Pubdate: Thu, 29 Dec 2016
Source: Knoxville News-Sentinel (TN)
Copyright: 2016 The Knoxville News-Sentinel Co.
Author: Kristi L. Nelson


Chief Medical Examiner Dr. Darinka Mileusnic-Polchan speaks as the
Regional Forensic Center released its 2010-2015 Drug-related Death Report
for Knox And Anderson Counties Monday, August 15, 2016 in the small
assembly room at the City-County Building. (MICHAEL PATRICK/NEWS SENTINEL)

Dr. Amy Hawes, assistant medical examiner, explains a portion of the
Regional Forensic Center's 2010-2015 Drug-related Death Report for Knox
And Anderson Counties on Monday, Aug. 15, 2016, in the Small Assembly Room
at the City County Building. (MICHAEL PATRICK/NEWS SENTINEL)

Dr. Darinka Mileusnic-Polchan, Knox County's chief medical examiner,
discusses the findings Monday, Aug. 15, 2016, of a study of drug-related

Dr. Amy Hawes, at podium, assistant medical examiner, and John Lott,
director of the Regional Forensic Center, explain a portions of their
2010-2015 Drug-related Death Report for Knox And Anderson Counties Monday,
August 15, 2016 in the small assembly room at the City-County Building.

Drug-related deaths in Knox and Anderson counties have doubled over the
past five years with a drug-related death rate higher than either the
state or the country.

Between 2010-2015, the two counties' combined drug-related deaths jumped
from 101 to 200 - from 12 percent to 19 percent of the total autopsies and
exams conducted in those counties.

Three-quarters of drug-related deaths in those two counties involved
prescription drugs - not illicit "street" drugs - though that may change
as prescription drugs become more difficult to obtain.

The Knox County Regional Forensic Center released a report Monday on
drug-related deaths in Knox and Anderson county between 2010-2015, in an
attempt to shed light on the growing drug-related death problem in East
Tennessee and the need for a system to track and address it.

The report also found that, although the number and types of drugs linked
to deaths have increased over those five years, oxycodone was always the
most frequently found drug in drug-related deaths.

Drug-related deaths occurred most often among people 45-54 years old,
followed by people 55-64 and 35-44.

And five ZIP codes - 37918, 37920, 37917, 37912 and 37849 - consistently
had more residents dying from drug-related causes.

"Based on the Knox and Anderson county data, drug-related deaths occur
mainly with people you work and go to church with and the parents of the
kids our kids play and go to school with," said report author John Lott,
senior director for the Knox County Regional Forensic Center. "They live
next door and in our neighborhoods.

This data can't tell whether drugs were prescribed to the deceased, or
diverted, or whether they were taken as prescribed - only that they
contributed to the death of the person taking them.

But it does show the prescription painkiller oxycodone has led the list of
top 10 drugs found in drug-related deaths in the two counties from

Morphine, oxymorphone and alprazolam (a sedative often sold under the
brand name Xanax) were near the top of the list every year. Cocaine was
No. 6 in 2010 and in the top five every year afterward, and was roughly
three times more prevalent in the 45-to-54-year-old group than in any
other age group. The "detox drug" methadone, No. 4 in 2010, has been
steadily creeping downward but still made the top 10 every year in the
report, and buprenorphine (suboxone) deaths also have risen.

"Most people don't die from one particular drug alone," said Dr. Amy
Hawes, assistant medical examiner for Knox and Anderson counties. "It can
be a combination of drugs."

A common combination in East Tennessee is oxycodone and a benzodiazepine,
such as Xanax, she said.

"It has become very clear in recent years that the prescription drug
epidemic is bearing down on East Tennessee," said Knox County Mayor Tim
Burchett. "The target is constantly moving. Every time we think we're
getting a handle on the problem, a new one pops up, in the form of new
drugs or the resurgence of old ones."

