1. Death by Drug Intoxication

2. Julia Pearson, PhD Chief Forensic Toxicologist Hillsborough County, Florida in lieu of Dr. Vernard Adams Chief Medical Examiner Hillsborough County, Florida

3. Function of Medical Examiner Chapter 406, Florida Statutes
Determine cause of death for death by:
Criminal agency
Suicide
Accident
Suspicious circumstances
Unusual circumstances
Suddenly while in apparent good health

4. Investigative Tools Inquiry Inspection of scene of death
Scene interviews
Telephone interviews
Inspection of scene of death
Medical records
Autopsy
Toxicology
Serology and chemistry tests

5. Autopsy At discretion of medical examiner Investigative tool
Provides information, not answer
Permission not required
Includes taking of specimens for testing

6. Toxicology
Testing for:
Drugs
Alcohols
Metals
Carbon monoxide

7. Determination of Cause of Death
Autopsy does not reveal cause of death
COD is from consideration of:
Circumstances
History
Autopsy findings
Toxicology tests
Other tests

8. Toxicology Tests Drugs: Carbon monoxide: Thin-layer chromatography
Gas chromatography/mass spectrometry
Liquid chromatography/mass spectrometry
Carbon monoxide:
Visible spectrometry

9. Accidental deaths Hillsborough County
Year 1995
Drug: 25
Drowning: 25
Traffic: 249
Year 2008
Drug: 223
Drowning: 20
Traffic: 268

11. Oxycodone Associated Deaths in Southwestern 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

12. Methadone 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

13. Methadone 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

15. FDLE Medical Examiners Commission 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

16. FDLE Medical Examiners Commission 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)

17. Virginia’s “Top 10 List” of Drugs causing Death in 2008
Methadone
Cocaine/benzoylecgonine
Morphine/heroin
Oxycodone
Hydrocodone
Alprazolam
Fentanyl
Diazepam
Diphenhydramine
Citalopram

18. In 2005, 6.4 million Americans Age 12+ used a prescription drug for non-medical purposes in past month
0.3 million
Sedatives
1.1 million
Stimulants
1.8 million
Anti-Anxiety Medication
Narcotic Pain Relievers
4.7 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)

19. 2005 Partnership and Attitude Study (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

20. Pain Highly subjective Acute (immediate) pain-precise location
Chronic (late) pain
Imprecise location (diffuse)
Emotional component
Opiates produce analgesia or relief from pain

21. Generalization in Pharmacology
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
Acute SOD in healthy vol “ general slowing of performance, not limited to specific skills or abilities”
Psychomotor functions have adjusted to a new balance; HOWEVER, anything that can upset the new balance will result in more noticeable effects

22. All substances are poisons; there is none which is not a poison
All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy.
Paracelsus ( )