Tuesday, March 31, 2009

Potent Heroin

We had a very concerning spike in heroin-related deaths this last December (8 in one month), which seemed to be a part of an apparent trend in such deaths. Because we found no adulterants in the specimens we obtained at the scenes of these deaths, nor in the bodies of those decedents, our thought was that there must have been a spike in the concentration of the heroin used. (As I was quoted in one article, it brought to mind the movie “American Gangster” in which a more pure heroin brought to Harlem resulted in a large number of deaths in the users.)

We felt that the concentration or purity was important information to know for our death investigations in these cases; as well it would be important information for local law enforcement agencies. We were able to get the DEA to do the testing for us.

The results have just come back. While they reinforce our opinion, they are nonetheless striking. We were able to send samples from 2 cases. (For comparison, let me mention that currently the average purity in Chicago is about 15%) In one case the purity was 23%. That is an increase of 50%. If you are used to shooting 15% stuff, a jump in purity of 50% certainly has the potential for lethality. The other specimen was even more impressive. It had a purity of 65%. That would be high-grade for snorting, if you shoot it you die with your syringe under your body.

I certainly do not advocate heroin use and support increased availability of treatment for addiction, but I also think it is crucial that we get this sort of information out so that users can know. When you get this stuff “on the streets” you never know the quality of the stuff. It could have lethal adulterants. It could be a lethal concentration. Maybe knowing that will deter some from using.

A couple of other points: I would note that we are working on developing the capability to do future purity testing in our lab; we are the only Coroner’s office in Illinois with our own toxicology lab. Once that is established we will be able to follow this trend continuously and help local law enforcement agencies with fast turn around in these results for their investigations.

The other piece we are working on is to better “quantify” the observation that these heroin deaths are not confined to our poorer neighborhoods, but span the county and its varied socioeconomic climes. That tells us that this is not a “disease” of the poor and that it is not a “gang problem”, both of which are ingrained opinions that need to be dispelled if we are to realistically address and remedy this problem of heroin use and heroin-related deaths.

Tuesday, March 24, 2009

Youth against drug use

This from a new facebook group that a friend sent me the link to:

This is our chance to create a movement for the fight in the war on drugs. Our youth are dying from the lack of awareness to our community's drug prevalence. Our suburban community officials don't believe it's a problem! "Not here, not in this town." Let's raise awareness! Don't let the people we have loved and lost be forgotten. They were all beautiful and irreplaceable human beings. Let's continue to honor their memory and raise awareness-- we can't let this continue to happen. We need to be their voice. It "is" happening in our towns! Open the eyes to those who are naive. Otherwise we will continue to lose those that we love. Together we can make a difference.

Interesting (and honest) stuff, spread the word.

Friday, March 20, 2009

Pain Killer Misuse can be a Killer

Treatment admissions for prescription pain killer misuse has risen dramatically over the past decade – from constituting 1 percent of all admissions in 1997 to now representing 5 percent, according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA).

That reflects what we are seeing too, increasing numbers of deaths from misuse of prescription pain meds. The numbers aren’t huge but they are there, another one today.

Drugs they can thrill ya, they can kill ya.

Ain’t no caring in much of our healthcare

WTF—I guess that is a bit strong, but it communicates my feelings after a call I got last night from a friend of mine. What is with healthcare providers?

I know this guy (granted most stories that start out that way don’t go well, but this isn’t that kind of story) who crashed his dirt bike (or was it an ATV?) and broke his leg a few weeks ago. Young guy in his 20s, healthy, unemployed and with no health insurance…

He had done work on his vehicle in preparation to sell it. He took it out for one last ride to make sure all was well for the sale, but crashed instead, an accident. The crash resulted in multiple fractures to one of his legs. He went to the local ER, got splinted and told that once the swelling improved and they were certain it wasn’t infected at the time of the trauma they would do a surgical repair.

