The Toxpod

Dimitri Gerostamoulos

September 04, 2019 Season 2 Episode 5
The Toxpod
Dimitri Gerostamoulos
Chapters
00:00:37
Career path
00:05:04
Involvement in TIAFT
00:10:06
Collaborations with UNODC
00:14:54
Interesting research
00:25:01
Toxicological issues in Australia
00:31:24
Advice for young toxicologists
The Toxpod
Dimitri Gerostamoulos
Sep 04, 2019 Season 2 Episode 5
Tim Scott & Peter Stockham
Dimitri Gerostamoulos joins The Toxpod
Show Notes Transcript Chapter Markers

We are joined by Dimitri Gerostamoulos, Head of Forensic Science and Chief Toxicologist at the Victorian Institute of Forensic Medicine.


Contact us at thetoxpod@sa.gov.au


The Toxpod is a production of Forensic Science SA and the South Australian Attorney General's Department. The opinions expressed by the hosts are their own and do not necessarily reflect the views of their employer. 



Tim:
0:01
Hello and welcome to The Toxpod. I'm Tim Scott.
Peter:
0:14
And I'm Peter Stockham.
Tim:
0:16
And we are here today with a very special guest, a man who needs no introduction but I'll give him one anyway. Dimitri Gerostamoulos is head of forensic science at the Victorian Institute of forensic medicine and president elect of TIAFT and has done a great many things in his career. Welcome Dimitri.
Dimitri:
0:33
Hello Tim. Hello Peter. Great to be here.
Tim:
0:36
Good to have you on The Toxpod. So I wonder if we could start off by you just telling our listeners a bit about your career path, how you got into the field, how you got to where you are today.
Dimitri:
0:47
Sure. I guess I'm, I'm fortunate in the sense that uh, when I finished my undergraduate degree in pharmacology and chemistry, the Victorian Institute of Forensic Medicine had just been set up and there was a fellow called Olaf Drummer who was largely looking after the tox laboratory, he was actually head of scientific services. And he had a couple of honours positions and one of them was looking at methadone deaths and the other one was looking at the incidence of cannabis in motor vehicle accidents. And I took the latter project and went down to the Institute, I was expecting to see this old man with a beard and some glasses in a white coat and I wasn't too far off. He wore a white coat, had a beard, but uh, he was very young then. And from there I completed my honours. I worked in the lab for a few years and then Olaf said, really if you want to progress do a PhD, so I did. And four years later I'd finished my thesis. I then got a postdoc position, all at the institute, and I analyzed toenails and hair samples and soil samples for inorganic arsenic in samples from rural Victoria. I'm looking at the sort of seepage from, um, arsenic treated material, which was used to set up, you know, fences right across rural Victoria that sort of seeps into the table water. And there was a suggestion that that inorganic arsenic was leading to higher rates of cancer in people in the country.
Tim:
2:15
Was anyone doing uh those kind of tests in hair at that time?
Dimitri:
2:19
Uh, not in hair. Um, we were, to get inorganic arsenic you basically had to use atomic absorption spectroscopy. So that was, um, cooking those at 300 degrees with uh, concentrated hydrochloric, nitric and sulfuric acid.
Peter:
2:34
Good stuff.
Dimitri:
2:35
It's a good start to Dorian Gray, especially with my hair, and I did that for two and a bit years, farmer's toenails, boy! Talk about specimens for, choice specimens for analysis. And um, I then finished that and then we had a heroin epidemic at the turn of the century. There were, you know, almost every day there was a person dying of heroin, uh, related causes. And I got involved in a research project that looked at some of the risk factors, so people injecting alone, people using multiple drugs, uh, people using more than what they might have used a few days ago where their tolerance is down. We identified a number of risk factors. And then the manager position came up. There was a sort of a change at VIFM, a sea change. I took the job and I, I've been there, well I managed the lab for the next 13, 14 years until the lab grew so big that I needed help. And, um, when I started we had 10 people. We've now got 42 people in the lab. So it's a huge change and I've got really capable people who work with me, so a great team. It's a good place and like your organization, um, there's a number of different disciplines at the Victorian Institute of Forensic Medicine, including forensic pathology, clinical forensic medicine, uh, the other laboratories. So it really is a great place to work. And I've been there pretty much my whole career. I'm fortunate, I suspect that I've been in the one place for a long time because it's allowed me to do things that maybe I wouldn't have if I'd, you know, hopped from institute or organization to organization. It's a great place to be.
