Evaluation of “Real-Time” Fatal Drug Overdose Surveillance by King County Medical Examiner's Office, Seattle, Washington

Harruff, Richard C.; Simpson, Celia M; Gifford, Amy L; Yarid, Nicole; Barbour, William L; Heidere, Catherine

doi:10.1097/paf.0000000000000798

Cited by 5 publications

(21 citation statements)

References 26 publications

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“…Public health agencies must also wait for the complete results, which can adversely affect the timely implementation of efforts focused on preventing drug‐caused deaths and warning the public of specific dangers. In order to address this issue, the King County Medical Examiner's Office in Seattle developed a program to speed up the cause of death determination for potential overdose deaths, facilitating more rapid death certification and communication of drug death information to the public health system [12]. From 2019 to 2021, the structured project utilized scene investigation, autopsy findings, and “real‐time” in‐house testing of blood, urine, and drug evidence from death scenes.…”

Section: Discussion Of Present Circumstancesmentioning

confidence: 99%

The effects of the (fentanyl‐fueled) drug overdose epidemic on medicolegal death investigation in the United States

Davis

Fligner

2023

Journal of Forensic Sciences

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The evolving opioid epidemic in the United States, fueled by illicit fentanyl, has greatly increased deaths from illicit drug use. These nonnatural deaths require formal death investigation. The National Association of Medical Examiners states in its Forensic Autopsy Performance Standards that autopsy remains a necessary component for proper investigation of suspected acute overdose deaths. If a death investigation office lacks adequate resources to investigate all deaths under its jurisdiction while meeting expected standards, then that office may be forced to consider altering its protocols for investigation by changing the types of deaths investigated or the extent of its investigations. Drug death investigations take longer to complete because novel illicit drugs and mixtures of drugs complicate toxicological analyses, prolonging a family's wait for completion of a death certificate and autopsy report. Public health agencies must also wait for results, but some agencies have developed mechanisms for rapid notification of preliminary results to allow timely deployment of public health resources. The increased deaths have strained the resources of medicolegal death investigation systems throughout the United States. Given the significant workforce shortage of forensic pathologists, newly trained forensic pathologists are too few to meet the demand. Nevertheless, forensic pathologists (and all pathologists) must make time to present their work and themselves to medical students and pathology trainees to encourage an understanding of the importance of quality medicolegal death investigation and autopsy pathology and to provide a model that can encourage interest in a career in forensic pathology.

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Section: Discussion Of Present Circumstancesmentioning

confidence: 99%

The effects of the (fentanyl‐fueled) drug overdose epidemic on medicolegal death investigation in the United States

Davis

Fligner

2023

Journal of Forensic Sciences

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show abstract

“…Drug evidence gathered from scenes is tested using a ThermoFisher TruNarc Raman spectrometer, a Rigaku ResQ Raman spectrometer, an MX908 high pressure mass spectrometer, and BTNX Inc. fentanyl-specific test strips with small samples of evidence appropriately diluted into water. This battery of in-house testing is used to certify overdose deaths if at least two of three testing modalities (blood plus urine or drug evidence testing) identifies the same drug [66]. The "two-test" rule was adopted to maintain a high specificity for the testing results and to minimize errors in death certification.…”

Section: Million In a Geographic Area Of 2307 Square Miles In Westernmentioning

confidence: 99%

“…The emergence of fentanyl in King County coincided with the development of KCMEO's real-time fatal overdose surveillance project [66]. From 2020 to 2022, KCMEO certified 2238 deaths due to drug overdose; 1552 (69%) were certified using the surveillance methods described above.…”

Section: Re Sultsmentioning

confidence: 99%

“…Thirty-four substances appearing 10 or more times in the 727 amended death certificates are listed in Table 2. The high accuracy of death certification by rapid surveillance methodology has been described earlier [66].…”

Section: Re Sultsmentioning

confidence: 99%

“…In the face of the crisis, several sources have described surveillance efforts to monitor the epidemic [28,[54][55][56][57][58][59][60][61][62][63]. As mounting caseloads overwhelmed state and county resources, leading to months-long delays in completing death certificates, the King County Medical Examiner's Office (KCMEO) in Seattle, Washington responded with a "real-time" fatal overdose strategy with goals of expediting death certificates and disseminating timely information to help guide the community's response [64][65][66]. The KCMEO is an integral part of Public Health-Seattle and King County and, thus, stands in the crossroads of the public health and criminal legal systems.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Medical examiner response to the drug overdose epidemic in King County Washington: “Real‐time” surveillance, data science, and applied forensic epidemiology

