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Why does it take weeks for toxicology reports?

Brian Freskos

Here is how Dr. Ruth Winecker, chief toxicologist for the N.C. Office of the Chief Medical Examiner, responded to this question:

“Essentially the answer is, it depends. For cases in which we only test for ethanol (drinking alcohol) the reports are certified within 72 hours of the receipt of the specimens. When the cause of death is potentially related to drugs or toxins the time it takes to certify a toxicology report is related to how complicated the case is and how many drugs are detected by the initial screening assays. For relatively uncomplicated cases the results are usually certified in 14-21 days. The remainder of the cases can take much longer.

“Autopsy toxicology testing is more complicated than portrayed in the popular media in shows such as CSI and NCIS. It’s also more time consuming. Hospital emergency departments and pre-employment drug testing laboratories are generally only screening for less than 20 drugs whereas the scope of laboratory testing for a forensic screening is much wider and often times the forensic laboratory is screening for several hundred drugs and toxic substances.

“Additionally, toxins or drugs for an autopsy report should be tested twice, once in the initial screening and once in a confirmation assay, which will unequivocally identify the drug or toxin and quantify the amount present. It’s essentially twice the work for one result. Further, there is no such thing as a ‘complete drug screen’ or even one screening procedure that will identify all possible drugs that might be present. In our laboratory there are four different screening assays that are utilized to detect several hundred of the most common drugs and toxins. Unfortunately, there are all kinds of less common or unique drugs and toxins that require special testing procedures. The procedures are time consuming as well. A forensic chemist may spend six or more hours in a day cleaning-up a biological specimen to make it suitable for instrumental analysis, then spend a day or more inspecting the results of the testing. The results are then inspected again by a senior forensic chemist and then a third time by a toxicologist before a toxicology report is certified. You can see how this might add up to a long time if a case has many drugs detected in the initial four screens that then have to be confirmed and quantified. In essence, the more complicated the case the longer the results will take.

“Moreover, there are new drugs being released all the time. Some are developed by pharmaceutical companies and approved by the FDA and some are from clandestine labs making new drugs of abuse from the synthetic cannabinoids (Spice) and cathinone (Bath Salts) families of drugs. The process of procuring certified reference materials to be used in assays for these new drugs and validating new assays is a lengthy one which can further delay the release of a toxicology report.”


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