From Death to Death Certificate: What do the Dead say?

Gill, James R.

doi:10.1007/s13181-016-0551-y

Cited by 20 publications

(8 citation statements)

References 28 publications

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“…The general rule followed in multidrug cases is that it is not typically feasible to quantify the role that an individual drug played in causing a death. Thus, the procedure in OFPA is to be inclusive and consider all drugs identified at more than trace amounts as contributing to the death (9). This practice sidesteps the wide variety of interpretive and technical issues that can arise when analyzing the results of a toxicological analysis.…”

Section: Discussionmentioning

confidence: 99%

Drug Overdose Surveillance and Information Sharing via a Public Database: The Role of the Medical Examiner/Coroner

Williams

Freeman

Mirigian

2017

Academic Forensic Pathology

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The medical examiner/coroner (ME/C) death scene investigation systems of the United States play a pivotal role in the current public health crisis created by the expanding drug dependency epidemic in the United States. The first point of recognition of a drug-related death in a community is often the local ME/C agency. This circumstance places these entities in an ideal position to provide surveillance data regarding the epidemiology of drug-related deaths occurring within the jurisdiction of the agency. The ability to surveil for the distribution and determinants among drug-related deaths at the first point of contact enhances the capacity to recognize actionable trends at the local, state, and national levels, including the ability to identify secular (longer-term) trends among various drugs and population subgroups, as well as activity spikes (outbreaks) associated with high-potency formulations and drug combinations. In this article, we describe the development and implementation of an online website that provides public access to a wide array of drug-related death surveillance resources and tools. The website gives users access to a detailed dataset that includes information regarding specific drugs, demographic information pertaining to the decedent, and to investigational findings related to the circumstances of the death. A unique aspect of the database is that it is populated by ME/C agencies and accessed by the public with no intermediary agency, so that the lag time between the identification and investigation of the death as drug-related and community knowledge of the circumstances of the death is minimized. Wide dissemination of accurate drug death surveillance information in an easily accessible and customizable format promotes societal awareness of the drug death epidemic, but also provides information to public health, law enforcement, regulatory, and other community-based organizations that can benefit from the most up-to-date knowledge. We envision a national system of surveillance at the regional ME/C level that would allow for optimal information dissemination and sharing. Such a system would likely allow for more efficacious allocation of resources at the regional and national level.

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Section: Discussionmentioning

confidence: 99%

Drug Overdose Surveillance and Information Sharing via a Public Database: The Role of the Medical Examiner/Coroner

Williams

Freeman

Mirigian

2017

Academic Forensic Pathology

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“…Further, accurate certification requires that drugs that did not contribute to the cause of death should not be recorded on death certificates [ 13 , 32 ••]. However, Gill pointed out that “in multi-drug intoxications, it usually is not possible to tease out an individual drug’s role” and thus “it is customary to include all the drugs (with concentrations greater than trace amounts) in the cause-of-death statement” [ 35 •].…”

Section: Investigation and Classification Of Overdose Deathsmentioning

confidence: 99%

Methodological Complexities in Quantifying Rates of Fatal Opioid-Related Overdose

et al. 2019

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Purpose of Review Effective responses to the US opioid overdose epidemic rely on accurate and timely drug overdose mortality data, which are generated from medicolegal death investigations (MDI) and certifications of overdose deaths. We identify nuances of MDI and certification of overdose deaths that can influence drug overdose mortality surveillance, as well as recent research, recommendations, and epidemiological tools for improved identification and quantification of specific drug involvement in overdose mortality. Recent Findings Death certificates are the foundation of drug overdose mortality surveillance. Accordingly, counts and rates of specific drug involvement in overdose deaths are only as accurate as the drug listed on death certificates. Variation in systematic approaches or jurisdictional office policy in drug overdose death certification can lead to bias in mortality rate calculations. Recent research has examined statistical adjustments to improve underreported opioid involvement in overdose deaths. New cause-of-death natural language text analysis tools improve quantification of specific opioid overdose mortality rates. Enhanced opioid overdose surveillance, which combines death certificate data with other MDI-generated data, has the potential to improve understanding of factors and circumstances of opioid overdose mortality. Summary The opioid overdose crisis has brought into focus some of the limitations of US MDI systems for drug overdose surveillance and has given rise to a sense of urgency regarding the pressing need for improvements in our MDI data for public health action and research. Epidemiologists can stimulate positive changes in MDI data quality by demonstrating the critical role of data in guiding public health and safety decisions and addressing the challenges of accurate and timely overdose mortality measures with stakeholders. Education, training, and resources specific to drug overdose surveillance and analysis will be essential as the nation’s overdose crisis continues to evolve.

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“…To certify the cause of death, in principle, forensic pathologists need to apply three main factors: the autopsy findings, the toxicology results, and finally, the history and circumstance of death (Gil, 2017;Dimaio & Dimaio, 2001).…”

Section: Introductionmentioning

confidence: 99%

“…However, forensic pathologists conclude that death from intoxication is very difficult. This is because drug and intoxication deaths are largely functional, and there are few definitive gross or microscopic findings at the autopsy to confirm the diagnosis (Gil, 2017). Furthermore, the level of drugs found in the postmortem is mostly not in a fatal range but displays a toxic level.…”

Section: Introductionmentioning

confidence: 99%

Rhabdomyolysis in drug-related deaths

Kaisang

Promsawat

Jantasorn

et al. 2020

Egypt J Forensic Sci

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Background This study aims to detect myoglobin staining in the cases in which were suspected that intoxication was the cause of death. Materials and method This study selected the drug-related death cases including those with toxic blood levels of substances. These drug-related death cases were classified into two groups: (1) suggestive of intoxication death group and (2) other causes of death group which was control group. The kidneys of all these cases were immunohistochemically stained with the myoglobin antibody for rhabdomyolysis diagnosis. Results There were 50 drug-related deaths separated into 28 study cases and 22 control cases. The positive myoglobin stain was found in 17 cases (60.7%) in the study group and 5 cases (22.7%) in the control group. The difference between two groups was statistically significant (p = 0.007). Conclusions Myoglobin detection in kidney by immunohistochemistry should be done to help for confirming the cause of deaths in these drug-related death cases.

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From Death to Death Certificate: What do the Dead say?

Cited by 20 publications

References 28 publications

Drug Overdose Surveillance and Information Sharing via a Public Database: The Role of the Medical Examiner/Coroner

Drug Overdose Surveillance and Information Sharing via a Public Database: The Role of the Medical Examiner/Coroner

Methodological Complexities in Quantifying Rates of Fatal Opioid-Related Overdose

Rhabdomyolysis in drug-related deaths

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