Our Research

Complementary insights from wastewater surveillance and the toxicology findings of clinical presentations involving new psychoactive substances in Australia.

Bade R, Nadarajan D, Harris K, Harvey C, Jiranantakan T, Morgan H, Partridge E, Schumann J, Smith JL, Weber C and Hall W
Journal of Analytical Toxicology, August 2026.
DOI: 10.1093/jat/bkag071
The growing emergence of new psychoactive substances (NPS) challenges traditional approaches to drug monitoring, highlighting a need for innovative surveillance strategies. We explored the potential to better understand the NPS market in Australia by combining wastewater analysis with toxicosurveillance programs. Focusing on a time of year of likely higher NPS and drug use, influent wastewater samples were collected from four Australian states (South Australia, Victoria, Queensland and New South Wales) over the New Year period from 2019-20 to 2024-25. Clinical samples presenting between 15 December and 15 January each period from the toxicosurveillance systems Emerging Drugs Network of Australia (including Western Australia, South Australia and Queensland), Emerging Drugs Network of Australia Victoria (Victoria) and Prescription, Recreational and Illicit Substance Evaluation – PRISE (New South Wales) were extracted. In total, 294 wastewater and 117 clinical samples were included in this work. A total of 47 individual NPS were found in both datasets. This included: 21 only in wastewater, 37 only in clinical, and 12 in both. Overall, 743 instances of NPS were found in all wastewater samples and 172 in clinical data. In wastewater samples, N,N-dimethylpentylone (54%), mitragynine (52%) and bromazolam (45%) were the most frequently detected. In the clinical samples, the most common were bromazolam (44%) and clonazolam (21%). Overall, synthetic cathinones and plant-based compounds were more prevalent in wastewater, and synthetic opioids and benzodiazepines in clinical samples. Differences in detected NPS classes illustrate the complementary nature of these surveillance systems. Higher wastewater concentrations may indicate broader use and lower acute harm than drugs identified clinically. Integrating these datasets with additional sources such as surveys, coronial records, police seizures, and drug-checking services can strengthen NPS monitoring.
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Post-mortem imaging in suspected child physical abuse: a systematic review.

Kelly BS, van Rijn RR, Bliss H, Cain T, Carter J, Chesters H, Fronczek J, Haboosheh A, Kan E, Kvist O, Marttinen F, Nagtegaal M, Rao P, Robinson C, Sidpra J, Offiah AC and Arthurs OJ.
European Radiology, 36(6):4739-4748 | June 2026
DOI: 10.1007/s00330-025-12172-1
OBJECTIVES: As post-mortem (PM) imaging in children becomes more common, there is a need to review the available evidence for its diagnostic yield in suspected child physical abuse. The aim of this review is to synthesise current evidence, assess study quality, and identify ongoing challenges. MATERIALS AND METHODS: Following PRISMA guidelines, databases were searched until 31 December 2024. Original research articles reporting data on at least ten children with PM imaging in the context of physical abuse were included. Titles and abstracts were screened by two expert reviewers; full texts were assessed by a third, independent reviewer and one of the previous reviewers. Data was extracted by one of 12 experts and independently verified. The study risk of bias was evaluated with the ROBINS-I tool. Study heterogeneity precluded meta-analysis, resulting in descriptive synthesis. RESULTS: Eighteen out of 1687 potential papers were included. Seven described PM radiography, five post-mortem computed tomography (PMCT), four both PM radiography plus PMCT, and two post-mortem magnetic resonance imaging (PMMR). All but one were retrospective, and most (11/18, 61%) had a moderate-to-high risk of bias. Post-mortem skeletal survey (PMSS) detected subtle fractures, particularly corner metaphyseal fractures. PMCT provided a high-resolution assessment of injuries, particularly rib fractures. PMMR contributed soft-tissue and intracranial detail. All studies emphasised the importance of correlating autopsy findings. Technical variation and potential biases limited direct comparisons between studies. CONCLUSION: PM imaging can reveal important injury patterns that may be overlooked by autopsy. Nevertheless, standardised imaging methods and larger prospective trials are needed to reduce bias and establish best-practice guidelines. KEY POINTS: Question What is the evidence for PM radiologic imaging in suspected physical abuse of children? Findings PM imaging complements autopsy, but diagnostic accuracy varies by modality. Study heterogeneity and bias limit current evidence. Clinical relevance PM imaging can detect injuries missed at autopsy in child abuse cases. Standardised protocols and higher-quality studies are urgently needed.
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Novel benzodiazepines in illicit drug use: sentinel emergency department data do not indicate disproportionate clinical harm.