Tim:
4:12
It's probably a bit of an unusual thing about, uh, the context in Australia. People do tend to stay in one place for quite a while, whereas in Europe and America, people move around a lot more.
Dimitri:
4:21
Yeah, that's true. That's true. But I guess, um, in my particular instance, uh, I've been very fortunate that I've had great mentors, like Olaf, like Stephen Cordner, who was director of the Institute for many years and now Noel Woodford. So I'm lucky. But I've also worked pretty hard to make sure that we've got a good facility and, um, you know, improving the way that we do things, looking at ways in which we can recommend, uh, strategies to prevent death, helping families, helping coroners, helping police. So, you know, for us as toxicologists there's a tangible outcome at the end, I think that may be not as apparent if you work in, you know, public health where strategies can often take years and decades to implement.
Peter:
5:03
Yeah, it's true. So you've been involved in TIAFT for many, many years. Maybe tell us a little bit about TIAFT.
Dimitri:
5:10
Sure. TIAFT is uh, well, it's the Association of Forensic Toxicologists, the International Association of Forensic Toxicologists, and it's roughly 2000 members now. And they consist of both developed and under developing countries. And it's an opportunity for toxicologists in many different areas, and it could be clinical toxicology, forensic toxicology, racing chemistry, uh, sports drug testing, workplace drug testing, to get together, to belong to an association that's got probably the best forensic tox experts anywhere, they're all there. And even the people that, you know, I sort of, um, grew up with, who are now come to be good friends actually. So when I started and I went to my first TIAFT meeting in 93, there were guys like Fred Rieders there, you know, this giant from the US, there was, um, Alan Curry, there was Irving Sunshine, and all of these guys had published and I'd read their material. Even guys like Pascal Kintz and Hans Maurer, and I met them over the years, they're actually pretty good people. And it allows you to get closer to perhaps collaborate with them. So we've had number of projects that we've worked on with Hans, for example, uh, with guys from Sweden, uh, guys from the US. So TIAFT allows you to connect to other experts around the world. And back then everything was requested by mail. So I used to get reprints in the mail. There'd be a letter, you'd get very excited when you got one from overseas. Uh, but now, you know, journals are very accessible. You can have a chat to anyone, you can ring them up, you can whatsapp them, you can, you know, and it's great. And TIAFT allows you that connection, which is really, really super.
Peter:
6:51
It's a great organization because everyone that you meet there is experiencing exactly the same problems, issues and challenges that you've got in your own laboratory, so...
Dimitri:
6:58
And TIAFT's done a lot of work to promote, uh, accessibility for young scientists. You know, when I first started, it was really difficult to be honest with you, to sort of break into that group. I felt always a little awkward, you know, being with some of these experts. And I'm sure that's, that's the case for some of the younger people today, but they've got a lot more opportunity. And they've got a lot more opportunity to travel to these meetings, whereas back then, um, I think it's probably cheaper today to go to a forensic tox meeting than what it was 25 years ago. And you have a lot more options about where you're going to stay, who you're going to stay with. So, uh, TIAFT is great like that and it's held in pretty good locations around the world, let's be honest, we're fortunate to travel the world and go to different places and experience different cultures and see how relevant some of the tox practices are in some countries, or the lack of, which leads to, you know, a lesser standard of forensic evidence, which means that cases don't get prosecuted. So cases involving drugs in drug facilitated sexual assault don't get prosecuted because they don't have the means in which to test these samples. You know, in places like Timor for example, where all they have is an ELISA to do drug facilitated crime cases. You know, it's, and I think TIAFT is making good strides to make toxicology more accessible to under developed countries. And you know, by spreading our expertise, attending meetings, talking to these people, um, we've sent people from our lab to underdeveloped countries to assist in, you know, setting up multianalyte methods that, that's the real practical stuff.
Tim:
8:36
So I'm sure a lot of our listeners would be interested to hear about what it's like to actually be a member of the TIAFT board. What, what does it involve? What kind of workload, what kind of travel and maybe what's something that you really enjoy about being on the board?
Dimitri:
8:50
Good question.
Peter:
8:50
I hope it's the travel cause you don't, are you ever at home?
