Coroner: Say no to organ donor financial incentives

I certainly don’t agree with financial incentives for organ donation. Seems like a step onto a slippery slope to me.

…the AMA adopted policy calling for the modification of current law to allow pilot studies on financial incentives for cadaveric organ donation…
The AMA already supports study into financial incentives for cadaveric organ donation…
Voluntary organ donation remains important, but motivational incentives that could increase organ donations — including financial incentives — must be studied

I know that there is a shortage of organs available for transplantation, but there has to be another way to increase donations. I like the commercials with Walter Payton’s children talking about its importance/value. More opportunities like that seem like a much better idea to me.

Coroner Relations

Dealing with people whose family member (or friend) has died is often incredibly difficult. All deaths are sudden, even those most anticipated (e.g. hospice deaths). It is an exceedingly emotionally charged time. It is not a time for thinking clearly, the thoughts race or the thought process slow to a crawl. The family and friends can’t “hear” or at least process what they hear adequately. Disbelief and doubt creep in (actually really roll in).

You try to anticipate that in talking with them, helping them through the processes, through the experience. Each death is different. Every person is different. Things may seem to be going well for them initially, but come tumbling down later. It may be hell for them from the beginning. You try to comfort, to be truthful, to be straight-forward. But it can be perceived as less than that. It can become distorted or seem to be distorted.

We always do our best. We are human, too, and “to err is human”. So we don’t always get it right. Or we may get it right, but it seems lees than right by those family members and friends. It gets put through a grinder, looked at with a microscope or telescope, at times with a less than perfect lens. It sometimes comes out looking less than perfect, even seemingly less than acceptable.

But we do it all again with the next individual who dies.

Broken heart?

I was going through some archived photos and found this one. Traumatic rupture of the heart or died of a broken heart?

Methadone Maintenance Therapy

I often get questions about methadone maintenance therapy from my deputies and other folks. I just came across this YouTube video about it that is excellent. (It is 10 minutes long)

Sorry I am sure there is a cooler way to do it, but this is the link.

Mandate Doctor Education to Save Lives

From the New York Times:

Should doctors be required to undergo special education in order to prescribe powerful narcotics? The Food and Drug Administration may soon recommend that they do so, though such a move would most likely prove controversial…
Dr. Rappaport said the F.D.A. was most concerned about potent and longer-acting narcotics like methadone, fentanyl and certain formulations of the drug oxycodone, the active ingredient in OxyContin.
With methadone [when prescribed as a pain med], fentanyl, which is available in patches, has been associated with patient deaths and injuries resulting from physician misprescribing or inadvertent patient misuse…
In the last two years, the agency has sent out alerts to doctors about both methadone and fentanyl, but officials acknowledged that preventable patient deaths were continuing.
“We are putting out communications,” said Dr. Gerald Dal Pan, who directs the F.D.A.’s office of surveillance and epidemiology. “We don’t know why they are failing.”

We have seen “mistakes” in prescribing and talked with prescribing physicians who are very unfamiliar with proper doses and precautions with these meds (e.g. knowledge of drug-drug interactions compounding lethality), although still prescribing them. When I say “we have seen”, I mean folks have died as a result. The “boxed warnings” and informational mailings have failed. I think mandated training is a step in the right direction.

Guest blogging

This and the last post are like guest blogging that the big guys do:

I quoted this from the link you posted Dr. Keller~

“Preventing substance abuse among teens is primarily a Mom and Pop operation,” noted Califano. “It is inexcusable, that so many parents fail to appropriately monitor their children, fail to keep dangerous prescription drugs out of the reach of their children and tolerate drug infected schools. The parents who smoke marijuana with children should be considered child abusers. By identifying the characteristics of problem parents we seek to identify actions that parents can take—and avoid—in order to become part of the solution and raise healthy, drug-free children.”

In my opinion!
Seems a great percentage of suburban parents & school system & the children themselves in my community just don't get it they seem to like to deny this entire drug issue.

YES THIS IS SO WRONG!

I do understand that an addict will do what ever it takes, lie, cheat steal, manipulate ~ to get what they want - some are predisposed to this disease ~ yes theses issues start at home ~ some things are out of the control of parents, teachers & friends.

Sometimes you have to set them free to follow their own path with hopes that they make the right choices.

Great article - thank you for posting!

- I lost my child due to this tragedy that has hit our community!

