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May 23, 1980

Completeness of Toxicological Analyses

Author Affiliations

Harvard Medical School Beth Israel Hospital Boston

JAMA. 1980;243(20):2030-2031. doi:10.1001/jama.1980.03300460014013

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To the Editor.—  Based on a survey of toxicological analyses performed by 24 coroners' offices, the recent article by Finkle et al (242:429, 1979) concluded that diazepam is a relatively safe drug. This opinion was based in part on the observation that chemical analysis detected diazepam as the sole agent in only two of 1,239 fatal overdoses where diazepam was detected. Moreover, diazepam was the sole drug detected in addition to ethanol in an additional 5.6% of cases. We are not disagreeing with the conclusion of this investigation, but we do question the validity of this kind of evidence that is so frequently used to implicate or exonerate a drug as a health hazard.The technical limitations of toxicological analysis obviously are an important determinant of whether a drug will be detected in overdosed patients. Thus, drugs that are difficult to measure will be implicated in only a fraction of