Greene S, Weber C, Lyons T, Schumann J and Hodgson S.
International Journal of Drug Policy | June 2026
DOI: 10.1007/s00330-025-12172-1
BACKGROUND: Novel or unregulated benzodiazepines are increasingly detected in illicit drug markets and may be perceived to pose greater clinical risk than regulated pharmaceutical benzodiazepines. However, much of the evidence underpinning these concerns derives from case reports, surveillance data, and settings characterised by extensive polysubstance exposure. We examined whether detection of novel/unregulated benzodiazepines is associated with greater acute clinical severity than pharmaceutical benzodiazepines in emergency department cases. METHODS: We conducted a retrospective analysis of the Emerging Drugs Network of Australia- Victoria (EDNAV) clinical registry, including analytically confirmed benzodiazepine-positive cases between 1 September 2020 and 30 November 2025. Cases were classified as involving novel/unregulated benzodiazepines (with or without pharmaceutical benzodiazepines) or pharmaceutical benzodiazepines only. Primary outcomes included severe toxicity (any of – intensive care unit admission, intubation, vasopressor use), respiratory depression, Poisoning Severity Score (PSS >=3), and in-hospital mortality. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs), accounting for age, sex, and co-detection of opioids, stimulants, and gamma-hydroxybutyrate (GHB).RESULTS: Among 2,638 benzodiazepine-positive cases, 772 cases involved detection of at least one novel/unregulated benzodiazepine (with or without concurrent pharmaceutical benzodiazepines) and 1,866 involved pharmaceutical benzodiazepines without any novel/unregulated benzodiazepines detected. Unadjusted analyses showed lower rates of several severe outcomes in the novel/unregulated group. After adjustment, detection of novel/unregulated benzodiazepines was not associated with increased odds of severe toxicity (aOR 0.84, 95% CI 0.67-1.06) or PSS >= (aOR 1.00, 95% CI 0.83-1.21). Opioid and GHB co-detection were the strongest predictors of severe outcomes. CONCLUSIONS: In this analytically confirmed cohort, novel/unregulated benzodiazepines were not associated with greater acute clinical severity than pharmaceutical benzodiazepines once polysubstance exposure was accounted for. These findings suggest that observed acute benzodiazepine-related harms are driven primarily by patterns of co-use, particularly opioid co-exposure, rather than regulatory status of benzodiazepine compounds.
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Analytically confirmed opioid detections from the Emerging Drugs Network of Australia.

Soderstrom J, Weber C, Greene S, Isoardi K, Alfred S, Tran V, Stockham P, Schumann J, Thompson A and Katovich D
Emergency Medicine Australasia,38(3):e70284 | June 2026.
DOI: doi.org/10.1111/1742-6723.70284
We describe analytically confirmed opioid-related presentations to emergency departments (EDs) in Australia. METHODS: Presentations with analytically confirmed opioid exposure, between January 2021 and December 2024, were identified from the Emerging Drugs Network of Australia (EDNA) Clinical Registry. Demographic data, clinical features, outcomes, naloxone dosing, and analytical toxicology results were extracted. RESULTS: Opioids were detected in 793 ED presentations. The majority were male (568, 71.6%) with a median age of 40 years (Q1-Q3: 30-48 years). Patients were unwell (Australasian Triage Score 1 or 2 = 700, 88.3%). Suicidal intent was noted in 55 (6.9%) presentations. Mono-opioid detections occurred in 550 (69.4%) presentations, most frequently heroin exposures (162, 29.5%). Novel opioids including citizens and U-Class synthetic opioids were uncommon (21, 2.6%). Illicit co-detections were common (547, 69.0%) especially with methylamphetamine (512, 64.6%), gamma-hydroxybutyrate (108, 13.6%), and diazepam (341, 43%). Naloxone was used in 498 (62.8%) presentations: median dose 400 mcg (IQR: 200-600 mcg). There was no difference in median naloxone dose for heroin (median 320 mcg) and novel opioids (median 500 mcg, p = 0.25). Intubation was more likely to occur in patients with novel opioids compared to heroin (8/21, 26/162, p = 0.020). CONCLUSIONS: Heroin was the most common analytically confirmed illicit opioid detected among opioid-related ED presentations. Novel opioids were uncommon with no difference in median naloxone dose used. There were higher intubation rates for novel opioids. Polydrug exposure is common, complicating the clinical picture. Increased awareness of the national Take Home Naloxone program, particularly by emergency physicians, is a key element of harm reduction.
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Trends in alcohol, MDMA, methylamphetamine and THC in injured and deceased motor vehicle drivers and motorcyclists over a decade (2010-2019) in Victoria, Australia.