Colleges shouldn't support lower drinking age

Honestly with the abuse of alcohol being so prolific it’s insane to even consider this. I was 18 in high school and I can’t imagine what this would create. At 18 I know I wasn’t prepared for alcohol, at 21 I don’t think I was prepared either. I already have enough clients coming to my unit (addictions treatment program) already. I don’t need them encouraged to start any younger. I can’t believe that this was even considered, knowing that the presidents of these universities should have first hand knowledge how dangerous alcohol is on college campuses its crazy to even see them considering this as a good idea (I know this first hand). What is the world coming to?

-Todd

This Tribune article caught my eye and ire as well. It certainly seems irresponsible to me for colleges to come out in support of lowering the legal drinking age.

Teen Access to Rx Drugs Easier than Beer

I came across a reference to a survey/study done by The National Center on Addiction and Substance Abuse (CASA) at Columbia University the other day. It is one of those “good news-bad news” bits of information.

While they have not seen an increase in drug use (that’s the good news), I found one set of findings particularly disturbing (although there was really nothing not disturbing in the findings):

For the first time in the CASA survey’s history, more teens said prescription drugs were easier to buy than beer (19 vs. 15 percent). The proportion of teens who say prescription drugs are easiest to buy jumped 46 percent since 2007 (13 vs. 19 percent). Almost half (46 percent) of teens say painkillers are the most commonly abused prescription drug among teens.

That first statement is incredible. Will this increased ease of acquiring prescription drugs to use and abuse lead to increased use in the near future? I think that it is very likely.

When teens who know prescription drug abusers were asked where those kids get their drugs:
• 31 percent said from friends or classmates;
• 34 percent said from home, parents or the medicine cabinet;
• 16 percent said other;
• Nine percent said from a drug dealer

The second listed source, in particular, should be relatively easy to control and we must get control or risk our children’s health and future.

It is easy to forget the illicit use of licit drugs in our haste to control illicit drug use, but our drug problem is a bigger problem.

Wrong

This is so wrong:

A father who purchased a keg of beer for his daughter's 19th birthday was cited with unlawful delivery of alcohol to minors.
David Zell, 46, 328 Bridgewood Drive, Antioch, admitted to Antioch police that he provided beer for the party even though he knew his daughter, Ashley Totten, 19, was underage, as were some of the friends who attended the party at his home on Aug. 2.

The Coroner knows that "you never know..."

It happened again last evening, someone died in a car crash.

But things are rarely that simple, that isolated. As is often the case, more people could have died in the crash, more lives are affected by the crash, and it brings to mind the fact that you never know…

A woman and her 2 children were out driving at dusk, intending to get home and continue on with their lives. Then what you hope will never happen happens. A driver on the other side of the road loses control of his car for some reason sending his car across and into the path of your car faster than you can react to avoid it. A collision occurs. The driver of the car that crossed the road dies of multiple injuries. Thankfully the woman and her children survive this one, but sometimes that doesn’t happen. There were some injuries, thankfully nothing too severe.

Two mothers’ lives were changed in the incident, the grieving mother of the young man who died in the crash and the injured mother driving the other vehicle. Neither will forget the crash or its outcome. Both will likely always think- you never know what will happen when you go out in your car.

You never know. Contact from Hungary

I don’t know if it is a sign that the world is shrinking because of our Internet connectivity, but I got an email from Hungary Monday.

It was from the father of an individual who was found dead and skeletonized in May of 2007. He came across a report of her death on the Internet. “Shock” and “devastating” were his descriptors of that discovery.

We were able to identify the young lady and law enforcement agencies helped locate family in Chicago. We were told by the family members we had contact with at the time of her discovery that they were this young woman’s only relatives and that her father was dead. We, therefore, did not look for him. (We have since lost contact with the other family members that we had contact with in 2007)

Certainly this is not the way to find out about the death of a loved one, but we were able to answer a number of his questions over the phone yesterday. Many questions remain about her death, however, with the continued investigation in the purview of the Lake County Sherriff’s Office. We were unable to determine her cause or manner of death, primarily because all that remained was skeleton and it had no marks or abnormalities, although there were some drugs in the clothing found with the sketalized remains.

We will be helping him arrange final disposition of his daughter, no one else made those arrangements. He plans to have her remains with him in Hungary after cremation. He, also, hopes that at some time the Sheriff’s Department might be able to get him a few more answers regarding her death (the case has “got cold”, as he put it in his email).

