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An important role of modern forensic and clinical toxicologists is to monitor the adverse events of novel psychoactive substances (NPS). Following a prior review from 2013 to 2016, this critical literature review analyzes and evaluates published case reports for NPS from January 2017 through December 2020. The primary objective of this study is to assist in the assessment and interpretation of these cases as well as provide references for confirmation methods. Chemistry, pharmacology, adverse events and user profiles (e.g., polypharmacy) for NPS are provided including case history, clinical symptoms, autopsy findings and analytical results. Literature reviews were performed in PubMed and Google Scholar for publications using search terms such as NPS specific names, general terms (e.g., ‘designer drugs’ and ‘novel psychoactive substances’), drug classes (e.g., ‘designer stimulants’) and outcome-based terms (e.g., ‘overdose’ and ‘death’). Government and website drug surveillance databases and abstracts published by professional forensic science organizations were also searched. Toxicological data and detailed case information were extracted, tabulated, analyzed and organized by drug category. Case reports included overdose fatalities (378 cases), clinical treatment and hospitalization (771 cases) and driving under the influence of drugs (170 cases) for a total of 1,319 cases providing details of adverse events associated with NPS. Confirmed adverse events with associated toxidromes of more than 60 NPS were reported including synthetic cannabinoid, NPS stimulant, NPS hallucinogen, NPS benzodiazepine and NPS opioid cases. Fifty of these NPS were reported for the first time in January 2017 through December 2020 as compared to the previous 4 years surveyed. This study provides insight and context of case findings described in the literature and in digital government surveillance databases and websites during a recent 4-year period. This review will increase the awareness of adverse events associated with NPS use to better characterize international emerging drug threats.

In 2007, the Bureau of Justice Statistics reported on 2004 data collected from the Census of Medical Examiner and Coroner Offices (CMEC). The CMEC was one of the first comprehensive reports on the state of the medicolegal death investigation system in the United States and included information on administration, expenditure, workload, specialized death investigations, records and evidence retention, and resources. However, the report did not include responses on questions that were related to toxicology such as specimen retention and type of testing. The purpose of this publication is to provide the community with toxicology laboratory‐specific responses from nearly 2000 medical examiner and coroner (MEC) offices. Data obtained from a BJS CMEC public use dataset for any remaining information that was not reported in the 2007 BJS report were evaluated specific to the operation of toxicology laboratories within a MEC office or specific to toxicology testing. The CMEC includes information on average operating budget for MEC offices with internal or external toxicology services, budget for toxicology/microbiology services, respondents’ routine uses of toxicology analysis, toxicology specimen retention time, average turnaround times, use of computerized information management systems, and participation in federal data collections. These historical data begin to address the present state of our nation’s toxicology laboratories within the medicolegal death investigation system and their preparedness for the current drug overdose epidemic.

In 2009, the Palm Beach County Sheriff’s Office Forensic Biology Unit developed an innovative DNA backlog strategy to construct and operate a centralized biological processing laboratory (BPL) within a law enforcement agency, the Boca Raton Police Services Department. The BPL became fully operational in 2012 and obtained accreditation in 2017. This coordinated, multi-agency agreement resulted in a streamlined process exemplifying several benefits such as communicating timely testing results, decreasing the case turnaround time, and decreasing the DNA case backlog. This paper provides a summary of the necessary considerations of location, construction, personnel, and services when constructing a BPL, as well as, provides a comparison of initial completion dates and ultimate completion dates over a three-year period from 2016 to 2018. Three LEAs submitted 613 cases to the BPL commensurate with jurisdictional population. Performance metrics such as types and number of criminal cases screened; the number of samples forwarded for PBSO DNA testing; the turnaround time to handle, screen, or analyze a forensic sample; evidentiary samples; and the number of profiles entered into the Combined DNA Index System (CODIS) database are reported. For example, prior to this DNA backlog reduction strategy, the FBU was taking an average of 153 days to handle, screen, or analyze a forensic sample from submission to final report and there was a backlog of 679 cases. From 2016 to 2018, the total average turnaround time for BPL decreased from 30.5 to 19.6 days, (35.8% decrease); and the FBU Request turnaround time decreased from 153 to 80 days (35% decrease). Monitoring laboratory metrics demonstrate the efficacy of the DNA backlog reduction strategy. There are several takeaway lessons from this experience, including (1) engaging legal counsel early to outline necessary legal procedures and the timeline; (2) bringing all stakeholders “to the table” early to discuss expectations, as well as legal and operational responsibilities; and (3) creating a realistic timeline as well as establishing a comprehensive memorandum of understanding by which all parties understand their roles and responsibilities. Understanding laboratory and non-laboratory policy issues is critical to implementation success and the efficacy of a BPL as a DNA backlog reduction strategy.

