Pharmacogenetics and Forensic Toxicology: A New Step towards a Multidisciplinary Approach

Pharmacogenetics analyzes the individual behavior of DNA genes after the administrationof a drug. Pharmacogenetic research has been implemented in recent years thanks to the improvement in genome sequencing techniques and molecular genetics. In addition to medical purposes,pharmacogenetics can constitute an important tool for clarifying the interpretation of toxicologicaldata in post-mortem examinations, sometimes crucial for determining the cause and modality ofdeath. The purpose of this systematic literature review is not only to raise awareness among theforensic community concerning pharmacogenetics, but also to provide a workflow for forensic toxicologists to follow in cases of unknown causes of death related to drug use/abuse. The scientificcommunity is called on to work hard in order to supply evidence in forensic practice, demonstrating that this investigation could become an essential tool both in civil and forensic contexts. Thefollowing keywords were used for the search engine: (pharmacogenetics) AND (forensic toxicology);(pharmacogenetics) AND (post-mortem); (pharmacogenetics) AND (forensic science); and (pharmacogenetics) AND (autopsy). A total of 125 articles were collected. Of these, 29 articles were includedin this systematic review. A total of 75% of the included studies were original articles (n = 21) and25% were case reports (n = 7). A total of 78% (n = 22) of the studies involved deceased people forwhom a complete autopsy was performed, while 22% (n = 6) involved people in good health whowere given a drug with a subsequent pharmacogenetic study. The most studied drugs were opioids(codeine, morphine, and methadone), followed by antidepressants (tricyclic antidepressants andvenlafaxine). Furthermore, all studies highlighted the importance of a pharmacogenetics study indrug-related deaths, especially in cases of non-overdose of drugs of abuse. This study highlights theimportance of forensic pharmacogenetics, a field of toxicology still not fully understood, which is ofgreat help in cases of sudden death, deaths from overdose, deaths after the administration of a drug,and also in cases of complaint of medical malpractice.