Back to the hospital he went 2 days ago, they loaned him a wheelchair, called a medi-van, and took him to the local orthopedist’s office. The orthopedist said that, indeed, he needed surgery for repair of the injury (and for the best outcome) and as soon as he came up with $30,000 cash he would be more than happy to do the surgery. The guy I know doesn’t have that much, so out of the office he went (with the wheelchair).

A friend of his suggested that he go to another hospital, surely they would see that he get the needed care. A young guy ought to have the treatment he needs so his leg can be the best it can be after it heals. He may need his leg to work, if a job becomes available. He might not want to spend the rest of his life in chronic pain nor with impaired mobility from suboptimal care and healing.

He went to another hospital, one his friend thought would surely help. He presented in the ER, because he had no other access to care. He was told (I am sure in a very caring way, they are a caring medical center, so much more than just a hospital) that if he paid 100% up-front they would be more than happy to give him the care he so obviously needed. There was nothing they could work out, there were no options, there wasn’t any real access to care. WTF.

Thursday, March 19, 2009

Rambling thought

I just got an email with a widget I could attach to my blog from Wellsphere (my blog is cross posted there). The widget contained a definition of “perseverance” that I don’t agree with:
The difference between a successful person and others is not a lack of strength, not a lack of knowledge, but rather a lack of will.

I disagree with the last word.

“Persistence despite obstacles” would work for me, but saying they lack “will” is wrong. There is a need for an action in the definition. Success is action, perseverance is action. The definition should communicate the need for action. Many have the will to accomplish something, but do not take action. (On the other hand, some times the obstacles win no matter your action.) But nothing fails faster than a lack of trying.

Wednesday, March 18, 2009

Heart attacks don’t only attack ‘old folks’

Shocked, concerned, dismayed, I’m not sure what word to use.

In the last couple of weeks we have had 3 folks in their 30s die due to heart disease. Granted they were overweight and had histories of hypertension, but seeming so young to have life-threatening (life ending) heart disease. Most of the time you don’t think of heart disease killing at such a young age.

What is going on? These folks, for the most part, didn’t access our healthcare system for personal of financial reasons (that can be hard to sort out, not being able to talk with the person involved in the decision making). Apparently, they weren’t able, for whatever reason, to make life style changes to impact the obvious risk factor with diet and exercise. Folks need to know the health decisions you make at any age (even when you are young) can, and does, impact your longevity.

Do what you can to not die before your time. Make good choices.

Friday, March 13, 2009

Coroner's office and child safety seats?

Press release we sent out today:

For Immediate Release

The Lake County Coroner’s Office is proud to announce its new partnership with Safe Kids Chicago, a Division of Children’s Memorial Hospital. The Safe Kids Buckle Up program strives to offer every driver who transports children, the opportunity to learn how to properly restrain children in age and weight appropriate car and booster seats. The office now has two deputies that are certified child passenger safety technicians.

“While 94 percent of America’s children are now regularly restrained, not enough kids are properly and safely restrained. This puts children at an unnecessary risk of being injured or killed in crashes because they are simply in the wrong car or booster seat or it is not properly installed” said Dr. Richard L. Keller, Lake County Coroner.

Parents are encouraged to make an appointment to bring their car or booster seats for inspection. The certified deputies will help parents learn to adjust the harness and properly place the car or booster seat in the vehicle.

To make an appointment for inspection, please call the Lake County Coroner’s office at (847) 377-2200.

Thursday, March 12, 2009

Spike in heroin deaths

This certainly caught the attention of the local media. Headline:

Heroin deaths on the rise
County officials blame change in percentage of purity

I was called by a local reporter about a drug-induced homicide case going to trial and I mentioned an apparent increase in heroin deaths recently (2008 to now) and my suspicion that it might be related to an increase in purity of our street heroin. An increase in concentration was inferred by our increase death incidence, our testing finding no adulterants similar to some cases of Fentanyl-heroin we saw in the past, and that some of the cases seemed to look like “hot-shot deaths” (syringe barely out of the arm). So we sent several samples found at death scenes to the DEA for purity/concentration testing. Many areas of the country monitor their concentrations (for example, Chicago found a 14.6% to 21.4% jump in 2007), our county has not followed that measure in the past but I think it is important information to have. We await our testing results.