Dimitri:
8:53
Travel's good, yeah, I'm at home and you know, uh, juggling, juggling the travel and the lab and, and home is difficult. It's not, you know, some, some days are good, some days not so good cause you miss some things and uh, you get told about them too. So, but on the flip side, it's great to be with a group of likeminded individuals who are all pretty good scientists. You know, the board is, consists of pretty good toxicologists who all contribute and have all contributed in the past. And what we do, what this current board is about is ensuring that we have proper processes in place for TIAFT. So things such as our guidelines, our constitution, our membership, uh, the benefits for TIAFT, um, how we run our organization. Um, what, what procedures and policies we have in place. Cause some of that in the past was a little bit up to whoever was president at the time. And so what we want to make sure is that for future committees or future people that come into the board, they can focus on other things. Um, and Mark's really keen to do that. I mean, he's the current president, so, and I'll continue some of that work, but maybe, maybe I've got some, some of my own ideas about what will happen next year when we, when we transition.
Tim:
10:06
And one of the things that you've been involved in through TIAFT is the links with the United Nations Office of Drugs and Crime. How did that all come about and get started, those collaborations?
Dimitri:
10:17
It's a good question. I mean, that involved, uh, Justice Tettey, who's the head of the forensic science division there reaching out to TIAFT to try and get toxicologists to collaborate with the UN. So he reached out to a number of us on the board, including myself, Simon Elliott, Heesun Chung, who you've also interviewed. And he invited us to an initial meeting in Vienna and Robert Kronstrand was there, Franco Tagliaro was there, uh, Eleuterio Umpierrez from Uruguay. And what we did is we gave him access to toxicologists through TIAFT. So trying to establish what the harms are associated with some of these NPS, these novel psychoactive substances, means that you've got to have access to the material that's produced around the world. And we gave the UN the ability to put that altogether into a portal. And the aim of this work is to develop threat assessment reports, uh, to identify some of the harms associated with, you know, things like Cumyl-PEGACLONE, uh, like some of the, um, FUBINACAs which have been involved in, you know, in deaths around the world. And to try and estimate a toxicity profile from some of the work that we're doing. And this would never have happened had he not had access to TIAFT. So prior to that it used to be, you know, a select committee that used to get invited to the UN. And they're emminent toxicologists, people like Olaf, for example, Hans and a few others. But now what they have access to is the whole, the whole membership. And that's, that's a huge resource for the UN to tap into. And really it's about the prevention of death. It's identifying some of the harms associated with taking these drugs. And I think if we can contribute to that, that's a great thing.
Peter:
12:04
It also works in the reverse way, it's also good for the UN, but it's also very good for the toxicologists because now they know what the major drugs are out there to look for. The most dangerous ones they can actually target. Rather than buying 2000 standards, they can buy 500 or something. More specific ones.
Dimitri:
12:20
That's true. And also I think as part of the UN's charter, is to make these sort of um, well these processes available to countries who don't have the same resources as the US, as Australia as the UK, as Germany. You know, what happens to places in South Africa or in, you know, Algeria or Egypt. I'm sure that they see these drugs and how is it that we can better allow them to contribute to the knowledge base by enabling them to detect these things. I mean that's, that's the real challenge going forward I think for TIAFT to be honest with you, is to expand our horizons and, and enable countries that might not have the knowledge that may not have the technical capabilities to start to contribute to sort some of the issues in their own local communities.
Tim:
13:08
And it may be a bit early for this, but has the UN got any sense yet of how effective this database is being that they're compiling, in terms of getting, getting the word out to labs that wouldn't necessarily know or even having practical impacts on the ground.
Dimitri:
13:22
No what it has done is substantiated their, their knowledge base. So they already had an idea that some of these things exist through literature. So they used to scour the literature and put those world drug reports together, which are fantastic documents. But now there's real data. There's real material associated with deaths in Brazil, in Canada, in New Zealand.
Peter:
13:45
And in a reasonably fast time compared to what it often takes to publish something.
Dimitri:
13:49
Correct. So what we're hoping to do is to have those portals open every, every few months and then quarterly assessment reports that are produced by the UN. So they're current, they're timely. Governments can look at these things and say, hey, you know, maybe the fentanyl epidemic isn't that far away in our country.
