High-level toxicology tests reveal mix of drugs used in overdoses

emily's and cody's opioids-1New toxicology tests that provide revealing information on the fatal substances consumed by Bartholomew County overdose victims are a window to potential solutions, giving officials deeper insight into rapidly changing trends that will help address the epidemic on a law enforcement level and a policy response by government, the coroner’s office says.

They come at a cost, however, with the high-level testing costing $250 or more — three to four times more than a standard drug panel conducted at the local hospital, officials said.

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Tests that the Bartholomew County Coroner’s Office have been conducting and chronicling for a year could become mandatory statewide in a bill approved by the Indiana State Senate last week. Senate Bill 139 passed in a 47-2 vote in the Senate, sending it to the House for consideration. If it were to become law, coroners would be required to obtain information about the deceased from INSPECT, Indiana’s prescription monitoring program.

Coroners would also have to extract and test certain body fluids and provide Indiana Department of Health officials with notice of the person’s death, along with test results and any information about the controlled substances involved. Indiana coroners would have to do this each time they suspect a cause of death to be an accidental or intentional overdose.

Bartholomew County has been conducting more extensive investigations and toxicology testing for suspected overdose deaths since the beginning of 2017. That resulted in a year-end report that documented that there were 30 confirmed overdose deaths last year, 26 of them opioid-related.

Coroner Clayton Nolting said the state’s idea to make that thoroughness a standard statewide is a great idea, but he questions where the money to pay for it would come from.

The deeper information is valuable, however, because it helps law enforcement, hospital officials and those involved in helping people understand what types of drugs are being used, they said.

Knowing that information can help police and first responders be more effective in reducing harmful drug use and overdoses, as the tests detail what types of drugs are being distributed and used locally.

By running the more extensive drug tests, Nolting and deputy coroner Jay Frederick have discovered that many overdose victims are dying after ingesting multiple substances, rather than just heroin or just fentanyl. Some Bartholomew County overdose victims are combining heroin with alcohol, fentanyl and hydrocodone, creating a lethal mix that lowers the person’s breathing rate so far that they die.

In-depth toxicology is far more expensive than a $70 standard toxicology panel at a local hospital. As the county coroner’s office works to determine a specific cause of death, tests that break down the type of opioid and its concentrations costs $200 to $250, Nolting and Frederick said.

To test for an exotic opioid — what is known as U-47700, carfentanil, Etizolam or other combinations being manufactured in drug labs — it’s another $135.

Nolting predicted that many of the smaller counties around Indiana will not have the money to run the kind of tests the bill might require.

“Those department will be blowing through their budgets by June or July,” he said.

Nolting returned to the Bartholomew County Council in December and received an additional appropriation of $14,016 for the 2017 budget after logging 145 death cases by the end of the year. Previous Coroner Larry Fisher had budgeted for the office to handle 115 cases last year.

The money covered expenses for autopsies, toxicology, labs, X-rays and other tests the coroner’s office utilizes, Nolting said.

“Our state is facing an opioid epidemic like we have never witnessed before,” said Senate Bill 139’s author, Sen. Jim Merritt, R-Indianapolis. “We cannot address individual communities’ needs without having the data to back up claims. Requiring coroners to record this information will increase the accuracy and specificity of Indiana’s drug overdose death data, which will help us in attacking this epidemic quickly and more effectively.”

DRUGS IDENTIFIED IN 2017 OVERDOSE DEATHS

Here is a list of some of the drugs that can be detected with the more detailed, and expensive, toxicology tests — all of them found in 2017 Bartholomew County overdose victims.

Fentanyl: An opioid used as a pain medication and for anesthesia. It is given by injection, as a skin patch and can be absorbed in tissues inside the mouth.

Oxycodone: An opioid that works in the brain to change how a person feels and responds to pain.

Methadone: An opioid that treats pain or is used as a therapy to help people who are attempting to recover from opioid addiction.

Tramadol: Opioid medication used to treat moderate to moderately severe pain.

Carfentanil: A synthetic opioid made up of fentanyl. However, Carfentanil is 100 times as potent as the same amount of pure fentanyl and 5,000 times as potent as a unit of heroin. It is sometimes described as elephant tranquilizer.

U47700: An opioid developed by Upjohn in the 1970s which is estimated to have more than seven times the potency of morphine when tested on animals. The drug has never been approved for human use or gone through normal drug testing for humans.

Etizolam: A substance chemically related to benzodiazepines, drugs that produce central nervous system depression and are commonly used to treat insomnia and anxiety. This is a prescription medication in Japan, India and Italy and has recently shown up in the illicit drug market in Europe and the United States.

OPIATES AND OPIOIDS

Opiates are derived from the poppy plant. Examples of opiates include heroin, morphine and thebaine. Examples of opioids are perscription pain medications Vicodin, Percoset and Oxycontin.

— Provided by Healthy Communities, Columbus Regional Health

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Julie McClure is assistant managing editor of The Republic. She can be reached at jmcclure@therepublic.com or (812) 379-5631.