International Association of Coroner’s and Medical Examiner’s Annual Symposium, July 2023, Las Vegas, NV

Amidst the crowd of conference attendees, a familiar face emerged – the coroner of a small rural county in the east-central part of Alabama, whose frequent visits to the NNPHI booth during the 2022 conference had left an indelible mark. The coroner greeted me not with a formal handshake but with an unexpected hug. His enthusiasm was palpable as he shared that he had received recognition in his local newspaper for securing an $11,000 award from the National Network of Public Health Institutes (NNPHI). This award was part of the Infrastructure Support for Medicolegal Death Investigation (MDI) Offices funding opportunity and marked a turning point for his office and countless others across the nation.

This funding initiative was the first of its kind for coroner, medical examiner, and MDI offices, providing small grants to purchase essential supplies for improved data sharing with vital records offices and public health agencies. A pivotal aspect of this support was the emphasis on electronic Case Management Systems (CMS), which addressed a significant gap outlined in a 2021 Bureau of Justice Statistics report that only 40% of coroner offices had a computerized CMS as of 2018.

The impact of this initiative extended beyond the transition to electronic records. Many CMS have interoperability with public health Electronic Death Registration Systems (EDRS), streamlining data collection efforts and enhancing the timeliness and accuracy of mortality data. In 2023, NNPHI awarded 52 offices these infrastructure grants totaling $815,000.

The urgency of this project was informed by the stark reality – that more than 1 million people in the United States have died of a drug overdose since 1999.[1] The continuous surge, which is evident by the 30% increase in overdose deaths from 2019 to 2020, requires a coordinated response. Notably, the rise in overdose deaths increasingly involves psychostimulants like methamphetamine and synthetic opioids such as fentanyl.[2]

Surveillance of drug overdose mortality emerged as a key component of overdose prevention efforts. The CDC-supported program called the State Unintentional Drug Overdose Reporting System (SUDORS)[3], spans 49 states and the District of Columbia, and is dedicated to collecting crucial drug overdose mortality data. The goals of SUDORS are to better understand the circumstances around overdose deaths, improve the timeliness and accuracy of data, and identify specific substances contributing to overdose deaths.

Recognizing the vital role of coroners, medical examiners, and MDI professionals in this fight, CDC and NNPHI joined forces to bring resources and training to the MDI community. Collaborating with key organizations – the International Association of Coroners and Medical Examiners (IACME), the Center for Forensic Science Research and Education (CFSRE), and the National Association of Medical Examiners (NAME) – this project was launched to provide enhanced overdose investigation trainings and infrastructure support grants.

Since 2021, this collaborative effort has offered 48 individual trainings, enriching the knowledge and capacity of MDI professionals on both national and state-specific levels. The ripple effect has been profound, extending beyond improved data surveillance to the integration of the MDI community into the broader public health framework.

This single interaction with the coroner from Alabama serves as a poignant reminder that, in the face of adversity, collaboration, funding, and training have the power to build the capacity of the organizations and individuals on the frontlines of the drug overdose epidemic.

Related Tools:

• About the State Unintentional Drug Overdose Reporting System (SUDORS)
• The Role of Comprehensive Medicolegal Death Investigation as Part of a Public Health Improvement Strategy

References:

[1]https://www.cdc.gov/opioids/data/index.html#:~:text=The%20Drug%20Overdose%20Epidemic%3A%20Behind,1999%20from%20a%20drug%20overdose.&text=More%20than%2075%25%20of%20drug,in%202021%20involved%20an%20opioid

[2] https://www.cdc.gov/mmwr/volumes/71/wr/mm7129e2.htm?s_cid=mm7129e2_w

[3] https://www.cdc.gov/drugoverdose/fatal/sudors.html