The November 2017 release of the Council of Economic Advisers’ White House report on the opioid crisis suggests that prior consideration of expenses severely underestimated the economic costs of the opioid crisis. When corrected for these losses, the annual cost from the opioid crisis leapt nearly 600%. The cost to the criminal justice system was estimated at $8 Billion of which $270 million is borne by crime laboratories. However, laboratory budgets have not grown at a rate capable of meeting this increased demand for forensic science services. The hidden costs of the opioid crisis borne by the forensic crime laboratories comes as funds are diverted in the laboratory to meet the increased demands for services in drug chemistry and toxicology. Dramatic increases in turnaround times across other areas of investigation continue to grow as the crisis accelerates. Keywords: Opioid crisis, Toxicology, Policy, Crime laboratories

The National Institute of Justice (NIJ) and its Forensic Technology Center of Excellence (FTCoE) hosted the National Opioid and Emerging Drug Threats Policy and Practice Forum on July 18–19, 2019, in Washington, DC. The forum explored ways in which government agencies and programs, law enforcement officials, forensic laboratory personnel, medical examiners and coroners, researchers, and other experts can cooperate to respond to problems associated with drug abuse and misuse. Panelists from these stakeholder groups discussed ways to address concerns such as rapidly expanding crime laboratory caseloads; workforce shortages and resiliency programs; analytical challenges associated with fentanyl analogs and drug mixtures; laboratory quality control; surveillance systems to inform response; and policy related to stakeholder, research, and resource constraints. The NIJ Policy and Practice Forum built off the momentum of previous stakeholder meetings convened by NIJ and other agencies to discuss the consequences of this national epidemic, including the impact it has had on public safety, public health, and the criminal justice response. The forum discussed topics at a policy level and addressed best practices used across the forensic community.

In many jurisdictions, public safety and public health entities are working together to enhance the timeliness and accuracy of the analytical characterization and toxicology testing of novel synthetic opioids. The improved sharing and early detection of these analytical data are intended to inform surveillance, interdiction efforts, patient intervention and treatment, all of which are critical to curbing the opioid epidemic. Forensic practitioners working to identify novel synthetic opioids struggle to provide timely results when encountering new or unknown substances, such as the fentanyl analogs. These compounds, which mimic heroin in pharmacologic effect but can be far more potent, are inconsistently present in chemical identification libraries, and are currently largely unavailable as reference materials for analytical comparison. Additionally, federal, state and local governments as well as nongovernmental organizations require potency, toxicity and potential-for-abuse data to evaluate the potential health risks of emerging drug threats. Subsequent scheduling efforts and criminal prosecutions also require these thorough drug characterization studies. Pilot programs have demonstrated that early communication of real-time drug toxicity and analytical data significantly impacts the successful response to emerging opioids. High-quality, real-time, national-level data on chemical composition, toxicological test data, drug toxicity and overdoses, and analysis of seized materials by law enforcement are needed to track drug trends. However, the USA still lacks a national system to coordinate and communicate toxicology, medical and medical examiner and coroner data with the broader medical and law enforcement communities. Opportunities to address these gaps as well as recent advancements collected through interagency efforts and technical workshops in the toxicology and analytical chemistry communities are presented here. Opportunities for partnership, increased communication and expanding best practices to move toward an integrated, holistic analytical response are also explored.

