Spike in overdoses leads to record number of autopsies
Posted September 17
BRADENTON, Fla. — Manatee County's morgue has been out of space since July, and the Medical Examiner's Office is performing a record number of autopsies as the heroin and fentanyl epidemic spirals out of control — again.
In July, the Medical Examiner's Office in the 12th District that includes Manatee, Sarasota and DeSoto counties performed a record 110 autopsies. Of those, 62 were performed in Manatee County.
The overdose spike continued into August, and a total of 105 autopsies were performed in the district, of which 64 were in Manatee County.
A major challenge in Manatee County: The medical examiner's facility is just not big enough with a morgue that has space for only 18 bodies.
"While this has happened rarely in the past — that we just flat out ran out of space for bodies — over the last two months, that has been almost the normal state where we were so full that we had to use other facilities at some cost to store bodies for us," Chief Medical Examiner Russell Vega told the Bradenton Herald. "Our body transport company has body storage capacity, and they were storing some bodies for us."
Vega said that allows them to avoid the undesirable alternatives: putting bodies on the floor or stacking bodies up.
"So we have had the two busiest months that we have ever had back-to-back in July and August, and it was mostly the drug overdose cases," Vega said.
Law enforcement has also seen an increase in the number of overdoses they have had to respond to this summer.
The Manatee County Sheriff's Office has responded to 733 suspected overdoses between January and August. More than two-thirds of those suspected overdoses occurred in July and August, however.
Early this year, overdoses had dramatically decreased, which the sheriff's office and other local law enforcement agencies believed was a result of the arrests of 15 people including who they believed was the top dealer in the area after an 18-month investigation.
The investigation began last September after overdoses spiraled out of control and dealers began cutting the heroin with fentanyl — a power painkiller that is 100 times more potent than morphine. This summer, the sheriff's office revealed that a synthetic form of fentanyl — cartenfentanil — had been found in at least one local heroin supply.
Cartenfentanil — which is 10,000 times more powerful than morphine — is a large animal tranquilizer that is generally used in exotic animals such rhinos, elephants and hippos.
Again, investigators are beginning to find overdose victims with the syringe in their hands or the needle still in their arms in some cases because of the potency of the drugs being cut into the heroin or passed off as heroin. Paramedics and emergency room staff at local hospitals often are having to give overdoses victims multiple doses of naloxone — a nasal spray that can stop or reverse the effects of an opioid overdose — in order to revive them.
"We have no explanation as to why the spike in July, other than the obvious that there is more fentanyl or cartenfentanil," sheriff's spokesman Dave Bristow said.
Last summer had been the first peak for the medical examiner, Vega said, initially breaking the record for the most autopsies performed in the district and Manatee County.
"Then the rest of the year was busy, slowed down a little bit," Vega said. "The beginning of this year was sort of average, like our old average every month until July. July again was our busiest month ever ... and then August was our second-busiest month ever, almost as busy as July."
Vega said the transition he has seen is that victims of overdoses have gone from using just heroin, to the combinations of heroin and fentanyl, and ultimately he is seeing more pure fentanyl.
So far this year, Vega has confirmed 14 overdose deaths were a result of heroin and/or fentanyl in Manatee County. Of those 14 confirmed overdose deaths, eight of the victims had used just fentanyl, two had used just heroin and four had used some combination of the two drugs.
"We don't know for sure about the summer cases because we are still waiting largely for all the results to come back," Vega said.
As of Sept. 8, Vega only had confirmed results from the toxicology lab at the University of Florida from cases from January through part of June.
"Based on the trends we are seeing so far, we are more concerned with the fentanyl analogs ... cartenfentanil seems to be of most concern based on law enforcement findings," Vega said. "The problem is with all these new analogs like with any designer drugs, the chemists on the dark side are a step ahead of us."
He just learned that the toxicology labs have developed a new analytical tool to identify cartenfentanil to determine if the drug is in a victim's body or blood. So only now are they able to begin to test for it.
The cartenfentanil, like the fentanyl, that is now being cut into the heroin supply or passed off as heroin, is now being synthesized in laboratories for drug dealers, Vega believes.
"We are seeing a little bit more of the cartenfentanil," Bristow said.
The sheriff's office has begun to more actively track overdoses this year, tracking not just the suspected overdose deaths closely but all suspected overdoses.
"We are trying to actively go to every overdose," Bristow said. "Hopefully we are going to see a drastic reduction."
Manatee County is in the midst of renovating another facility for the Medical Examiner's Office. The new facility will have double the capacity, Vega said, and is greatly needed.
The average number of autopsies that used to be performed in the district was anywhere from 625 to 650 a year, Vega said. In 2015, when the first uptick of heroin and fentanyl overdoses was seen, he said his office performed 820 autopsies.
"That increase was almost entirely due to overdoses," Vega said.
Other death cases have increased as well.
"There were more suicides. There were more traffic fatalities," Vega said. "I think that it's entirely reasonable that these things are at least indirectly tied together, some of these other kinds of death with drug problems."