Plenary Session (27th August 2024)
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Keynote: Changing landscape of DOA and other drug trends (by Dr. Simon Elliott)
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Synopsis: For many years, classical drugs of abuse have been amphetamines, heroin/morphine, cocaine, cannabis and hallucinogens (e.g. LSD). Whilst prescription drugs such as benzodiazepines and barbiturates have also been abused, in recent years the range of drugs abused (both prescription and non-prescription in nature) has expanded dramatically. This lecture will describe and provide background on the often less well known but increasingly abused drugs such as loperamide, GHB/GBL, gabapentinoids, tramadol, kratom, volatiles (‘poppers’, nitrous oxide), fentanyl, olanzapine, promethazine and quetiapine as well as the significant number of New Psychoactive Substances (NPS) that have emerged over the last 15 years (e.g. cathinones, synthetic cannabinoids, benzodiazepines and synthetic opioids). The challenges this changing landscape poses, especially analytically will also be discussed as well as the context of their abuse (including drug use in prisons, poly-drug use and abuse through use of high doses) and toxicological considerations.
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Biography: Dr Simon Elliott has 30 years’ experience in forensic toxicology and is a Consultant Forensic Toxicologist, independent Business Consultant and Director of Elliott Forensic Consulting Ltd and Toxicology UK Ltd. He was previously the Director of Global Forensics at Abbott (2017-2018) having also been the founder and Managing Director of Forensics Ltd (ROAR Forensics, subsequently Alere Forensics) in Malvern, Worcestershire, UK (2008-2017). Dr Elliott previously worked as a Clinical Scientist in the NHS at Birmingham City Hospital for over 10 years specifically involved in clinical and forensic toxicology as Section Head of Forensic Toxicology. He is a Visiting Professor in Forensic Toxicology at King’s College London and holds a BSc in Biochemistry from the University of Bath and a PhD in Biochemical Toxicology (studying GHB) from the University of Birmingham. He is a Chartered Scientist and European Registered Toxicologist as well as being a member of a number of professional organisations including The International Association of Forensic Toxicologists (TIAFT, President Elect), the LTG, Chartered Society for Forensic Science, Association of Clinical Biochemistry and Royal Society of Chemistry in addition to being a founder and Past Chair of the UK & Ireland Association of Forensic Toxicologists (UKIAFT). An author of over 90 scientific publications, articles and book chapters, he is on the Editorial Board of Drug Testing & Analysis and Forensic Science International journals as well as being an Associate Editor of the Journal of Analytical Toxicology and an Editor of Wiley’s WIREs Forensic Science (Toxicology) and Clarke’s Analysis of Drugs and Poisons. Dr Elliott has presented at many national and international meetings (including invited speaker) as well as presenting expert evidence for many years in Coronial, Civil and Criminal Court. He is an adviser to the World Health Organisation (WHO) and a member of the WHO Expert Committee on Drug Dependence as well as technical adviser to the United Nations Office on Drugs and Crime (UNODC) and formerly the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). He continues to provide expert evidence and advice to the Criminal Justice System as well as Governments, policing, solicitors, HM Coroners and a variety of laboratories, both in the UK and abroad including the Middle East, West Indies, Europe, Australasia, Africa and North America.
Toxicology Workgroup (TXWG) scientific session
(28th August 2024)
Prodrugs & more unusual aspects of NPS (by Dr. Simon Elliott)
Synopsis: The concept of a substance acting as a prodrug for an intended drug is not new (especially in medicine) but this has now also extended to considerations of prodrugs of new psychoactive substances (NPS). In some countries, the constant evolution of NPS has led to the introduction of various alternative methods of drug control. Whether for this reason or in the pursuit of user experimentation, prodrugs of NPS have been discussed, developed, and exploited, posing some distinct forensic challenges. This is especially the case within toxicological analysis of biological fluids and for some substances, also forensic chemical analysis, through inherent instability of the prodrug or metabolism in the body. Particular examples of NPS prodrugs include 1-propanoyl-LSD, 1-butanoyl-LSD, 1-acetyl-LSD, and 2C-B-AN. Various prodrugs for stimulant and hallucinogenic substances in particular have appeared in the literature and have been discussed within drug user forums and made available for purchase online. Presently, drug monitoring data from national and international systems indicate that prodrugs are not widely available or problematic. Nevertheless, it is important that there is sufficient awareness of the prodrug concept and potential impact and associated forensic implications, not just for chemical analysis but also for toxicological considerations when a substance has been used.
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Ketoacidosis in post-mortem toxicology (by Dr. Simon Elliott)
Synopsis: Ketoacidosis is the result of biochemical changes that occur in the body often associated with alcoholism, diabetes and in some circumstances, poor nutrition/starvation. Specifically, there is a change in the body's fuel pathway resulting in the breakdown of fatty acids producing ketone bodies such as acetone and particularly beta-hydroxybutyrate that reduce the body pH which can result in illness and potentially death. Ketoacidosis as a possible cause of death can be overlooked in post-mortem investigations. Therefore, this lecture discusses the background and causes with presentation of analytical and interpretative considerations to assist investigators in identifying such cases.