The number of deaths attributed to fentanyl more than doubled over the
past two years. It was found in four deaths in 2010, two in 2011, nine in
2012, and five in 2013, but 18 in 2014 and 24 in 2015. Lott said that
includes both pharmaceutical fentanyl or and fentanyl produced in
clandestine labs, which means the potency can vary. The Tennessee Bureau
of Investigation has reported packets of heroin laced with fentanyl as
well as pure fentanyl packaged and sold as heroin.

Heroin showed up in the top 10 for the first time last year, found in 25
deaths. It wasn't recorded in any deaths in 2010-2013 but was found in 11
in 2014.

Heroin is metabolized more rapidly than other drugs, Hawes said, so the
center has adapted testing to account for that. That's been a fairly
recent change, so it's possible heroin use was under-reported in the
analysis. Still, anecdotally, some prescription-drug users are turning to
heroin as other drugs become more expensive and difficult to get, Hawes

"It's cheaper, and it's stronger" than prescription painkillers, Hawes said.

Lott said the center expects to see an increase in deaths related to
illicit or "designer" drugs, in part fallout from changing legislation
that regulates pain clinics and prescribing of prescription painkillers.

"Based on the data, we believe the 45-54-year-old age group will continue
to be the lead age group, followed by the 55-64-year-old age group," he

Already between Jan. 1-June 30 of this year, the center has seen 127 death
cases suspected to be related to drugs, although most of those cases
haven't yet been finalized.

"However, the current estimate does put us on a path to have more
drug-related deaths this year than in 2015," Lott said.

The report was prepared using data from certified death certificates and
medical examiner case files for autopsies and exams from Anderson and Knox
counties, because the center provides death scene investigation for those
counties and Dr. Darinka Mileusnic-Polchan is the chief medical examiner
for both.

The center has been informally collecting the data for years and was able
to analyze it because of increased staffing, Mileusnic-Polchan said.

It's limited, though, by the way the deaths are reported - or, in the case
of people who die in some hospitals and medical facilities, not reported
to the medical examiner's office. In some cases, a physician might certify
a cause of death on a death certificate that doesn't specify drugs were
involved; those cases aren't reported to the medical examiner's office,
either. Others have been caught when the medical examiner, as is required
by law, gets a cremation request for approval and finds the death might
have been drug related. In that case, the body is brought to the Regional
Forensic Center for exam or autopsy.

And drug use contributes to some deaths reported as traffic accidents or
suicides, Mileusnic-Polchan noted.

Tennessee has no statewide electronic death certificate system that can
collect data and share it in real time.

"We believe this report is an undercount of the total number of overdose
deaths," Lott said.

Lott and Mileusnic-Polchan propose training doctors, hospitals and medical
facilities on when death cases should be reported to the county medical
examiner, and want consequences in place for those who are properly
trained but still don't follow reporting requirements.

They're also prepared to ask for local funding for the center to help with
drug-related autopsies and toxicology testing they expect to continue to
increase. That "eats a up a large chunk of our operating budget,"
Mileusnic-Polchan said, "but we have to do it, because we have to know
what we're dealing with."

Finally, they want to address, at a regional level, a national problem:
the lack of consistent real-time monitoring and reporting of drug-related
deaths. The staff of the Regional Forensic Center has presented a plan to
the Office of National Drug Control Policy and other federal agencies to
try to get funding for a regional coalition, led by the center, that can
effectively monitor, report and compile data on drug-related deaths, along
with coordinating efforts to fight drug-related issues.

"These are not just numbers," Mileusnic-Polchan said. "There are people
(and) families behind these numbers."

Better data, the report said, can help organizations reduce drug deaths -
by, for example, knowing how to prepare for overdoses, or identifying
unscrupulous prescribers.

Karen Pershing, executive director of Metro Drug Coalition, said that
nonprofit found no surprises in the report. The coalition routinely hears
stories from family members affected by drug death looking for an outlet
for their grief, she said.

But the report, and subsequent tracking, can really help organizations
like hers "get in front" of trends in drug use to tailor prevention and
intervention efforts. Pershing hopes the center gains funding to
facilitate better real-time monitoring of drug-related deaths.

"Investing in the problem is critical," Pershing said. "Anytime we can get
more in-depth data ... the better off we're going to be."
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