Prescritpion Drug Abuse

Some highlights from the National Prescription Drug Threat Assessment 2009:

When abused, not only are these drugs dangerous in their own right, they often lead to the use of harder drugs, with life-altering consequences.

Diversion and abuse of prescription drugs are a threat to our public health and safety--similar to the threat posed by illicit drugs such as heroin and cocaine," said Director Kerlikowske. "In 2006, the last year for which data are available, drug-induced deaths in the United States exceeded firearm-injury deaths and ranked second only to motor vehicle accidents as a cause of accidental death.

Friends or relatives are the primary sources for CPDs [controlled prescription drugs] among most abusers…Teenagers find diverted CPDs readily available.

CPD abuse is most prevalent among young adults.

This certainly coincides with our experience with increasing numbers of prescription drug deaths that we rule accidental, i.e. not suicide, just folks using, overusing and abusing prescription drugs.

One death affects so many

I was sent a copy of an article that appeared in a local paper (I don’t have a link). The article title and the fact that I have a couple of pre-prom events later this week got me thinking and writing.

The article’s title (actually a guest essay/opinion) was “A child’s death is just one effect of underage drinking” and it covers other effects of alcohol on adolescents similar to stuff I have written about before. The tangent my brain went off on, however, was the effect the death had on those connected to the teen who dies and/or the people that are affected by the death.

The teen that died and the potential lost. What or who could they have affected through their life? What relationships never formed? What discoveries would have been made? That potential never realized, at what cost and to what effect?

The death will have deep and permanent effects on the teen’s family and friends. It will have effects on everyone that those folks relate to and come into contact with, likely throughout their lives. There will be effects even on folks only peripherally “related” to the teen that dies. Effects on others at their school who may not have known them, but hear of the death, folks at their church, like a pebble into water the waves propagate outward.

Folks previously affected by death may have ‘old wounds’ reopened or at least disturbed, even folks who may just hear about it in the news. Again propagating waves.

Those that respond to the scene of the death and those that may work to save them pre-hospital and in the ER will be affected. We all like to think we are stoic and unaffected, but these deaths affect even the most seasoned.

For others injured in the incident, each would have their own cascade of affected folks. Pebbles into the water.

Lastly, you always have to have an “other” category.

One death affects so many.

Can driving distracted = reckless homicide?

There was apparently a report on the radio earlier today (I didn’t hear it, but one of my employees let me know) referring to a recent death in our county. I had a bit about it earlier this week in a post. There is also a listener poll on the WGN website pertaining to the death asking if a death caused by a distracted driver should be pursued as reckless homicide? From what I heard, our State’s Attorney has decided “no”, at least in this case.

We have not yet closed our investigation and ruled on the manner of this woman’s death, but I think we are leaning toward (reckless) homicide.

Is driving distracted by eating or texting or doing your nails really any different than being distracted by the effects of alcohol?

Yes I know, and truly believe, that the driver’s self punishment is going to be greater than anything the court system could mete out, but that is no reason to not prosecute this case as you would any other similar case. If it is wrong, it is wrong. If you pursue it in some, you should pursue it in all. Reckless homicide is not restricted to cases in which intoxication is demonstrated.

Added: Interesting fact from an article I just came across

A study by the National Highway Traffic Safety Administration and Virginia Tech Transportation Institute showed that simple distractions - talking on a cell phone, reaching for something on the floor, looking too long at something on the side of the road - caused 80 percent of the crashes and 65 percent of the near-crashes observed.

Coroner: Killer Heroin Isn’t From Mexico

I got in a discussion (argument is just a bit too strong) with an Associated Press reporter yesterday (Hi, Sophia). It became rapidly apparent that she had already written her article and wanted only quotes and information that went along with what she had decided the story was.

She called to ask about the recent increase in heroin deaths that has occurred here in Lake County, an increase that I have attributed to (and demonstrated with testing) an increase in purity or strength of our heroin on the street. She asked the usual questions about the ages of the victims, other demographic information, and about them dying nearly instantly upon injecting. It all seemed to be going along fine as fact finding until she asked where I thought the heroin was coming from.