Schumann J; Di Rago M; Woodford N; Glowacki L; Fitzpatrick J; Kelly M; Beck B; Drummer OH; Gerostamoulos D; Dipnall
Injury Prevention. 32(4):579-590 | July 2026
DOI: 10.1136/ip-2024-045342
BACKGROUND: Driving under the influence of alcohol and other drugs contributes significantly to road traffic crashes worldwide. This study explored trends of alcohol, methylamphetamine (MA), 3,4-methylenedioxy-N-methylamphetamine (MDMA) and DELTA9-tetrahydrocannabinol (THC), in road crashes from 2010 to 2019 in Victoria, Australia.
METHODS: We conducted a cross-sectional analysis using data from the Victorian Institute of Forensic Medicine and Victoria Police, examining proscribed drug detections in road crashes. Time series graphs per substance explored indicative trends and comparisons between road users. Negative binomial regression models, with robust SEs and adjusted for exposure (kilometres travelled, Victorian licence holders), modelled the incidence rate ratio, with a Bonferroni-adjusted alpha=0.007 for multiple comparisons. RESULTS: There were 19 843 injured drivers and 1596 fatally injured drivers. MA had the highest prevalence (12.3% of fatalities and 9.1% of injured drivers), demonstrating an increase over time. Overall, 16.8% of car drivers and motorcyclists tested positive for one or more drugs, with 14% of crashes involving a blood alcohol concentration (BAC)>=0.05%. MA and THC were the most common drugs in fatalities. Between 2015 and 2019, MA was detected in 27.9% of motorcyclist fatalities, followed by THC (18.3%) and alcohol >=0.05% (14.2%), with similar but lower frequencies among injured motorcyclists. Alcohol detections (>=0.05% BAC) in fatalities declined but increased in injured motorcyclists and car drivers until plateauing in 2017. THC detections rose among injured drivers until 2018, detected in 8.1% and 15.2% of injured and fatal drivers, respectively. MDMA-positive driving decreased among injured drivers and remained stable at ~1% of fatalities. CONCLUSIONS: Despite enhanced road safety measures in Victoria, drug-driving persists, indicating a need for revised prevention strategies targeting this growing issue.
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Best practice for forensic anthropology reporting: a statement by the Board of the Forensic Anthropology Society of Europe (FASE).

Cunha E, Petaros A, Brits D, Cattaneo C, Kranioti E, Ross AH, Adalian P, Obertova Z and de Boer HH.
International Journal of Legal Medicine | July 2026
DOI: 10.1007/s00414-026-03903-0.
The case report is the primary means by which forensic anthropologists communicate the outcomes of their examination. Despite their central role, considerable variability currently exists in the content, structure, and clarity of such reports. Drawing on published guidelines, forensic science standards, and the collective experience of an international group of practitioners from the Board of the Forensic Anthropology Society of Europe (FASE), this paper presents practical recommendations for forensic anthropology reporting. It outlines the fundamental aims and principles of reporting, identifies essential report elements, and distinguishes minimum requirements from discretionary components. Emphasis is placed on scientific integrity, transparency of methods and reasoning, and clear communication to a diverse audience. These recommendations are meant to be applicable across jurisdictions and professional contexts, including independent practice, while remaining aligned with contemporary forensic science standards. By promoting consistency and clarity in reporting, these recommendations aim to support the reliability, interpretability, and admissibility of forensic anthropological evidence, and to strengthen the contribution of forensic anthropology to medico-legal investigations.
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Postmortem submergence interval (PMSI) and human decomposition in anthropogenically constructed aqueous environments (pools, bathtubs, hot tubs, and spas).

Vienna C. Lam MA, Gail S. Anderson PhD, Melanie S. Archer MD, Gemma C. Dickson PhD, Samantha K. Rowbotham PhD
Journal of Forensic Sciences | March 2026
Journal of Forensic Sciences | July 2026
DOI: 10.1111/1556-4029.70316
Postmortem decomposition changes of bodies in aquatic environments may offer valuable insights into the postmortem submergence interval (PMSI) for medicolegal death investigators. However, the effects of immersion on the onset of such changes are poorly understood. The aims of this study were to augment what is known about the statistical relationship between PMSI and observable decomposition changes across three body regions (head, torso, and limbs) and to quantify the influence of extrinsic (e.g., clothing, immersion, location, and body position) and intrinsic (e.g., height, weight, BMI) moderating covariates for bodies in aqueous anthropogenically constructed environments. This study retrospectively examined 79 deceased adults recovered from pools, bathtubs, hot tubs, and spas between January 2010 and December 2019 in Victoria, Australia.
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Benchmarking KinSNP®: A study on genetic relationship prediction for forensic applications.

R. Daniel, J. Raymond, A. Sears, N. Scudder, D. Hartman
Forensic Science International | Volume 383 | June 2026
Accurate kinship inference is a cornerstone of forensic DNA analysis, particularly in cases involving unidentified human remains in the absence of direct reference samples or when suitable familial antemortem samples are lacking. This study evaluates the performance of KinSNP®, a forensic software tool developed by Othram, for predicting genetic relationships using whole genome single nucleotide polymorphism (SNP) data. The findings provide further evidence to support the utility of KinSNP® as a secure, offline solution for SNP-based kinship analysis in forensic contexts, including disaster victim identification and long-term missing person investigations.
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Detection of Nitazenes (2-Benzylbenzimidazoles) – novel synthetic opioids in coronial casework in Victoria, Australia.

