0:00

Hello and

0:11

welcome to The Toxpod. I'm Tim

0:13

Scott.

0:14

And I'm Peter Stockham.

0:15

And we are here today with a very special

0:17

guest, a man who needs no introduction

0:20

but I'll give him one anyway. Dimitri Gerostamoulos is

0:23

head of forensic science at the Victorian Institute

0:25

of forensic medicine and president

0:28

elect of TIAFT and has done

0:30

a great many things in his career. Welcome Dimitri.

0:33

Hello Tim. Hello Peter. Great to be here.

0:35

Good to have you on The Toxpod. So I

0:38

wonder if we could start off by you just

0:40

telling our listeners a bit about your career

0:42

path, how you got into the field,

0:44

how you got to where you are today.

0:47

Sure. I guess I'm, I'm fortunate

0:49

in the sense that uh , when I finished

0:52

my undergraduate degree in pharmacology

0:54

and chemistry, the Victorian Institute

0:57

of Forensic Medicine had just been set up and

1:00

there was a fellow called Olaf Drummer who

1:02

was largely looking after the tox

1:04

laboratory, he was actually head of scientific

1:06

services. And he

1:09

had a couple of honours positions and one of them

1:11

was looking at methadone deaths and

1:13

the other one was looking at the incidence of cannabis

1:15

in motor vehicle accidents. And I took

1:18

the latter project and

1:20

went down to the Institute, I was expecting to see this old man

1:22

with a beard and some glasses in a white coat

1:25

and I wasn't too far off. He wore a

1:27

white coat, had a beard, but

1:30

uh , he was very young then. And

1:33

from there I completed my honours. I

1:35

worked in the lab for a few years and

1:37

then Olaf said, really if you want to progress do a

1:39

PhD, so I did. And

1:42

four years later I'd finished my thesis.

1:44

I then got a postdoc position, all

1:47

at the institute, and I analyzed toenails

1:50

and hair samples

1:52

and soil samples for inorganic

1:55

arsenic in samples from rural Victoria.

1:57

I'm looking at the sort of seepage from

1:59

, um, arsenic treated material,

2:03

which was used to set up, you know, fences

2:05

right across rural Victoria that

2:08

sort of seeps into the table water. And there

2:10

was a suggestion that that inorganic arsenic

2:12

was leading to higher rates of cancer in people in

2:14

the country.

2:15

Was anyone doing uh those kind of tests in

2:17

hair at that time?

2:18

Uh , not in hair. Um,

2:20

we were, to get inorganic arsenic you

2:23

basically had to use atomic absorption spectroscopy.

2:26

So that was , um , cooking

2:28

those at 300 degrees with uh

2:30

, concentrated hydrochloric, nitric

2:32

and sulfuric acid.

2:34

Good stuff.

2:34

It's a good start to Dorian

2:37

Gray, especially with my hair, and

2:39

I did that for two and a bit years, farmer's

2:42

toenails, boy! Talk about specimens

2:45

for, choice specimens for analysis. And

2:49

um, I then finished that and then we had a heroin epidemic

2:52

at the turn of the century. There were, you know,

2:54

almost every day there was a person dying of heroin , uh

2:57

, related causes. And I got involved

2:59

in a research project that looked

3:01

at some of the risk factors, so people

3:03

injecting alone, people

3:05

using multiple drugs , uh

3:07

, people using more than what they might

3:10

have used a few days ago where their tolerance

3:12

is down. We identified a number

3:14

of risk factors. And then the manager

3:16

position came up. There was a sort of a change

3:18

at VIFM, a sea change. I took the job

3:21

and I , I've been there,

3:23

well I managed the lab for the next 13, 14

3:25

years until the lab grew so big

3:28

that I needed help. And

3:30

, um , when I started we had 10 people.

3:32

We've now got 42 people in the lab. So

3:35

it's a huge change and I've

3:37

got really capable people who work with me,

3:39

so a great team. It's a good place

3:42

and like your organization , um,

3:44

there's a number of different disciplines

3:47

at the Victorian Institute of Forensic Medicine, including

3:49

forensic pathology, clinical forensic medicine

3:52

, uh, the other laboratories. So

3:54

it really is a great place to work. And I've been

3:56

there pretty much my whole career.

3:58

I'm fortunate, I suspect that I've been

4:01

in the one place for a long time because

4:03

it's allowed me to do things that maybe

4:04

I wouldn't have if I'd, you

4:07

know, hopped from institute or organization

4:09

to organization. It's a great place to be.

4:11

It's probably a bit of an unusual thing about , uh,

4:14

the context in Australia. People do tend to stay

4:16

in one place for quite a while, whereas in Europe

4:18

and America, people move around a lot more.

