TCAS has wide experience with pharmaceutical toxicology and has performed
many assessments involving prescription medications, drugs of abuse, vaccines and
over-the-counter preparations. Although pharmaceutical use can be a significant toxicological
factor in a variety of claims, the real and potential effects must be correctly
assessed by the expert toxicologist. Aside from direct effects, pharmaceutical use
can also explain unusual behaviors and/or account for injury claimed to be attributed
to another agent.
For example, some
powerful prescription drugs can directly or indirectly cause certain medical conditions.
Others can exacerbate and/or cause increased susceptibility to exposure-induced
health effects (a recent TCAS case study highlights this
fact). Certain pharmaceuticals can also impair or enhance the metabolism of other specific
drugs by increasing their blood levels into the toxic range. Children, older adults
and women can also be at higher risk of adverse health effects from pharmaceuticals.
The U.S. Food and Drug Administration lists more than 160,000 pharmaceutical packages
registered and approved for sale in the U.S.1 This
staggering number of drugs means that, aside from effects resulting from abuse, the
potential for interactions and/or medication errors is very high. Additionally,
new biopharmaceuticals (new drugs developed through biotechnology) are increasingly available.
Although this can increase the complexity and potential for drug interactions, new
innovations do not negate the basic toxicological principle, "The
dose makes the poison."
The following paragraphs provide general toxicological outlines of pharmaceuticals
for which TCAS has performed toxicological assessments, produced
written reports and/or provided expert testimony, subsequent to being retained by
defendants, plaintiffs, State attorney generals, prosecutors and/or public defender's
offices. We invite you to
contact our office if you have questions or concerns regarding any prescription medication or pharmaceutical not listed on this
Drugs of Abuse and Drug Testing
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Drugs of abuse frequently involve the ingestion, insufflation or injection of illegal drugs or the misuse of
prescription medications, generally with negative consequences and frequently in
the context of litigation. Drug abuse "cutting agents" (adulterants) and contaminated needles can
also induce unique, adverse health issues including cardiac arrythmia, convulsions, sepsis, AIDS, hepatitis and other diseases.
TCAS has in-depth experience in interpreting laboratory test results and
assessing toxicological issues for common drugs of abuse including (but not limited
- Cocaine Metabolites
- Heroin Metabolites
- LSD and Hallucinogens
- Marijuana Metabolites
- Methadone Metabolites
- Opiates & Opioids
- Peyote (mescaline)
Refer to our Drugs of Abuse
page for more detailed information
Pharmaceuticals and Prescription Medications
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TCAS has broad experience in cases involving hundreds of different pharmaceuticals,
prescription medications, vaccines, additives and over-the-counter preparations. As a toxicologist
and licensed clinical, environmental and forensic laboratory director, Dr. Sawyer
has in-depth experience with drug testing, chain-of-custody procedures, interpreting
laboratory analyses and application of peer-reviewed methods to produce scientifically
credible toxicological assessments. He is familiar with the latest technology used
to conduct sampling and analyses of pharmaceuticals, drugs of abuse, synthetic compounds,
organic compounds, neurotoxins and many other specialized substances. The following
partial catalog lists some of the most frequent pharmaceuticals
of interest in cases for which TCAS has been regularly retained in both
investigative and causative assessment capacities:
Neurotoxins and Neurotoxicity
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A neurotoxin is a naturally- or industrially-produced substance which adversely
affects the human nervous system. Neurotoxicology is the study of the adverse effects
of chemical agents on the structure or function of the nervous system including
the brain and sensory organs. The U.S. EPA provides considerable information on
many aspects of neurotoxicology.3 The symptoms and
health effects of most neurotoxins are well-documented, but of all the various toxic
substances, neurotoxins are among the most problematic as they can not only adversely
impact multiple systems and organs simultaneously but also amplify the adverse effects
of other substances. For example, although lead's neurotoxic targets include the
heart, bones, intestines, kidneys, brain and reproductive system, lead can also
cause oxidative stress which prevents the body from detoxifying itself through inhibition
of antioxidants. Similarly, chronic exposure to various heavy metals such as aluminum,
manganese, arsenic, thallium and others can lead to systemic disruptions and neurological
disorders. Certain gases can also produce lethal neurotoxic effects (such as in
a recent TCAS case study in which a victim was exposed to methyl
Organic neurotoxins can be particularly toxic. For example, the botulinum toxins,
which are among the most toxic substances known, can be fatal after exposure to
only a few billionths of a gram. Other organic neurotoxins include venom, pesticides,
organic solvents (chlorinated solvents and hexa-/hepta-carbons at high dose levels),
contaminated seafood, poisons, molds, fungi, organophosphate nerve gas and others.