Tim:
14:07
Yeah. And a lot of people are prevented from reporting stuff in the literature, unfortunately through, you know, just, they can't get the permission to publish it, but, uh, they might be willing to submit it to some kind of database like this.
Dimitri:
14:18
So it's almost like an early warning system, um, which is great, but you're right, uh, getting material out quickly is not easy in our field and it should be, I mean, if you look at how we treat our people clinically in hospitals who present from, you know, overdoses of drugs, we try to treat them as quick as we can, but yet, you know, when we have a death, it often takes quite a lot longer for us to get that material out. And that might be really important. You know, if you've got a bad batch of drugs, for example, that results in three or four people dying, that information is really important to drug users in the community. But you know, we've got a long way to go on that.
Tim:
14:54
So you see a lot of research, going to conferences. What's one area of research that's happening at the moment that you're just really excited about, that really makes you pay attention when you see there's the talk on this?
Dimitri:
15:05
So something that uh, well there is a lot of stuff being presented on NPSs. So novel psychoactive substances, sometimes too much to be honest with you. But I like to interpret numbers. So at the end of the day when we produce a tox report, what do those numbers really mean? And that's, that's forever been a challenge as long as I've been in the field about what a level of a drug means in the context of a case. Um, so I'd like to see more research around those, more case interpretations. Um, I'd also like to see more post-mortem research cause we don't know a lot about what happens to drugs post-mortem. We had some research being done in the eighties and nineties, but human tissue acts around the world put really a stop to that. Even at our own organization, to obtain tissue from a deceased person is far more difficult for research purposes. You have to get approval from the next of kin, which is absolutely appropriate. But it has stifled the research in post-mortem toxicology and we continue to assume that drugs behave in a certain manner, that drugs are stable, that drugs do not change. Um, but we know that that's not the truth. And we don't really have, um, we haven't really progressed on the sort of understanding of post-mortem toxicology since the eighties or nineties.
Tim:
16:25
Yeah. If you go to a typical toxicology conference and just by the sheer number of lectures, you would think that NPS is kind of 90% of what we encountered, which is not true at all. It's 1% of what we encounter, if that, maybe.
Dimitri:
16:37
That's, that's very true. The traditional drugs dominate. Yet we still, you know, have trouble interpreting levels of, for example, methamphetamine or THC, god forbid I mentioned THC. The drug that just keeps giving, uh toxicologically. I mean it is a wonder drug in so many ways, not only from a, um, a health perspective, you know, it's seen as an alternative to pain relief. It's a, it's a challenge to determine the drug analytically. It still continues to, you know, to confound us in so many ways. It is a wonder drug. No wonder Marilyn's been studying this for 30 years. Um, so look, I'm, I'm excited about the fact that young people are doing research that they're presenting casework, that they are having a go at, you know, understanding what tox means. Cause Irving Sunshine once said, and I'm, I might be paraphrasing Heesun here. Toxicology is pretty easy. You only need two lessons. Each lesson's 10 years, 10 years each.
Tim:
17:33
Yeah that's a good quote.
Dimitri:
17:35
It is. He was a real pioneer along with Allan Currie of course. Um, these people are sort of gods in the tox world and um not, not as, not a lot is known about them, our young people don't know enough about some of the pioneers. And, um, I'd like to focus on those when I get, when I get my chance to be TIAFT president is to bring some of those pioneers to the fore and really look at their achievements. So you might not know, but Vern Plucarn, who's a forensic pathologist in Victoria, in 1966 advocated the use of sodium fluoride, potassium oxalate in all blood tubes for alcohol estimation.
Tim:
18:09
Is that right?
Dimitri:
18:10
And that was 53 years ago as a recommendation for the proper analysis of ethanol in forensic sampling. Pretty amazing.
Tim:
18:21
And now you wouldn't do without it.
Dimitri:
18:22
Absolutely. Absolutely.
Peter:
18:25
So, um, in terms of research, is there anything you're up to at your institute you can tell us about?
Dimitri:
18:29
So we're doing a lot of drugs, drugs and driving research. I mean, we're in that workspace because we do a lot of work for, um, law enforcement around drug testing, so...
Tim:
18:40
Are you doing, are you doing the most, anywhere in the world now? You seem to be doing a lot of oral fluid testing of drivers.