On May 10–11, 2016, the US Department of Justice (DOJ) National Institute of Justice (NIJ), the Netherlands Forensic Institute (NFI; Dutch Ministry of Security and Justice of the Netherlands), the International Society for Forensic Radiology and Imaging (ISFRI), the International Association of Forensic Radiographers (IAFR), and NIJ’s Forensic Technology Center of Excellence (FTCoE) at RTI International organized and convened the International Forensic Radiology Research Summit (IFRRS) at the Academic Medical Center in Amsterdam. The summit assembled 40 international subject matter experts in forensic radiology, to include researchers, practitioners, government employees, and professional staff from 14 countries. The goal of this 2-day summit was to identify gaps, challenges, and research needs to produce a road map to success regarding the state of forensic radiology, including formulating a plan to address the obstacles to implementation of advanced imaging technologies in medicolegal investigations. These proceedings summarize the meeting’s important exchange of technical and operational information, ideas, and solutions for the community and other stakeholders of forensic radiology.

This study is a 6-month retrospective analysis of urine drug testing (UDT) data from a pain management population among specimens with clinician-ordered marijuana testing (N = 194 809). Descriptive statistics about the specimen positivity of clinician-ordered marijuana UDT are provided as well as other drug positivity. Specimens from men and adults aged 18 to 34 years had the highest prevalence rates of marijuana positivity. The prevalence of past-month marijuana use among a comparative national population was lower than the prevalence of positive marijuana tests in the UDT specimens by all characteristics. Among the specimens tested for illicit drugs and marijuana, 4.0% were positive for amphetamine, 2.8% were positive for cocaine, and 0.9% were positive for heroin. The most common prescription drugs listed were opioids (64.7%), benzodiazepines (20.5%), and antidepressants (19.9%). In sum, the findings reflect previous research showing high rates of marijuana use, illicit drug use, and prescription drug use in a pain management population.

The Forensic Resource/Reference on Genetics-knowledge base (FROG-kb) web sitehttps://frog.med.yale.edu/FrogKB/was introduced in 2011 and in the five years since the previous publication ongoing research into how the database can better serve forensics has resulted in extensive redesign of the database interface and functionality. Originally designed as a prototype to support forensic use of single nucleotide polymorphisms (SNPs), FROG-kb provides a freely accessible web interface that facilitates forensic practice and can be useful for teaching and research. Based on knowledge gained through its use, the web interface has been redesigned for easier navigation through the multiple components. The site also has functional enhancements, extensive new documentation, and new reference panels of SNPs with new curated data. FROG-kb focuses on single nucleotide polymorphisms (SNPs) and provides reference population data for several published panels of individual identification SNPs (IISNPs) and several published panels of ancestry inference SNPs (AISNPs). For each of the various marker panels with reference population data, FROG-kb calculates random match probabilities (RMP) and relative likelihoods of ancestry for a user-entered genotype profile (either completely or partially specified). Example genotype profiles are available and the User's Manual presents interpretation guidelines for the calculations. The extensive documentation along with ongoing updates makes FROG-kb a comprehensive tool in facilitating use of SNPs in forensic practice and education. An overview of the new FROG-kb with examples and material explaining the results of its use are presented here.

Novel psychoactive substances (NPS) represent significant analytical and interpretive challenges to forensic and clinical toxicologists. Timely access to case reports and reports of adverse incidents of impairment or toxicity is imperative to clinical diagnosis and treatment, as well as to interpretation of forensic results. Delays in identifying the presence of a novel intoxicating agent have significant consequences for public health and public safety. Adverse effects of intoxications with novel cannabinoids, stimulants, hallucinogens, benzodiazepines and opioids spanning January 2013 through December 2016 as reported in emergency departments, death investigations, impaired driving cases and other forensic contexts are the subject of this review. Discussion of the chemistry, pharmacology and adverse events associated with novel drug classes is summarized and described within. Adverse effects or symptoms associated with ingestion of more than 45 NPS have been abstracted and summarized in tables, including demographics, case history, clinical or behavioral symptoms, autopsy findings and drug confirmations with quantitative results when provided. Based on these findings and gaps in the available data, we provide recommendations for future toxicological testing of these evolving substances. These include development and management of a national monitoring program to provide real-time clinical and toxicological data, confirmed analytically, on emerging drugs and their known toxidromes and side effect profiles. Increased efforts should be made to analytically confirm the agents responsible for clinical intoxications involving adverse events in emergency department admissions or hospitalizations. Evidence-based community preparedness among analytical laboratories gained through active communication and sharing of toxicological findings and trends in NPS is imperative to assist in enabling early detection of new drugs in forensic and clinical populations.