i. Autopsy as a tool

Drug Induced Homicide Defense Toolkit

District Attorneys Association (NDAA) encourages developing partnerships with

coroners because they "may be able to perform a quick verbal assessment of causation

based on the evidence at the scene."115

i. Autopsy as a tool

While the National Association of Medical Examiners recommends that all suspected

overdoses receive an autopsy, local laws, budgets, and coroner politics governing

jurisdiction influence which cases receive autopsies.116

An autopsy includes an external and internal examination of the body by a forensic

pathologist (either a medical examiner or a physician employed by a coroner).

Intoxication deaths are “largely functional deaths” and there are few conclusive anatomic

findings at autopsy to confirm the diagnosis.117 In a suspected overdose death, the

forensic pathologist will look for signs of illicit drug use, such as needle marks or drug

evidence on the body or clothing.118 Internally, the pathologist may find pulmonary

115 NDAA, The Opioid Epidemic: A State and Local Prosecutor Response at 9.

116 Nat’lAss’n of Med. Examiners, ForensicAutopsy Performance Standards 1 (Oct. 16, 2006).

117 James R. Gill, From Death to Death Certificate: What do the Dead say?, 13 J. Med. Toxicol. 111, 113 (2017), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330954/.

118 Gregory G. Davis et al., National Association of Medical Examiners Position Paper: Recommendations for the Investigation, Diagnosis, and Certification of Deaths Related to Opioid and Other Drugs, 41Am J Forensic Med Pathol 152, 153 (2020), https://pubmed.ncbi.nlm.nih.gov/32404634/.

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Disclaimer: All content is provided for informational purposes only and does not constitute legal advice

Drug Induced Homicide Defense Toolkit

edema, a distended bladder, or brain swelling.119 Pulmonary edema is a hallmark of fatal

opioid intoxication cases.120 The development of pulmonary edema is a well-recognized

consequence of narcotic intoxication but has been associated less frequently with the use

of stimulants. Pulmonary edema appears as a blood-tinted foam exuding from the

121

mouth and nostrils, as well as in the lungs and airway. Termed a “foam cone,” this finding

is highly suggestive of heroin (and perhaps other opioid) overdose as a consequence of

pulmonary edema. The presence or absence of pulmonary edema does not provide

122

concrete answers, but is a piece of physical evidence to draw attention to.

119 D. Kimberley Molina et al., Testing an Age-old Adage: Can Autopsy Findings be of Assistance in Differentiating Opioid Versus Cardiac Deaths?, 65 J Forensic Sci. 112, 112-116 (2020), https://onlinelibrary.wiley.com/doi/abs/10.1111/1556-4029.14174; See also Gary L. Henderson, Fentanyl-Related Deaths: Demographics, Circumstances, and Toxicology of 112 Cases, 36 Journal of Forensic Sciences 422, 427 (1991), https://pubmed.ncbi.nlm.nih.gov/2066723/.

120 MichaelA. Graham, Forensic Lung Pathology, Dail and Hammar’s Pulmonary Pathology 1174, 1204-05 (2008), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120111/; see also Danielle E. Pelletier et al., Common Findings and Predictive Measures of Opioid Overdose,Academic Forensic Pathology 91, 91-98 (2017), https://journals.sagepub.com/doi/abs/10.23907/2017.011.

121 MichaelA. Graham, Forensic Lung Pathology, Dail and Hammar’s Pulmonary Pathology 1174, 1214 (2008), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120111/.

122 Ricardo Jorge Dinis-Oliveria et al.,

“Foam Cone ” exuding from the mouthed nostrils following heroin overdose, 22 Toxicology Mechanism and Methods 159, 159-160 (2012), https://pubmed.ncbi.nlm.nih.gov/22242632/.

Version Date July 2021 – Check https://ssrn.com/abstract=3265510 for most current edition

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