Informed by interviews with personnel in medical examiner (ME)/coroner offices, this brief discusses opportunities and implementation strategies for rapid toxicology screening tools.
When a drug-related death is suspected in a medicolegal death investigation, the ME/C office will order toxicology testing to identify whether a drug is present in the decedent. Interviewees indicated that such testing may take about 10 weeks or longer, depending on the caseload of the testing laboratory. This brief focuses on potential opportunities for simpler, lower cost toxicology screening that can be used by ME/C offices, mostly in the form of immunoassay screening; however, despite the advantages, the sensitivity, specificity, and effectiveness of these tools are limited, thus constraining their use in casework. Potential opportunities for screening tools and their limitations are discussed in this brief. The brief features a case study of the King County (Washington State) Medical Examer’s Office, which uses rapid testing with comprehensive toxicology testing in decreasing the burden of extended turn-around times. Two lessons learned are noted. First, collaboration across stakeholder groups is the key for implementing new workflows. Buy-in from the Washington State Patrol enabled a successful and informative pilot study. Second, although screening techniques can be used in streamlining and making decisions, they should be used with, but not in place of, confirmatory toxicology testing. Among the issues discussed are the lack of alignment of current products to fit ME/C screening needs and the limited return on investment in some ME/C offices. The overall conclusion is that implementation of these screening tools is not a conclusive means of addressing systemic workforce and resource issues; however, they may be useful in efforts to counter long turn-around times in smaller, resource-challenged offices.