Importance And Approach To Manner Of Death Determinations In Opioid-Related Deaths
INTRODUCTION: Accurate opining of manner of death by the forensic pathologist in cases of opioid overdoses is important for the families of the decedents and for public health purposes. While the majority of opioid deaths are accidental, suicide opioid deaths are likely under reported. This results in skewed vital statistics, preventing an accurate understanding of the opioid epidemic and impairing public health intervention.
CASE HISTORY: A 33 year-old male died of a heroin overdose. The manner of death likely would have been deemed accidental if not for strong evidence of suicide that emerged late in the investigation through dialogue between the forensic pathologist and the decedent's family. This evidence included text messages sent by the decedent shortly before his death that revealed his suicidal ideations and intentions.
DISCUSSION: This case highlights the importance of an engaged relationship between the medical examiner office and the decedent's family. A cooperative relationship can empower the family to participate in the investigation, which may provide useful information. Determining the manner of death in opioid deaths can be challenging, especially differentiating between accident and suicide. The cultural, religious, and legal implications of suicide further complicate this process. However, efforts must be made to reach accurate opinions, especially because manner of death data helps to inform the physicians, policy-makers, and others that are working to prevent opioid-related morbidity and mortality. A checklist of key investigative information and procedures is provided to assist the forensic pathologist when investigating potentially difficult manner of death determinations in opioid deaths.