Dimitri:
18:47
Um, I'm pretty sure that along with some other states in Australia, we do the most drug testing for driving anywhere in the world. Last year, I think we issued 23,000 reports with Victoria police, or this year we're about to.
Peter:
19:01
The roadside testing scheme that's not done by your institute, but done by law enforcement, that's got to be one of the largest, well probably the largest in the world.
Dimitri:
19:09
It is. I think collectively around Australia, there's probably more than 500,000 random roadside drug tests done. And you know, if you take the average of 10% of those, uh, that's, that's an enormous number of confirmations done in forensic labs. So yes, we're focusing around that. We're looking at how effective that that testing is in terms of prevention terms of a deterrence, things that we could be doing better analytically because as you know, there isn't an evidential test at the roadside. That's, that's a problem. Um, as there is for alcohol. So, you know, at the roadside you can, you can prosecute someone on the basis that you've got an evidentiary breath test, you don't have that with drugs. So currently we're somewhat limited, which requires the lab to be the arbitrator and rightly so, um, whether that changes in the next 10 years, I don't know. But there's some research around that. And what we want to do is see how effective these roadside programs are because drugs are prevalent in the community. 20% of all drivers killed in Victoria are stimulant positive. You know, that's not an isolated finding because in injured drivers, it's somewhere between 12 and 14%. So it's, it's not an aberration that's only in deceased drivers. It's prevalent, it's prevalent in the community. 40% of our homicide cases involve methamphetamine. So these drugs are dangerous. They can lead to people having accidents. Of course, they increase your risk of having an accident despite the, to the contrary, some, some people are trying to show otherwise. There's, there's enough research to show that, you know, cannabis is a risk on our roads as are stimulants. And if you ask me whether I'd rather fly to the US with a pilot with a little bit of cannabis or with a pilot with no cannabis, I'll take the latter every day.
Tim:
20:50
Yeah. And your institute as well in conjunction with Monash University has done a lot of stuff around epidemiological studies and especially the codeine, you know, prescriptions and so on, the rise of codeine and looking at, um, societal implications, like the one punch deaths that have happened. Uh, can you tell us a bit about that?
Dimitri:
21:12
Yeah we've done a lot of work in that space. So largely aimed at prevention. So preventing people from dying in the future as a result of taking too many opioids, as a result of avoiding situations where they get involved in, um, you know, in, in violent, um, exchanges with people who are drug affected. Uh, so we, we started the one punch, uh, investigation sometime ago after a young fellow lost his life following a punch, I think shortly after a New Year's, uh, party. And you know, he's a young fellow, 21 year old, fell back, hit the ground and he died. And I thought at that time and I, with my coworker Jennifer Pilgrim, I said, you know, let's have a look at how common single punches are. We, we did an investigation over 10 years and we found more than a hundred of these cases, which is pretty, pretty shocking. Um, and most of those involved alcohol and when? Uh, usually late at night on a Thursday, Friday, Saturday night between the hours of 12 and 3, not a, not a lot of good happens between those hours. And drugs were a factor in those. Now, primarily alcohol, but certainly stimulants. And that was one aspect of research, which is really, you know, evidenced based and can lead to strategies for prevention in terms of maybe restricting the sale of alcohol or being conscious that you know, people who drink and then get into altercations can end up with a single blow which renders them unconscious and you know, in a, in a pretty bad way. But some of the other research that we've done is around opioid mortality, looking at how prevalent drugs are amongst healthcare professionals, which was an eyeopener. We've also done a lot of drugs and driving work, epidemiological stuff, looking at risk, your relative risk of having an accident with certain drugs on board. That's been good. Done a lot of post-mortem research. So that was my hotbed for a long time. A lot of work around heroin deaths. And we present this material. You know, we've always had the opportunity and I've been fortunate that the institute has supported our initiatives to present this both locally and internationally.
Tim:
23:16
You seem to have found a balance that I think maybe a lot of people find it very hard to find, which is as you go higher in our field, probably in any field, you tend to get further away from the thing that you started doing in the first place, which in our case it's science and research as well. You've managed to keep a hand in research even while taking on significant managerial responsibilities and other organizational responsibilities outside of that. I don't know if you feel like you have the balance right, but how you managed to find that? How have you juggled that? What have you found difficult?