Some pharmaceuticals can produce neurotoxic effects, either independently or in
combination with other substances. An objective toxicological exposure assessment
is an absolute necessity in cases where neurotoxins are involved. TCAS
has been regularly retained in both investigative and causative assessment capacities
in cases involving neurotoxins. Please contact our
office for additional information.
Show all results for "Drug Toxicity"
Drug toxicity may occur due to any of several factors including (a) excessive or
incorrect dose, (b) impaired metabolism due to interference from other pharmaceuticals
and (c) impaired renal or liver function by other causes. This phenomenon can happen
to persons of all ages (including infants) due to greater quantities of administered
medications per unit of body weight. As noted in a recent AARP publication,2
"Drug toxicity is a common and significant health problem, yet it often goes
undetected by patients and physicians who do not recognize it as the cause of such
symptoms as mental disorientation, dizziness, blurred vision, memory loss, fainting
and falls. Although drug toxicity may result when a medication dose is too high,
it can also occur if a person's ability to metabolize a drug changes over time."
Drug toxicity can also occur when multiple medications interact unpredicably (see
below) or interact with other substances (such as alcohol or drugs of abuse which
can alter metabolism). An objective toxicological exposure assessment can be instrumental
in establishing or refuting causation in cases involving drug toxicity. Please
contact our office for additional information.
Polypharmacology and Drug Interactions
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With some 160,000 pharmaceutical packages currently registered and approved for
sale in the U.S.,1 drug interactions are inevitable
and can produce a vast range of toxicological effects. A recent TCAS
case study highlights the results that can occur from multiple drug
interactions and the resulting polypharmacological effects. The term "polypharmacology"
refers to a single drug acting upon multiple targets of a unique or multiple disease
pathway. Polypharmacology is generally discouraged due to nonselectivity of pharmaceutical
interactions. However, when patients combine certain medications in sufficient doses,
they can inadvertantly produce polypharmacological effects. Prescription errors
and/or combinations of pharmaceuticals resulting from ill-advised prescriptions
or circumstances can, in some cases, lead to malpractice litigation (see below).
TCAS has conducted numerous toxicological assessments with respect to drug
interactions and polypharmacological effects. Please contact our
office for additional information.
Prescription Errors and Medical Malpractice
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Adverse drug events (ADEs) in which patients are harmed as a result of exposure
to pharmaceuticals are common in the U.S. with some 700,000 emergency department
visits and 100,000 hospitalizations reported each year.4
Elderly patients are particularly vulnerable to ADEs as they more frequently use
multiple pharmaceuticals and are more susceptible to adverse effects. In cases involving
prescription errors or medical malpractice, the expert toxicologist follows a highly
specific process of investigation as well as application of generally-recognized
scientific, forensic and deductive principles. This involves a detailed review of
a patient's medical history and application of the basic principles of toxicological
causation. It is important to note that it is the toxicologist's task to identify
the true cause — which may or may not be solely related to the suspected pharmaceutical
or which may be related to an underlying condition or toxicant. The expert toxicologist's role is
to provide a causative or contributory opinion with respect to exposure based upon
an objective investigation of all available case facts including medical records,
pharmacological records, deposition transcripts, police reports, generally-accepted
toxicological studies and other related data. Please contact our
office for additional information.
Notes and References
- U.S. Food and Drug Administration, "National Drug Code Directory," Drug
Approvals and Databases, 2015
- Mary A. Fischer, " When Medicine Makes You Sick," A.A.R.P. 2010
- U.S. EPA, Citations to scholarly
articles and reference material, (multiple EPA references)
- U.S. Department of Health and Human Services, " Patient Safety Primer: Medication
Errors," Agency for Healthcare Research and Quality, 2010
- TCAS montage (report demonstrative, redacted), public domain thumbnail images courtesy
www.scx.hu. Photos by Adam Ciesielski, Cape Town, Western Cape; Dima V (3); Cristian
Bender, Tubarao, SC; Jeroen Belen, Alkmaar, NH; Patricia Yliniemi; Juan Manuel Navarro,
Leon, GTO; Luis Francisco Cordero, Quito, Pichincha, GR.