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Smiley-McDonald HM, Keyes KA, Wire S, Greenwell K, Santos NA, Ropero-Miller JD. The impacts of governing agency: A comparison of resources in the patchwork of medicolegal death investigation systems. Forensic Sci Int Synerg 2024; 8:100467. [PMID: 38638873 PMCID: PMC11024903 DOI: 10.1016/j.fsisyn.2024.100467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
In the United States, medical examiners and coroners (MECs) fill critical roles within our public health and public safety systems. These professionals are primarily charged with determining the cause and manner of death as they investigate deaths and respond to associated scenes and mass fatalities and can also help identify trends in public health crises through medicolegal death investigations. Despite their instrumental role, they are organized in disparate systems with varying governing structures, functions, staffing, caseload, budget, and access to resources. This paper examines data from the 2018 Census of Medical Examiner and Coroners to evaluate MEC operations in the United States. The findings show that MEC offices' organizational and operational governance structures greatly influence resources, workloads, and access to information and services. Standalone MEC offices were generally better resourced than those affiliated with law enforcement, public health, forensic science, district attorneys, or other agencies.1.
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Affiliation(s)
| | - Kelly A. Keyes
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Sean Wire
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Kathryn Greenwell
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Nelson A. Santos
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Jeri D. Ropero-Miller
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
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Vaillancourt L, Viel E, Dombrowski C, Desharnais B, Mireault P. Drugs and driving prior to cannabis legalization: A 5-year review from DECP (DRE) cases in the province of Quebec, Canada. ACCIDENT; ANALYSIS AND PREVENTION 2021; 149:105832. [PMID: 33220606 DOI: 10.1016/j.aap.2020.105832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/14/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To examine alleged drug-impaired driving in the province of Quebec (Canada), including drug use profile amongst suspected impaired drivers, prior to recreational cannabis legalization and major modifications to the legislation regarding driving under the influence of drugs (DUID). METHODS The Laboratoire de sciences judiciaires et de médecine légale (LSJML) performs toxicological analyses on all biological samples collected during a Drug Evaluation and Classification Program (DECP) evaluation by a Drug Recognition Expert (DRE). A targeted analysis of 137 drugs and metabolites by liquid chromatography - tandem mass spectrometry (LC-MS/MS) is systematically carried out, enhanced by gas chromatography - mass spectrometry (GC-MS) general unknown screening if deemed necessary. Data from all DECP cases analyzed from January 2014 to December 2018 was compiled and summarized. RESULTS In the 5-year period studied, a total of 2 982 DECP cases underwent toxicological analysis. Age of the intercepted drivers varied between 14-82 years old (average 33 years old), with 79 % men and 21 % women. At least one substance with impairing potential was detected in 98 % of cases. In 89 % of cases (n = 2 640), at least one substance detected matched a category of drug suspected of causing impairment. At the other end of the spectrum, there were 270 cases (9%) where the findings did not match any of the categorie(s) suspected by the DRE, 66 negative cases (2%) and 6 incomplete evaluations. Substances most commonly detected belonged to the central nervous system (CNS) stimulants (72 %), CNS depressants (61 %) and cannabis (48 %) categories. Most prevalent substances were methamphetamine (54%), cannabis (11-nor-9-carboxy-tetrahydrocannabinol or THC-COOH, 48 %), cocaine (29 %) and gamma-hydroxybutyrate (GHB, 24 %). Polydrug consumption was common, with two or more substances with impairing potential detected in 79 % of cases. There were 113 occurrences of new psychoactive substances (NPS), the most prevalent being rolicyclidine (PCPy, 47 %), methylenedioxypyrovalerone (MDPV, 17 %), methylbenzylpiperazine (MBZP, 13 %) and flubromazolam (10 %). Drug prevalence patterns varied geographically, as well as with age and gender. Indeed, methamphetamine and GHB were more popular amongst women, whereas cannabis and cocaine were more prevalent amongst men. Cannabis and CNS stimulants were more common amongst younger drivers (14-34 years old); CNS depressants, dissociative anesthetics and non-psychoactive drugs prevalence increased with age. CONCLUSIONS An up-to-date database of DUID cases is a powerful tool in identifying trends and threats, focusing resources and orienting research and development activities. Such a database, combined with the data presented in the current study, will be key in evaluating the impact of new regulations, i.e., recreational cannabis legalization and modifications to the DUID legislation.
