No Spike of Suicides With the Holidays

I was listening to a speaker yesterday and she brought up the old saw that there is a peak of suicides between Thanksgiving and New Year’s Day. It is one of those statements that seems to make sense logically, but is nonetheless not true. 

Suicide is amongst the leading causes of death in our country and every one is a tragedy (although I am not sure that the latter is always true and I will come back to that shortly). While we may be more acutely aware of the tragedy of suicide during this holiday stretch, the incidence of suicide actually peaks in the spring.

I thought I’d take this opportunity to mention just a few other facts about suicide. First, we do not die by suicide at the depths of our personal darkness, but as the energy returns to us we can then act on the thoughts that we had at our darkest. That explains why people “seem better, seem OK” just before they take their own life. It may also explain why suicide peaks in the spring, the renewal of our world returns the energy to act. It also explains why someone who has started on medication for their depression is at increased risk of death by suicide. It is not the medication itself, but the fact that it has lifted them out of the “goo” of depression to the point that they can now act.

I’d also like to mention that there are considered to be 3 categories of suicide. The first accompanies the deep, existential pain of depression. That feeling that the world would be better off with out us or that we would be better off without the world, the only resolution for our pain. The first category of death by suicide accompanies that severe, clinical depression. The heavy blanket sensation that life can get no better. The second category is situational, e.g. accompanying a loss of job and that blow to our identity or a broken relationship. The third category is the rational choice, this usually accompanies the knowledge that you are terminally ill and that your death is imminent or the process will be unbearable for you. The last is the category in which I am not certain that the death is totally a tragedy, although it will always be for the survivors. also, I would note as well that the first 2 categories are at times mixed and synergistic in being a driver toward suicide.

What to do at this time of year, or at any time, when encountering someone with thoughts of suicide. Push them to get help, at the very least to talk to 1-800-suicide or visit their website (www.suicidepreventionlifeline.org). Get them to pause and think as well. There are often options that they do not see at first. Help them expand their thoughts, of possibilities and consequences, but, foremost, get them to professional help.

Fear the Heroin, not the Krokodil

I know it is jazzier, “sexier” to put Krokodil front and center in the news these days. However, for a news outlet (CBS2) to step on a report about a community forum discussing the scourge of heroin sweeping the suburbs, seemingly to grab attention and not give useful information, is reprehensible in my way of thinking. 

Yes, talking about a drug whose name translates to crocodile as “flesh-eating” (all news outlets) and/or as a drug that turns people “into zombie-like creatures” (CNN) gets folks to tune in and buy your newspaper. But how about a little truth in reporting. Krokodil is a drug made from codeine and various “household” chemicals, including gasoline. When injected it has a high potential of destroying blood vessels in various parts of the users body, dead blood vessels equal dead skin/tissue. It does not “eat” flesh. It no more makes the user “zombie-like” than any number of other illicit and licit drugs. Krokodil use has grown in some countries where codeine is cheap and readily available, while heroin is expensive and difficult to come by. That is not the case in the US and especially not true in the Chicago area.

Krokodil may or may not be in our area. Keep in mind that having “dirty” works for injection preparation or poor injection technique can lead to blood vessel “death” just as certainly as Krokodil.

In our area heroin is cheap ($5-10 a dose), potent, and readily available. I have spoken of that many times in this blog over the years, e.g. 2008 Illicit Drug Prices and 2009 Coroner riffs on heroin deaths. Heroin deaths have shown no signs of abating and they are definitely increasing in many areas around Chicago. The heroin, available in most any neighborhood any more, is so pure you don’t have to inject it, making it oh so much easier to use. It’s purity makes it profoundly addicting as well. It is so cheap that it crowds out competing drugs.

Heroin use and abuse must be our focus, as it was yesterday, is today, and needs to be in the forseeable future. Heroin is the drug scourge locally, not some drug that makes it easier to write catchy headlines and subject teasers. Heroin is what we must fear (and work to get control of), not Krokodil.

Myth of Fingerprints

“I’ve seen them all and, man, they’re all the same”. OK, perhaps not quite all the same as Paul Simon says, but there are enough similarities to bring doubt on the surety of “a match”. TV and movies make it all seem so simple. Throw the latent print found at the scene or on the murder weapon into a computer and out pops the name (and often a picture) of the guilty party.