Dimitri:
23:47
Well it keeps you healthy toxicologically. I think you've got to be in that space to know what's happening in the lab. I'm not a, I'm not on the bench anymore, but I certainly am in the lab because my office is in the lab and you know a number of times I've been asked to possibly move, but I don't want to because it keeps you close to your people and it keeps you close to what's happening in the lab. And while I might not know exactly how one of our new beaut LC mass specs work, I certainly can, I can understand how it's applied and where the benefit is in doing some research around that. So, no I haven't got the balance right Tim, no doubt about that. But I've worked pretty hard. And uh, often, you know, there are nights where you go home and you finish stuff and it's almost impossible during the day to get a block of work done to write a paper or to read a paper. So I tend to do that on the way when I get home, um, weekends sometimes or when I travel. So when I travel on the plane.
Tim:
24:46
Yeah, I guess you get a lot of time if you're on a plane to Europe.
Dimitri:
24:48
Yeah, I've written papers on planes in between watching films. So, um, but that's, that's a good, that's a good thing in my job as well, I do get to travel and go to different places and I'm fortunate, I'm very fortunate.
Peter:
25:02
So we're here in Australia. Is there any particular issues in our region which differ from other regions of the world, do you think?
Dimitri:
25:08
Only that Australia is a pretty high consumer of stimulants. We know that, we heard the other day from one of our emergency doctors from Perth that Perth is the meth city, meth capital of Australia. We've got problems with stimulants right around the country. We've got problems with illicit drugs. Uh, there's a burning issue around pill testing, which is really interesting from a tox perspective. So we heard David Caldicott give us a lecture the other day at the FACTA meeting, which was held in Adelaide, and he talked about not only the analytical component but the fact that there's an intervention. And I think that's forgotten to be honest with you. That intervention component, which allows doctors, who really are trying to save lives about, you know, having a conversation with a young person who is about to take a drug maybe for the first time about what that drug can do to them. And while I think we were a bit skeptical about the analytical merits of the testing, it's something that we can help with. We are the experts when it comes to testing samples. And we've got colleagues who tests pills and test powders and seizures and seized material. So why can't we assist them to develop something more mobile that is applicable, uh, in a, in a dance festival situation? Um, and my view is that if it's worth saving a young person's life, someone who might make a mistake, you know, because they're young and foolish or they choose to, I mean, we, we were there once upon a time as well. Maybe we just didn't have the sort of availability of drugs that young people have access to today. So we had alcohol, possibly cannabis and a few stimulants, but the variety of NPS that are available today, means that, you know, the, there's good evidence that pill testing and an intervention actually does save lives. And I think that's important. We're about preventing deaths aren't we?
Peter:
26:55
That's right, yeah.
Tim:
26:56
It's ironic that our, our business is, you know, post-mortem toxicology. That's a large part of what we do. In an ideal world, we probably wouldn't exist as post-mortem toxicologists. Uh, but yeah, reducing death is something that I think we're all very passionate about.
Dimitri:
27:10
And one thing I'm also passionate about is providing an analytical service to our hospitals. You know, for a long time a sort of analytical service to hospitals has been simple and maybe not as effective as it could be. Sure, it'll tell you that there's a class of drugs there, but sometimes you might want to know what that drug is and it may be more important with some of these exotic NPS that we know, uh, are being used and are being consumed. If we could provide a rapid service to our hospitals, that may allow clinicians to better treat some of these individuals because it ultimately reduces their time in hospital, reduces the health burden and allows the treatment to be better directed towards an individual. But that may not always be the case because our clinicians are pretty good at treating people, um, depending on their sort of toxidrome. But if we could tell them that this person has, for example, Cumyl-PEGACLONE in their system, all right, it's a synthetic cannabinoid that may, that may better target some of the treatment that they're going to provide. You know, and before I finish, which hopefully won't be, won't be too soon, but I'd like to see that we establish some sort of clinical service for, for our hospitals in a rapid, meaningful way. Like, we can do some fantastic analyses looking at hundreds of drugs in minutes. We can identify things that we could never see before with the new technologies. Why can't we make that accessible to our public health system?
Peter:
28:32
And often that could be because we're often siloed into our forensic world rather than a clinical world.
Dimitri:
28:39
These are things that we should be trying to do I think, um, even though our funding is primarily from justice, you know, justice departments to look at law, you know, more medico legal death investigations or uh, criminal work. Um, I think there's a role for us to play, uh, in, in assisting, uh, clinicians, um, in terms of drug detection. And what, what sort of information we can provide to them, because it's not just the detection of the drug. Maybe we can provide them some information about the pharmacology of these drugs too.
