It seems like if someone goes into an emergency room, they can get a toxicology report super fast depending on the emergency but if someone dies the toxicology report takes months. Why is that?
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Answer:
The tests run in hospital test for the common offenders: opioids, thc, meth, benzos…
They are run using blood and/or urine samples. The general idea is if they are actively suffering effects of the toxin, it is likely actively circulating in their body and you will find it there. Also, having a live patient to help you rule out possibilities about what they may have ingested helps narrow it down. But you are not getting a complete “tox screen.” Those don’t exist.
Post-mortem, the blood is clotted, there may not be much urine, and we don’t know if they died from an active circulating toxin, or the effects of the toxin (liver failure, kidney failure, arrhythmia), thus all possible tissues are tested for many possible toxins, and typically tested in a staged manner, the most likely/common being tested first, then gradually testing the more odd or less common toxins. These tests cost a lot of money and need to be run individually on their own piece of tissue.
In a live patient, if the standard toxicology report is negative, then they need to sample other organs, which means taking a biopsy of the liver/kidney/whatever, which usually involves surgery and taking as little as possible to minimize the potential complications of the surgery.
In a deceased patient, you can take the whole liver. Both kidneys. Whole heart. And run tests until you run out of money or body parts.
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