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The Office of the Chief Medical Examiner, Virginia Department of Health.

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Presentation on theme: "The Office of the Chief Medical Examiner, Virginia Department of Health."— Presentation transcript:

1 The Office of the Chief Medical Examiner, Virginia Department of Health

2 Deaths from Heroin and Prescription Opiates in Virginia: An Overview William T. Gormley, MD, PhD, Chief Medical Examiner Rosie Hobron, MPH, Forensic Epidemiologist Data Sources: Office of the Chief Medical Examiner, Virginia Medical Examiner Data System (VMEDS)

3 Office of the Chief Medical Examiner Code of Virginia § Investigation of deaths: obtaining consent to removal of organs, etc.; fees

4 Deaths from Heroin and Prescription Opiates

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7 Heroin and Prescription Opiates Heroin under-represented Heroin is Morphine Pro-drug Diagnosis of Heroin COD 6-Acetyl Morphine Circumstances Opiates – prescription vs. illicit Medical Records Scene and circumstances

8 Heroin 3,6 Diacetyl Morphine 6-Acetyl Morphine Morphine Inactive Metabolites T ½ 2-3 min T ½ < 5 min T ½ 2-3 hours

9 Definition Half Life The length of time it takes the concentration of a drug in the blood to decrease to ½ of its current value

10 Heroin Diacetyl (3,6) Morphine T ½ 2-3 min Inactive but rapidly converted to morphine Liver – glucuronide – kidney RUSH occurs while conversion to 6-MAM and morphine in brain

11 6-acetyl morphine Monoacetyl morphine T ½ less than 5 min Psychoactive metabolite, somewhat more potent than morphine May be responsible for RUSH Greater histamine release than morphine when IV

12 Morphine T ½ 2 – 3 hours Liver – glucuronide - kidney

13 Heroin 3,6 Diacetyl Morphine 6-Acetyl Morphine Morphine Inactive Metabolites T ½ 2-3 min T ½ < 5 min T ½ 2-3 hours

14 Heroin > 20% average annual increase over decade 35% increase from 2011 to % increase from 2012 to 2013

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16 Opiates – Prescription vs. illicit

17 Prescription Opiate Drugs 4 % average annual increase over 7 years 13% increase from 2012 to % projected increase from 2013 to 2014

18 Heroin and Prescription Opioids

19 Heroin and Prescription Opiate Drugs From , nearly 70% of all drug/poison deaths were attributed to opiates.

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21 Surveillance Roles Situational Awareness Monitor death incidence as close to real time as possible. Forecast and warn public. Prevention Identify strategies. Evaluate and document result of strategy implementation.

22 Surveillance Data OCME Death data delayed by 3 to 6 months Other data streams include: Hospital and ER admissions – VDH Law enforcement drug seizures – DFS Law enforcement intelligence – i.e. Fusion Prescription Monitoring Program (PMP)

23 Summary Heroin under-represented Heroin is Morphine Pre-drug Diagnosis of Heroin COD 6-Acetyl Morphine Circumstances Opiates – prescription vs. illicit Medical Records Scene and circumstances General increase in deaths from both over the last decade. Heroin approximately 20% per year, 35% in 2012, >50% in 2013 Prescription opiates approximately 10% per year, 15% in 2012 Surveillance Situational Awareness Identify Prevention Strategies Evaluate Prevention Strategies


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