Laboratory guidelines and standards in clinical and forensic toxicology

Abstract

An overview is given of the existing standards and guidelines for analytical toxicology. Details about guidelines concerning forensic toxicology, clinical toxicology, point-of-care testing, and an area of overlap are provided. Guidelines and standards exist for forensic toxicological analysis in general and for specific situations, e.g., workplace drug testing and driving under the influence of drugs and alcohol. For workplace drug testing, detailed guidelines exist in the U.S.A., Australia, and Europe describing for example the methods used, their cut-off and the process of sample handling. Some governments describe the methods and quality requirements for blood alcohol testing for driving under the influence of alcohol in detail in their laws. In the area of clinical toxicology, guidelines not only focus on the analytical aspects of analysis but also on the timeliness of results. According to the US- and UK-based practice guidelines for the emergency department, the turn-around time should be 1 or 2 h, respectively, for a specific set of analytes. Guidelines are either being developed now or already available (e.g., workplace drug testing, breath alcohol analysis) for point-of-care testing in analytical toxicology. In the context of brain death and sexual assault cases, specific demands need to be imposed because of the unique aspects of drug analysis in these situations (variety of drugs used, low concentrations). Many guidelines and standards are available and it is up to every laboratory to choose the best ones depending on the area of activity and the legal and regulatory environment.