{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T10:46:54Z","timestamp":1777373214682,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2016,3,1]],"date-time":"2016-03-01T00:00:00Z","timestamp":1456790400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Academic Forensic Pathology"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Deaths due to drug intoxications in the United States have increased. Public health agencies track the specific intoxicants using death certificate data in order to develop and focus prevention strategies. Criteria used to decide what deaths need toxicological investigation and how these deaths are certified will affect this data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed the investigative, autopsy, and toxicology reports of 118 fatal intoxications that were certified as \u201cacute opiate intoxication.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 113 decedents in whom morphine was detected, 84 were determined to involve heroin. For 61 of 84 heroin deaths, the heroin diagnosis was based upon the detection of diacetylmorphine, 6-acetylmorphine, and\/or a lower blood codeine to morphine concentration. For 23 of 84 deaths, the determination was based upon morphine detection and illicit substances and\/or paraphernalia at the scene. Of the 61 of 84 heroin deaths diagnosed by direct toxicology results, 33 of the 61 (54%) did not have illicit substances or paraphernalia at the scene. Toxicology identified 33 of 84 (39%) heroin fatalities that would not have been distinguished from morphine intoxication by the scene investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The majority of deaths due to opioids can be further classified based upon the toxicological analysis and scene investigation. As heroin deaths may have no illicit substances\/paraphernalia at the scene, investigators should not solely base their decision to perform an autopsy\/toxicology on the scene absence of illicit drugs\/paraphernalia. In our study sample, if toxicology testing were to be only performed when illicit substances\/paraphernalia were found at the scene, a high portion of heroin deaths (39%) would have been missed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.23907\/2016.012","type":"journal-article","created":{"date-parts":[[2018,6,27]],"date-time":"2018-06-27T15:34:27Z","timestamp":1530113667000},"page":"114-121","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["An Underestimation of Heroin Deaths Due to the Use of \u201cAcute Opiate Intoxication\u201d on Death Certificates"],"prefix":"10.1177","volume":"6","author":[{"given":"James R.","family":"Gill","sequence":"first","affiliation":[{"name":"Connecticut Office of the Chief Medical Examiner"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory A.","family":"Vincent","sequence":"additional","affiliation":[{"name":"Office of Chief Medical Examiner of the City of New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison","family":"Toriello","sequence":"additional","affiliation":[{"name":"Office of Chief Medical Examiner of the City of New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lewis S.","family":"Nelson","sequence":"additional","affiliation":[{"name":"New York University School of Medicine - Emergency Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2016,3,1]]},"reference":[{"issue":"81","key":"bibr1-2016.012","first-page":"1","author":"Warner M.","year":"2011","journal-title":"NCHS Data Brief."},{"key":"bibr2-2016.012","doi-asserted-by":"crossref","unstructured":"SgarlatoA., deRouxS.J. Prescription opioid related deaths in New York City: a 2 year retrospective analysis prior to the introduction of the New York State I-STOP law. Forensic Sci Med Pathol. 2015 Sep; 11(3): 388\u201394. PMID: 26233936. http:\/\/dx.doi.org\/10.1007\/s12024-015-9699-z.","DOI":"10.1007\/s12024-015-9699-z"},{"key":"bibr3-2016.012","doi-asserted-by":"crossref","unstructured":"CiceroT.J., EllisM.S., HarneyJ. Shifting patterns of prescription opioid and heroin abuse in the United States. N Engl J Med. 2015 Oct 29; 373(18): 1789\u201390. PMID: 26510045. http:\/\/dx.doi.org\/10.1056\/nejmc1505541.","DOI":"10.1056\/NEJMc1505541"},{"key":"bibr4-2016.012","doi-asserted-by":"publisher","DOI":"10.23907\/2012.027"},{"key":"bibr5-2016.012","doi-asserted-by":"publisher","DOI":"10.23907\/2013.010"},{"issue":"1","key":"bibr6-2016.012","doi-asserted-by":"crossref","first-page":"77","DOI":"10.23907\/2013.011","volume":"3","author":"Davis G.G.","year":"2013","journal-title":"Acad Forensic Pathol."},{"key":"bibr7-2016.012","doi-asserted-by":"publisher","DOI":"10.23907\/2011.005"},{"key":"bibr8-2016.012","doi-asserted-by":"publisher","DOI":"10.23907\/2013.029"},{"issue":"18","key":"bibr9-2016.012","first-page":"2391","volume":"66","author":"Helpern M.","year":"1966","journal-title":"N Y State J Med."},{"key":"bibr10-2016.012","doi-asserted-by":"crossref","unstructured":"HelpernM. Fatalities from narcotic addiction in New York City. Incidence, circumstances, and pathologic findings. Hum Pathol. 1972 Mar; 3(1): 13\u201321. 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PMID: 15189677. http:\/\/dx.doi.org\/10.1093\/jat\/28.4.260.","DOI":"10.1093\/jat\/28.4.260"},{"issue":"11","key":"bibr13-2016.012","first-page":"36","volume":"96","author":"Cordy C.","year":"2013","journal-title":"R I Med J (2013)."},{"key":"bibr14-2016.012","doi-asserted-by":"crossref","unstructured":"Greenwood-EricksenM.B., PoonS.J., NelsonL.S.  Best practices for prescription drug monitoring programs in the emergency department setting: results of an expert panel. Ann Emerg Med. 2015 Nov 24. pii: S0196-0644(15)01415-8 [Epub ahead of print]. PMID: 26619757. http:\/\/dx.doi.org\/10.1016\/j.annemergmed.2015.10.019.","DOI":"10.1016\/j.annemergmed.2015.10.019"},{"key":"bibr15-2016.012","doi-asserted-by":"publisher","DOI":"10.1520\/JFS15258J"},{"key":"bibr16-2016.012","doi-asserted-by":"publisher","DOI":"10.23907\/2015.055"},{"key":"bibr17-2016.012","doi-asserted-by":"crossref","unstructured":"BoernerU. The metabolism of morphine and heroin in man. 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