Forensic Doctor Tells Congress: Not Enough Medical Examiners to Deal with U.S. Opioid Deaths

ST. JOHNSBURY, VT - FEBRUARY 06: Drugs are prepared to shoot intravenously by a user addicted to heroin on February 6, 2014 in St. Johnsbury Vermont. Vermont Governor Peter Shumlin recently devoted his entire State of the State speech to the scourge of heroin. Heroin and other opiates have begun …
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WASHINGTON, D.C. — Fatalities from the ongoing opioid epidemic gripping the United States are fueling “personnel shortages” and equipment failures within America’s “death investigation system,” a forensic doctor told lawmakers Thursday.

According to the most recent data from the U.S. Centers for Disease Control and Prevention (CDC), drug overdoses in 2015 yielded an unprecedented 52,404 deaths, including 33,091 (more than 60 percent) that involved an opioid.

“The opiate crisis is a slow moving mass fatality event that occurred last year, is occurring again this year, and will occur again next year. Each year getting worse than the previous,” declared Dr. Thomas Gilson, the chief medical examiner for Cuyahoga County in Ohio, dubbed the nation’s overdose capital in late 2016.

Dr. Gilson’s comments were part of his written testimony prepared for a synthetic opioids hearing Thursday held by the Senate Homeland Security and Government Reform Subcommittee on Investigations.

The forensic pathologist pleaded U.S. lawmakers for more funds to combat the increase in heroin-related deaths facing the coroner’s office in his jurisdiction and those across the rest of the nation, saying:

At this time, however, local resources have been exhausted. The Death Investigation System and local Forensic Labs are now facing double-digit caseload increases annually, personnel shortages, equipment breakdown and failure and costly and complex processes to identify, catalog, standardize, and confirm an ever-changing menus of substances known as novel synthetic opioids — the fentanyl analogs.

Fentanyl refers to a powerful synthetic opiate that is driving opioid-affiliated deaths.

This year, the coroner’s office in the Dayton, the capital of Ohio, reportedly ran out of room for opioid overdose bodies.

Dr. Gilson told Senators the epidemic is overloading the entire country’s death investigation system, noting:

There is a national crisis in death investigation. My field of specialty, forensic pathology, is in dire need. Less than 500 forensic pathologists practice in the United States. Currently, 28 different offices across the United States are seeking to hire forensic pathologists. As the oldest training program in existence, our office is one of only 35 in the country. Our program graduates 1 or 2 doctors a year in a system that only produces a few dozen new forensic pathologists annually. It is essential that additional support be given to these programs as well as incentives for doctors to enter this field.

Experts who testified during the Senate panel hearing stressed the need to tackle the deadly problem associated with the use of fentanyl.

“Chemical flows from China have helped fuel a fentanyl crisis in the United States, with significant increases in U.S. opioid overdoses, deaths, and addiction rates occurring over the last several years,” reported the U.S.-China Economic and Security Review Commission this year.

Most of the fentanyl in the United States originates in China.

“According to U.S. law enforcement and drug investigators, China is the primary source of fentanyl in the United States. Along with shipments sent directly to the United States, fentanyl is shipped from China to Mexico and, to a lesser degree, Canada, before being trafficked across the U.S. border,” noted the commission.

“China is a global source of fentanyl and other illicit substances because the country’s vast chemical and pharmaceutical industries are weakly regulated and poorly monitored,” it also said.

An official from the Customs and Border Protection (CBP) component of the U.S. Department of Homeland Security (DHS) told lawmakers that fentanyl seizures have skyrocketed in recent years.

Robert Perez, the acting executive assistant commissioner for CBP’s operations support, testified that the agency’s fentanyl seizures increased more than 200-fold from 2 pounds in 2013 to 440 pounds last year.

The CBP official acknowledged that interdicting fentanyl and other synthetic drugs, primarily smuggled through official ports of entries (POEs) and the international mail system, presents a “daunting task” for the federal government.

“Fentanyl is the most frequently seized illicit synthetic opioid, but CBP has also encountered various types of fentanyl analogs,” Perez told lawmakers.

The U.S.-China Economic and Security Review Commission added, that “the combination of the drug’s potency and affordability has made fentanyl an increasingly common drug in the United States, often mixed with heroin or cocaine — either intentionally or without the user’s knowledge — to increase its euphoric effects.”


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