4:21

Yeah, that's true. That's true. But I guess

4:23

, um, in my particular instance

4:26

, uh, I've been very fortunate that

4:28

I've had great mentors, like Olaf, like Stephen Cordner, who

4:31

was director of the

4:33

Institute for many years and now Noel Woodford. So I'm lucky.

4:36

But I've also worked pretty hard to make sure that we've got

4:38

a good facility and , um, you

4:40

know, improving the way that we do things,

4:43

looking at ways in which we can recommend

4:45

, uh, strategies to prevent

4:47

death, helping families, helping

4:49

coroners, helping police. So, you know,

4:51

for us as toxicologists there's a tangible

4:54

outcome at the end, I think that

4:56

may be not as apparent if you work in, you

4:58

know , public health where strategies

5:00

can often take years and decades to implement.

5:03

Yeah, it's true. So you've been

5:05

involved in TIAFT for many, many years.

5:07

Maybe tell us a little bit about TIAFT.

5:09

Sure. TIAFT is uh , well,

5:12

it's the Association of Forensic Toxicologists,

5:14

the International Association of Forensic Toxicologists,

5:18

and it's roughly 2000

5:20

members now. And they consist of both

5:22

developed and under developing countries.

5:25

And it's an opportunity for toxicologists

5:28

in many different areas,

5:31

and it could be clinical toxicology, forensic

5:33

toxicology, racing chemistry

5:35

, uh , sports drug testing

5:37

, workplace drug testing, to get together,

5:40

to belong to an association that's

5:42

got probably the best forensic tox

5:44

experts anywhere, they're all there.

5:47

And even the people that, you know, I sort of

5:49

, um , grew up with, who

5:51

are now come to be good friends actually.

5:54

So when I started and I went to my first TIAFT

5:56

meeting in 93, there were guys like Fred

5:58

Rieders there, you know, this giant

6:00

from the US, there was , um,

6:03

Alan Curry, there was Irving Sunshine, and all of these guys

6:06

had published and I'd read their material.

6:08

Even guys like Pascal Kintz and Hans Maurer,

6:11

and I met them over the years, they're actually pretty

6:13

good people. And it allows you

6:15

to get closer to perhaps collaborate with

6:17

them. So we've had number of projects that we've worked on

6:20

with Hans , for example , uh,

6:22

with guys from Sweden , uh , guys

6:24

from the US. So TIAFT allows

6:27

you to connect to other experts around

6:30

the world. And back then everything

6:32

was requested by mail. So I used

6:34

to get reprints in the mail. There'd be a

6:36

letter, you'd get very excited when you got one from

6:38

overseas. Uh , but now,

6:40

you know, journals are very accessible. You can

6:43

have a chat to anyone, you can ring them up, you can

6:45

whatsapp them, you can, you know, and it's

6:47

great. And TIAFT allows you that connection,

6:49

which is really, really super.

6:51

It's a great organization because everyone that

6:53

you meet there is experiencing exactly the same problems,

6:55

issues and challenges that you've got

6:57

in your own laboratory, so...

6:58

And TIAFT's done a lot of work

7:00

to promote , uh, accessibility for

7:02

young scientists. You know, when I first

7:04

started, it was really difficult to be honest with

7:06

you, to sort of break into that group.

7:09

I felt always a little awkward,

7:11

you know, being with some of these experts. And I'm sure

7:13

that's, that's the case for some of the younger people

7:15

today, but they've got a lot more opportunity. And

7:18

they've got a lot more opportunity to travel to these meetings, whereas

7:21

back then , um, I think

7:23

it's probably cheaper today

7:25

to go to a forensic tox meeting than what it was 25

7:28

years ago. And you have a lot more options

7:30

about where you're going to stay, who you're going to stay with. So

7:33

, uh , TIAFT is great like that

7:35

and it's held in pretty good locations around

7:37

the world, let's be honest, we're fortunate to travel

7:39

the world and go to different places

7:42

and experience different cultures and see

7:44

how relevant some of the tox practices are

7:46

in some countries, or the lack of,

7:49

which leads to, you know,

7:52

a lesser standard of forensic evidence,

7:55

which means that cases don't get prosecuted. So

7:57

cases involving drugs in drug

7:59

facilitated sexual assault don't get prosecuted

8:01

because they don't have the means in which

8:03

to test these samples. You know , in

8:06

places like Timor for example,

8:08

where all they have is an ELISA to do drug facilitated

8:11

crime cases. You know, it's

8:13

, and I think TIAFT is making

8:15

good strides to make toxicology

8:18

more accessible to under developed countries.

8:21

And you know, by spreading our expertise,

8:23

attending meetings, talking to these people

8:25

, um, we've sent people

8:28

from our lab to underdeveloped countries

8:30

to assist in, you know, setting

8:32

up multianalyte methods that, that's

8:34

the real practical stuff.