Tim:
29:11
Yeah. That's the really exciting part of it to me, is working at what, and the combinations of the drugs and what effects they might have. It's all extremely complex depending on where they are in that timeline, when they took the different drugs, which ones are coming down, which ones are going up and so on.
Peter:
29:27
At the moment in virtually every hospital, they don't even know what drugs they are taking, they've taken. They just may see the, they may just see a GHB result when they've actually got GHB plus methamphetamine plus lots of other things, so...
Dimitri:
29:38
Plus, plus, plus.
Peter:
29:39
Yes.
Dimitri:
29:39
Often multiple, you know, drugs are involved in a, in a presentation. It's not a single drug really.
Peter:
29:46
So I can say one thing about doing that sort of work. It's really good fun if, if you're interested, if you're a scientist and you love toxicology, try and get involved. Try and spark your colleagues up to try and get something organized because even if it takes some of your own time, you're going to, you're not going to get funding immediately. But if you do a, maybe a small study with a colleague that you know in an emergency hospital, get some interest generated.
Tim:
30:10
It's very rewarding.
Dimitri:
30:11
And it also gives you a perspective on what drugs are really dangerous. You know, some drugs are much, well, some drugs are safer in overdose than others, but opioids in overdose, they're bad news.
Tim:
30:22
And it's really hard to get that from post-mortem tox sometimes because you find a drug, maybe you find an NPS or something, but it's there, what did it mean? Did it cause the death? Who really knows in a lot of these cases.
Dimitri:
30:34
And we've also got to be conscious of the fact that there are a whole range of, um, you know, fentanyl type substances that we haven't really seen yet. I mean, if you look at what's happening in the US it's an absolute tragedy, and we've got some of those triggers here. We've got a significant drug abusing drug, opioid dependent population. We have the same sort of triggers. We've reduced, uh, availabilities of some of the more common opioids. That's happened. Um, have we seen an increase in fentanyl deaths? Not really. Not yet, but the, that takes time for us to sort of follow the US, the US market. We did that for oxycodone. You know, we had an epidemic of deaths involving oxycodone. Maybe that's going to be the case with fentanyl, maybe not. But there's some lessons for us about how we go about preventing some of this stuff by looking at what's happening in, in the US and in Canada.
Tim:
31:24
So just as we finish up here, I wonder if there's some advice that you would give to a young toxicologist who's maybe just got into the field, they're just starting out. What advice would you give them in terms of their career and what path they should take?
Dimitri:
31:37
So if you are just starting out, you've got to be persistent, you've got to persist. And that, you know, that may be true for a lot of things, but you've got to persist because there's a lot to get your handle on, get your head around for tox. It's not only the instrumentation, it's not only the number, the sheer number of drugs, it's, it's about the numbers that we produce and what they mean at the end of the day as well. So yes, persistence that pays off, but you know, get to meetings, uh, write to people, uh read. So when you're travelling, when you're going home, pick up a paper, take it with you, you know, get a, get a paper that's scientifically relevant to what you're doing and read it. And it might be a review paper. There is so many good review papers written by experts around the field. Um, people like Olaf, people like Marilyn Heustis, people like Hans, people like Bob Flanagan, um, Simon Elliott, Mark LeBeau. You know, read them, read those articles, know what they're talking about, and then go to TIAFT meetings or come, come to a FACTA meeting where you can get exposure to some of these people.
Tim:
32:44
It's, I could never just read a review article because when you see something interesting and then you go and check out the reference and then that leads you onto another one and another one, and then pretty soon that's your day gone.
Dimitri:
32:53
Isn't that great?
Tim:
32:54
Yeah, it is. That's the great thing about science. Well, thanks very much for joining us, Dimitri. It's been a pleasure to have you.
Dimitri:
32:59
Thank you for having me.
Tim:
33:01
And thank you to you, our listeners. Uh, if you want to contact us, you can email us at thetoxpod@sa.gov.edu.
Peter:
33:09
We'll catch you next time.
Career path
Involvement in TIAFT
Collaborations with UNODC
Interesting research
Toxicological issues in Australia
Advice for young toxicologists
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