This was brought up to me a few years ago when a juror asked if we had fingerprinted the weapon that caused the death in a death by suicide to prove that the individual had indeed shot himself. That and some recent reading brought out a couple of tidbits that I thought I would share. 

Fingerprint identification happens when the arches, whorls, and loops present in a fingerprint are compared to some prints that are on record in a database somewhere or compared to a set taken from a specific individual. The comparison process finds parts that seem distinctive in the found print and those bits are compared to the set of possible fingerprints looking for similarities. So the second limiting factor in print ID is that you have to have a print of a known individual to compare with. That does not always exist, although it always seems to on TV. 

The first limiting factor is getting that latent print, latent print means one left behind to be found. The thing to know here is that the average latent print is only about 20% of a fingerprint, severely limiting the amount of the print information available for comparison. In the case of a gun trigger, the maximum amount of a print that could be found (not even considering that gunmetal is a poor surface to recover a print from) would be well less than that 20%. Definitely not enough data points for any real comparison.

Even if you have a full print, is this comparison thing an exact science as we are led to believe? Consider that a study done a few years ago in seasoned fingerprint examiners (I have lost the exact reference) showed as much as a 1 in 5 misidentification rate. Many times there are similarities enough to fool the most seasoned of investigators into making an incorrect finding, let alone the initial fingerprint screen by computer comparing thousands upon thousands of prints. It is not an exact science. The best that can be truthfully said is that there is a certain probability of certainty that this print matches a given individual’s. There is always the possibility of at least very similar prints being present in multiple individuals.

Do we really know that people with identical fingerprints don’t exist? In one episode of the Sopranos (don’t you miss the Sopranos?), Christopher waxed poetic on just this issue. His point was that without actually comparing everyone’s fingerprints in the entire world, alive and dead, you can never know for sure that there are no identical fingerprints. Keep in mind that Nancy Knight of the National Center of Atmospheric Research found 2 identical snowflakes during a snowstorm in Wisconsin a few years ago. If the myth of no identical snowflakes existing has been busted, who are we to say that the same is not true of fingerprints?

Cocaine in a Poly-substance Death

I am back to blogging here. I missed this site, but, interestingly, even when I wasn’t posting I still had something like 80 visits per day on average. It may be a lazy re-start, but I am going to begin by elevating a comment for the "Cocaine and Death" post. (Even when I wasn’t posting here comments have been posting and I have been answering questions)

A comment by Anonymous:

Thank you in advance for any answers you may be able to give. My boyfriend was alive at 8am on Friday and found dead at 5pm on Saturday. He was a very depressed drug addict that had been self professed clean for 9 months. The date of the autopsy was Monday morning at 8am which is 39 hours after he was found. My first question is are the toxicology numbers based off blood tests done @ time of autopsy or was blood taken @ crime scene? What I want to know is...when it shows a certain number for cocaine and benzoylecgonine in his blood, has some of it had time to leave his blood before the count was taken?

It shows results from blood test as follows: Ethanol 0.035 g/100mL Carisoprodol 9.1 ug/mL Meprobamate 4.4 ug/mL Cocaine 65 ng/mL Benzoylecgonine: Present not quantified Zolpidem: Present not quantified The supplemental report on liver tissue specimen showed Zolpidem 1700 ng/g Another supplemental report taken from chest blood to show Zolpidem 650 ng/mL

The autopsy ruled diagnosis as
1. Multiple drug toxicity a. circumstantial evidence b. diffuse visceral congestion c. pulmonary edema and congestion d. froth & aspirated content in upper and lower airways e. postmortem blood toxicology: Multiple drugs present. Zolpidem is in toxic range
2. No significant trauma
3. Early postmortem decompositional changes.
Manner of death: Accident
In the report it shows he had greenish skin coloration in several places as well as marbling apparent over left side of trunk and left thigh.