Scully L, Castle JW, Di Rago M, de Boer HH, Schumann J, Crump K, Glowacki L and Gerostamoulos D
Metabolites,16(6):358 | May 2026
DOI: https://doi.org/10.3390/metabo16060358
Background: The 2-benzylbenzimidazoles or nitazenes are an evolving class of highly potent mu-opioid receptor agonists. Nitazenes were originally developed in the late 1950s for pharmaceutical use as analgesics; however, due to their extreme potency and the risk of adverse health outcomes, pharmaceutical research was discontinued. Since 2019, nitazenes have emerged as illicit drugs of abuse, causing significant concern. From 2021, they have been detected in both coronial and clinical casework in Victoria, Australia. This study examined nitazene-related coronial casework in Victoria from 2021 to 2025 to explore the trends and characteristics of nitazene-related deaths. Methods: Relevant cases were identified from the Victorian Institute of Forensic Medicine’s (VIFM’s) case management system. Data were collated and analysed from all coronial cases where a nitazene was detected by a toxicological analysis between 1 January 2021 and 31 December 2025. Trend comparisons were made with nitazene detections reported in other countries. Results: Nitazenes were detected in 23 deaths from a total of approximately 33,108 coronial cases admitted to the VIFM for investigation over the time period. The age range was 17-45 years, with a median of 32 and with 87% of the deaths being male. The nitazenes detected were protonitazene (n = 14), metonitazene (n = 5), isotonitazene (n = 2), N-pyrrolidino etonitazene (n = 2), N-desethyl isotonitazene (n = 1), methylenedioxynitazene (n = 1) and etodesnitazene (n = 1). Two cases contained more than one nitazene; both involved protonitazene, one involved metonitazene, and the other involved N-desethyl isotonitazene and methylenedioxynitazene. The timeline of detection of these nitazenes displays similarities with emergence trends in other countries. The nitazene concentrations ranged from 0.1 to 33 ng/mL. Broad polydrug usage was evident in all cases, with other drugs co-detected in the blood including stimulants (particularly, methylamphetamine (48%) and cocaine (44%)) as well as pharmaceutical benzodiazepines (43%) and pharmaceutical opioids (22%), and 13% had 6-monoacetylmorphine detected in either blood or urine. Novel benzodiazepines (39%) were also common, including bromazolam, which was co-detected in 35% of cases. Nineteen deaths were attributed solely to nitazene-related mixed-drug toxicity, while the remaining four cases were attributed to cardiac- and pulmonary-related disease, with polydrug use deemed a contributing factor. Conclusions: This novel case series adds comprehensive toxicological information to the body of evidence reinforcing the high risk of harm associated with the use of nitazenes. It is imperative that toxicology services continue to monitor for nitazenes to promote community awareness against nitazene-related harm.
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Adjustment for dispensed doses does not explain higher antidepressant concentrations in post-mortem toxicology.

Lim JS, Noghrehchi F, Buckley NA, Schumann J and Cairns R
British Journal of Clinical Pharmacology, 92(5):1362-1373 | May 2026 (Published online first | Nov 2025)
DOI: 10.1002/bcp.70389
BPost-mortem detection of a medicine following suicide can be due to two main reasons: the decedent was taking that medicine therapeutically before death, and/or the medicine was involved in the suicidal act (poisoning-related suicide). We aimed to investigate how antidepressant concentrations differed between poisoning and non-poisoning suicides. We hypothesized that the predictive value of these concentrations and the separation between poisoning and non-poisoning concentrations would improve by adjusting for dose dispensed to the decedent. METHODS: We analysed post-mortem toxicology results from suicides in Australia, July 2013 to October 2019, linked to the individual’s dispensing history. Suicides were classified as poisoning- or non-poisoning-related by coroners. We analysed the distribution of concentrations through descriptive statistics, precision-recall curves and quantile regression to compare poisoning and non-poisoning concentrations. We adjusted concentrations by estimated daily dose and total drug quantity dispensed in 90 days and re-assessed model performance. RESULTS: We had sufficient sample size to analyse nine antidepressants: amitriptyline (n = 149), mirtazapine (n = 399), citalopram (n = 116), escitalopram (n = 297), fluoxetine (n = 183), sertraline (n = 253), duloxetine (n = 122), venlafaxine (n = 261), desvenlafaxine (n = 194). Selective Serotonin Reuptake Inhibitor non-poisoning and poisoning concentrations were similar, with no high certainty threshold for poisoning for citalopram and sertraline. Amitriptyline had the best separation between poisoning and non-poisoning concentrations. Adjustment by estimated daily dose improved the separation of lower quantiles through quantile regression but did not help identify thresholds that separated poisonings and non-poisonings. CONCLUSIONS: Dose adjustment generally did not improve the separation of poisoning vs non-poisoning suicides, indicating that post-mortem concentrations may not have clear dose-concentration relationships.
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Post-mortem examination of Sudden Cardiac Death: current issues and future directions.

