Laura M. Labay, Ph.D., F-ABFT, DABCC-TC
There are tolerant individuals that have active drugs within their system well above concentrations that may be considered fatal to drug-naive individuals. Epidemiological data demonstrate that within the last decade the number of accidental, substance-related deaths has increased to epidemic proportions. Evidence at the scene and on the body helps to triage the case and ascertain if the death warrants an autopsy. Different opinions about how to work up suspected drug fatalities, the autopsy versus external exam requirement, and death certification of cases with positive drug findings exist among medical examiners. The data shows that no matter the approach, it is important to consider the role of drug tolerance when developing death investigation protocols and interpreting toxicology results.