-related death cases in Europe April, 2019 TECHNICAL REPORT I An analysis of post-mortem toxicology practices in drug-related death cases in Europe Legal notice This publication of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is protected by copyright. The EMCDDA accepts no responsibility or liability for any consequences arising from the use of the data contained in this document. The contents of this publication do not necessarily reflect the official opinions of the EMCDDA’s partners, any EU Member State or any agency or institution of the European Union. Luxembourg: Publications Office of the European Union, 2019 ISBN 978-92-9497-408-2 doi 10.2810/81554 TD-01-19-354-EN-N © European Monitoring Centre for Drugs and Drug Addiction, 2019 Reproduction is authorised provided the source is acknowledged. Recommended citation: European Monitoring Centre for Drugs and Drug Addiction (2019), An analysis of post-mortem toxicology practices in drug-related death cases in Europe, Technical report, Publications Office of the European Union, Luxembourg. 2 TECHNICAL REPORT I An analysis of post-mortem toxicology practices in drug-related death cases in Europe Contents Acknowledgements ..................................................................................................................................... 4 Executive summary ..................................................................................................................................... 6 Background and objectives ..................................................................................................................... 6 Key findings ............................................................................................................................................ 6 Limitations ............................................................................................................................................... 7 Conclusions ............................................................................................................................................ 7 Introduction ................................................................................................................................................. 9 Part 1: Scoping study on national reference documents that address drug-related death toxicology investigations in Europe (28 EU Member States plus Norway and Turkey) ................................................. 11 1.1. Objective and methods ...................................................................................................................... 11 1.2. Findings ............................................................................................................................................. 12 1.2.1. Coverage of post-mortem toxicology in national and international guidelines ............................ 12 1.2.2. Decision-making on the application of post-mortem forensic toxicological investigations in suspected drug-related deaths ............................................................................................................. 16 1.2.3. Pre-analytical management: sample collection, preservatives, storage of post-mortem specimens, preparation and extraction ................................................................................................. 16 1.2.4 Calibration in the case of post-mortem specimens ...................................................................... 18 1.2.5. Standards for post-mortem screening and confirmatory analytical methods .............................. 18 1.2.6. Analytical methods for new psychoactive substances in post-mortem specimens ..................... 21 1.2.7. Interpretation and reporting of findings in forensic toxicology ..................................................... 23 1.2.8. Certification of drug-related deaths ............................................................................................. 24 1.3. Discussion .......................................................................................................................................... 25 Part 2: Survey of practices — mapping the ‘typical’ or ‘standard’ toxicology practices in place in each country .......................................................................................................................................................... 26 2.1. Objective ........................................................................................................................................... 26 2.2. Methods ............................................................................................................................................ 26 2.3. Results .............................................................................................................................................. 27 2.3.1 Characteristics of participating laboratories ................................................................................. 27 2.3.2. Collection of test material for toxicological analysis .................................................................... 28 2.3.3. Laboratory equipment ................................................................................................................. 29 2.3.4. Analytical strategy ....................................................................................................................... 31 2.3.5. Analytical strategy: classification ................................................................................................ 33 2.3.6. Special analytical considerations and reporting .......................................................................... 34 2.3.7. Substance group coverage ......................................................................................................... 35 2.3.8. Collaboration/information exchange ........................................................................................... 38 2.3.9. Coverage of new psychoactive substances ................................................................................ 39 2.3.10. Suggestions for improvements ................................................................................................. 41 3. Discussion and conclusions ...................................................................................................................... 43 3.1 Interpreting drug-related death prevalence data against the background of toxicology standards and capacity in European countries ................................................................................................................. 43 3.2. Conclusions ....................................................................................................................................... 43 3.2.1. Consequences and priorities for public health ............................................................................ 44 References .................................................................................................................................................... 46 3 TECHNICAL REPORT I An analysis of post-mortem toxicology practices in drug-related death cases in Europe Acknowledgements Authors: Axel Heinemann and Stefanie Iwersen-Bergmann (Institute for Legal Medicine, University Medical Center Hamburg-Eppendorf, Germany) The authors, as well as the project coordinator at the European Monitoring Centre for Drugs and Drug Addiction, Isabelle Giraudon, would like to extend their sincere thanks and appreciation to the experts who participated in the survey, to the drug-related deaths national experts and to the Reitox national focal points. We also wish to thank Ana Gallegos, Chara Spiliopoulou and Pirkko Kriikku for peer reviewing this report, as well as Nicola Singleton for editing the report and Pamela Nfondja for supervising the survey data management. 4 TECHNICAL REPORT I An analysis of post-mortem toxicology practices in drug-related death cases in Europe Tables Table 1 Relevant international and national guidance/reference documents Table 2 Recently published methods for the analysis of NPS in post-mortem specimens (examples) Table 3 Survey response: laboratories per country Table 4 Laboratories reporting using specimens from ‘needle autopsies’ Table 5 Classification of analytical strategies for screening and confirmation in the event of a suspected DRD Table 6 ‘What kind of substances does your analytical strategy usually cover?’ (examples) Figures Figure 1 Laboratory equipment for analytical oriented chromatography and mass spectrometry (percentage of laboratories equipped) Figure 2 Time of implementation of new techniques/methods (% of laboratories, unknown excluded) Figure 3 Substance groups that are at present included in immunological screening at present (percentage of laboratories with positive answer) Figure 4 Substance groups included in immunological screening in the past 5 years (percentage of laboratories with positive answer) Figure 5 ‘When questions arise about substances you cannot analyse in your laboratory, do you have the opportunity to send samples to a specialised laboratory?’ (%) Figure 6 Analytical strategy and capacity for established substance group: coverage in routine versus ‘on request’ testing (percentage of laboratories) Figure 7 Analytical strategy and capacity for some exemplary opioids and other substances: coverage in routine versus ‘on request’ testing