Medical examiner response to the drug overdose epidemic in King County Washington: "Real-time" surveillance, data science, and applied forensic epidemiology.
applied forensic epidemiology
autopsy
data science
drug evidence testing
drug overdose epidemic
fentanyl
forensic pathology
forensic toxicology
medicolegal death investigation
real-time surveillance
Journal
Journal of forensic sciences
ISSN: 1556-4029
Titre abrégé: J Forensic Sci
Pays: United States
ID NLM: 0375370
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
revised:
16
06
2023
received:
27
02
2023
accepted:
27
06
2023
medline:
6
9
2023
pubmed:
7
7
2023
entrez:
7
7
2023
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 37417312
doi: 10.1111/1556-4029.15329
doi:
Substances chimiques
Fentanyl
UF599785JZ
Methamphetamine
44RAL3456C
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1632-1642Subventions
Organisme : Centers for Disease Control and Prevention / American Public Health Data Science Demonstration Project
Organisme : Centers for Disease Control and Prevention Overdose to Action
Organisme : Paul Coverdell Forensic Sciences Improvement Grants Program
Informations de copyright
© 2023 American Academy of Forensic Sciences.
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