8:36

So I'm sure a lot of our listeners would be interested to hear

8:38

about what it's like to actually be

8:40

a member of the TIAFT board. What, what

8:42

does it involve? What kind of workload, what kind

8:45

of travel and maybe what's something

8:47

that you really enjoy about being on the board?

8:49

Good question.

8:49

I hope it's the travel cause you don't, are

8:52

you ever at home?

8:53

Travel's good, yeah, I'm at home and you know , uh

8:55

, juggling, juggling the travel and

8:58

the lab and, and home is difficult.

9:00

It's not, you know, some, some days are good,

9:02

some days not so good cause you miss some things

9:05

and uh, you get told about them too. So,

9:07

but on the flip side, it's great to be

9:09

with a group of likeminded individuals

9:12

who are all pretty good scientists. You

9:14

know, the board is, consists of pretty

9:16

good toxicologists who all contribute

9:18

and have all contributed in the past. And what we do,

9:21

what this current board is about is ensuring that we

9:23

have proper processes in place for TIAFT.

9:26

So things such as our

9:29

guidelines, our constitution,

9:31

our membership , uh , the benefits

9:33

for TIAFT , um, how

9:35

we run our organization. Um,

9:38

what, what procedures and policies we

9:40

have in place. Cause some of that in the past was

9:42

a little bit up to whoever

9:44

was president at the time. And so what

9:46

we want to make sure is that for future

9:49

committees or future people that come into the board , they can focus

9:51

on other things. Um, and Mark's

9:53

really keen to do that . I mean, he's

9:55

the current president, so,

9:58

and I'll continue some of that work, but maybe,

10:00

maybe I've got some, some of my

10:02

own ideas about what will happen next year when we,

10:04

when we transition.

10:06

And one of the things that you've been involved in through TIAFT

10:08

is the links with the

10:11

United Nations Office of Drugs and Crime. How did that all come

10:14

about and get started, those collaborations?

10:16

It's a good question. I mean, that involved

10:19

, uh , Justice Tettey, who's the head

10:21

of the forensic science division

10:23

there reaching out to TIAFT to

10:26

try and get toxicologists

10:28

to collaborate with the UN. So

10:30

he reached out to a number of us on the board, including

10:33

myself, Simon Elliott , Heesun Chung

10:36

, who you've also interviewed. And

10:39

he invited us to an initial meeting in

10:41

Vienna and Robert

10:43

Kronstrand was there, Franco Tagliaro was there

10:45

, uh, Eleuterio Umpierrez from

10:48

Uruguay. And what we did

10:50

is we gave him access to toxicologists

10:53

through TIAFT. So trying

10:56

to establish what the harms are associated with some

10:58

of these NPS, these novel psychoactive

11:00

substances, means that you've got to have

11:02

access to the material that's produced around

11:04

the world. And we gave

11:06

the UN the ability to put that altogether

11:08

into a portal. And the aim

11:10

of this work is to develop threat assessment

11:12

reports , uh, to

11:14

identify some of the harms associated with,

11:17

you know, things like Cumyl-PEGACLONE , uh,

11:20

like some of the , um, FUBINACAs which

11:23

have been involved in, you know, in deaths

11:25

around the world. And to try and estimate

11:27

a toxicity profile from some of the work that we're

11:29

doing. And this would never have happened

11:31

had he not had access to TIAFT. So

11:34

prior to that it used to be, you know , a

11:36

select committee that used to get invited to the UN.

11:39

And they're emminent toxicologists, people

11:41

like Olaf, for example, Hans

11:44

and a few others. But now

11:46

what they have access to is the whole,

11:49

the whole membership. And that's, that's

11:51

a huge resource for

11:54

the UN to tap into. And

11:56

really it's about the prevention of death. It's identifying

11:58

some of the harms associated with taking these drugs.

12:01

And I think if we can contribute to that, that's

12:03

a great thing.

12:04

It also works in the reverse way, it's also good for

12:06

the UN, but it's also very good for the toxicologists

12:08

because now they know what

12:10

the major drugs are out there to look for. The most

12:12

dangerous ones they can actually target. Rather

12:15

than buying 2000 standards, they can

12:17

buy 500 or something. More specific

12:19

ones.

12:19

That's true. And also I think as part

12:22

of the UN's charter, is

12:24

to make these sort of um,

12:27

well these processes available to countries

12:29

who don't have the same resources as the US, as Australia

12:32

as the UK, as Germany. You

12:35

know, what happens to places in South

12:37

Africa or in, you know , Algeria

12:40

or Egypt. I'm sure that they see these

12:42

drugs and how is it that we

12:44

can better allow them to contribute

12:47

to the knowledge base by

12:49

enabling them to detect these things.

