In the rural and suburban communities where the opioid epidemic has hit hardest, so many people are dying of overdoses that medical examiners are unable to autopsy all the bodies. That means critical information—including accurate tallies of drug deaths that are used to inform policy—may be overlooked.
According to Vice News, an estimated 70 medical examiners offices around the country have accreditation from the National Association of Medical Examiners. NAME requires that no single medical examiner perform more than 250 autopsies a year, to minimize potential errors and ensure a standard of quality is met.
“If you go over that line, you’re more likely to make mistakes, take inappropriate shortcuts, etc.,” NAME president Brian Peterson explained to Vice. “If you’re under that line, you’re more likely to do a thorough job.”
The problem is, the opioid crisis has produced a massive increase in the number of bodies that indicate drug abuse as a possible cause of death. While full-body autopsies were once the standard way to establish proof of an overdose death, medical examiners’ offices are instead sending off samples for toxicology screenings. The practice keeps the number of autopsies down so the examiner's accreditation isn’t threatened. But it also means that once an overdose is ruled out, there’s no way to examine the body to establish the cause of death. The wait for a toxicology report to be completed can be as long as a month. By then, the body has generally been buried or cremated.
“The risk is to possibly miss an alternative cause of death,” Thomas Andrew, former chief medical examiner of New Hampshire, told the UK’s Daily Mail.
The way to solve the problem would be to increase the number of staffers, but that would require more resources and credentialed professionals to fill the jobs. Most ME offices don’t have budgets that would allow them to take on more hires.
“It's not like people are sending extra funds our direction,” Peterson, who in addition to his role at NAME is a medical examiner in Wisconsin, told the Daily Mail.
Connecticut’s Office of the Chief Medical Examiner experienced a threefold increase in the number of opioid-related deaths last year. The office performed so many autopsies its accreditation was removed this year. Chief medical examiner James Gill hardly expects to get the money his office would need to hire staff to meet demand. In the past, the state legislature hasn’t “been willing to fund us to the level we need,” Gill told Vice.
“It has strained our resources, our finances,” Andrew told the Daily Mail. “We can't use all of our resources to just do drug deaths. Where would the traffic crashes fit in? Where would the suicides fit in?”
Another issue is that there just aren’t that many forensic pathologists in the field. Vice points out that “just 35 people graduated from U.S. and Canadian medical schools and became forensic pathology residents in the 2015-2016 school year, according to the Association of American Medical Colleges.” If budgets were adjusted, the task of filling those positions would still be difficult.
“We just don’t produce enough new medical examiners each year to serve the country,” Thomas Baker, a Minnesota-based medical examiner, told Vice.
Without the clarity that autopsies provide, there’s a chance record-keeping around opioid deaths could be off. One University of Virginia study suggests that various issues result in opioid deaths being undercounted by as much as 20 percent. As Vice warns, those miscounts mean “prosecutors can have a harder time proving cause of death in criminal cases, and states may miss crucial public health information, especially during a crisis of unprecedented proportion.” Already tight budgets are likely to remain that way if death tolls are underestimated.
Jeff Sessions has suggested the Department of Justice will relaunch the war on drugs, although by every measure, the lengthy campaign was an unmitigated failure. Don Winslow, author of The Cartel and The Force, recently offered a list of the drug war's consequences in a piece for Time.
After five decades of this war, drugs are cheaper, more plentiful and more potent than ever (as Mr. Sessions himself has conceded)...The so-called War on Drugs quadrupled our prison population (overwhelmingly and disproportionately composed of minorities), handed out life sentences to nonviolent offenders, militarized our police forces, promoted the disgusting concept of for-profit prisons, shredded the Bill of Rights and cost taxpayers upward of a trillion dollars.
A World Health Organization survey recently found that America leads the world in illicit drug use. The U.S. also jails more people than any other country, by percentage and raw numbers.
Instead of the relaunching the war on drugs, the U.S. would do well to look at other countries with more successful responses to drug problems. In 2001, Portugal changed its laws to be less punitive for users caught with small amounts of drugs, and also instituted an aggressive public health campaign to address issues around addiction and drug abuse. Decriminalization has helped drive down overdose rates in the country drastically. New York Times columnist Nicholas Kristof notes that Portugal's “drug mortality rate is the lowest in Western Europe — one-tenth the rate of Britain or Denmark — and about one-fiftieth the latest number for the U.S.” In the U.S., which had 64,000 drug overdose deaths in 2016, an increase of just over 20 percent from the year prior, the number of deaths is expected to be even higher this year.
“Most of us went [to] and are in this field because we can handle [it] emotionally. But what’s changed is, it’s just non-stop,” Kent Harshbarger, a forensic pathologist in Ohio, told Vice. “It’s like drinking from a firehose. It’s just coming too fast.”