Difficulties in Determining a Drug Overdose Death

Difficulties in Determining a Drug Overdose Death By Maia Szalavitz June 16, 2010

…the case [see full story] has also highlighted the difficulty of accurately determining if a cause of death is indeed a drug overdose.

Six years later, there has been no progress on this front: there is still no way to determine if or what drugs are responsible for death, even as the drug-war propaganda insists on claiming the opposite .

“You can die from a drug and you can die with a drug,”

Many drugs that may be contained in fatty tissue in a living body are released into bodily fluids after death,

Circumstances of death surrounding drug use are also often difficult to untangle:

In the Schneider case, virtually all the patients who died were found to have multiple drugs in their bloodstream, often including illegal drugs; in addition, many of the patients were known sufferers of chronic pain with chronic, life-threatening diseases such as heart disease and high blood pressure — conditions that can cause death on their own, without drugs.

Dr. Steven Karch, a cardiac pathologist based in Berkeley, Calif., who has written two widely respected texts on the topic. On June 7, he testified for the defense in the Wichita case, stating that in most instances of drug overdose, the currently available medical technology cannot accurately determine whether or which drugs caused death.

Several scientific factors conspire to complicate the issue:

  • First is the widely acknowledged question of tolerance.

Patients who take pain medications over the long-term will necessarily build up some amount of tolerance to the drugs. That means that a dosage of a painkilling opioid such as methadone or fentanyl that would be therapeutically appropriate for a pain patient could be enough to kill a person who has never taken them before; in a methadone patient, an extremely high dose might not even be enough to address withdrawal symptoms.

In other words, Karch says, the “lethal dose” of these drugs is impossible to standardize, even for patients who are taking a single drug rather than a combination of many.

A 2000 study by Karch compared methadone patients who had died from clear causes, such as car accidents, with those who had died of a suspected overdose. Karch found that there was no predictable difference in the postmortem blood levels of methadone between the two groups.

“You can die from a drug and you can die with a drug,”

says Karch. “When you have four orders of magnitude separating either end of the curve, many of these deaths may not have to do with drugs at all.”

  • A second complication in cause-of-death findings is what medical examiners call “postmortem redistribution,”

Many drugs that may be contained in fatty tissue in a living body are released into bodily fluids after death, which confuses the analysis of substance samples taken postmortem.

In a study published in March in the American Journal of Clinical Pathology, Apple and colleagues measured fentanyl levels in bodies immediately after death and again several hours later at autopsy.

The researchers found that

  • some bodies had no detectable levels of the drug at the first measurement but
  • showed significant levels at the second — and that these levels varied widely depending on which part of the body was sampled.

juries across the country are in some cases hearing evidence based on shaky forensic science or from forensics professionals who lack the necessary expertise.

It’s a giant miscarriage of justice,” he says.

He recalls the malpractice and murder convictions that were won many years ago against doctors who were thought to have killed patients by administering digoxin, a drug for arrhythmia and other heart problems.

It turned out that the drug collected in the heart muscle in live patients and was released into the body after death, making safe doses of the drug look deceptively high — a result similar to those seen in current studies of fentanyl and methadone.  


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