Why does toxicology take so long?
July 25th, 2011
05:07 PM ET

Why does toxicology take so long?

Lab tests to determine what killed singer Amy Winehouse will take  two to four weeks, according to the Scotland Yard.

Unlike television crime shows where results are instant, standard toxicology tests can require several steps, taking up to several weeks.

An autopsy completed Monday afternoon was inconclusive and investigators will need the toxicology results to determine the singer’s cause of death, according to a police statement.

Toxicology tests are used to determine whether and how much legal or illegal drugs a person has taken.   While it’s unclear what caused Winehouse’s death, her erratic behavior and drug problems were public after she reached musical stardom in 2007.

In post-mortem toxicology screenings, blood is drawn from various areas of the deceased person’s body. This initial test  indicates what type of drugs, such as opiates or amphetamines, might be present.

The secondary part is where it becomes complicated.

Drug analysis a multistep process

If the screening test indicates the person may have had opiates in his or her body, further tests are required to figure out what kind of opiates and in what amount.

“You confirm the preliminary test,” said Douglas Rohde, supervisor of chemistry and toxicology at the Lake County Crime Lab in Ohio.  “You confirm that drug is actually there. There’s not one test as seen in 'CSI.' There’s no quick test that gives you a positive identification and confirmation. The confirmatory tests can take days or weeks, if they have to be repeated.”

To confirm that a person had a type of drug in his or her body, the drug has to be separated from the blood or tissue.

The gold standard for drug identification is gas chromatography-mass spectrometry, an instrument that looks at drugs at the molecular level.  Its even more advanced version is called liquid chromatography tandem mass spectrometry.

“You go through and run individual tests, running a specific test to get a level of a specific drug,” said Dr. Daniel Spitz, chief medical examiner in Macomb and St. Clair Counties in Michigan.

This process could take several days depending on the types of drugs found in the body. And drugs could be present in very minute levels, in measurements like parts per million or parts per billion.  Rohde likens it to searching for five black marbles in a pile of 1 million white marbles.

In the final step, the toxicologist reviews the evidence and determines whether drugs found in the body were enough to kill an individual.   That report is submitted to the coroner or medical examiner, at least in the United States.

Cases involving Michael Jackson, Heath Ledger and Anna Nicole Smith were complicated because they had several different drugs in their bodies - some of the substances “weren’t in the regular menu in the toxicology lab,” Rohde said.

“Anytime you have a notorious person die of suspect means and they have past history of drug abuse, the toxicology report is very important,” he said.  “You don’t want to rush it.”

In a high-profile case like Winehouse's, it is most likely that the lab will run several tests to confirm its findings.

Follow @CNNHealth on Twitter

soundoff (59 Responses)
  1. Ohhh!

    Thank you. I've always wondered.

    July 25, 2011 at 18:08 | Report abuse | Reply
  2. BC

    I wonder if there's a chemical profile for "boredom" or "SBD" inhalation.

    July 25, 2011 at 18:15 | Report abuse | Reply
  3. dr oz

    drugs and booze. end of story. so sad. lets move on

    July 25, 2011 at 19:39 | Report abuse | Reply
  4. HRPufnstuf

    Her parents were "shocked" by her death. The rest of us weren't.

    July 25, 2011 at 21:07 | Report abuse | Reply
  5. God

    Obviously, you have no character defects, are in perfect health, and are privy to universal facts that have nothing to do with you. I'm sure those around you would not be shocked by your callousness, self-righteous judgment, and inhumanity. Gee, you sound perfect!

    July 25, 2011 at 22:10 | Report abuse | Reply
    • Rob

      Sounds more like your describing yourself...

      July 26, 2011 at 07:03 | Report abuse |
  6. Erik

    A little disappointed in the article, I was hoping for a clearer explanation for why it takes so long. The only real reason I saw was "This process could take several days depending on the types of drugs found in the body." Several days somehow leads to "2+ weeks". I guess this scientific field has not learned about parallelization or pipelining of tests?

    July 25, 2011 at 22:34 | Report abuse | Reply
    • I'm easily swayed

      You have to figure in commercial breaks.

