Mapping Coroner Data

Our office almost seems awash in County maps. Maybe awash is hyperbole, but how often do you get to use words like that. Actually we have 4 large (like 3 X 4) maps, not counting our even bigger detailed map of the county. The reason for the 4 maps is that sometimes is “better” to look at something graphically than just numbers and letters on a sheet of paper or computer screen.

We started with one plotting the locations of illicit drug overdose deaths (primarily those involving cocaine and heroin). We have 3 years of data on one map and another with stick pins for this year as we add deaths. It is interesting to see the dispersion across the county of these cases. They aren’t in just the “bad neighborhoods” (I live in Waukegan, considered by many as one of those “bad neighborhoods”), but also in many affluent areas of the county. Free time and disposable income are contributing factors.

The other 2 maps were projects we gave our interns with 4 years of data on each. One map is violent deaths, gun-related and other homicides, along with house fire deaths. The other has car crashes and train related deaths. The violent deaths do clump more in certain communities verifying what most folks would suspect, but it is interesting to see it mapped. The car crash map tells us that there are no particularly fatal intersections or stretches of road that we ought to push to fix.

I think it is interesting stuff and a nice way to get a handle on a bit of the information that flows through the Coroner’s Office.

Quotes about kids (link sent by a friend):

Children have never been very good at listening to their elders, but they have never failed to imitate them.
James Baldwin

Your children will see what you're all about by what you live rather than what you say.
Dr. Wayne Dyer

Driving Distracted Kills

Report that could have saved lives is buried for 7 years, holy mackerel.

… cellphone use behind the wheel "has contributed to an increasing number of crashes, injuries and fatalities."

… a problem that could be as bad as drunk driving…

We have seen car crash deaths in which the driver’s cell phone “rang” moments before the crash and likely contributed to the crash. It is a little harder to check to see if they had dialed out, but no doubt there were some of those as well.

Driving distracted is deadly and it is great to finally have the data to prove that released. At the very least, the dangers of driving distracted need to be taught to teens in tandem with the dangers of driving intoxicated from whatever source. Parents need to warn their kids. PSAs (do they do PSAs anymore?) need to heat the airwaves. It is a real threat to the lives of folks in cars. And I think particularly the young, just based on their volume of phone use.

IL HB 497 (awaiting Governor’s signature)

Synopsis As Introduced
Amends the Alcoholism and Other Drug Abuse and Dependency Act. Provides that the Director of the Division of Alcoholism and Substance Abuse within the Department of Human Services may publish an annual report on statewide drug overdose trends, may establish a program to provide for the publication of drug overdose prevention, recognition, and response literature, may provide advice to State and local officials concerning drug overdose problems, and may award grants to create or support local drug overdose prevention, recognition, and response projects. Requires a health care professional prescribing an opioid antidote to a patient to ensure that the patient receives certain patient information; provides for immunity from disciplinary or other adverse administrative action; and provides for administration of an opioid antidote in an emergency. Requires the Director of the Division of Alcoholism and Substance Abuse, in consultation with statewide organizations, to develop and disseminate to health care professionals, community-based organizations, substance abuse programs, and other organizations training materials in video, electronic, or other formats to facilitate the provision of the required patient information. Effective January 1, 2010.

I think it is great that this bill passed and I hope the Governor signs it to move it along. It will need to go to another governmental committee (I forget the name) where they flesh out the details and hopefully that will go well.

It will be good for everyone to be aware of statewide (and, I hope, regional) trends pertaining to drug overdose. I also hope that the reporting will include information on the nonfatal overdoses. It will be easier to target prevention and intervention based on real data.

In addition to that, making Narcan available in the community (with education and training in its use for emergencies) will undoubtedly save lives.

I look forward to the implementation of this new law and we can join some other states in these prevention efforts.

Hopeless teens, self-fulfilling prophesy

Talk about an OMG moment. I first heard about this on the radio this morning, and then I came across this article:

A surprising number of teenagers -- nearly 15 percent -- think they're going to die young, leading many to drug use, suicide attempts and other unsafe behavior, new research suggests.

…a sizable number of teens may take chances "because they feel hopeless and figure that not much is at stake,"…

I still need to track down the study, but I would rate this as one of the most upsetting study findings I have come across in some time.

Where do these teens get this message? What can we do to give them the information/knowledge that that is in fact not the truth? If this is a prime motivator behind substance abuse, violent behavior and risk taking in this number of teens, we need to have a new focus in dealing with these kids. How do we affect behavior that has this type of an underpinning?