12:51

I mean that's, that's the real challenge going forward

12:53

I think for TIAFT to be honest with you, is to expand

12:55

our horizons and,

12:57

and enable countries that might not

13:00

have the knowledge that may not have the technical

13:02

capabilities to start

13:04

to contribute to sort some of the issues in

13:06

their own local communities.

13:07

And it may be a bit early for this, but

13:09

has the UN got any sense yet

13:11

of how effective this database is

13:14

being that they're compiling, in terms of

13:16

getting, getting the word out to labs that wouldn't

13:18

necessarily know or even having practical impacts

13:20

on the ground.

13:21

No what it has done is substantiated

13:23

their, their knowledge base. So

13:25

they already had an idea that some of these things exist

13:28

through literature. So they used to scour

13:30

the literature and put those world

13:32

drug reports together, which

13:34

are fantastic documents. But

13:36

now there's real data. There's real

13:39

material associated with deaths in

13:41

Brazil, in Canada, in

13:44

New Zealand.

13:45

And in a reasonably fast time compared to

13:47

what it often takes to publish something.

13:49

Correct. So what we're hoping to do is to have those

13:51

portals open every,

13:53

every few months and then quarterly

13:56

assessment reports that are produced by the UN.

13:58

So they're current , they're timely. Governments can look

14:00

at these things and say, hey, you

14:03

know, maybe the fentanyl epidemic isn't that far

14:05

away in our country.

14:06

Yeah. And a lot of people are prevented from reporting stuff

14:08

in the literature, unfortunately through,

14:11

you know , just, they can't get the permission to publish

14:13

it, but , uh, they might be willing to

14:15

submit it to some kind of database like this.

14:17

So it's almost like an early warning system , um,

14:20

which is great, but you're

14:22

right , uh , getting material out quickly

14:24

is not easy in our field and it should

14:26

be, I mean, if you look at how we treat

14:29

our people clinically in hospitals who present

14:31

from, you know, overdoses of drugs,

14:33

we try to treat them as quick as we can,

14:36

but yet, you know, when we have a death, it

14:38

often takes quite a lot longer for us to get

14:40

that material out. And that might be really important. You

14:43

know, if you've got a bad batch of drugs, for example, that results in

14:45

three or four people dying, that information

14:48

is really important to drug

14:50

users in the community. But you know,

14:52

we've got a long way to go on that.

14:54

So you see a lot of research, going to conferences.

14:57

What's one area of research that's happening

14:59

at the moment that you're just really excited

15:01

about, that really makes you pay attention

15:03

when you see there's the talk on this?

15:05

So something that uh

15:07

, well there is a lot of stuff being presented on

15:10

NPSs. So novel psychoactive substances, sometimes

15:12

too much to be honest with you. But I like

15:14

to interpret numbers. So at the

15:17

end of the day when we produce a tox report, what

15:19

do those numbers really mean? And

15:21

that's, that's forever been a challenge as long

15:23

as I've been in the field about what a

15:25

level of a drug means in the context of a

15:27

case. Um, so

15:29

I'd like to see more research

15:32

around those, more case interpretations.

15:35

Um, I'd also like to see more post-mortem

15:37

research cause we don't know a lot about

15:40

what happens to drugs post-mortem. We

15:42

had some research being done in the

15:44

eighties and nineties, but human tissue acts around the world

15:47

put really a stop to that. Even

15:49

at our own organization, to obtain

15:51

tissue from a deceased person is far more difficult

15:54

for research purposes. You have to get

15:56

approval from the next of kin, which is absolutely

15:59

appropriate. But it has stifled

16:01

the research in post-mortem toxicology

16:04

and we continue to

16:07

assume that drugs behave in a

16:09

certain manner, that drugs are stable,

16:11

that drugs do not change. Um,

16:13

but we know that that's not the truth. And

16:16

we don't really have , um,

16:18

we haven't really progressed on the sort

16:20

of understanding of post-mortem toxicology

16:23

since the eighties or nineties.

16:24

Yeah. If you go to a typical toxicology conference

16:27

and just by the sheer number of lectures, you would

16:29

think that NPS is kind of 90%

16:31

of what we encountered , which is

16:34

not true at all. It's 1% of what we encounter, if

16:36

that, maybe.

16:37

That's, that's very true. The traditional drugs dominate.

16:39

Yet we still, you know, have

16:41

trouble interpreting levels of , for example,

16:43

methamphetamine or THC, god forbid

16:46

I mentioned THC. The drug that just keeps

16:48

giving, uh toxicologically.