      July 26, 2011 at 02:47 | Report abuse |
    • Gerry

      More likely the general public wouldn't understand scientific methodology much less evidentiary methodology. The medical examiner examines the samples in increasingly finer detail so that determinations of death can be accurately assessed in full knowledge that thousands of CSI fans and a handful of low-level lab technicians will be seond-guessing them.

      July 26, 2011 at 08:08 | Report abuse |
    • DoctorV

      As a medical student I rotated through the office of the medical examiner, but I am by no means an expert. The thrust of what they're getting at, though, is that if you know what you are looking for it is relatively easy to test. For example, we can check someone's blood for cocaine in the ER and get a yes or no answer within a few minutes. If you want to know how much cocaine, however, there are a lot of processing steps that have to be done by skilled lab personnel, there is no automated machine.

      At the medical examiner's office it is even more complicated since you don't know beforehand everything you will be interested in quantifying. So first you have to extract the chemicals from the blood; not all substances will be extracted under the same chemical conditions so you have to do it several ways. Then you can start running them through the GC mass spec to try to get a qualitative idea of what you are dealing with. Then you get to do all the work of quantifying it. Then in a high-profile case like this you get to repeat everything several times to make sure you haven't screwed anything up. And don't forget you have dozens of other cases rolling in all the time that need your attention too. In the end a week or two to get all this done is not too bad.

      July 26, 2011 at 11:25 | Report abuse |
  7. Fled

    So .... they're saying if nothing's found that could of killed her, she died of natural causes?
    But what if what killed her was not " in the regular menu in the toxicology lab,”??

    July 26, 2011 at 01:01 | Report abuse | Reply
    • Hasher Iva

      It means they will find something they don't recognize from their 'normal' list of chemicals wn will have to match it to something.

      Taking a couple of weeks to process the samples multiple times and work the schedule with hundreds of samples waiting to be processed sounds like a reasonable time. It's not like CSI where they put a drop of blood in the 'machine' and it spits out a complete listing of everything that's in that too small drop of blood.

      July 26, 2011 at 16:31 | Report abuse |
  8. fernace

    Isn't it also true that each case has to be in line, & wait it's turn. Not to mention the underfunded & understaffed labs, with the heavy backlog! Or is that just true in this country??

    July 26, 2011 at 03:23 | Report abuse | Reply
  9. Sir Skeet

    I work in a toxicology lab, and we get deceased specimens (blood, liver, ect) for testing all the time. We screen the specimen first using a very sensitive test (EMIT or ELISA) then confirm with GC-MS (what they talk about in this article. The screening tests can take anywhere from 15 minutes to 3 hours depending on the type of screening method used. Once we know it's positive for a analyte (lets say opiates), we test the specimen to determine what kind of opiate (hydrocodone, morphine, codeine, ect.). That test takes up to 8 hours to process, and then maybe another 8 hours to run depending on how many patients you're running along with the standards and control that go with them. So maybe a day to get results. More if you have to repeat. There is NO way it takes weeks to get these results. It's pure BS.

    July 26, 2011 at 06:58 | Report abuse | Reply
    • montyhp

      So you drop everything for someone like Amy Winehouse? Or do you add it to your backlog? Do you work over the weekend? Just wondering because management has to figure these things out.

      July 26, 2011 at 07:49 | Report abuse |
    • tox

      it could have been a seizure from not having drugs

      July 27, 2011 at 11:28 | Report abuse |
  10. swiss

    thanks so much for this piece – I have been wondering what is entailed and what would require weeks, what an autopsy does and doesn't show, etc, and have been disappointed that no news sources have bothered to prvode any information on these processes. Sure, some people might not be interested or able to follow, but I think it wouldn't be above most people's heads, and making assumptions like no one is curious, or it's about "science" so they won't get it, contributes to the dumbing down of people in our time. This piece may not be heavyweight, but at least it raised the issue, and then some informed people have added to the dialog in comments. Thanks to the commenters for taking time to do that 🙂 We will decreasingly be able to rely on quality and veracity of media sources, so it will revert back to the people–particularly people with expertise and knowledge in less common areas–to fill in the gaps for the rest of us.

    July 28, 2011 at 03:20 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.