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Opioids & Death Investigation: A “Perfect Storm” - Archival
The scope of the opioid epidemic presents unprecedented challenges to the medical examiner and coroner community. This webinar explored the intersection of the opioid epidemic with the work of America’s medical examiners and coroners.
Original Live Webinar took place on 10/3/2017.

The opioid epidemic in the US has resulted in historic numbers of drug-related fatalities.  The Centers for Disease Control notes that more than six out of ten drug-related fatalities involve an opioid. Since 1999, the number of deaths involving opioids—including prescription opioids and heroin—quadrupled.  Some 91 Americans die every day from an opioid overdose.  Drug-related fatalities now exceed the peak numbers of other public health scourges such as HIV (1995), motor vehicle accidents (1972), and gun violence (1993).

Medical examiners and coroners (ME/C) are responsible for investigation and certification of all unnatural deaths in their jurisdictions, in accordance with state statute.  Such unnatural deaths include apparent drug intoxications.  Components of ME/C death investigations include assessment of the scene of death, review of medical records, coordination with law enforcement and first responders, performance of an autopsy, collection of appropriate specimens for toxicological analysis, interpretation of laboratory results, and death certification.  This labor-intensive process requires both medicolegal death investigators and forensic pathologists (FPs).

The addition of the opioid epidemic to the numerous challenges already facing the ME/C system in the US has resulted in what some medical examiners have called a “perfect storm.”  Workforce issues—particularly the shortage of FPs in the US—have stretched many ME/C offices to a breaking point, threatening accreditation.  Approximately 500 FPs practice full time in the US, a number far below the estimated 1000-1100 needed to provide medical examiner and forensic pathology coverage to all jurisdictions in US.  This dearth of qualified FPs predated the opioid epidemic, and workforce projections through 2030 predict a worsening shortage of pathologists in the US.

Standards promulgated by the National Association of Medical Examiners recommend that all apparent drug-related fatalities undergo a complete postmortem examination, but more and more ME/C systems are having difficulty meeting this standard.  The increased volume and cost of postmortem toxicological testing has added further strains to the budgets of most ME/C offices—budgets that are almost entirely dependent on state- or county-level funding.  Law enforcement and prosecutors expect autopsy reports and reliable toxicological findings when charging the sellers of opioids that resulted in a fatality.  The seemingly endless proliferation of fentanyl analogs requires routine communication between FPs and toxicologists so that FPs understand what assays are currently available, and what new analogs are present in the community.

The opioid epidemic is taxing many institutions in the US—law enforcement, the courts, healthcare, laboratories, first responders, and death investigation systems.  The latter is particularly strained by this epidemic, given the hodgepodge nature of death investigation in the US and the marked shortage of qualified forensic pathologists.  At present, no ready solution to this “perfect storm” in medicolegal death investigation exists.

Learning Objectives

•	Describe the strains that the unprecedented number of opioid-related fatalities, superimposed on an already understaffed medicolegal death investigation system, has produced.

•	List the typical and less common autopsy findings encountered in opioid-related fatalities

•	List the factors that coroners and medical examiners must consider when approaching, investigating, and certifying a potential opioid-related fatality

This webinar was recorded in its entirety at the time of the Live event in order to capture the one on one interaction with the presenter.  Funding for this Forensic Technology Center of Excellence event has been provided by the National Institute of Justice.


Dr. Andrew Baker
Dr. Baker is an MD and is a graduate of the University of Iowa. He completed his pathology residency at the University of Iowa, and a forensic pathology fellowship in Minneapolis. He is board-certified in anatomic, clinical, and forensic pathology.