16:50

I mean it is a wonder drug in so

16:52

many ways, not only from a

16:55

, um, a health perspective,

16:57

you know, it's seen as an alternative to pain

16:59

relief. It's a , it's

17:01

a challenge to determine the drug

17:03

analytically. It still continues

17:06

to, you know, to confound us in so many

17:08

ways. It is a wonder drug. No wonder Marilyn's been

17:10

studying this for 30 years. Um,

17:13

so look, I'm , I'm excited about

17:16

the fact that young people are doing research that

17:18

they're presenting casework , that they are having

17:21

a go at, you know, understanding what tox

17:23

means. Cause Irving Sunshine once said, and I'm

17:25

, I might be paraphrasing Heesun here. Toxicology

17:28

is pretty easy. You only need two lessons.

17:30

Each lesson's 10 years, 10 years

17:33

each.

17:33

Yeah that's a good quote.

17:35

It is. He was a real pioneer along with Allan

17:37

Currie of course. Um, these people

17:39

are sort of gods in the tox world

17:42

and um not, not as , not a lot

17:44

is known about them, our young people don't know

17:46

enough about some of the pioneers. And , um,

17:49

I'd like to focus on those when I get, when

17:51

I get my chance to be TIAFT president is to bring

17:53

some of those pioneers to the fore

17:55

and really look at their achievements. So

17:58

you might not know, but Vern Plucarn, who's

18:00

a forensic pathologist in Victoria, in

18:02

1966 advocated the use

18:04

of sodium fluoride, potassium oxalate in

18:07

all blood tubes for alcohol estimation.

18:09

Is that right?

18:10

And that was 53

18:12

years ago as a recommendation

18:16

for the proper analysis of ethanol

18:18

in forensic sampling. Pretty amazing.

18:20

And now you wouldn't do without it.

18:22

Absolutely. Absolutely.

18:24

So , um , in terms of research, is there anything

18:26

you're up to at your institute you can tell us about?

18:29

So we're doing a lot of drugs , drugs

18:31

and driving research. I mean, we're in that

18:33

workspace because we do a lot

18:35

of work for , um, law enforcement

18:38

around drug testing, so...

18:40

Are you doing, are you doing the most, anywhere in

18:42

the world now? You seem to be doing a lot of oral

18:44

fluid testing of drivers.

18:47

Um, I'm pretty sure that along with some other states

18:49

in Australia, we do the most drug testing for

18:51

driving anywhere in the world. Last

18:54

year, I think we issued 23,000 reports

18:56

with Victoria police, or this

18:58

year we're about to.

19:00

The roadside testing scheme that's not done

19:02

by your institute, but done by law enforcement,

19:05

that's got to be one of the largest, well probably

19:07

the largest in the world .

19:08

It is. I think collectively around Australia, there's probably

19:11

more than 500,000 random roadside drug

19:13

tests done. And you know, if you take

19:15

the average of 10% of those , uh

19:18

, that's, that's an enormous number of confirmations

19:20

done in forensic labs. So yes, we're

19:23

focusing around that. We're looking at how effective

19:25

that that testing is in terms of prevention

19:28

terms of a deterrence, things that we

19:30

could be doing better analytically because as you know,

19:33

there isn't an evidential test

19:35

at the roadside. That's, that's a problem.

19:38

Um, as there is for alcohol.

19:40

So, you know, at the roadside you

19:42

can, you can prosecute someone on the basis

19:44

that you've got an evidentiary breath test, you

19:47

don't have that with drugs. So currently we're

19:49

somewhat limited, which requires

19:51

the lab to be the arbitrator and rightly

19:53

so , um, whether that changes in

19:55

the next 10 years, I don't know. But there's

19:58

some research around that. And what we want to do

20:00

is see how effective these roadside

20:02

programs are because drugs

20:04

are prevalent in the community. 20% of

20:06

all drivers killed in Victoria are stimulant

20:09

positive. You know, that's not

20:11

an isolated finding because in injured

20:13

drivers, it's somewhere between 12 and 14%.

20:16

So it's, it's not an aberration

20:18

that's only in deceased drivers. It's prevalent,

20:21

it's prevalent in the community. 40% of our homicide

20:23

cases involve methamphetamine. So

20:25

these drugs are dangerous.

20:28

They can lead to people having accidents. Of course,

20:30

they increase your risk of having an accident despite

20:33

the, to the contrary, some, some people are trying to

20:35

show otherwise. There's, there's enough research

20:37

to show that, you know , cannabis is

20:39

a risk on our roads as are stimulants.

20:42

And if you ask me whether I'd rather fly

20:44

to the US with a pilot with a little bit of cannabis

20:47

or with a pilot with no cannabis, I'll take the latter

20:49

every day.