Married to dope

My wife got a book recently that she said I should take a look at. It is “Esquire Presents: What It Feels Like:…” by AJ Jacobs. It is an interesting, quick read with short essays on things like what it is like to be gored by a bull or survive a hurricane. I wanted to share one bit from “What It Feels Like To Do Heroin”. I share this so that it can inspire parents, schools, and other groups to push primary prevention; to work hard to prevent that first use. So that people ensure access to secondary prevention (treatment) and, maybe, reduce a bit of the stigma of seeking help and the stigma attached to those people who become users:

Everybody looks at you with reproach…you are married to dope. It’s more than half your life. It is your life. All you want is to be high. And if you are sick, all you want is to get right. It all comes down to one thing: The first time you did heroin you felt better than you’d ever felt in your entire life.” (David “Wilson”, 41, former addict)

This essay is about heroin, but it equally applies to prescription pain meds and any number of other addictive drugs.

I am reading a report on the growing crisis with prescription drug overdoses, more on that later.

Healthier Community

I went to a presentation by Dr. James Galloway the other day. It was in support of a pilot program in Chicago to “Build a Healthier Chicago”. Their website is worth a visit.

They are working to develop plans to improve the “pre-medical” parts of our healthcare crisis, as well as working with the more traditional outlets of medical care. They feel that our current situation can be summed up:

Physical activity (lack of), nutrition (unhealthy), and smoking are the three most important areas to target to improve the health of our nation.

I applaud their efforts and it would be great to bring a similar effort here and across the country.

The idea that individual health choices and personal behaviors are the most important determinants of chronic disease is an idea whose time has come…(George Menasah, MD)

But while individual choices are important:

…it is unlikely that individually attempted changes in lifestyles and behaviors alone can avert the growing epidemic of chronic disease that we are witnessing.

As long as a burger and fries are cheaper and more accessible than fruits and vegetables, as long as kids’ brains are bathed with seductive media blitzing in support of unhealthy diet and activity choices, as long as the community does not value and encourage healthier lifestyles, they will not happen. We need a community effort for a healthier community. We need to change our social norms to support/encourage a healthier (and safer) community.

"No one deserves to die by overdose"

…deaths from drug overdoses have been rising and have reached crisis levels in our country. A newly-released report by the Drug Policy Alliance documents the extent of the problem: drug overdose is now the second-leading cause of accidental death in America, surpassing firearms-related deaths. And it's not just young people who are dying of overdoses: overdose is the number-one injury-related killer among adults aged 35-54.

This is true not only with illicit drugs but also with the misuse, overuse and abuse of prescription drugs.

But efforts to implement … solutions are hamstrung by a drug-war mentality in which there are "good" drugs and "bad" drugs and, by extension, good drug users and bad drug users, the latter seen as somehow deserving of death when they overdose. No one deserves to die by overdose. Everyone deserves a second chance at life, and to be treated compassionately …
We need to accept the reality that people will always use drugs, whether legal or illegal, prescribed or sold on the street, mood or performance enhancers, pain killers or stress reducers or sleep-enablers. We are a nation of drug users. We must learn how to reduce the harms associated with our drug use, including reducing the unconscionable and unnecessary number of deaths from overdose.

We must address this problem in new ways. Not just law enforcement, although that is critical, but with well thought out plans and programs. We must use every piece of information that we can access to tackle this crisis. Education, primary prevention before folks use, secondary prevention to prevent relapse and reuse, making a wide variety of treatment available because there is no a one size fits all solution. We must work together, because this is not their problem, it is not my problem, it is our problem. People shouldn't feel as if their toes are getting stepped on or they are being upstaged by someone "out of the box" before they are. There is plenty of work to go around and we all have to work together to get this work done.

Where death delights to help the living

I like this line (it came to me on a listserv; sorry, I wrote it down without the name of person who contributed it and I don’t believe they cited the author), unfortunately the Latin line looks to be a bit long to put over the door to our office building (would be cool though):

Hic locus est ubi mors gaudet succurrere vitae

This is the place where death delights to help the living

Healing Community Problems

I was listening to a radio program a few weeks ago (At Issue on WBBM, no link). The folks being interviewed represented a few anti-violence programs in Chicago and had several interesting points. One of the things someone brought up was a list of 3 things that interfere with finding and applying solutions to problems, community problems in particular. I think the list is applicable to a number of problems, not just violence, so I thought I’d put them in here:

First, people won’t work to solve a problem that they don’t think affects them, that they don’t think is theirs. If you see a problem as someone else’s or can convince yourself that it is the other guy’s problem, you think they should work on the solution. I don’t have to; it is your problem you fix it.

Second, people don’t care about the problem. Granted a number of folks just don’t care about much of anything, but his doesn’t mean they are all uncaring people. Many have enough other problems that they don’t have room on their plate for something else to “care about”. When you are scrambling to get food on the table and a roof over your head, you may not “care” about violence outside your house.

Third, if people do not know what works they get overwhelmed thinking of or trying a solution and may quit. We need to put proof that there are solutions that work in the hands of the folks who can and will work toward a solution. The proof must be real and fact-based, not anecdotal. In the case of community violence, there is very good evidence that CeaseFire and it violence interrupters and other interventions work and should be in widespread usage.

