Opioid Response WorkgroupWashington State Department of Health

King County Medical Examiner’S OfficeReal-Time Fatal Drug Overdose

Surveillance Project

Richard Harruff and Nicole YaridMay 2, 2019

State-Wide SurveillanceTraining Conferences

Thurston County – Marxch 21

Snohomish County – April 10

Kitsap County – May 8

Yakima County – June 13

Spokane County – June 24

Real-Time Fatal Drug Overdose Surveillance

Washington state has seen an steadily increasing rate of drug overdose deaths, including those due to opioids• Historically, in the PNW, black tar heroin from Mexico has been

predominant opioid causing OD deaths

• Over the last 3 years in King County, fentanyl and its analogueshave been responsible for deaths at a nearly exponentially increasing rate, threatening to become the dominant opioid and driving the local epidemic to levels similar to those in the eastern US

In response to the emergence of these highly lethal opioids, KCMEO, with support of DOH, started an innovative “Real-

Time Fatal Drug Overdose Surveillance Project”

Real-Time Fatal Drug Overdose Surveillance

Real-time fatal drug overdose surveillance strategy:• Employing dedicated investigative and technical

personnel• Deploying new technologies for rapid analysis of drug

samples and toxicology screening of blood samples• Creating a surveillance database as a repository for all

information related to every suspected and confirmed OD death

• Assembling a network of local, state, and federal public health, laboratory, and law enforcement partners

• Distributing weekly bulletins notifying partner agencies of recent drug OD deaths and trends

• Posting alerts regarding OD clusters and emerging drug threats

Real-Time Fatal Drug Overdose Surveillance

The heart of the surveillance project comprises new technologies and personnel funded by various sources:

• 2 handheld Raman spectrometers• TruNarc - DOH funding

• Rigaku – King County funding

• Portable high-pressure mass spectrometer – Coverdell Grant funding

• Chemiluminescent toxicology blood screening instrument –King County funding• Single-use test kits – Coverdell Grant funding

• Full-time medicolegal death investigator – DOH funding

• Part-time student intern – King County funding

Real-Time Fatal Drug Overdose Surveillance

The surveillance project has been successful in: • Drastically reducing the time required to

identify and confirm drug overdose deaths to the range of hours to days (compared to traditional methods based on death certificates, taking weeks to months)

• Contributing to multiple public health responses and law enforcement investigations

OBJECTIVES

• Reduce the social and economic burden of drug use (deaths, overdoses, homelessness, criminality, etc.)

• Create a statewide network of partner agencies for collecting and sharing information from deaths due to suspected drug overdose

• Encourage partnerships between law enforcement and public health to reduce both supply and demand.

PURPOSE• Provide guidance in identifying and reporting drug evidence

collected at scenes of suspected drug overdose deaths.

• Help agencies obtain Raman devices and urine dipsticks to facilitate rapid identification of drug evidence.

• Encourage partner agencies to contribute to a central data repository of fatal drug overdose information.

• Distribute a simple form with procedures to report deaths due to suspected drug overdose.

• Provide access to weekly bulletins describing drug overdose deaths from around Washington.

• Show how to assist the Washington State Patrol Toxicology Laboratory in expediting reports of deaths due to suspected drug overdose

KCMEO RESOURCES

Surveillance personnel:• Medicolegal death investigator• Student intern• “Information coordinator” – pendingTechnology:• Raman devices: TruNarc, Rigaku• High pressure mass spectrometer: MX908• Blood toxicology screening: RandoxDatabase:• Information collection and distribution

Evidence, Data Collection and Follow-up

Raman Spectroscopy (TruNarc) In House Drug Testing

• https://www.youtube.com/watch?v=hd9a6-Ol_Tw&feature=youtu.be

RigakuRaman Spectrometer

MX 908Mass Spectrometer

RandoxToxicology Blood Screening

Not all white powdery substances are illicit…

1. Medicolegal investigators conduct scene investigation.

2. Full autopsy examination is performed. Urine is dipstick tested for fentanyl.

3. Drug evidence collected from scene is field tested.

4. Pathologists create list of probable drug OD cases, including the predicted drug(s).

5. Blood samples are submitted to the tox lab for expedited testing. Drug evidence may also be sent for chemical analysis.

6. Pathologist or investigator contacts family to obtain additional information for identifying source of drug(s) or supplier.

7. A weekly “Bulletin” is emailed to a network of federal, state, and local criminal justice and public health agencies.

8. Justice is served, lives are saved, hooray.

OD Surveillance Protocol

King County Medical Examiner’s Office(206) 731-3232

Evidence, data collection and follow-up:• Tawn Midkiff (tmidkiff@kingcounty.gov)

Procedures, surveillance network, and publications:• Nicole Yarid (yaridni@kingcounty.gov)

Drug evidence testing:• Megan Slavich (mslavich@kingcounty.gov)

Program Director:• Richard Harruff (richard.harruff@kingcounty.gov)

THANK YOU!