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August 08, 2019
By Joseph A. Prahlow, MD, FASCP, and Prentiss Jones, Jr., PhD, F-ABFT
More than 130 people in the United States die each day from an opioid overdose.1 Addiction to opioids—from prescription pain killers to heroin and synthetic opioids--has reached epidemic proportions.
Medical Examiners’ and Coroners’ (ME/C) offices nationwide are overwhelmed by the number of deaths related to opioid overdoses. The epidemic has also created more work for hospitals and laboratories, which vary widely in how they handle patients who overdose and laboratory specimens.
In our session, “The Opioid Epidemic: Hospital, Pathology, and Laboratory Considerations,” on September 12 at the ASCP 2019 Annual Meeting in Phoenix, we will provide an overview of the opioid epidemic from the perspectives of a forensic pathologist and forensic toxicologist. We’ll also discuss how hospitals, laboratories and pathology departments can assist medical examiners that are investigating opioid-related deaths.
Our session will offer guidance on how to implement various strategies within the hospital laboratory to ensure that suitable blood specimens are collected and maintained for subsequent forensic testing.
While many cases involving opioid overdose result in relatively immediate death, there are instances where people survive an overdose for several days, weeks or longer before dying. In such cases, it’s critical for the healthcare team to obtain blood specimens early and retain them. If those specimens are discarded too soon, there are no blood samples to test after death has occurred. Without such samples, ME/Cs are unable to certify these deaths with any degree of certainty, thus leaving surviving loved ones without the information and closure that they need.
Recent news accounts have suggested that the number of opioid-related deaths is decreasing as a result of an antidote, Naloxone (also known as Narcan®), a medication classified as an “opioid antagonist” used to counter the effects of opioid overdose. However, Narcan® doesn’t diminish the fact we are still dealing with the crisis.
In order to deal effectively with this epidemic, we need good data and to get that, we need good death investigations. That means we need laboratories to be up to date with analytical methods and pathologists and toxicologists to be in sync in their understanding and interpretation of opioids.
Joseph Prahlow, MD, FASCP, is a forensic pathologist and deputy medical examiner with the Department of Pathology at Western Michigan University Homer Stryker M.D. School of Medicine in Kalamazoo, Michigan. He is also professor and vice chair of the Department of Pathology. Prentiss Jones, PhD, F-ABFT, is a forensic toxicologist and Director of Toxicology with Western Michigan University Homer Stryker M.D. School of Medicine. He is also an associate professor in the Department of Biomedical Sciences. They will present the session, “The Opioid Epidemic—Hospital, Pathology, and Laboratory Considerations,” during the ASCP 2019 Annual Meeting on September 12 in Phoenix.
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