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Abstract
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From: 30th meeting of SFTA- 59th meeting of TIAFT - September 2022
Aim
This presentation describes challenges and ethical strategies for forensic toxicologists summoned to testify in complex polydrug "drug delivery resulting in death" cases, wherein they are asked to assign weight to the presence and concentrations of individual drugs provided by one individual to another whose death resulted from their use. The United States continues to suffer from an opioid epidemic with over 103,000 deaths projected for 2022. Today's opioid market is dominated by illicit fentanyl, and frequent appearance of novel synthetic opioids (NSOs), which appear in combination with one another, with other novel psychoactive substances (NPS), and with legacy drugs of abuse. The relentlessness of the opioid crisis in the U.S has led to the development of strategies and programs aimed at reducing the toll on lives. Harm deduction efforts have included expansion of effective drug treatment programs, syringe exchange programs, drug checking programs, and educational campaigns. Supply reduction strategies have included increased interdiction of substances at the Southwest border with Mexico, enhanced data-driven interception of mail-order drugs in international express shipping and heightened criminal justice responses to possession and distribution of illicit fentanyl. Many of these initiatives have had specific impacts on forensic toxicologists and challenged previous models for interpretation and testimony. Drug supply reduction strategies at state and federal levels have led to the passage of laws allowing enhanced charging and sentencing ranges for drug distribution that results in the death of the user. Drug delivery resulting in death is currently charged under theories ranging from First Degree Murder to Involuntary Manslaughter, with many states enacting specific "drug delivery homicide" laws. The theory of the legal charging decision in drug delivery resulting in death cases dictates the level and type of causation and intent that must be proven but all cases are dependent to some degree on requisite proof, notably forensic toxicology testimony, that the drug or substance distributed caused or contributed to the user's death. Post-mortem cases that are the subject of those prosecutions typically involve multiple legacy, NPS, and prescription drugs of abuse, thereby creating a complex toxicological presentation that can only be properly understood with expert forensic toxicology and pathology interpretation. Lay persons, including prosecutors and criminal justice attorneys, are regularly making charging and sentencing decisions based only on the numbers in a toxicology report and a Google Search on "lethal levels". Even experienced prosecutors with a foundational understanding of toxicology are prone to believing that elevated drug concentrations "must be" lethal or fatal. It is common that once a person is charged, the toxicologist is consulted for the first time only when the case is coming to trial, and the unwinding of inaccurate presumptions and invalid conclusions of the toxicological results by the lawyers or pathologists is a very difficult and unpleasant exercise that puts the toxicologist under undue and unfair pressure.
Method
In 2019, the National Institute Standards and Technology (NIST) adopted American Standards Board (ASB) Best Practice Recommendation 037 "Guidelines for Opinions and Testimony in Forensic Toxicology", that endorses scientifically acceptable practices in testimony and admonishes against unprofessional and unscientific testimonial practices. In 2020, NIST adopted ANSI/ASB Standard 053 for Report Content in Forensic Toxicology.
Results
Between these two documents, forensic toxicologists have a roadmap for report drafting, expert witness report-writing, and testimony preparation that will allow a toxicologist to stay within community-based professional standards for interpretation, and their subject-matter expertise, and will empower them to withstand pressure to venture beyond accepted limits.
Conclusion
The attendee will leave with an understanding of the scope of actions, decisions, and preparation a toxicologist must undertake to opine and testify with confidence in poly-drug homicide cases.
Language: en |