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Death by Drug Death by Drug IntoxicationIntoxication
1995-20081995-2008
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Julia Pearson, PhDJulia Pearson, PhD
Chief Forensic ToxicologistChief Forensic ToxicologistHillsborough County, FloridaHillsborough County, Florida
in lieu of Dr. Vernard Adamsin lieu of Dr. Vernard AdamsChief Medical ExaminerChief Medical Examiner
Hillsborough County, FloridaHillsborough County, Florida
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Function of Medical ExaminerFunction of Medical ExaminerChapter 406, Florida StatutesChapter 406, Florida Statutes
• Determine cause of death for death by:– Criminal agency– Suicide– Accident– Suspicious circumstances– Unusual circumstances– Suddenly while in apparent good health
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Investigative ToolsInvestigative Tools
• Inquiry– Scene interviews– Telephone interviews
• Inspection of scene of death• Medical records• Autopsy• Toxicology• Serology and chemistry tests
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AutopsyAutopsy
• At discretion of medical examiner
• Investigative tool
• Provides information, not answer
• Permission not required
• Includes taking of specimens for testing
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ToxicologyToxicology
• Testing for:– Drugs– Alcohols– Metals– Carbon monoxide
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Determination of Cause of DeathDetermination of Cause of Death
• Autopsy does not reveal cause of death
• COD is from consideration of:– Circumstances– History– Autopsy findings– Toxicology tests– Other tests
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Toxicology TestsToxicology Tests
• Drugs:– Thin-layer chromatography– Gas chromatography/mass spectrometry– Liquid chromatography/mass spectrometry
• Carbon monoxide:– Visible spectrometry
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Accidental deathsAccidental deathsHillsborough CountyHillsborough County
Year 1995• Drug: 25• Drowning: 25• Traffic: 249
Year 2008• Drug: 223• Drowning: 20• Traffic: 268
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Accidental Drug DeathsHillsborough County
0
50
100
150
200
250
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
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Oxycodone Associated Deaths in Oxycodone Associated Deaths in Southwestern Virginia, 2001Southwestern Virginia, 2001
The frequency of oxycodone found in postmortem cases in southwestern Virginia is increasing. In 1998 oxycodone was identified in fewer than 10 cases. In 1999, it was identified in 19 cases and in 2000, 30 cases.
James J. Kuhlman et al, Virginia Department of Forensic Science
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Methadone Strikes Again, 2005Methadone Strikes Again, 2005
While certifying toxicology results at the Office of the Chief Medical Examiner in North Carolina, it appeared that there were an extraordinary number of deaths involving methadone in which the accompanying information did not suggest it should be present.
Diana Garside, North Carolina Medical Examiner’s Office
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Methadone Toxicity Fatalities, 2007Methadone Toxicity Fatalities, 2007
Over the past several years, Medical Examiners in Kentucky and around the nation have observed a dramatic rise in drug intoxication deaths involving the prescription medication methadone.
Donna Stewart et al, Kentucky Medical Examiner’s Office
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Most Frequently Detected Drugs in 1186 Hillsborough County Cases in 2008
(regardless of cause of death)
0
50
100
150
200
250
300
Ethan
ol
Cocain
e
Oxyco
done
Alpraz
olam
Meth
adon
e
Mor
phine
Codein
e
Hydro
codo
ne
Cariso
prod
ol
Meth
amph
etam
ine
Propo
xyph
ene
Fenta
nyl
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FDLE Medical Examiners FDLE Medical Examiners Commission Drug Report 2007Commission Drug Report 2007
• Cases of drugs causing death in Florida– Cocaine 843 – Methadone 785– Benzodiazepines 743
• Alprazolam 572
– Oxycodone 705– Ethanol 466– Hydrocodone 264– Morphine (heroin) 255
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FDLE Medical Examiners FDLE Medical Examiners Commission Drug Report 2007Commission Drug Report 2007
• Methadone deaths by age (total 785)
• <18 yrs (13 cases)
• 18-25 yrs (161 cases)
• 26-34 yrs (180 cases)
• 35-50 yrs (297 cases)
• >50 yrs (134 cases)
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Virginia’s “Top 10 List”Virginia’s “Top 10 List”of Drugs causing Death in 2008of Drugs causing Death in 2008
1. Methadone2. Cocaine/benzoylecgonine3. Morphine/heroin4. Oxycodone5. Hydrocodone6. Alprazolam7. Fentanyl8. Diazepam9. Diphenhydramine10. Citalopram
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Stimulants
Sedatives
4.7 million
0.3 million
Narcotic Pain Relievers
Anti-Anxiety Medication
1.1 million
SOURCE: 2005 National Survey on Drug Use and Health (NSDUH), published Sept 2005 by Dept of HHS / Substance Abuse and Mental Health Services Administration (SAMHSA)
1.8 million
In 2005, 6.4 million Americans Age 12+ used a In 2005, 6.4 million Americans Age 12+ used a prescription drug for non-medical purposes in prescription drug for non-medical purposes in
past monthpast month
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2005 Partnership and Attitude Study 2005 Partnership and Attitude Study (PATS)*(PATS)*
Alarming number of teens have a false sense of security about the safety of abusing prescription medications
19% of teens report abusing prescription medications to get high
40% believe that prescription medicines are “much safer” to use than illegal drugs
31% believe there’s “nothing wrong” with using prescription medicines without a prescription “once in a while”
29% believe prescription pain relievers are not addictive
*18th annual study of teen drug use and attitudes Released in April 2006 by The Partnership for a Drug-Free America
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PainPain
• Highly subjective
• Acute (immediate) pain-precise location
• Chronic (late) pain– Imprecise location (diffuse)– Emotional component
• Opiates produce analgesia or relief from pain
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Generalization in Generalization in PharmacologyPharmacology
The more acute the use
The more naive the user
The more significant the effects
The more chronic the use-NOT Intermittent
Leads to a tolerant subject
The more subtle the effects
Psychomotor functions have adjusted to a new balance; HOWEVER, anything that can upset the new balance will result in more noticeable effects
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All substances are poisons; there is All substances are poisons; there is none which is not a poison. The right none which is not a poison. The right dose differentiates a poison and a dose differentiates a poison and a remedy.remedy.
Paracelsus (1493-1541)Paracelsus (1493-1541)