Original Communication
Chronic drug use confirmed by hair analysis: Its role in understanding both the medical cause of death and the circumstances surrounding the death

https://doi.org/10.1016/j.jflm.2008.08.012Get rights and content

Abstract

Analysis of hair for drugs is now a well established technique. It is being used increasingly in crime investigation but seldom in routine Coroner’s toxicology. Hair analysis is the only method of obtaining a reliable drug history for the weeks or months prior to death.

Between 2004 and 2006 from the cases reported to HM Coroner, hair was submitted for analysis in addition to the routine specimens for 286 selected cases. These were all cases where drug use was thought to be involved in the death. The usefulness of the data from hair analysis was evaluated along with the data from the conventional samples. The types of cases were identified where hair analysis provided valuable supporting evidence.

It was found that reliable information concerning long-term drug use was important in a wide range of cases including: – demonstrating a history of drug use or lack of it, demonstrating tolerance or lack of it, compliance with medication, death due to long-term cocaine use and its role in depression/suicide, sudden unexplained death, and excited delirium. The cases types are illustrated by reference to individual cases and the implications of the findings discussed.

The study demonstrated that hair analysis can provide vital evidence in a wide range of cases reported to HM Coroner. This evidence can be invaluable to the pathologist, Coroner, and the family of the deceased in understanding both the medical cause of death and the circumstances surrounding the death.

Introduction

At a Coroner’s post-mortem samples are taken for toxicological analysis from those cases where drug use/abuse may have influenced death. Traditionally these samples have included femoral vein blood, gastric contents, urine, and liver, and for certain cases, vitreous humor. However the analysis of these samples reveals only short term drug use, that is, the drugs used in the hours before death.

With the recent advances in technology it has become possible for analysis of hair for drugs to be used as a routine procedure. For example it is used routinely for verification of drug use history in child custody cases where a parent needs to show absence of drug use. In Germany and Italy if a person has their driving licence refused, withdrawn or suspended because of drug related offences, before the licence is returned drug abstinence must be proved and hair analysis is mandatory for this purpose.1 Hair reveals a person’s long-term drug history. Drugs are incorporated into hair at the growing point; they pass from the blood circulating the follicle into the hair shaft at the root tip. Once the drug is incorporated into the hair it is fixed, and it stays fixed in the hair as it grows. This produces a “tape-recording” of drug use over time. Hair grows at a rate of between 0.32 and 0.46 mm/day with a mean rate of growth of 1 cm per month used by analysts for interpretive purposes.2 Head hair is the recommended sample for analysis, but if it is not available then hair from other body sites can be used. However, hair from other sites on the body will have different growth rates making it more difficult to interpret the time period of drug ingestion.3

There have been several papers suggesting the value of hair analysis in post-mortem toxicology including papers by Kintz,4 Kronstrand et al.,5 and Couper et al.,6 but to date there has been no study using hair analysis as an adjunct to Coroner’s post-mortem toxicology.

The Toxicology Unit at Imperial College London developed a method for the simultaneous detection and quantification of the major drugs of abuse and their metabolites.7 These include amfetamine, metamfetamine, methylenedioxymethamfetamine (MDMA or ecstasy), methylenedioxyamfetamine, morphine, 6-monoacetylmorphine, codeine, dihydrocodeine, cocaine and its mteabolites benzoylecgonine and ecgoninemethylester, cocaethylene (formed when ethanol and cocaine are ingested simultaneously), diazepam and its metabolite desmethyldiazepam. These compounds are analysed from a single extraction and a single injection onto the gas chromatograph–mass spectrometer (GC–MS) using selective ion monitoring mode (SIM). A full screen for other drugs can then be carried out on the same extract by injecting a further aliquot using the GC–MS in scan mode. The complete analysis can be carried out using a single 20–50 mg sample of hair making the method ideally suitable for Coroner’s work. The method which was fully validated and previously described elsewhere7 was used to analyse all samples in this study.

Since 2004, in addition to the more traditional samples, hair has regularly been submitted from selected cases covered by the Coroner’s jurisdiction of Eastern District of Greater London. The usefulness of the data from hair analysis was evaluated along with data from the conventional samples for the 286 cases submitted between 2004 and 2006. Presented here are the types of cases, illustrated by reference to individual cases, where analysis of hair has assisted the pathologist in establishing the cause of death, and the Coroner in reaching a verdict. The results of hair analysis were considered in combination with all other relevant information. The implications of the findings are discussed.

A protocol for collection of post-mortem hair samples was issued to all the mortuary staff and pathologists concerned with collection of the hair samples. The protocol stated that the hair was to be collected before the start of the examination to avoid contamination with blood; the sample was taken from the posterior vertex of the head as this is the area where hair growth is least variable. The hair was to be cut as close to the scalp as possible and the cut ends kept aligned and wrapped in the foil which was provided. The foil was to be placed in a tamper proof bag for transportation to the laboratory. The protocol advised that the hair was not to be plucked and was not to be sent with the scalp attached. It also stated that if head hair was not available then pubic, axial or chest hair could be collected. If any of the above procedure had not been followed this was noted in the case file and an appropriate comment was included in the final report.

The hair was segmented, shampoo washed and solvent washed. After drying it was cut into 1 mm lengths and the drugs were extracted by incubating overnight with dilute acid. This was followed by a clean-up stage using solid-phase extraction with mixed-mode cartridges. After derivatisation with MSTFA and MBTFA the extracts were analysed using GC–MS.7 The washes were always analysed to check for environmental contamination.

Section snippets

Demonstrating a history of drug use

In 76 of the 286 cases the hair sample was from a death involving heroin use. This was determined by standard toxicological analysis of post-mortem blood and urine. Sometimes with these cases the family denies that the deceased was a drug user, and they may also claim that it must have been the first time of use and suggest that someone could have assisted the deceased. If such allegations are made they require investigation by the police. As drug users can be very adept at concealing their

Conclusion

Evidence concerning long-term drug use can be as important in helping to establish the cause of death and reaching a verdict as evidence concerning acute drug ingestion. Blood, urine, and other specimens which give evidence concerning the drugs taken within hours of death are routinely analysed in Coroner’s work, but analysis of hair, which may provide evidence of drug use in the weeks or months prior to death, is not a routine procedure. The results of this study suggest that analysis of hair

Conflict of interest statement

None of the authors have any conflicts of interest with respect to this study.

Funding source

There was no funding sponsor for this study.

Ethics

The study was approved by Riverside Research Ethics Committee.

References (23)

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  • Cited by (21)

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