Michaud K, Parsons S, Basso C, Fronczek J, Van der Wal AC, De Boer HH.
Forensic Sciences Research, 2026, Vol. 11, Issue 3 | May 2026
DOI: 10.3788/tfsr20260047
Forensic and clinical pathologists are confronted daily with cases of sudden death (SD) due to natural causes, mainly cardiac disease. SD is often the first clinical manifestation of underlying cardiovascular disease in previously asymptomatic and assumed “healthy” individuals. International and national guidelines established in the fields of forensic and clinical medicine recommend that an autopsy should be performed in all cases of SD, particularly in young adults. Often, autopsy is the only way to diagnose sudden cardiac death (SCD) or confirm a suspected clinical diagnosis of fatal heart disease. Postmortem diagnosis is essential not only to determine the cause of death, but also to assess any medical and/or criminal/legal aspects when the death is linked to medical or police interventions. As many causes of SCD are genetic in origin and may affect the deceased’s relatives, a correct diagnosis is of paramount importance, as it could prevent premature deaths among relatives. In addition, autopsy is essential for a comprehensive assessment of disease progression, associated complications, and the effects of treatment. However, there are still major problems associated with autopsies of SCD. There is a lack of universally adopted examination standards, and there are major difficulties associated with distinguishing normal from abnormal autopsy findings, performing and interpreting postmortem genetic testing, and interpreting toxicological findings. Research in this field is also inherently limited. This article addresses these five major
issues and proposes solutions to resolve them.
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Sustainability of the de-implementation of low-value care in infants with bronchiolitis: 2-year follow-up of a cluster randomised controlled trial.

Ramsden V, Babl FE, Haskell L, Wilson C, Middleton S, Schembri R, King A, Wallace A, Partyka A, Baldock C, Wong J, Steinmann K, Mills L, Phillips N, Poulter N, Jani S, Kenny S, Oakley E, Lithgow A, Wilson P, McInnes E, Dalziel S and Tavendern E
BMJ Quality & Safety, 35(5) | April 2026 (Published online first | July 2025)
DOI: 10.1136/bmjqs-2024-018135
BACKGROUND: In 2017, the PREDICT (Paediatric Research in Emergency Departments International Collaborative) network conducted a cluster randomised controlled trial (cRCT) at 26 Australian and New Zealand hospitals to improve bronchiolitis care. Findings demonstrated that targeted interventions significantly improved adherence with five evidence-based low-value bronchiolitis practices (no chest radiography, salbutamol, glucocorticoids, antibiotics and epinephrine) in the first 24 hours of hospitalisation (adjusted risk difference, 14.1%; 95% CI: 6.5% to 21.7%; p<0.001). During the intervention year (2017), intervention hospital (n=13) compliance was 85.1% (95% CI: 82.6% to 89.7%). This study aimed to determine if improvements in bronchiolitis management were sustained at intervention hospitals 2 years post-trial completion. METHODS: International, multicentre follow-up study of hospitals in Australia and New Zealand that participated in a cRCT of de-implementation of low-value bronchiolitis practices, 1 year (2018) and 2 years (2019) post-trial completion, obtained retrospectively from medical audits. Sustainability was defined a priori as no more than a <7% decrease to any level of improvement in adherence for all five low-value practices (composite outcome) from the cRCT intervention year. RESULTS: Of the 26 hospitals, 11 intervention and 10 control hospitals agreed to participate in the follow-up study. Data were collected on 3299 infants with bronchiolitis 1 year (intervention and control hospitals) and 1689 infants 2 years post-trial (intervention hospitals). Adherence with no use of the five low-value practices 2 years post-trial completion was 80.9% (adjusted predicted adherence, 80.8%, 95% CI: 77.4% to 84.2%; estimated risk difference from cRCT outcome -3.9%, 95% CI: -8.6% to 0.8%) at intervention hospitals, fulfilling the a priori definition of sustainability. DISCUSSION: Targeted interventions, delivered over one bronchiolitis season, resulted in sustained improvements in bronchiolitis management in infants 2 years later. This follow-up study provides evidence for sustainability in de-implementing low-value care in bronchiolitis management.
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Post-mortem cardiac-specific troponin-I (cTnI) to determine the cause of non-traumatic hemopericardium.

