Tracking Opioid Overdoses. Real World -Real Time Dotti Owens-Ada County Coroner

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1 Tracking Opioid Overdoses Real World -Real Time Dotti Owens-

2 Overdose in the news

3 National Opiate Related Stats Drug overdose is the leading cause of accidental death in the United States Surpassed auto accident fatalities for first time ever Surpassed firearms related deaths in the United States for first time ever 80% of Heroin users started out misusing prescription pain killers 94% of people in treatment chose heroin because pills were harder to obtain or too expensive

4 Crisis in Our Communities Families are shattered, without regard to income, race, ethnicity, gender, educational attainment or family structure Drug dependency becomes the norm in households, while individual s children often witness parent s chronic use. Generational users are being created Dependency creates Dr. Shoppers, and when desperation hits, heroin (opioid) becomes an easily accessible and inexpensive alternative.

5 Opioid Crisis in Idaho Cause: Overprescribing Easy access Social acceptance Inability to cope and a false sense of security is fueling the opioid problems in our communities Heroin, fentanyl and prescription opioids have a foothold in our society

6 Typical Overdose Cases Chronic Pain Many times lack of or minimal diagnosis (not the pain patients OD ing) Excessive scripts without follow-up Dr. Shopping- Many graduate to Heroin Heroin/meth/presc combo s Jail time and prior arrests, Prior encounters; EMS/Police

7 Opioids We are all in this together. Taken To Soon Their deaths are sudden. Decedents are often found in parks, parked cars, hotels, sober houses and in bathrooms Many times, family, friends, roommates and loved ones report hearing sound sleeping and snoring, then find them cold, stiff and pulseless in the morning. Pulmonary edema from drug ingestion often leaves its victims with a foam cone. Typical victim year old men-

8 Opioids ǀ We are all in this together Coroner Investigations Imperative Physical indicators/evidence of drugs or paraphernalia are often present (track marks, spoons, prescription medications, foam cone) Forensic photography Interviews family, friends, neighbors Medical and Mental Health history records Board of Pharmacy (BOP) Medications confiscated at scene, counted and compared with BOP

9 What people think an OD looks like

10 What todays OD s look like

11 Opioidsǀ We are all in this together Forensics If no formal medical diagnosis is present, a forensic autopsy should be conducted Autopsy preliminary indicators of overdoses are identified by pulmonary edema, lung congestion and edema in the airway and mouth (foam cone). Heart, lungs and sometimes bladder are enlarged. Toxicology Specimens are sent to Forensic Toxicology lab. Results generally take 4-6 weeks. Initial autopsy findings confirmed with tox results Hospital admission blood (VERY Important) most hospital do not quantify tox results and only retain specimens for 72 hours

12 Stake Holders Role Coroner/ME Offices Coroner s/medical Examiners certify death certificates on all overdoses Preliminary investigations will produce a pending cause and manner Once tox results are received, investigators cases and pathology reports are updated to reflect findings. A supplemental DC is completed and submitted to EDRS Information obtained is collected through the State Office of Vital Statistics for further analysis and repository Public Health Programs are developed based on the data gathered and reported on in death certificates. Suicide prevention programs, opioid addiction and awareness programs, allocation of Federal/State funding, etc.

13 Social Media Challenges Misinformation from social media platforms, such as Facebook, Twitter and Snapchat have created new challenges. It is not uncommon to encounter situations where friends or family try to fix or counter the effects of an overdose is progress We are starting to approach these cases as homicides, and charge as such, when paramedics have been neglected to be notified.

14 Opioids We are all in this together. Idaho s Drug of Choice 1. Opioids, Methadone, Oxy, Hydrocodone 2. Heroin - Illicit Opioid 3. Meth 4. Combo; heroin, meth, opioids 5. New designers; pinky (U-47700), spice (opioid induced), etc.

15 Multi-agency cont. Partnerships with local LE, DEA, and other agencies for education, community outreach, prescription tracking and support groups

16 Idaho Steps Up!! Coroner Association Grants Training; Identifying Overdoses Three day s at ACCO Morgue and Investigations Toxicology; Counties with limited budgets are receiving supplemented funds to pay for toxicology for potential overdoses. Education opportunities!!