My questions are 1. when they talk about decompositional changes such as marbling, are they going by time of autopsy or when found at crime scene? Trying to find time of death 2. when they talk about the levels of each drug in the system are they talking about blood taken at crime scene or from autopsy 3 days later? Did drugs have time to leave his system and alter numbers? He had been depressed for a week and threatened suicide. So many drugs in his system including the cocaine and "toxic levels" of ambien yet ruled an accident...why? When did he last use cocaine and how much? Does this look like suicide to you? And what time would you put his death? I thank you so much for taking the time to read this. I appreciate any answers you may be able to provide.
 --------------------------------------------------

There is a lot of great stuff in this comment. First of note is the classic autopsy findings of an overdose death. “Froth”, also referred to as “Purge” or purge fluid, was found in the airways, classic. Vascular congestion was present in the lungs and other organs. Aspirated material was also noted in his airways. This combination of autopsy findings scream overdose. Considering the lab results, the zolpidem/Ambien level found is definitely in the toxic range. While not at toxic levels, it is important to not ignore all of the other substances obviously ingested, most notably a muscle relaxant and alcohol. Certainly the cocaine should not be ignored as well. It would have been most appropriate to call this individual’s death as due to poly-substance ingestion.

As I replied to Ms Anonymous: “I would agree with your feeling that the mix of drugs makes it likely that this was a death by suicide. Particularly in view of your relating that he had been depressed and threatening suicide recently. Although, people don’t use cocaine for suicide, as a rule, the others drugs with the Ambien at that level would have me to call this a suicide. Some investigators/coroners are hesitant to call a suicide, even when it stares them in the face. They, too, are inhibited by the possible stigma and the possible reaction of family and friends to suicide being listed as a manner of death. That is unfortunate and a disservice to all. We need to move beyond the stigma and approach suicide head on or we will never be able to make treatment available to those in need.”

The body also had early signs of decomposition present at autopsy. This may seem a bit early for it to begin, but cocaine and other drug overdoses, as well as death in hot surroundings (not known in this case), can speed the decomposition process.

I also commented: “The cocaine level would seem to point to a draw shortly after the body was found. Cocaine does metabolize in the body after death, via red blood cell enzymes. The level of cocaine in his blood, and not just the metabolite benzoylecgonine, would tell us that he died within a couple short hours after use (anything more defined would be guess). It is a little trickier to known when he died without further information regarding rigor, livor, etc, but likely not all that long before being found. Also, there is no way to back calculate to tell the amount of cocaine used.”

Keep those questions coming in. I am honored to help folks find the answers to questions that they can’t seem to get answered elsewhere, apparently including where these deaths have been investigated. I look forward to our ongoing discussions and being able to share information with you, my readers.

Grad School

I haven't posted in quite a while and I am not sure if anyone even bothers to look here any more.I thought I did owe folks an explanation, in case they drop by again.

The primary reason I am not posting is that I am in online Grad School working on a Masters in Secondary Education. That is consuming all my free time. Two papers a week and participation in online discussions takes time and my creative juices. I am preparing for life after the Coroner's Office (December 2012). I have decided on a career change to what has always been my second choice for a career. I am going to teach high school or middle school, and I am looking forward to the future.

As I told a group of students recently at a career day event I participated in. Never be locked into what you think you are going to do for the rest of life. We really can never be sure what we will "do" "when we grow up".

“Relief-oriented use of marijuana by teens”

That is the title of an article in last April’s Substance Abuse Treatment, Prevention and Policy.

While this study in has a very small sample size, it nonetheless presents an interesting point, and one that needs to be taken into account when attempting to limit the use of illicit drugs (and the illicit use of licit drugs) by teens.

…these teens differentiated themselves from recreational users and positioned their use of marijuana for relief by emphasizing their inability to find other ways to deal with their health problems, the sophisticated ways in which they titrated their intake, and the benefits that they experienced…Marijuana is perceived by some teens to be the only available alternative for teens experiencing difficult health problems when medical treatments have failed or when they lack access to appropriate health care.

One of the common reasons for use of illicit drugs is self-medication. Certainly a completely different approach would be needed in these individuals than in recreational users. Likely these folks present a different set of challenges.

Driven to Distraction

Subject: Driven to Distraction video goes live; please share!

Good morning task force supporters,

Please take a few moments to watch our fantastic new YouTube video featuring Dr. Brian Johnston of Harborview.

Call to action: Watch this video and share it with as many friends, colleagues and groups as possible. To watch, please click on the front page of our web site, nodistractions.org" or go directly to the YouTube link which can be copied and pasted into your own e-mails:

http://www.youtube.com/watch?v=sjj2dLfeERE


Many wonderful people helped make this video possible, and we will be acknowledging each of them on our web site soon.


Thanks for spreading the word!

Lindsay Pease
Driven to Distraction Task Force of Washington State