de Boer HH, Sutton ED, Pricone M and Parsons S
Forensic Science, Medicine & Pathology, 22(1):239-244 | March 2026 (Published online first: July 2025)
DOI: 10.1007/s12024-025-01043-2
BHemopericardium is regularly seen at autopsy and post-mortem imaging. Once traumatic cases and resuscitation artefact are excluded, hemopericardium is almost always due to either ruptured myocardial infarction or aortic dissection. In this study, we explored whether post-mortem cardiac-specific troponin I (cTnI) can be helpful when autopsy is not feasible and post-mortem imaging findings are inconclusive. Post-mortem cTnI levels were compared between 46 cases with hemopericardium due to ruptured myocardial infarction (RMI), 38 cases of hemopericardium due to aortic dissection (AoD), and 44 cases of natural deaths without hemopericardium (controls). The results showed significantly higher cTnI levels in the RMI group (median 5,821 ng/L) compared to AoD (median 273 ng/L) and controls (median 95 ng/L). Receiver operating characteristic (ROC) analysis indicated that a cTnI threshold of 1,483 ng/L provided the best balance of sensitivity (87%) and specificity (90%) for distinguishing RMI from AoD. Levels of cTnI above 9688 ng/L were exclusively seen in RMI, whilst levels < 250 ng/L excluded this diagnosis. Calculated likelihood ratios demonstrated that higher levels of cTnI favour RMI over AoD, but substantial overlap between the cohorts limited the diagnostic value of intermediate cTnI values. Autopsy remains the gold standard for determining the cause of hemopericardium and cTnI testing is best reserved for cases in which an autopsy is not feasible.
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Identification of N-Benzothiazoles-Lurasidone as an enzymatic degradation product of Lurasidone.

Farrell K, Fraser T, Butzbach D, Castle J and Kirkbride KP
Journal of Analytical Toxicology | February 2026
DOI: https://doi.org/10.1093/jat/bkaf097
Background: The 2-benzylbenzimidazoles or nitazenes are an evolving class of highly potent mu-opioid receptor agonists. Nitazenes were originally developed in the late 1950s for pharmaceutical use as analgesics; however, due to their extreme potency and the risk of adverse health outcomes, pharmaceutical research was discontinued. Since 2019, nitazenes have emerged as illicit drugs of abuse, causing significant concern. From 2021, they have been detected in both coronial and clinical casework in Victoria, Australia. This study examined nitazene-related coronial casework in Victoria from 2021 to 2025 to explore the trends and characteristics of nitazene-related deaths. Methods: Relevant cases were identified from the Victorian Institute of Forensic Medicine’s (VIFM’s) case management system. Data were collated and analysed from all coronial cases where a nitazene was detected by a toxicological analysis between 1 January 2021 and 31 December 2025. Trend comparisons were made with nitazene detections reported in other countries. Results: Nitazenes were detected in 23 deaths from a total of approximately 33,108 coronial cases admitted to the VIFM for investigation over the time period. The age range was 17-45 years, with a median of 32 and with 87% of the deaths being male. The nitazenes detected were protonitazene (n = 14), metonitazene (n = 5), isotonitazene (n = 2), N-pyrrolidino etonitazene (n = 2), N-desethyl isotonitazene (n = 1), methylenedioxynitazene (n = 1) and etodesnitazene (n = 1). Two cases contained more than one nitazene; both involved protonitazene, one involved metonitazene, and the other involved N-desethyl isotonitazene and methylenedioxynitazene. The timeline of detection of these nitazenes displays similarities with emergence trends in other countries. The nitazene concentrations ranged from 0.1 to 33 ng/mL. Broad polydrug usage was evident in all cases, with other drugs co-detected in the blood including stimulants (particularly, methylamphetamine (48%) and cocaine (44%)) as well as pharmaceutical benzodiazepines (43%) and pharmaceutical opioids (22%), and 13% had 6-monoacetylmorphine detected in either blood or urine. Novel benzodiazepines (39%) were also common, including bromazolam, which was co-detected in 35% of cases. Nineteen deaths were attributed solely to nitazene-related mixed-drug toxicity, while the remaining four cases were attributed to cardiac- and pulmonary-related disease, with polydrug use deemed a contributing factor. Conclusions: This novel case series adds comprehensive toxicological information to the body of evidence reinforcing the high risk of harm associated with the use of nitazenes. It is imperative that toxicology services continue to monitor for nitazenes to promote community awareness against nitazene-related harm.
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The frequency, patterning and morphology of thorax fractures resulting from cardiopulmonary resuscitation in the paediatric (0–3 years) population.

Samantha Rowbotham
Pathology Update 2026 Abstracts Supplement RCPA | February 2026
When cardiopulmonary resuscitation (CPR) has been administered in cases of suspected child abuse, it is difficult to differentiate if thorax fractures were the result of CPR or physical abuse. Cases of non-traumatic paediatric deaths where CPR occurred were collected from 2007–2020 from the Victorian Institute of Forensic Medicine, with descriptive and bivariate analyses were used to document fracture patterns and types and investigate how the variables influenced fracturing. The research findings provide an empirical evidence base for interpreting if thorax fractures may be attributed to CPR.
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Prevalence of psychoactive drugs in injured drivers over 10 years in Victoria, Australia.