Also, hopefully getting out this information to the public can help drive down heroin use and encourage folks to seek treatment for their addiction (and decrease deaths).

Tuesday, March 10, 2009

Beat the Reaper

Cool way to get the word out (as I have said before teens must get learning messages in multiple ways multiple times for it to sink in):

new interactive computer CD intended to help young people anticipate the disastrous consequences of choices they're often confronted with…

…Beat the Reaper…

I haven’t seen the CD yet, but I welcome anything that helps teach kids to think, to not take chances, make good choices, and live.

Four prescription painkillers and a half bottle of wine were all it took.
Stephen Pheasant, 15, of Benton City, ingested the concoction one night early last year, and he never woke up. His death was a shock to his friends and family, but most of all, it was an outcome he didn't see coming…

His story is one of several real-life examples included in a new interactive computer CD intended to help young people anticipate the disastrous consequences of choices they're often confronted with.

Monday, March 09, 2009

Non-medical use of pain relievers

From a SAMHSA press release:

Adults aged 18 to 25 currently using pain relievers for non-medical reasons increased from 4.1 percent in 2002 to 4.6 percent in 2007…

youths aged 12 to 17 … non-medical use of pain relievers … declined from 3.2 percent in 2002 to 2.7 percent in 2007…

Use among adults aged 26 or older increased from 1.3 percent to 1.6 percent

While the use among 12 to 17 year olds seems to hold some promise, it remains a topic rarely spoken of or adequately addressed in in-school programs, as far as I know. Over-use and abuse of prescription pain relievers is a large problem for society (“5.2 million people aged 12 years or older in 2007”), yet it remains poorly addressed. It is multifaceted in cause (not just to get high), contributing factors (diversion, over-prescribing, poor control/understanding of effects, etc), and the way it is viewed (‘not as bad as using street drugs’).

My other thought on this: how many of these folks will move on to illicit drugs? I have not seen that sort of research and it might be a bit tough to do. But, in my limited experience, a fair number of them will. In many places (like our county and its surrounds) heroin is cheaper and easier to get than prescription pain relievers on the illicit market, making it a fairly ‘natural’ switch. Using illicit drugs and/or the illicit marketplace often contributes to social, legal and societal problems compounding the “effects” of the drugs.

Thursday, March 05, 2009

Medical Homicide

I was reading an article on “Medical Homicide and Extreme Negligence” in my recent edition of The American Journal of Forensic Medicine and Pathology (no link). Having had a case of medical neglect found to be homicide by an inquest jury it was nice to review some of the pertinent definitions. We will continue to watch for other medical cases along with our “more usual” investigations:

Reckless endangerment…the conscious disregard of a known substantial likelihood of injury to the patient

Criminal neglect typically is defined as the failure to provide timely, safe, adequate, and appropriate services, treatment, and/or care to a patient.

In instances of extreme medical negligence, a homicide manner of death is appropriate because the fatality is due to criminal acts (or inactions) of another.

I stand by the jury verdict in our case and will not hesitate to rule similarly in the future if I feel that the case meets these definitions.

Natural deaths…natural disease... Therapeutic complications…predictable complications…appropriate medical therapy…Accidents…unanticipated complications and/or inappropriate therapies…Homicides…death at the hand of another person or death due to the hostile or illegal act or inaction of another person.

Our ruling of a homicide does not mean criminal prosecution should or will occur, but, importantly such a ruling:

…also furthers one of the major goals of the medicolegal death investigation system, which is to safeguard the public health.

(American Journal of Forensic Medicine and Pathology, March 2009; 30: 18-22)