Challenges and Future Trends of Forensic Toxicology

Dear Colleagues,

Forensic toxicology is undergoing rapid transformation driven by changes in the drug market, analytical innovation, and evolving evidentiary needs. Beyond traditional criminal casework, the relevance of hospital-based healthcare disputes is increasing, where forensic toxicology supports the reconstruction of adverse events, assessment of therapeutic appropriateness, and evaluation of causality (e.g., procedural sedation, peri-operative analgesia, medication errors, drug–drug interactions, and iatrogenic intoxications). In these settings, the growing complexity of polypharmacy and combined use of prescription drugs, alcohol, and substances of abuse requires fit-for-purpose analytical strategies integrating targeted screening with robust quantitative confirmation.

A key challenge remains postmortem interpretation: postmortem redistribution, microbial neoformation, and analyte degradation—together with substance pharmacokinetics/pharmacodynamics, drug interactions, and the clinical context of administration—may lead to misleading causal inferences. Accordingly, a multi-matrix approach (peripheral vs. cardiac blood, vitreous humor, urine, and bile), complementary biomarkers (EtG/EtS, n-propanol, specific metabolites), and critical evaluation of sample preservation, additives (NaF), chain of custody, and therapeutic timelines are essential.

Integration of toxicological results with medical records, dosing times, anesthesiology data, and anatomo-pathological findings can reduce bias and strengthen evidentiary conclusions. Future priorities include international harmonization of cutoffs and methods and the adoption of green toxicology practices to reduce solvents, waste, and energy without compromising quality and traceability.

Dr. Pietro Zuccarello
Guest Editor

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