Matthew Di Rago, Dimitri Gerostamoulus, Carla Morris, Gemma Wynd, Noel W. Woodford, Olaf H. Drummer AO.
Forensic Science International | Volume 380 | February 2026
One thousand of the mandatory blood specimens taken from injured drivers attending a hospital over a decade were analyzed for a full range of legal and illegal drugs in an accredited forensic toxicology laboratory with confirmation by a validated LC-MS/MS procedure. The presence of more than one common illicit drug (THC, methamphetamine, MDMA, cocaine, heroin), with or without ethanol, increased from 4.3 % in the first 5 years to 5.8 % in the last five years, which may reflect a higher crash risk for those drivers.
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Characteristics of infant deaths with positive hair toxicology.

N. Thomson, J. Fronczek, M. Lynch, J.L. Schumann
Forensic Science, Medicine and Pathology | Open Source | January 2026
Sudden Unexpected Death in Infancy (SUDI) is the term given to all unexpected infant deaths, comprising accidental, non-accidental and natural deaths including Sudden Infant Death Syndrome (SIDS). All infant deaths between 1st January 2014 and 31st of December 2023 with positive hair toxicology in the state of Victoria, Australia, were reviewed for toxicology results, pathology findings and SIDS risk factors. Our study revealed a pattern of cumulative risk factors for SIDS among infants with positive hair toxicology – this is especially important given the high number of infant deaths which remain unascertained following investigation.
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ChatGPT’s performance on a specialist forensic pathology examination: implications for forensic pathologists
and non-specialists.

Hans H. de Boer, Gregory Young, Heinrich Bouwer, Karen J. Heath
International Journal of Legal Medicine | December 2025
The use of artificially intelligent Language Models (LLMs) like ChatGPT is increasing rapidly in medicine, but their accuracy, reasoning quality, and contextual safety remains an issue. This is especially relevant for forensic pathology, where balanced reasoning, contextual sensitivity, and precise communication are essential. We performed an in-depth assessment of ChatGPT’s capabilities and limitations for forensic pathology, which also improves our understanding of the risks and benefits of LLM use in medicine more broadly. ChatGPT can reliably reproduce well-established forensic pathology knowledge. However, it lacks the capabilities needed for higher-level tasks and often generates unjustifiably confident and misleading output.
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The Seaport criteria for lymphocytic myocarditis: Implications for sudden death in infancy (SUDI).

Hans H. de Boer, Sarah Parsons, Barbara Sampson, Katarzyna Michaud
Forensic Science International | December 2025
We read with great interest the systematic review “Sudden Unexpected Death in Infancy (SUDI) and myocarditis: state of the art and medico-legal implications” by Giovannini et al. [1]. Their work is thorough and comprehensive, and highlights important diagnostic challenges relevant to both pediatric and forensic autopsies. We agree with the authors that the diagnosis of myocarditis is multifaceted, requiring careful integration of clinical history, circumstances of death, autopsy findings, and the results of ancillary investigations. Histology is arguably the key element of this assessment. The authors recurrently refer to the Dallas criteria [2] as the framework for interpreting histological findings. However, as they correctly acknowledge, these were developed for endomyocardial biopsies, and their sensitivity, specificity and reproducibility in autopsy specimens are unclear. The authors therefore advocate for revision and harmonization of diagnostic guidelines, a statement with which we fully concur. Importantly, since the review’s inclusion window ended in 2024, new consensus guidance has become available. In June 2025, the Society for Cardiovascular Pathology (SCVP) and the Association for European Cardiovascular Pathology (AECVP) jointly published the “Seaport criteria” for the diagnosis of lymphocytic myocarditis. Separate guidelines were made available for endomyocardial biopsies [3] and for larger specimens, including autopsy hearts [4]. These criteria directly address the lack of harmonized and up-to-date histological diagnostic standards highlighted by Giovannini et al.
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An assessment of skeletal fracture patterning resulting from fatal motorcycle crashes.

Wulff AR, Dipnall JF, Biggs MJ, Fernandez RG, De Boer HH, Rowbotham SK
International Journal of Legal Medicine | November 2025
DOI: 10.1016/j.forsciint.2025.112740
Motorcycle crashes result in the deaths of hundreds of motorcyclists annually in Australia and Great Britain. To assist with investigations into the circumstances of such events, forensic practitioners may be asked to infer the context in which hard and soft tissue injuries were produced. At present, limited research exists relating to skeletal fracture patterns in motorcycle crash fatalities for forensic practitioners to compare their cases with. Therefore, this study evaluated fracture patterns across the whole-body of 200 deceased adult motorcycle riders and pillion passengers whilst considering the influence of contextual variables. Cases were obtained from the Victorian Institute of Forensic Medicine, Australia, and the East Midlands Forensic Pathology Unit, England, United Kingdom, between 2012 and 2020. Intrinsic and extrinsic variable data was gathered from medico-legal reports, while skeletal trauma data was recorded using post-mortem computed tomography scans. Descriptive statistics, modified Poisson regression and negative binomial regression were undertaken to investigate fracture patterning, including the effect of the different contextual variables. The study found skeletal trauma to be common, and often extensive, in deceased motorcyclists, with fracturing of the thorax (95%), lower limbs (69%), upper limbs (65%), and skull (64%) being particularly frequent. The variables shown to affect fracture patterning and the number of bones fractured comprised age, helmet use, impact type and object, speed and ejection status. This research may aid forensic practitioners in their investigations by facilitating an enhanced understanding of fracture patterning and causation in fatal motorcycle crashes.
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An examination of skeletal fracture patterns in car occupants following fatal motor vehicle incidents.