I told her that based on the fact that it is white heroin that it comes from Colombia or Asia (and that in turn based on Department of Justice information). She then asked about heroin from Mexico. I explained that Mexican heroin is either brown or black and not white. She pushed the Mexican source theory, “because of all the violence at the border”. I explained that while some of the Colombian heroin may come through Mexico; the stuff we are seeing is not Mexican in origin. “It has to be”, she replied. I explained that most Colombian and Asian heroin does not come through Mexico, but directly into the US in other ways. Violence or not, her preconceived notions or not, the heroin on our “streets” is not Mexican. She quickly ended the interview at that point, asking if there was anyone else she could talk to in the County, undoubtedly looking for someone to support her incorrect thoughts on the matter.

So no matter what she ultimately reports, I want you to know that white heroin (the predominant type used east of the Mississippi) is from Colombia and, in ever growing amounts, from Southwest and Southeast Asia. The black tar and brown powder stuff more used to the west is the stuff from Mexico.

File under: fun facts to know and tell.

Coroner and Parent Trying to Forestall Death Isn't Easy

A death occurred over the weekend, actually several occurred, but I am writing about just one of them.

A woman riding/driving a motorcycle died after being hit from behind by a car. I talked to reporters and gave them part of the story: the motorcyclist had stopped at a yellow light, the driver of the car was driving distracted (I would not give any details as to what that entailed) and did not stop for the yellow light, striking the motorcycle. The motorcyclist was thrown from her cycle and was pronounced dead at a local hospital shortly after the crash.

The next reporter to call, called after seeing the story on the website of the first reporter’s newspaper. He said he read in the posted article that the driver of the car was doing her nails and asked if that was indeed the case. Apparently, the first reporter got the story from law enforcement personnel involved in the investigation of the case.

Subsequent newspaper stories were not too careful with attribution of that part of the story, so many have assumed it came from me. Oh well, what can you do.

Beyond that, I really wanted to write about another aspect of the whole deal. After the call from the second reporter (he was only one of four reporters I talked to on Sunday about the death) I talked with my 18 year old daughter about the death, always trying to impress upon her to make good choices and not take chances. I mentioned that the story was up on the Internet about the distracted driver in the crash. My daughter’s response was that she sure wasn’t going to do her nails while driving again.

I wouldn’t have guessed that she would ever do such a thing, but apparently so. As a parent it is difficult to think of all the things you need to warn your children about. That is an incredibly difficult job.

Swine flu perspective

Swine flu. Be afraid, be very afraid. People are fearful and demanding that something be done. Government officials are clamoring to do something. Wait, that was from news reports in February of 1976.

The swine flu has been here before. It was here in 1918-19 and again in 1976. It is not new. It cannot be caught from pork food items. Yes, it can kill, but so does the more common flu. The post-WWI swine flu killed 500,000 in the U.S. (and recent evidence points to it having started here). The outbreak in 1976 killed one (however the hurriedly set-up vaccine program killed and debilitated hundreds). Our usual seasonal flu kills about 36,000 each year. We need to keep this swine flu in perspective. Don't panic, no matter how the media frenzy pushes you. Yes, even one death is too many, but unfortunately death happens and not all of them can be prevented.

Wash your hands and do the things you usually do to not catch the usual seasonal flu -- eat well, drink plenty of fluids, get rest -- all bolster your immune system.

Will we have a replay of "the Great Plague," as the 1918 pandemic was called? Not likely. Times have changed. Living conditions have improved. Sanitary conditions have improved. Underlying health status has improved. Healthcare has improved.

Be aware, but don't be swept away.

Coroner riffs on heroin deaths

As one of the local police chiefs told me today: “it is your fault”. I pushed out the information a little while ago that we have had an increase in our number of heroin deaths, with a significant peak last December, and demonstrated with test results that it is at least in part due to an increase in the purity of the local heroin. Apparently because of that heroin deaths are really getting noticed. Other counties have put out information that they, too, have seen increases in their numbers. Newspapers, TV and radio stations have done reports. Everyone wants something done and those that can do something want to do something (hence the police chief’s call).

We need to guard against misinformation and incorrect conjecture about who, what where, and why. In our county (and I would guess the same is true in other counties) the heroin deaths are occurring throughout the county, across geographic and socioeconomic “boundaries”. With many of them, particularly among the young victims, there seems to be a significant predilection for those with disposable income and extra free-time (just as we see in underage drinking, although I know they are very separate problems).

