The number of people dying from opioid overdoses is skyrocketing so quickly that medical examiners’ offices across the country cannot autopsy them all.
These offices are being forced to neglect suspected opioid overdose victims by giving them a watered-down version of an autopsy that provides a minimal amount of information on their death.
In doing so, they risk missing an alternative cause of death and incorrectly calculating the number of opioid overdose victims they have seen. This, in turn, could affect the way government resources dedicated to the crisis are allocated.
But if they examine every suspected victim, they could lose their National Association of Medical Examiners (NAME) accreditation, which would make them appear unreliable in court.
Because of the issue, these offices are having to prioritize the types of cases they are tasked with, predicting that the worst of the opioid crisis has not even come yet.
And more and more they are choosing to focus on homicides rather than opioid overdoses, which have become predictable in recent years as they have overtaken gun violence, car crashes and HIV as a leading cause of death.
The opioid epidemic is producing too many bodies for medical examiners’ offices across the country to handle
Dr Thomas Andrew, a medical examiner in New Hampshire, first suspected that the opioid epidemic would prove disastrous at the end of 2013, when his office autopsied the first victim it had seen who died of a fentanyl-heroin combination.
‘It has changed the entire face of our practice,’ Dr Andrew said, referring to the opioid epidemic.
The office he works in only employs two forensic pathologists, who have had to deal with a drastic influx of bodies in the past four years since the epidemic took hold.
His office is now receiving upwards of 500 opioid overdose victims a year. Between the two staff members who are trained to autopsy them ‘the number’s don’t add up,’ Dr Andrew explained.
‘It has strained our resources, our finances,’ he continued. ‘We can’t use all of our resources to just do drug deaths. Where would the traffic crashes fit in? Where would the suicides fit in?’
Furthermore, if either of the forensic pathologists in his office do more than 250 autopsies a year, the office could lose its status as a NAME accredited institution, which might have severe consequences.
Brian Peterson, president of NAME, said that losing accreditation looks bad in the eyes of jury members. ‘If you lose your accreditation, now you have to explain that in court,’ he said.
Ironically, the medical examiner’s office he works in Milwaukee, Wisconsin, is currently at risk for losing their accreditation.
The office has seen a 12 percent increase in the number of bodies they receive in the last year alone, and Peterson said that they do 30 to 40 more autopsies this year, they will lose their NAME-accredited status.
He explained that offices nationwide are coming to a crossroads and having to decide whether or not to keep their accreditation, which makes them look good in court, or to autopsy every suspected opioid overdose victim.
As a result, many are deciding to go with the policy that if a case appears to be caused by an opioid overdose, the victim will simply have an external examination and a toxicology workup, which will confirm the examiner’s suspicion.
The danger with this policy is that if the toxicology report comes back and proves that an examiner is wrong, there is little that can be done to then look at the body, which has likely to have already been buried or cremated.
Dr. Andrew said that toxicology results, depending on how complicated they are, can take up on one month to process.
‘The risk is to possibly miss an alternative cause of death,’ he added.
And what’s worse is that Peterson does not think that his office has endured the epidemic’s harshest statistics yet. He said: ‘I personally think we haven’t seen the peak of the case numbers.’
Peterson said that, in order to solve the problem, more forensic pathologists need to be made available to medical examiners’ offices.
But this is not financially possible for many of the offices. ‘It’s not like people are sending extra funds our direction,’ Peterson explained.
Dr. Andrew confirmed that, saying that while more man-power would potentially solve the problem, it is an unrealistic answer.
He said his office needs up to five forensic pathologists to do the work that two are being given now. ‘That’ll never happen,’ he said.
With the opioid epidemic in the US continuing to escalate with no end in sight – despite the government’s efforts to control it – no answer for this bleak problem appears to be working.
Without funds for extra staff members or lenient accreditation standards, many offices are being forced to forgo autopsies on suspected overdose victims and hope for the best. ‘What do you do?’ Peterson concluded.