More on drug deaths around the world

I thought you might be interested in some further correspondence regarding the case I posted on last week.

Is it the norm to use Cocaine together with Heroine?

Assuming that he had the Thrombi at the time of death, could this mean that he as a long term addict? I mean is there any way in knowing from the toxic report whether he was a long term addict or if this was something he started doing recently, and if the report mentioned that there was no external injuries to the body, will they also take needle marks into account?

What about the Amitrippyline – could this just be a coincidence that he took an antidepressant or could it be part of a drug or a mix of drugs he took? And according to the amount – how many pills did he take?

This is really important, as we suspect that he could have been given these ‘drugs’ by another person, against his will, that is why I need to determine if he was addict or not, if at all possible?

And if the blood cloth didn’t hit his lungs – would he have died anyway?

Regards
Katie
South Africa - Bloemfontein

My answers to those questions:

It is not at all unusual for a person to take Cocaine and Heroin together. In our experience with drug deaths, the number of those dying with heroin alone as opposed to cocaine and heroin together is about equal.

The thrombi are only relevant to his death and/or pre-death state. They would not likely be a chronic problem nor reflect chronic addiction.

There is no real way, based on testing, to know if he was a long term addict with certainty, although the lack of apparent medical problems (as seen in some addicts) at autopsy would make long term addiction a somewhat less likely possibility.

Needle marks would have been looked for and commented on if present. It is not unusual these days to snort/inhale cocaine and heroin.

The Amitriptyline level is not toxic or indicative of an overdose; it is within the range of people taking it therapeutically (possibly in the range of 150 mg as a dose).

The amitriptyline could have been “slipped to him”. The cocaine and heroin is not active, in any significant way, if taken by mouth, so the likelihood of it being given to him against his will is essentially zero (without needle marks).

The clot in his lungs killed him, but certainly cocaine and heroin can and do kill in other ways.

I hope these help.

An interesting proposal, let's brainstorm a solution

How's this for a "forward":

Please allow me to introduce myself and the circumstances that have brought me to contacting you.

My name is Pamela Hewett, I am a 39 year old Illinois Police Officer and have served my communities for the past 14 years. My husband is also a (16 year Police) Officer. I come to you on a bended knee and humbly request your assistance in a matter of great importance to myself and my family..........

Recently tragedy struck when my sister (Gina M. Smith of Cross Junction VA) was over prescribed medications. It cost her a beautiful and promising life, and she was only 47 years old. She left behind two very young beautiful daughters, one of which had the misfortune of finding her mother laying deceased from the overdose of Oxycontin, Xanax, Percocet, and what ever else she was prescribed. I know you may shake your heads and believe there is nothing you can do to change the tragedy of what has happened, but I believe that is not true. Please read on:

Through my research I have found that the dangers of these drugs have been known since shortly after being created. The increase in abuse has nearly quadrupled since then, and yet nothing has been done to stop it. Prescription drug deaths’ is fast becoming the leading cause of death among Americans, and now I take that extremely personal because it took someone from us that was a vibrant and beautiful person. You see, this started for my sister when she was diagnosed with Breast Cancer in 2002. You know what? She was cancer free when she died. She beat the cancer but not the drugs that should have been monitored and cut off long before 2008.

As a law enforcement officer, I do not understand why, if someone is wanted on warrants for escape, drug trafficking, or any other serious or heinous crime, police can enter a persons name into our computers and we SEE this information NATIONALLY. If someone is a registered sex offender, the same concept applies…. why can’t medical professionals have this same accommodation ?

I need your help - Some how, some way, we need to establish a NATIONAL DATABASE similar to what the police use, only it would be for the use of medical professionals. Please help me to stop the doctor shopping and countless unnecessary deaths which is on the rapid rise. Let’s help to save other families from this heartache and anger and grief. I know, when a law is put in place, criminals always find a way around it, but just think of the people who won’t be able to do that, and the lives that might be saved?

I am proposing that the database requirements be that when someone is requesting pain management, (resulting in the distribution of anything in the Schedule 1, Schedule 2, or any other prescriptions that may prove a risk for creating addiction) that BEFORE a Doctor distributes the medication, the national database would have to be checked. In order to obtain these kinds of medicines people would have to present not only a photo ID but their social security card as well. It's allot harder to forge or duplicate social security numbers than it is Names / ID cards. There are also more intricate controls that can be considered.

