Cuyahoga County Coroner's Office, 2121 Adelbert Road, Cleveland, OH 44106 U.S.A.

The concentration of drugs found in the nails of each hand, foot and nasal swab were compared with those of their corresponding postmortem fluids. Eight cases were screened for cocaine and metabolites and in all of these cases, the fingernails and/or toenails were positive for cocaine, benzoylecgonine, and ecgonine methyl ester. Norcocaine was found in 7 cases and cocaethylene was detected in the toenails of two cases with values of 0.95 and 0.08 ng/mg. Concentration ranges (ng/mg) for nails were as follows: cocaine 4.16 - 397.4; benzoylecgonine 1.8 - 170.3; ecgonine methyl ester 0.19 - 26.98; and norcocaine 0.11 - 32.74. Cocaine was detected in the blood for 5 of the 8 cases. Nasal swabs (2 swabs per nostril) were collected for 7 of the cases and all were positive for cocaine with values ranging from 7.34 to 10,229 ng/swab (mean=2262).

Eight cases were also screened for opiates and in 7 of these, the fingernails and/or toenails were positive for morphine with concentrations ranging from 0.03 - 407.9 ng/mg. In 5 of these cases, 6-monoacetylmorphine and codeine concentrations ranged from 0.18 - 103.6 and 0.06 - 10.4 ng/mg, respectively. Hydromorphone was detected in 2 fingernail specimens with concentrations of 0.02 and 0.44 ng/mg with no drug detected in the corresponding blood. In 6 of the cases, morphine was found in the blood. Nasal swabs were collected for 4 cases and all were positive for morphine with values ranging from 2.29 to 114.9 ng/swab (mean=30.9).

These results demonstrate that nails may provide an alternate matrix for postmortem drug detection in cases where conventional matrices are unavailable. Whenever possible, fingernails are the specimen of choice since in this study, the drug concentrations measured were consistently one order of magnitude greater than drugs detected in toenails.