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‘We literally can’t keep up:’ Opioid crisis causing backlog in forensics

 

Editor’s Note: This is the fifth part of a seven-part series on West Virginia University’s efforts to address the opioid crisis in the state. The speakers in this series shared the work and progress in their respective fields and departments at an academic media day held by WVU on Nov. 13.

By TIFFANY TOWNER
Times West Virginian

MORGANTOWN, W.Va.  — Multiple experts have discussed the ways in which West Virginia struggles to deal with the effects of the opioid crisis, and according to Suzanne Bell, director of the West Virginia University Department of Forensic and Investigative Science, that applies to the forensics field as well.

Suzanne Bell shows a representation of the potency of different drugs. Each amount show the lethal dose of the drug if you inject it.
(Times West Virginian photo by Tiffany Towner)

As the use and abuse of opioids grows, so do the problems in the forensics field, including identifying drugs, handling potentially lethal mixtures and keeping up with death investigations, Bell said.

‘Wild toxicity’

Forensic laboratories are facing technical and analytical challenges in testing drugs, Bell said.

Their normal procedure is to test materials, determine what they are, confirm it and provide that data to a public health official, drug enforcement or the judicial system. Bell said a simple screening test used to work for this.

“In the field, typically officers in the past would have a color-change agent of some type … and if there’s a suspicious powder they would test it,” Bell said. “It wasn’t meant to be definitive. It was just meant to give them an idea of … do I have probable cause? Can’t do that anymore, because this stuff is too dangerous.”

Bell displayed a graphic showing depictions of the lethal amounts of heroin, fentanyl and carfentanil if injected. The lethal amount of heroin (which is 10 times more potent than morphine) was a small amount at the bottom of a tiny vial. The amount of fentanyl, an opioid pain medication that is 10 times more potent than heroin, took up an even smaller section of its vial. The carfentanil, an elephant tranquilizer 10 times more potent than fentanyl, was shown to the side of a penny, and it was just a sprinkling of a few grains.

Recently, Bell pointed to national stories of heroin being seized that contained fentanyl and/or carfentanil. Drugs users may not even know these more-lethal drugs have been mixed in, she said.

“I don’t handle fentanyl in my laboratory,” Bell said. “I don’t let the students handle fentanyl in my laboratory, let alone carfentanil. … Now you can see why the problem is people aren’t even opening packages in the field. You can’t. That will kill you dead.”

Handling such dangerous drugs requires the use of high-level protective equipment, Bell said, which makes it hard for forensic scientists to do their jobs. And in the field, she said officers generally don’t open anything anymore.

First responders need to be careful with these toxic drugs, which can go through the skin, Bell said, and she added that even drug-sniffing dogs are in danger, as the drugs can affect them the same way as it can humans.

“A lot of dogs are being killed by this because they affect them the same way,” Bell said. “So they can’t let the dogs sniff out drug evidence like they did before.”

Identification issues

“On average, a new drug is identified in the United States every seven to 10 days,” Bell said. “We can’t keep up.”

These new compounds are not only challenging to identify, she said, but also are so new they may potentially not be illegal yet.

Simple screening tests that used to be employed to identify drugs no longer work, Bell said, and in more-involved analyses, the drugs can be separated into their components and looked at chemically to try to identify them. But Bell said the only way to definitively identify a drug is to compare it to an actual sample of that drug, which is known as a reference standard.

Because the drugs are coming out too fast, there sometimes is no reference material to which the drugs can be compared, she said, which will cause the drug to be ruled indeterminate. At that point, Bell said the samples will typically be sent to the DEA, which has a special testing lab.

Sometimes it’s hard to get the reference standards, which can be expensive, Bell said, as it takes companies months to make them.

“Now in addition to that, every sample has to be treated like it can kill you, because it can.”

Getting backed up

“We see these inconclusives more often,” Bell said, adding that in the past samples were set aside if they couldn’t be identified. The backlog is too big now, she said, that they can’t do that anymore.

The backlog doesn’t just exist in laboratories, Bell said. Medical examiners, coroners and death investigators throughout the country are also seeing backlogs.

In West Virginia, there’s an Office of the Chief Medical Examiner that is in charge of death investigations. That office responds to death scenes to determine if the cause of death is questionable. A cause of death is typically ruled to be one of five things: natural, accidental, suicide, homicide or indeterminate.

Indeterminate used to be unusual, Bell said, but are now becoming more common.

“Part of this is related to the challenge with the toxicology to find these brand-new things that we’re not geared up to find,” she said. “We’re coming back to where the medical examiner system is much more about public health because they’re the first ones that spot these new drug trends when they cause overdose deaths.”

Autopsies and toxicology reports are both important in telling the story of what happened with a death, Bell said, but there’s a slow turnaround time, because their departments are so backed up.

Additional challenges

Unfortunately, Bell said not a lot of medical residents choose to go into the forensic pathology field.

“There’s a huge lack of trained forensic pathologists in the United States,” she said. “I think there’s 500 over the whole United States. How many more are needed? About 500 to 600, she said. One of the issues with attracting people to the field is that it doesn’t pay as well as similar jobs, though it requires the same amount of training.”

Bell said some people are working on developing instruments to test drugs in the field, but it would never replace the work of chemists.

And the drugs keep coming in, Bell said.

“These are, by and large, large-scale industrial processes taking place in China, or other places, but that’s the big source of this,” she said.

While there are some labs in the United States making these drugs, she said the process to make them isn’t easy compared to making something like methamphetamine.

“We literally can’t keep up,” Bell said. “Can’t keep up with the compounds, can’t keep up with the dead and the dying, and we can’t keep up with the new standards that we need. It’s affecting every aspect of typical forensic chemistry.”

TOMORROW: Paul Speaker, associate professor of finance and adjunct associate professor of economics in the WVU College of Business and Economics, discusses some of the hidden costs of the opioid crisis.

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