Wulff AR, Dipnall JF, Biggs MJ, Fernandez RG, Cheshire EC, De Boer HH, Rowbotham SK
Forensic Science International | November 2025
DOI: 10.1016/j.forsciint.2025.112740
Hundreds of thousands of car drivers and passengers die each year in motor vehicle incidents globally. In addition to determining cause of death, forensic practitioners may be asked to infer the circumstances of the incident from associated injury patterns. At present however, evidence of the skeletal fracture patterns of deceased car occupants and associated mechanisms is sparse. Therefore, this research aimed to examine wholebody fracture patterns in occupants of four-wheeled passenger vehicles (i.e., cars) who died after motor vehicle incidents in the context of the intrinsic and extrinsic variables that influence fracturing. The sample comprised 200 adults admitted to the Victorian Institute of Forensic Medicine, Australia, and the East Midlands Forensic
Pathology Unit, United Kingdom, between 2012 and 2020. Contextual data was collected from medico-legal reports, and the skeletal trauma was examined from full-body post-mortem computed tomography scans. Fracture patterning, and the influence of intrinsic and extrinsic variables on fracturing, was analysed using descriptive statistics and modified Poisson regression. Almost all occupants (99 %) sustained fractures, with 96 % exhibiting multi-regional trauma. The thorax (92 %) and skull (72 %) were the most frequently fractured regions and exhibited the highest fragmentation. Older occupants and males were associated with a decreased fracture risk to the skull and thorax, respectively. Furthermore, seating position, impact type and impact object influenced fracture risk across the skull, cervical and lumbar vertebrae, limbs and pelvic girdle. This study augments current understandings of the complexity and patterning of skeletal fractures in fatal motor vehicle incidents, and the circumstances that produce them.
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Determination of normal post-mortem computed tomography (PMCT) parameters for the temporomandibular joint.

Megane Beaugeois, Chris O’Donnell, Lyndal Bugeja, Richard Huggins, Joanna Glengarry
International Journal of Legal Medicine | Open Source | May 2025
Post-mortem radiology, particularly post-mortem computed tomography (PMCT), has become an important tool in forensic death investigation, offering valuable insights into the cause and manner of death. The objective of this study was to define the normal configuration of the temporomandibular joint (TMJ) in the post-mortem setting, using a newly developed measurement method, the TMJ PAT (perpendicular assessment tool), to assess the relationship between the mandibular condyle and the articular eminence on PMCT scans. The study’s findings enhance the understanding of post-mortem TMJ anatomy and provide a reliable tool for distinguishing normal from abnormal TMJ configurations, crucial for accurate analysis in the death investigation setting.
WINNER: “Best Technical Article, Note or Case Study”: ANZPAA NIFS Best Paper Awards 2025
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Changes over time in novel benzodiazepines contributing to fatal overdoses in Victoria, Australia.

Jennifer L. Schumann, Rebekka Syrjanen, Jeremy A. Dwyer
Drug and Alcohol Review | Volume 44 | Open Source | April 2025
Novel benzodiazepines (NBZN) have increased in availability and use since the mid-2000s, with a corresponding rise in associated harms including deaths. The study used data from the Victorian Overdose Deaths Register to explore which specific NBZNs and combinations of NBZNs contributed over time to Victorian overdose deaths between January 2009 and December 2023. The findings reflect the transiency of NBZNs in Victoria’s unregulated drug market and highlight the importance of certain harm reduction measures in addressing increasing NBZN use.
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Retrospective review of forensic entomology casework in eastern Australia from 1994 to 2022.

Matt Krosch, Nikolas Johnston, Kirby Law, James Wallman, Melanie Archer
Forensic Science International | Volume 367 | February 2025
Forensic entomology can be a crucial source of information for medicolegal investigations, with its most well-known application being for estimating minimum post-mortem interval (mPMI) in death investigations. This project collated and analysed data from expert forensic entomological casework reports for five eastern Australia jurisdictions (South Australia, Victoria, New South Wales, Australian Capital Territory and Queensland) for a period spanning nearly thirty years (1994–2022). The accuracy and investigative ‘value’ of mPMI estimates was assessed, which demonstrated that entomology-derived timeframes are largely reliable. The paper reports the first records in Australian casework for several species and highlight several areas that require additional research to fill critical gaps in our knowledge. Overall, this review represents highly practical real-world data that will be of enduring benefit to the forensic community.
COMMENDATION: “Best Technical Article, Note or Case Study”: ANZPAA NIFS Best Paper Awards 2025
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