FY2023 Coverdell. Strengthening death certification and detection of emerging drug trends through improvement of toxicology testing at autopsy.

Proposal Abstract

The Arapahoe County Coroner’s Office (ACCO) proposes to implement extended toxicology testing on all coroner cases where toxicology testing is indicated.  Cases under the jurisdiction of the ACCO grew from 607 in 2019 to 891 in 2021, with the number of postmortem examinations rising precipitously from 493 (2019) up to 739 (2021), a 50% increase in caseload that is most significantly driven by the fentanyl epidemic and emergence of other substances.  In 2019, death certifications in Arapahoe County included 29 fentanyl-related deaths and a total of 111 deaths by accidental overdose, while in 2022 those numbers increased to 128 fentanyl-related deaths (a 341% increase) and 201 overdose deaths, similar to numbers seen nationwide.  While we have seen a marked increase in drug-related deaths, our annual toxicology budget has not been funded at a reciprocal rate, with a resultant deficit in funding which requires cutting corners whenever possible.  

Medical Examiner and Coroner (ME/C) office across the country are in a unique position to act as an early notification system for emerging drug trends within their communities through identification of novel substances involved in fatalities investigated by those offices. Unfortunately, emerging substances are not commonly covered by basic toxicology panels and require more expensive expanded panels that have a broader scope of testing which is better suited for capturing emerging trends in dangerous intoxicants.  Our toxicology budget does not provide funding to meet our current workload or realize an increase in capacity; unfortunately we expect to see a continued rise in cases due to the ongoing epidemic of opioid and synthetic drug related deaths along with the sustained population growth within our county. Current budget-driven practices are to order only a basic panel on suspected illicit drug overdose deaths, and to refrain from toxicology testing when a traumatic cause is evident (primarily suicides and traffic-related deaths). Insufficient testing of current cases fails to identify emerging or novel substances, fails to provide families and community partners with valuable information, and fails our public health duty to provide informative data for early detection and ongoing prevention. The proposed project will provide funding for ACCO to bridge the gap between the current toxicology budget and the resources needed to allow for extended toxicology testing on all coroner cases including cases of traumatic deaths, in order to evaluate the presence of emerging substances within the community.  By providing detailed toxicologic data, more complete cause of death determinations will occur, and the understanding of correlations between substances and causes and manners of death will be significantly improved.  This action will serve not only the citizens of Arapahoe County, Colorado, but also provide useful information to integrate with data from other Colorado counties and for national statistical analysis to provide greater insight into trends in toxicology.