Chemical Warfare on the Mind and Body.

Think about it. Could the current epidemic of drug deaths represent a kind of chemical warfare, where the weapon is the drug and the mechanism is the addiction? A veritable army consisting of 63,632 persons in the US died from drug overdose in 2016 1. Recently, half of the country has seen a significant increase in the rate of overdose deaths, largely driven by opioids (especially heroin, fentanyl and other synthetic opioids) but more recently with a new twist-a resurgence of drug deaths that include stimulants, particularly cocaine and methamphetamine (2, 3, and Fig. 1).


Fig. 1: Statistically significant drug overdose death rate increase from 2015-2016, US states Available at:

The causalities are in the prime of their life, able-bodied men and women in their 20’s to 40’s, and come from not just the demographic you think, but from all demographic and socioeconomic strata. Heroin addicts over the age of 55 years who have “managed” their addiction over the preceding decades with their usual supply of heroin, have been getting caught in the crossfire of the opioid epidemic, unknowingly consuming and dying from more potent heroin, heroin mixed with fentanyl, pure fentanyl, or fentanyl-like substances 4.

Is it intentional? Could there be a grand insidious scheme to do away with a population? The thought is disconcerting. Clever “marketing” easily lures those looking for the quick fix, the magic pill, the feeling of belonging, or a better way to cope with the stresses of life. On the other hand, addiction drives demand and demand drives the big profits made by clandestine drug labs 5. Clandestinely manufactured drugs (synthetic drugs) invade from within and outside a country’s borders by land, by sea, by air, underground, and by mail via online transactions 6,7,8. They are being made increasingly more potent and therefore potentially more deadly, and always a step or two ahead of the regulatory laws in places that have them.

Forensic toxicology laboratories struggle to keep up with the barrage of new “products” but must since the detection of each new drug is what keeps the wheels of justice turning, which is what the public expects and demands. In order to optimize patient care and the prevent deaths, hospital labs must also “keep up with the times” in regards to their ability to detect novel synthetic drugs 9.

Jails, hospitals, foodbanks, crisis hotlines, and other social safety nets are being taxed to their limits by those battling addiction or by their dependents left financially and emotionally bereft after the battle has been lost through death 10.

A country continues to loose individuals who would otherwise be contributing members of society through their intellectual and/or physical abilities 11. Anecdotes of the difficulties with finding drug-free workers should be warnings to be heeded and defining the scope of the actual toll on the workforce and the economy will require continued and vigilant study 12, 13.

Through periodic statistical reports and public media alerts regarding drug trends, Medical Examiners and Coroners (ME/C) are part of the army helping to fight the chemical war. Uniformity amongst ME/C offices in reporting specific drugs on death certificates is imperative 14, 15. Through diagnosis, treatment, prevention, and proper reporting of drug-related deaths, clinicians too play a vital role as combatants in the fight to save lives 16.



  1. US drug overdose deaths continue to rise; increase fueled by synthetic opioids. Press release: March 29, 2018. Centers for Disease Control and Prevention. Available at: .
  2. Drug overdose death data. Centers for Disease Control and Prevention. Available at: .
  3. New surge of meth, cocaine mixed with powerful opioid pushes Ohio’s drug overdose death toll higher. April 2, 2018. Akron Beacon Journal/ Available at: .
  4. Opioid overdose deaths by age group. Available at:,%22sort%22:%22asc%22%7D .
  5. Understanding Clandestine Synthetic Drugs. Available at: .
  6. Buxton J Bingham T. The Rise and Challenge of the Dark Net Drug Markets. Global Drug Policy Observatory Policy Brief. Jan 2015. Available at: .
  7. Over and Under. USA Today. Available at: .
  8. Fighting the Opioid Scourge. Department of Homeland Security-US Customs and Border Protection. Available at: .
  9. Tufel G. Continuing the Battle Against Drugs of Abuse. Clinical Lab Products. June 25, 2015. Available at: .
  10. Karsala M. The opioid epidemic and its impact on the health care system. The Hospitalist. October 24, 2017. Available at: .
  11. Valentic S. Workplace Drug Overdoses is Driving Need for Action. EHS Today. August 13. 2018. Available at: .
  12. Schwartz ND. Economy Needs Workers, but Drug Tests Take a Toll. New York Times, July 24, 2017. Available at: .
  13. Aliprantis D and Chen A. The Opioid Epidemic and the Labor Market. Economic Commentary. Sept. 29, 2017. Available at: .
  14. Slavova S, O’brien D, Creppage K, et. al. Drug Overdose Deaths-Let’s Get Specific. Public Health Report. July-Aug. 2015. Vol. 130. Available at: .
  15. Harper J. Omission on Death Certificates Lead to Undercounting of Opioid Overdoses. National Public Radio. Shots Health News Series. March 22, 2018. Available at: .
  16. Szalavitz M. Opioid Overdose: Emergency Treatment Is Crucial, but It’s Not Enough. Scientific American. May 13, 2016. Available at: .

Body of Evidence Part III: Just Brown Baggin’ It.

There seems to be some lingering confusion among some hospital medical personnel and those involved with the recovery of human tissue and organs on the proper way to preserve potential evidence on the hands of patients who have died in the hospital as a result suspected foul play or outright homicidal violence. Recently, tissue procurement technicians placed plastic bags on the hands of a decedent who was destined to be transported to the local medical examiner’s office due to death circumstances highly suspicious for foul play.

Plastic bags, latex or nitrile gloves should NEVER be placed hands of a decedent that is a Medical Examiner’s or Coroner’s case. Because of their impermeability, unlike paper, they will contain condensation produced by the body’s heat prior to cooling. This condensation can promote the growth of bacteria and mold that can interfere with or preclude the recovery of foreign materials, i.e. the perpetrator’s DNA or the gunshot residue from the shooter’s gun.

PAPER not plastic please! A paper bag placed over each hand secured at the wrist by a rubber band is modus operandi! Better, forensically speaking (as well as more environmentally friendly).

Sometimes visuals are better memory aids:


YES!                                                                 NO!


NO!                                                     MAYBE.


(Only those of you who grew up in the 70’s watching the Gong Show will understand the last one.)


Your memory aide and ticket to more CME credits available at: .