To get the community together on working to address/solve community problems we must show them that it affects them, tell them why they should care, and show them what works for a solution. We can work together for community solutions and community healing of a wide range of problems. Community problems can only be solved on a community basis.

Not that it has a much to do with the forgoing, but I have been wanting to share a quote I caught from Bill Murray on TV a while back:

It is not about doing the right thing; it is about doing the next thing right.

Substance Abuse Treament Clinic

I sent this out as a media release, from me personally, yesterday and I thought I'd also share it here:

I am the Lake County Coroner. I am also a husband and a parent. I spend some of my free time as the Medical Director of a new substance abuse treatment clinic in Waukegan, by the name of Green Dragonfly.

I agreed to serve as the Medical Director for a number of reasons. Drug overdose is the number one cause of "unnatural" deaths in Lake County. Something needed to be done. The aunt (Mary) of a 25 year old who died of an overdose while on the waiting list for a local treatment program demanded it. The son of an elderly woman who had become dependent (doctor talk for addicted) on pain medications because of inappropriate over-prescribing by her doctor sent me an email in July 2007 asking me where he could take her for treatment. I didn't know. Opiate-related (heroin and prescription drugs) deaths more than tripled 2007 to 2008 and continue high in 2009.

Green Dragonfly opened in October 2008, currently has 92 patients and continues to grow. Mary (mentioned above) put the clinic together and continues as its Office Manager. She asked for my help and I agreed. More than one third of the patients are being treated for addiction to prescription pain medicines or their addiction started with prescription meds. 60% are employed in a variety of jobs while in treatment. The patients live though out Lake County, in McHenry and Kenosha Counties.

Being in treatment helps these people stabilize their lives. People are less likely to break the law. People can be more productive, contributing members of society. Treatment restores them, improves their lives and improves our community.

This substance abuse epidemic must be attacked with prevention, education, and increasing the likelihood that someone who abuses drugs gets treatment by increasing the availability of treatment and eliminating the stigma of seeking help and getting treatment. I want to be able to tell the 6 mothers of children who have had recent overdose deaths that we are doing everything we can to try and prevent a 7th from joining their group.

Drug Info for Parents

A freind of mine sent me a link to this and now i share it with you (I haven't read the whole thing, so I do not vouch for the information, but it seems helpful through the part I have read):

A Guide for Parents to Educate Themselves About Drugs Before Educating Their Kids

...if you are a parent, sometimes saying “stay away from drugs, they are bad for you”, isn’t good enough...

How do you explain to them all of the drugs that are out there and why they are dangerous and what they could do to you if you take them? Here is a list of drugs that every child should be aware of. It may be lengthy, and going over all this information with your children could take a while, but you have to remember that it is for their benefit as well as you, the worried parent.

They are us

I participated in a town hall meeting last evening about an apparent increase in drug use and drug-related deaths locally. One thing (among many) got me thinking afterwards. A couple of the presenters pushed the point that the young people who have died or otherwise used and abused drugs (heroin being a primary focus of the event) bought the drugs outside the area they lived in. This is not really true according to our investigations and other information sources, but that is the story they pushed. I made the point that these young people (the audience being primarily parents) are, quite often, getting their drugs in their own neighborhoods. Sure, before they are resold here someone gets them in Chicago or Milwaukee, but the end users can and do get the drugs close to home.

One speaker described how dangerous and scary the places where drugs are sold are. How his agents, when they do drug buys, have 4 back-ups watching over them to help if the need arises. How violence can erupt at any time. (Although it seems to me that they are the police and their buying introduces variables that do not exist in the more typical drug buy.) I know some of these places are rough and potentially dangerous, like places on the west side of Chicago. But to painting them so ominously, so evil, particularly areas near where I live (North Chicago and Waukegan were specifically mentioned) does seem a bit melodramatic (for crying out loud, I live in Waukegan with my family). Realize that nearly all drug buys go off without a hitch or we would have dead addicts littering our streets.

My thought here is that this smacks of feeling the need to paint these folks as the other, the evil other. Demonize them and we don’t really have to deal with them. They are outside our communities. They live and do evil things elsewhere. Our community is safe. It (the bad stuff) is only outside our community. Sure sometimes it creeps in and affects one of our own. But it is not us, it is them. It is evil contagion from outside. We don’t have to deal with the ickiness, just continue to buff up our stuff.

One of the points I hope I made was that young people are getting the drugs, quite often, near home. The drug sellers are often “us”. The drug users and abusers are “us”. They are among us. Very often you can’t tell by looking at them. They work in our stores and restaurants. They walk by us on the streets and go to school with our kids. They aren’t fiends. They don’t look like the alleged meth user pictures on the Internet that one of the presenters showed.

We as a community need to respond to saves others in our community. Our focus must be more than arrest and imprison. We must make sure help and treatment is available. We must get rid of the stigma and shame that often accompanies seeking and getting help for drug use or mental health issues. “They” are not “others”, they are “us”.

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).