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Affiliation(s)
- Lucie Vaillancourt
- Laboratoire de sciences judiciaires et de médecine légale, Department of Toxicology, 1701 Parthenais Street, 12(th)floor, Montreal, Quebec, Canada
| | - Edith Viel
- Laboratoire de sciences judiciaires et de médecine légale, Department of Toxicology, 1701 Parthenais Street, 12(th)floor, Montreal, Quebec, Canada.
| | - Cynthia Dombrowski
- Laboratoire de sciences judiciaires et de médecine légale, Department of Toxicology, 1701 Parthenais Street, 12(th)floor, Montreal, Quebec, Canada
| | - Brigitte Desharnais
- Laboratoire de sciences judiciaires et de médecine légale, Department of Toxicology, 1701 Parthenais Street, 12(th)floor, Montreal, Quebec, Canada
| | - Pascal Mireault
- Laboratoire de sciences judiciaires et de médecine légale, Department of Toxicology, 1701 Parthenais Street, 12(th)floor, Montreal, Quebec, Canada
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Wójtowicz A, Wietecha-Posłuszny R, Snamina M. Contemporary trends in drug analysis of vitreous humor: A critical review. Trends Analyt Chem 2020. [DOI: 10.1016/j.trac.2020.115935] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ferreira E, Corte Real F, Pinho e Melo T, Margalho C. A Novel Bioanalytical Method for the Determination of Opioids in Blood and Pericardial Fluid. J Anal Toxicol 2020; 44:754-768. [DOI: 10.1093/jat/bkaa064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 05/23/2020] [Accepted: 06/03/2020] [Indexed: 12/28/2022] Open
Abstract
Abstract
Opioids are the drugs most commonly detected in overdose deaths and the second most consumed worldwide. An analytical methodology has been optimized and fully validated for the determination of codeine, morphine, 6-acetylmorphine, 6-acetylcodeine, oxycodone, oxymorphone and fentanyl in whole blood and pericardial fluid. The internal standards used were codeine-d3, morphine-d3, 6-acetylmorphine-d3 and fentanyl-d5. Before solid-phase extraction, volumes of 250 μL of blood and pericardial fluid were subjected to a protein precipitation (with 750 μL of ice-cold acetonitrile) and a microwave-induced oximation was performed using a solution of 1% aqueous hydroxylamine hydrochloride in phosphate-buffered saline (1:2, v/v). Finally, the dried extracts were further derivatized with a solution of n-methyl-n-(trimethylsilyl) trifluoroacetamide + 5% trimethylchlorosilane under microwave irradiation. The chromatographic analysis was carried out using gas chromatography–mass spectrometry operating in electron impact and selected ion monitoring mode. For all analytes, the method was linear between 5 and 1,000 ng/mL with determination coefficients (r2) >0.99. Depending on the analyte and matrix, the limit of detection varies between 3 and 4 ng/mL. Intra- and intermediate precision (<20%) and bias (±20%) were acceptable for all analytes in both matrices. The stability of the substances in the studied matrices was guaranteed, at least, 24 h in the autosampler, 4 h at room temperature and 30 days after three freeze/thaw cycles. This methodology was applied to real samples from the Laboratory of Chemistry and Forensic Toxicology, Centre Branch, of the National Institute of Legal Medicine and Forensic Sciences, Portugal.
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Affiliation(s)
- Elisa Ferreira
- Instituto Nacional de Medicina Legal e Ciências Forenses, I.P. (INMLCF, I.P.), Laboratório de Toxicologia Forense da Delegação do Centro, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
- Departamento de Química da Faculdade de Ciências e Tecnologia da Universidade de Coimbra, R. Larga 2, 3004-535 Coimbra, Portugal
| | - Francisco Corte Real
- Instituto Nacional de Medicina Legal e Ciências Forenses, I.P. (INMLCF, I.P.), Laboratório de Toxicologia Forense da Delegação do Centro, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
| | - Teresa Pinho e Melo
- Departamento de Química da Faculdade de Ciências e Tecnologia da Universidade de Coimbra, R. Larga 2, 3004-535 Coimbra, Portugal
| | - Cláudia Margalho
- Instituto Nacional de Medicina Legal e Ciências Forenses, I.P. (INMLCF, I.P.), Laboratório de Toxicologia Forense da Delegação do Centro, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
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Slavova S, Delcher C, Buchanich JM, Bunn TL, Goldberger BA, Costich JF. Methodological Complexities in Quantifying Rates of Fatal Opioid-Related Overdose. CURR EPIDEMIOL REP 2019; 6:263-274. [PMID: 31259141 PMCID: PMC6559129 DOI: 10.1007/s40471-019-00201-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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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Affiliation(s)
- Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY USA
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave, Suite 242, Lexington, KY 40504 USA
| | - Chris Delcher
- Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, KY USA
| | - Jeannine M. Buchanich
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Terry L. Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave, Suite 242, Lexington, KY 40504 USA
- Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY USA
| | - Bruce A. Goldberger
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Julia F. Costich
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave, Suite 242, Lexington, KY 40504 USA
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY USA
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Pan M, Wang X, Zhao Y, Liu W, Xiang P. A retrospective analysis of data from forensic toxicology at the Academy of Forensic Science in 2017. Forensic Sci Int 2019; 298:39-47. [DOI: 10.1016/j.forsciint.2019.02.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/18/2019] [Accepted: 02/23/2019] [Indexed: 12/28/2022]
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