Substance Abuse in WV - West Virginia State Medical Association

Bureau for Public Health | NEWS Continuedtoxicology findings, and review ofdecedent medical and prescriptionmonitoring program records.Indicators for fatal drugintoxication included: one or moremeasured drug concentrationsat or above published fatal drugconcentration ranges 5 , or multipledrugs in combination judged to bepotentially fatal; evidence of nonmedicalroutes of drug administration,such as drug “snorting” or needledrug abuse, as documented bydeath scene investigation findings;and witnessed signs of significantdrug toxicity such as lethargy,labored breathing or developmentof pulmonary edema as suggestedby frothy nasal exudates. Potentiallylethal concentrations of drugs inthe blood were more likely to beimplicated as a cause of death incases where there was evidence ofdrug diversion, defined as druguse in the absence of documentedprescription access to the identifiedpharmaceuticals within 30 days ofthe decedent’s death. Evidence ofSchedule II to IV drug diversionwas documented by review ofprescription monitoring programand medical records review ineach case. Relatively high ratiosof parent to metabolite drugconcentrations, suggestive of naïveor intermittent drug use, wheresignificant development of drugtolerance would be unexpected, werealso used to assess the role of thesepharmaceuticals in causing death.As part of this 2006 study of fatalpharmaceutical intoxications, 295deaths were identified as the resultof clearly accidental fatal drug abuse,rather than suicidal drug over-useor drug use circumstances unclearfor intentionality, where one or morepharmaceutical medications weresignificantly contributory to death.Figure 1.Figure 2.SUBSTANCE ABUSE IN WV | Vol. 106 89