Harruff

Yarid

Barbour

et al. 2023

Journal of Forensic Sciences

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As the overdose epidemic overwhelmed medicolegal death investigation offices and toxicology laboratories, the King County Medical Examiner's Office responded with “real‐time” fatal overdose surveillance to expedite death certification and information dissemination through assembling a team including a dedicated medicolegal death investigator, an information coordinator, and student interns. In‐house testing of blood, urine, and drug evidence from scenes was performed using equipment and supplies purchased for surveillance. Collaboration with state laboratories allowed validation. Applied forensic epidemiology accelerated data dissemination. From 2010 to 2022, the epidemic claimed 5815 lives in King County; the last 4 years accounted for 47% of those deaths. After initiating the surveillance project, in‐house testing was performed on blood from 2836 decedents, urine from 2807, and 4238 drug evidence items from 1775 death scenes. Time to complete death certificates decreased from weeks to months to hours to days. Overdose‐specific information was distributed weekly to a network of law enforcement and public health agencies. As the surveillance project tracked the epidemic, fentanyl and methamphetamine became dominant and were associated with other indicators of social deterioration. In 2022, fentanyl was involved in 68% of 1021 overdose deaths. Homeless deaths increased sixfold; in 2022, 67% of 311 homeless deaths were due to overdose; fentanyl was involved in 49% and methamphetamine in 44%. Homicides increased 250%; in 2021, methamphetamine was positive in 35% of 149 homicides. The results are relevant to the value of rapid surveillance, its impact on standard operations, selection of cases requiring autopsy, and collaboration with other agencies in overdose prevention.

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A Year of Deaths Due to or With COVID-19 Under Universal Postmortem Testing in San Francisco

Miyashiro,

McFarland

2023

Am J Forensic Med Pathol

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The Health Officer of the City and County of San Francisco, California, issued the order that all decedents were required to have a documented COVID-19 test effective from June 2020 to June 2021. The justification for the requirement was that complete data on COVID-19 status at the time of death were needed to help protect first responders and funeral home workers, identify missed cases, and characterize the places of death for otherwise unknown COVID-19 cases. To fill the gap in COVID-19 testing for all decedents, particularly among persons dying outside of hospitals, a specialized Decedent Testing Unit was created along with an increased capacity of the Office of the Chief Medical Examiner. From July 1, 2020, to June 30, 2021, the Decedent Testing Unit and Office of the Chief Medical Examiner provided postmortem testing results for 2776 decedents. Of these, 80 tested positive for COVID-19 for a positivity rate of 2.97%. The largest number of COVID-19–positive specimens were collected from persons who died at home (n = 37, 46.3%), followed by those who died in hospice (n = 20, 25.0%), other places outside of homes or facilities (n = 8, 10.0%), and in skilled nursing or long-term care facilities (n = 7, 8.8%). Follow-up of California death records found that 17 of these 80 cases (21.3%) had COVID-19 listed as one of the causes of death, 22 (27.5%) mentioned COVID-19 under “other conditions,” and 41 (51.3%) made no mention of COVID-19. In the context of providing the COVID-19 status of decedents not otherwise known to have infection, our data help gauge the likelihood of missing deaths due to or with COVID-19 and inform future public health decisions on whether to require universal postmortem testing with COVID-19 resurgences or with new deadly epidemics.

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Evaluation of “Real-Time” Fatal Drug Overdose Surveillance by King County Medical Examiner's Office, Seattle, Washington

Cited by 5 publications

References 26 publications

The effects of the (fentanyl‐fueled) drug overdose epidemic on medicolegal death investigation in the United States

The effects of the (fentanyl‐fueled) drug overdose epidemic on medicolegal death investigation in the United States

Medical examiner response to the drug overdose epidemic in King County Washington: “Real‐time” surveillance, data science, and applied forensic epidemiology

A Year of Deaths Due to or With COVID-19 Under Universal Postmortem Testing in San Francisco

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