20:50

Yeah. And your institute as well

20:53

in conjunction with Monash University has done

20:55

a lot of stuff around epidemiological

20:57

studies and especially

21:00

the codeine, you know, prescriptions

21:02

and so on, the rise of codeine and

21:04

looking at , um, societal

21:06

implications, like the one punch

21:09

deaths that have happened. Uh , can you

21:11

tell us a bit about that?

21:12

Yeah we've done a lot of work in that space. So

21:14

largely aimed at prevention. So

21:16

preventing people from dying in the future as a

21:18

result of taking too many opioids,

21:21

as a result of avoiding situations where

21:23

they get involved in , um, you

21:25

know, in , in violent , um,

21:27

exchanges with people who are drug affected

21:30

. Uh, so we, we

21:32

started the one punch , uh

21:34

, investigation sometime ago after

21:36

a young fellow lost his life following a

21:38

punch, I think shortly after a New

21:40

Year's , uh , party. And

21:43

you know, he's a young fellow, 21 year old,

21:46

fell back, hit the ground and he died.

21:48

And I thought at that time and

21:50

I , with my coworker Jennifer

21:52

Pilgrim, I said, you know, let's have a look at how common

21:54

single punches are. We, we did

21:57

an investigation over 10 years and we found more

22:00

than a hundred of these cases, which is pretty, pretty

22:02

shocking. Um, and most

22:04

of those involved alcohol and when? Uh

22:06

, usually late at night on a Thursday, Friday,

22:08

Saturday night between the hours of 12 and 3,

22:11

not a , not a lot of good happens between

22:13

those hours. And drugs were a factor in

22:15

those. Now, primarily alcohol, but certainly

22:18

stimulants. And that

22:21

was one aspect of research, which is

22:23

really, you know , evidenced based and

22:25

can lead to strategies for prevention

22:28

in terms of maybe restricting the

22:30

sale of alcohol or being conscious

22:32

that you know, people who drink and then get into

22:35

altercations can end up with a single

22:37

blow which renders them unconscious

22:39

and you know, in a , in a pretty bad way.

22:42

But some of the other research that we've done is around opioid

22:45

mortality, looking at how prevalent

22:47

drugs are amongst healthcare professionals,

22:49

which was an eyeopener. We've also

22:51

done a lot of drugs and driving work, epidemiological

22:54

stuff, looking at risk, your relative risk

22:56

of having an accident with certain drugs on board.

22:59

That's been good. Done a lot of post-mortem research. So

23:01

that was my hotbed for a long time. A lot

23:03

of work around heroin deaths. And

23:05

we present this material. You know, we've always had

23:08

the opportunity and I've been fortunate that the institute

23:10

has supported our

23:12

initiatives to present this both locally and internationally.

23:16

You seem to have found a balance

23:18

that I think maybe a lot of people find it very

23:20

hard to find, which is as you go higher in

23:23

our field, probably in any field, you tend

23:25

to get further away from the thing

23:27

that you started doing in the first place, which in our case it's science

23:30

and research as well. You've

23:32

managed to keep a hand in research even

23:34

while taking on significant

23:36

managerial responsibilities and other

23:39

organizational responsibilities outside of that.

23:41

I don't know if you feel like you have the balance

23:43

right, but how you managed to find

23:45

that? How have you juggled that? What have you found difficult?

23:47

Well it keeps you healthy toxicologically.

23:50

I think you've got to be in that space

23:52

to know what's happening in the lab. I'm not a

23:54

, I'm not on the bench anymore, but I certainly

23:56

am in the lab because my office is in the lab

23:59

and you know a number of times I've been

24:01

asked to possibly move, but I don't want to

24:04

because it keeps you close to your people and

24:06

it keeps you close to what's happening in the lab. And while

24:08

I might not know exactly how one

24:10

of our new beaut LC mass

24:13

specs work, I certainly can, I

24:15

can understand how it's applied and

24:18

where the benefit is in doing some research

24:20

around that. So, no I

24:22

haven't got the balance right Tim, no doubt

24:25

about that. But I've worked pretty hard.

24:27

And uh , often, you know, there are nights

24:29

where you go home and you finish stuff and

24:31

it's almost impossible during the day to get a block

24:34

of work done to write a paper

24:36

or to read a paper. So I tend to

24:38

do that on the way when I get home

24:40

, um, weekends sometimes

24:42

or when I travel. So when I travel

24:44

on the plane.

24:46

Yeah, I guess you get a lot of time if you're on a plane to

24:48

Europe.

24:48

Yeah, I've written papers on planes in

24:50

between watching films. So , um,

24:53

but that's, that's a good , that's a good thing in my

24:56

job as well, I do get to travel and go to different places

24:58

and I'm fortunate, I'm very fortunate.

25:01

So we're here in Australia. Is there any particular

25:04

issues in our region which differ

25:06

from other regions of the world, do you think?

