tracking opioid overdoses · inability to cope and a false sense of security is fueling the opioid...

Tracking Opioid Overdoses

Real World - Real TimeDotti Owens-Ada County Coroner

Overdose in the news

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

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.

Dotti Owens, M.A., D-ABMDI | Ada County Coroner

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


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

Taken To Soon

Opioids We are all in this together.|

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 40-60 year old men-


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


What people think an OD looks like


What todays OD’s look like


Opioids ǀ 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


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.


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.


Idaho’s Drug

of Choice

Opioids We are all in this together.|

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.


Multi-agency cont.

� Partnerships with local LE, DEA, and other agencies for education, community outreach, prescription tracking and support groups


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!!


tracking opioid overdoses · inability to cope and a false sense of security is fueling the opioid...

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