The Science Behind Forensic Drug Analysis
Crime dramas have stood the test of time as one of the most popular TV show and movie genres, and many share one pivotal moment: a grizzled detective making their way down to the lab to meet with a forensic analyst who, with the help of some seemingly magical scientific tests, helps them crack their case. While those scientists may get just a moment of screentime, their work is often key to solving the mystery. But what does the job of a forensic scientist look like in the real world?
Alex Krotulski, PhD, can tell you that his job involves much more than what you’ve seen in the movies. He’s an up-and-coming forensic toxicologist who works with doctors and medical examiners to help understand how drugs play a role in medical conditions, crime, and death. Dr. Krotulski breaks down what forensic toxicology is and explains why it’s essential to combat the issue of rising drug overdose deaths.
Q: How would you describe your research to the person riding the elevator with you?
A: Our team conducts forensic toxicology research, which means we look for the presence of drugs in biological samples. We apply this research often in the context of medical or legal settings. Specifically, we focus on analytical toxicology (what drugs are present) and interpretive toxicology (what effects did the drug have) for existing recreational drugs and newer drugs like novel stimulates, designer benzodiazepines, and synthetic cannabinoids. These results can help us understand the potential role a drug had in a person’s death, illness, or mental or physical impairment. Our goal is to find what drugs are appearing on the street and how they impact factors like mortality, public health, and public safety.
Q: Why is forensic toxicology important?
More and more people are dying each year of drug-related causes. We work with medical examiners and coroners to help determine cause of death where a drug overdose is suspected. This ultimately helps the CDC track drug deaths and provides closure to families grieving the loss of loved ones. The more we know about the effects of a drug — especially the adverse ones — the better prepared scientists and medical professionals can be to interpret the symptoms (e.g. nodding, incoherence, etc.) and effects (driving while intoxicated or overdose) they’re seeing in people who come in with one or more recreational drugs in their system.
What’s more, overdoses from opioids, namely fentanyl, continue to increase in the U.S. Toxicologists are trying everything we can to keep up with the increasing pace. Our laboratories are constantly evaluating new technology that is faster and more sensitive so we can obtain highly accurate and precise results. Our laboratory has been extremely proactive about developing new toxicology tests in a timely manner so we can test for new drugs as close to their emergence as possible.
Q: Where do forensic toxicologists fit in the broader fields of medicine and forensic science?
A: We work with both clinicians and medical examiners. When working with medical examiners, we’re often trying to answer the question of “why did this person die?” There are certain indicators at autopsy that may point to drug-related death — such as fluid in the lungs — so we work to pair those findings with our test results.
On the clinical side, we help make sense of how toxicology tests correlate with the observations of a clinician. For example, a clinician may notice signs of sedation, despite a negative urine drug screen. There are certainly things that a drug screen can miss. Or a patient may begin to act erratically after administration of the opioid antidote naloxone – this may signify that other drugs (like methamphetamine or synthetic cannabinoids) are present in the patient’s system in addition to suspected opioids. In these scenarios, clinicians often want to know why the patient exhibited certain symptoms or acted the way they did, and we can help determine the drug culprit at the center of the issue.
Q: What sort of factors do you look for when investigating a drug?
A: We look for common adverse effects — for example, with opioids, we often see slowing of the breath — so our goal is to examine if that can occur, how quickly it can occur, and whether naloxone is effective in reversing it. Then, we look for any unexpected effects — for example, we’ve noticed certain novel synthetic opioids have been linked to cardiac arrest among emergency department patients. Additionally, we also track how many fatal vs. non-fatal overdoses we see for each drug (or no overdoses at all), because it’s usually a good indicator of the drug’s negative effects.
Q: What’s a surprising statistic about forensic toxicology?
A: Our research team has developed a variety of methods to characterize new drugs entering the U.S. supply. We use analytical chemistry to identify drugs of today and of the past using a database of more than 1,100 targets. Through our efforts, we’ve found that there are, on average, about 30 new drugs appearing in the U.S. every year that we haven’t studied before, with many unknown effects and interactions with other drugs already available. There are also about 100 novel psychoactive substances being used across the country in any given year (though these statistics are likely underreported).
Q: What first sparked your interest in your area of research/your research question?
A: I’ve always been passionate about chemistry, and the field of forensic science in general has always piqued my interest. Forensic toxicology is the perfect blend of chemistry, pharmacology, and toxicology, and I feel forensic toxicologists are well trained to answer complex questions about drug use, effects, and outcomes.
Q: What is the best memory you have from your research?
A: It’s hard to pick one, but many of my best memories relate to success within the field and achievements that are recognized through publications, presentations, and awards. Our data is now commonly used by and cited by the Drug Enforcement Administration, the Centers for Disease Control and Prevention, and other health and safety organizations for drug scheduling actions, prevention and control measures, and even educational purposes. I am also humbled and honored to have received the inaugural 2021 Society of Forensic Toxicologists (SOFT) Research in Forensic Toxicology Award and the 2022 American Academy of Forensic Sciences (AAFS) Toxicology Section’s Irving Sunshine Award for Outstanding Research by a Young Investigator.