25:08

Only that Australia is a pretty

25:10

high consumer of stimulants. We know that,

25:12

we heard the other day from one of our emergency

25:15

doctors from Perth that Perth is

25:17

the meth city, meth capital of

25:19

Australia. We've got problems with stimulants

25:22

right around the country. We've got problems with illicit drugs.

25:25

Uh , there's a burning issue around pill testing, which

25:27

is really interesting from a tox perspective.

25:30

So we heard David Caldicott give us a lecture

25:33

the other day at the FACTA meeting, which

25:35

was held in Adelaide, and

25:37

he talked about not only the analytical component

25:39

but the fact that there's an intervention. And I think

25:41

that's forgotten to be honest with you. That intervention

25:44

component, which allows doctors,

25:46

who really are trying to save lives about,

25:49

you know, having a conversation with a

25:51

young person who is about to take a drug maybe for the first

25:53

time about what that drug can do to them. And

25:56

while I think we were a bit skeptical

25:58

about the analytical merits of the testing,

26:00

it's something that we can help with. We

26:03

are the experts when it comes to testing samples.

26:06

And we've got colleagues who tests pills and test

26:08

powders and seizures and seized material.

26:11

So why can't we assist them to develop

26:14

something more mobile that is applicable

26:16

, uh, in a, in a dance festival

26:18

situation? Um, and my

26:21

view is that if it's worth saving

26:23

a young person's life, someone who might make

26:25

a mistake, you know, because they're young

26:27

and foolish or they choose to, I mean, we , we

26:29

were there once upon a time as well.

26:31

Maybe we just didn't have the sort

26:33

of availability of drugs that young people

26:35

have access to today. So we had

26:37

alcohol, possibly cannabis and a few

26:39

stimulants, but the variety

26:42

of NPS that are available today, means

26:44

that, you know, the , there's good evidence

26:46

that pill testing and an intervention

26:49

actually does save lives . And

26:51

I think that's important. We're about preventing deaths aren't we?

26:54

That's right, yeah.

26:55

It's ironic that our, our business

26:58

is, you know, post-mortem toxicology.

27:00

That's a large part of what we do. In an ideal

27:02

world, we probably wouldn't exist as

27:04

post-mortem toxicologists. Uh, but yeah,

27:07

reducing death is something that I think we're all very

27:09

passionate about.

27:10

And one thing I'm also passionate about is providing

27:12

an analytical service to our hospitals.

27:14

You know, for a long time a sort of analytical

27:17

service to hospitals has been simple

27:20

and maybe not as effective as it

27:22

could be. Sure, it'll tell you that there's a class of

27:24

drugs there, but sometimes you might want to know what that drug

27:27

is and it may be more important

27:29

with some of these exotic NPS that we know

27:31

, uh , are being used and are being

27:33

consumed. If we could provide

27:35

a rapid service to our hospitals, that

27:37

may allow clinicians to better treat some

27:40

of these individuals because it ultimately reduces

27:42

their time in hospital, reduces the health

27:44

burden and allows the treatment to be better

27:46

directed towards an individual. But

27:48

that may not always be the case because our clinicians

27:50

are pretty good at treating people, um

27:53

, depending on their sort of toxidrome.

27:56

But if we could tell them that this person has,

27:58

for example, Cumyl-PEGACLONE in their

28:00

system, all right , it's a synthetic cannabinoid

28:03

that may, that may better target some

28:05

of the treatment that they're going to provide. You know,

28:08

and before I finish, which

28:11

hopefully won't be, won't be too soon, but

28:13

I'd like to see that we establish some sort of clinical

28:15

service for, for our hospitals

28:17

in a rapid, meaningful way. Like, we

28:20

can do some fantastic analyses

28:22

looking at hundreds of drugs in minutes.

28:25

We can identify things that we could never see before

28:27

with the new technologies. Why can't we

28:29

make that accessible to our public health

28:31

system?

28:32

And often that could be because we're often

28:35

siloed into our forensic world

28:37

rather than a clinical world.

28:39

These are things that we should be trying to

28:41

do I think , um, even though

28:43

our funding is primarily from justice,

28:45

you know, justice departments to look at law,

28:48

you know, more medico legal death investigations

28:50

or uh , criminal work. Um

28:53

, I think there's a role for us to play , uh,

28:56

in, in assisting , uh,

28:58

clinicians , um, in terms

29:00

of drug detection. And what , what

29:02

sort of information we can provide to them, because it's not

29:04

just the detection of the drug. Maybe

29:07

we can provide them some information about the pharmacology

29:09

of these drugs too .