Police departments use AFIS (Automated fingerprint identification system) - which gives us NATIONAL information off of one fingerprint when someone is "in" the system. Why cant it be a requirement of identification that a thumbprint of a patient be tied to their identifiers once they begin using prescription pain management? There could be no forging a fingerprint. The medical professionals could help abruptly halt the doctor shopping that is killing our citizens. They will be able to enter the database with the patient information and see exact dates, locations, and medications obtained.

I believe that by establishing this sort of a control system, we can change the tide of rapidly increasing prescription deaths. Sitting back and conducting studies of how prescription drugs are so heavily abused and a leading cause of death in America is doing nothing to correct the problem.

Please join in and assist me to get this completed. If you can not or do not want to assist, then forward this to someone who can and will help this idea become reality. I want to reach as many people as possible to raise awareness & to get this job done.

Sincerely

Pamela L. Hewett
3504 Vine St
McHenry IL 60050

DNA Profile match, what are the odds?

Criminal DNA “testing” is not a matching of the entire genetic makeup of an individual (which is unique), but is a matching of a “genetic profile”, a small (13 loci) piece of the full genome of the individual. Over the last couple of years questions have been raised about whether the FBI estimated odds of unrelated people sharing profiles is 1 in 113 billion or if it is in fact a much more likely event.

A recent article in the LA Times lays out the case for lower odds. It relates that a 9 of 13 loci match is really not all that rare of an event even between two folks that appear quite different and have no demonstrable relationship. The article also points out that a 13 out of 13 loci match in a pair of unrelated folks may be a possibility as well.

It should be noted (as in the article) that officials do try to match all 13 out of 13, but at times fewer loci are available for comparison depending on the specimen or sample.

Our justice system relies heavily on the FBI odds estimate. We owe it to our citizenry to be more certain that it is based on “good” science. We need to prove that we can be confident in that odds estimate. We need to seek the evidence, the proof, just as the article calls for further study, a study that really should not be all that difficult to do.

Choking game isn't a game

Just a reminder about the “choking game”, I wrote about it here and here.

Just as a reminder it is a “game” “played” most often by young teenage and pre-teen boys, often for the “rush” (although girls are not immune). Also, at times I think, it is done for the shock value and risk involved in this “play”.

“Play” hanging isn’t a game.

It only takes about 8 pounds of pressure on the neck to stop blood flow to and from the brain with the result being death. 8 pounds of pressure, the weight of the head, can result in death. This can occur in the sitting or near sitting position, lying or near-lying position, or suspended. The key is you don’t have to be suspended to die.

Drug deaths all over the the world

The internet uniting the world:

Anonymous has left a new comment on your post "Another drug-related death":

Dear Dr Keller
On 22/10/2005 my brother was found unconsience in his room. He was hospitilized 14:00 and was pronounced dead 17:15. The Post mortem was found to be PULMONARY EMBOLISM FOLLOWING OVERDOSE OF MORPHINE AND COCAINE. A toxic was done and the following was found - Amitriptylline - 0.08micorgram per ml of blood, Caffiene in the blood, Cocaine, Codeine, Morphine, Bensylecgonine and paracetamol in the urine. No external injuries was found on his body. He also had a Secondary haemorrage in the midbrain. Pleura dn lungs - both lungs congested with saddle thrombus in the pulmonary artery. Mediastinum and oesaphagus, trachea and bronchi, intestines and mesentry, pancreas, Liver, Galbladder and biliary passages, spleen, Kidneys was all congested. Would this all be from one substance he took or several, could it have been suicide? What does congested mean? I would realy appreciate your opinion.
Regards from South Africa

My reply

The congestion referred to is vascular congestion likely related to decreased cardiac output (heart pumping action) and/or increased venous stasis (with dilated blood vessels) due to the cardiovascular effects of the drugs. The cocaine directly can cause a midbrain bleed.

That vascular congestion also contributes to the formation of clots (thrombi) that can travel to the lugs resulting in death.

The 2 primary substances in this intoxication are cocaine (its metabolite benzylecgonine) and “morphine”. The source of the “morphine” might be heroin or any number of opiates that metabolize to morphine in the body (with codeine as a co-metabolite, co-ingestion, or as the source of the morphine).

Suicides using illicit drugs is fairly rare, most of these deaths are “accidents” related to drug use and abuse.