This is not a “gang problem”, as some would have you believe, it is easier to say it is gangs (the others) than to work to seek out the real sources and solutions. While a big local source is the “west side markets in Chicago”, our local resellers are local kids/folks in affluent and poor neighborhoods alike.

I have been asked in a couple of recent interviews (including one yesterday for a Chicago college newspaper) is it the increased purity alone or is there increased use. I believe it is both. The “new” heroin is deadlier and more addicting. It is easier to use, you can inhale it and you don’t have to inject it. One “new” group of users we are seeing are those folks who start with pain pill use that progresses to over-use and abuse. Then for several reasons they switch to heroin, it is cheaper, easier to get with no doctor or ER shopping required, also when your doctor cuts you off you have to go somewhere.

What to do? I do know that we have to use all the resources we can, all of the sources of information that we have (including the previously unused information that Coroners and MEs have). We need to increase addiction treatment availability, the entire spectrum of treatment options. We need to inform folks that this is happening and not let the public and public officials ignore the problem. This is going to require work and cooperation. Not just the Coroner, not just police and other law enforcement, but moms and kids and other just plain folks. We must get creative with solutions and with information acquisition.

What we are doing now isn’t working. People are dying, kids are dying (an 18 year old last Friday).

Coroner gets bouquet of bones for Spring

Aah, the first signs of spring. The crocuses are blooming and the daffodils are pushing up through the ground. And one of our “signs of spring”, the bones are appearing

We have had several “bone cases” through the last couple of weeks. People, and particularly dogs, find the bones as the snow goes away. Folks are concerned that they may have happened upon some grisly murder and dismemberment scene and we get called. We get called either directly by the finder or, more commonly, by the law enforcement agency that the bones are turned into.

The picture posted above actually involved a radio interview (XLC) because one of the morning show’s host’s dog found the bone. The host was convinced that it was a human bone, the victim of an ax murder. To her dismay, it is a much more mundane animal bone, not human.

I am glad to say that all of our cases have been animal bones, so far this year. It does happen that we get a human bone or skeleton from time to time, again particularly in the Spring

Cyanide death

Although we don’t encounter cyanide related deaths very often, I have written about it before.

We had a cyanide death recently in our County. Word of the woman’s death “leaked” to the media and I got a half dozen calls from various outlets. I say “leaked” because I didn’t report it to the media (I get calls daily asking for information on “reportable deaths”, i.e. deaths they can do news stories on) because in our ongoing investigation at the time we were trying to decide between suicide and accident (the local media does not do stories on suicides, unless they are public).

The woman had died by inhaling cyanide gas, there was no evidence of a caustic ingestion, after generating the gas by mixing crystalline cyanide with an acid (or possibly with water, although this is a less “efficient” chemical reaction to generate hydrogen cyanide gas than the acid).

The media questions were interesting, but settled into disappointment after talking with me. I still do not know where their limited (incorrect?) initial information came from. I got questions like: Was she murdered? Did someone inject her with the cyanide? Was she hit and then given the cyanide? Etc.

No real story here. Based on our now completed investigation it appears it was an unfortunate accident. She apparently had the cyanide in her home for over 15 to 20 years. She had gotten the opinion of a “chemist” and/or from the internet that cyanide loses it toxicity over the years and becomes non-toxic after 20 years (important note: that is not true!). She did post a warning to anyone who might be entering her home that there was cyanide in her home. We surmise that she was cleaning up the cyanide in her basement (likely in preparation to move south) when the gas was generated by chemical reaction and she was overcome and died.

More on deadly heroin

Headline 1 today: Spike in suburban heroin deaths

A story about the apparent increase in heroin related deaths across several local counties, with a law enforcement report of increased heroin seizures and arrests. It even mentions an increase in folks seeking treatment of heroin addiction in the area (great to see that).

Headline 2 today: Heroin in Fox Lake death of lethal purity, official says

(That official being me) An article about our finding (of course, with the help of DEA testing) increased purity/concentration of heroin in at least some of our cases as an explanation of Headline 1.


Increased availability of increasingly deadly heroin, what a foundation for disastrous consequences.

Law enforcement needs to cooperatively work to track and stem the flow (we will do all we can to help here), courts need to push folks to treatment, and treatment programs must gear up to treat those in need; or we will continue to see increased business from a drug originally spelled “heroine”.

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.

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.

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.

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.

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.

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.

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).

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.

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.