29:11

Yeah. That's the really exciting part of it to me, is working

29:14

at what, and the combinations of the drugs and

29:16

what effects they might have. It's all extremely

29:19

complex depending on where they are in that

29:21

timeline, when they took the different

29:23

drugs, which ones are coming down, which ones are going

29:25

up and so on.

29:26

At the moment in virtually every hospital, they don't

29:28

even know what drugs they are taking, they've taken. They

29:30

just may see the, they may just see

29:32

a GHB result when they've actually got GHB

29:35

plus methamphetamine plus lots of other

29:37

things, so...

29:38

Plus, plus, plus.

29:39

Yes.

29:39

Often multiple, you know,

29:41

drugs are involved in a , in a presentation.

29:43

It's not a single drug really.

29:46

So I can say one thing about doing

29:48

that sort of work. It's really good fun if,

29:50

if you're interested, if you're a scientist

29:52

and you love toxicology, try and get involved.

29:55

Try and spark your colleagues up

29:57

to try and get something organized because even

29:59

if it takes some of your own time, you're going to

30:01

, you're not going to get funding immediately. But if you do

30:04

a, maybe a small study with a colleague that

30:06

you know in an emergency hospital, get

30:08

some interest generated.

30:09

It's very rewarding.

30:11

And it also gives you a perspective on what drugs are really dangerous.

30:14

You know, some drugs are much, well,

30:16

some drugs are safer in overdose than others, but

30:19

opioids in overdose, they're bad news.

30:22

And it's really hard to get that from post-mortem

30:24

tox sometimes because you find a drug, maybe you

30:27

find an NPS or something, but

30:29

it's there, what did it mean? Did it cause the

30:31

death ? Who really knows in a lot of these cases.

30:34

And we've also got to be conscious of the fact that there

30:36

are a whole range of , um, you know,

30:38

fentanyl type substances that we haven't

30:40

really seen yet. I mean, if you look at what's

30:42

happening in the US it's an absolute tragedy, and

30:45

we've got some of those triggers here. We've got

30:47

a significant drug abusing drug,

30:49

opioid dependent population. We

30:52

have the same sort of triggers. We've reduced

30:54

, uh , availabilities of some of the more

30:56

common opioids. That's happened.

30:59

Um , have we seen an increase in fentanyl deaths?

31:02

Not really. Not yet, but the,

31:04

that takes time for us to sort of follow

31:06

the US, the US market. We did

31:08

that for oxycodone. You know, we had

31:10

an epidemic of deaths involving oxycodone.

31:13

Maybe that's going to be the case with fentanyl , maybe not.

31:15

But there's some lessons for us about how

31:17

we go about preventing some of this stuff by

31:20

looking at what's happening in, in the US

31:22

and in Canada.

31:24

So just as we finish up here, I wonder if there's

31:26

some advice that you would give to a young toxicologist

31:30

who's maybe just got into the field, they're just starting out.

31:32

What advice would you give them in terms of their career

31:35

and what path they should take?

31:36

So if you are just

31:38

starting out, you've got to be persistent, you've

31:41

got to persist. And that, you know, that may be

31:43

true for a lot of things, but you've got to persist

31:45

because there's a lot to get your handle

31:47

on, get your head around for tox . It's

31:49

not only the instrumentation, it's

31:51

not only the number, the sheer

31:53

number of drugs, it's , it's about the numbers

31:56

that we produce and what they mean at the end of the day as

31:58

well. So yes,

32:00

persistence that pays off, but

32:03

you know, get to meetings , uh

32:05

, write to people, uh read.

32:08

So when you're travelling, when you're going home,

32:10

pick up a paper, take it with you, you

32:12

know, get a , get a paper that's scientifically

32:15

relevant to what you're doing and read it.

32:17

And it might be a review paper. There is so

32:19

many good review papers written by experts

32:21

around the field. Um, people like

32:24

Olaf, people like Marilyn Heustis,

32:26

people like Hans , people like Bob

32:29

Flanagan , um , Simon Elliott , Mark

32:32

LeBeau. You know, read them, read

32:34

those articles, know what they're talking about,

32:37

and then go to TIAFT meetings or come, come

32:39

to a FACTA meeting where you can

32:41

get exposure to some of these people.

32:43

It's, I could never just read a review article because

32:46

when you see something interesting and then you go and check

32:48

out the reference and then that leads you onto another one and

32:50

another one, and then pretty soon that's your day gone.

32:53

Isn't that great?

32:53

Yeah, it is. That's the great thing about science. Well,

32:56

thanks very much for joining us, Dimitri . It's been a pleasure

32:58

to have you.

32:59

Thank you for having me.

33:00

And thank you to you, our listeners. Uh

33:02

, if you want to contact us, you can email

33:04

us at thetoxpod@sa

33:08

.gov.edu .

33:09

We'll catch you next time.