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May 18--CULLMAN -- A county coroner's discretion to utilize toxicology reports to determine a cause of death has far-reaching consequences, from financial security for the deceased's families to the implementation of new public health and drug enforcement policies.
Whether a person died from an accidental drug overdose or simply from cardiac arrest -- caused by that overdose -- the decision is left to an elected coroner. What is listed on a death certificate can affect survivors' life insurance benefits but also offer invaluable insight to law enforcement about emerging drug trends.
Blount County Coroner John Mark Vaughn, chairman of the Alabama Coroners' Association's training commission, said in recent years, the commission has pushed for coroners across the state to adopt toxicology analysis as an indispensible tool for death investigations.
While toxicology reports are the best way to discover what combination and the amount of medication someone ingested leading to their death, a majority of Alabama coroners are not utilizing them for death investigations, Vaughn said.
"Having that information is critical," Vaughn said. "We have 67 counties and 67 coroners, each operating under different policies. We need an uniform system statewide."
He pointed to several factors at play: uncooperative family members that fear the social stigma of a loved one dying from a drug overdose, the backlog of cases with the Alabama Department of Forensic Sciences -- the state lab that performs toxicology reports -- and possibly an unwillingness by coroners to go a step further.
"Twenty years ago, you get a death call, and it's a scenario where a person in their mid-20s has died unexpectedly at home," Vaughn said. "The deceased had no previous health problems, and no foul play is suspected. Coroners would often write it off as cardiac arrest, but that's not fair to the family. It also doesn't help anyone from a public health or law enforcement standpoint. We should be asking, 'What triggered that cardiac arrest? What got us to this point?'"
Vaughn said in his county, accidental overdose caused by multiple prescription medications is killing people in the prime of their life -- mid-20s through mid-40s. He estimated it comprised a third of his total caseload. Prescription opiate painkillers taken in combination with benzodiazepines (used to treat anxiety) seems to be a particularly devastating cocktail if not taken property, he said.
"People that are prescribed this medication or who abuse it think they know where their line is, but then we get the call," Vaughn said.
According to the Centers for Disease Control and Prevention, 100 people die from drug overdoses every day in the United States. The rate has tripled since 1990.
Nearly three out of four prescription drug overdoses are caused by prescription painkillers --also called opioid pain relievers, according to the CDC. The unprecedented rise in overdose deaths in the U.S. parallels a 300 percent increase since 1999 in the sale of painkillers. These drugs were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined.
In Alabama, the prescription drug overdose rate was 13.1 death per 100,000 people in 2008, higher than neighboring Mississippi (10.6) and Georgia (9.5).
Alabama also had among the highest rate of prescription painkillers sold in the nation, 9.7 kilograms per 10,000 people in 2010. Florida had the highest rate of 12.6 kilograms per 10,000 people.
Cullman County Coroner Steve Rodgers said he routinely orders toxicology reports and his predecessor Gary Murphree said he did as well as coroner. Rodgers said it can take six months to receive results back from the state lab.
"Toxicology reports are a very valuable tool for coroners and law enforcement and beneficial to families," Murphree said. "They should be done and done right."
According to the ADFS, it receives and completes more than 4,000 cases annually. State medical examiners submit specimens from autopsies it conducts, but local police, county sheriff departments, Alabama State Troopers and county coroners submit the bulk of specimens. Any law enforcement agency may submit specimens for examination.
"The state lab's backlog is just crushing," Vaughn said. "I don't think it's fair to keep the family dangling for months with a death certificate that says 'pending toxicology.'"
Vaughn said his office has begun collecting urine samples on the scene and testing them for drugs with the same tests used by hospitals. Murphree, who is running for coroner, has proposed outsourcing toxicology testing to private labs. He said families could pay $100 to cover the lab fees and get expedited results.
"Especially if life insurance is involved, that would be something I think some families would be willing to do to know sooner," Murphree said.
As far as providing clues of emerging drug trends to law enforcement, it's up to county coroners to maintain statistics on drug-releated deaths. Once a cause of death has been determined, death certificates go into the state lab's files, Vaughn said.
"Law enforcement needs to know what's going on in their communities," he said. "It can give them the information to know which direction they should be going in, maybe taking a hard look at over-prescribing by doctors or people forging prescriptions."
--Tiffeny Owens can be reached at firstname.lastname@example.org or 256-734-2131.
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