Drug-Related Deaths: Investigation, Prosecution and Review Strategies

Presenters:• Patricia Daugherty, JD, Assistant District Attorney, Milwaukee

County (WI) District Attorney's Office• Michael Baier, Overdose Prevention Director, Maryland

Department of Health and Mental Hygiene• Erin Haas, MPH, Overdose Prevention Local Programs Manager,

Maryland Department of Health and Mental Hygiene

Law Enforcement Track

Moderator: Connie M. Payne, Executive Officer, Department of Specialty Courts, Kentucky Administrative Office of the Courts, and Member, Operation UNITE Board of Directors

Disclosures

Michael Baier; Erin Haas, MPH; Patricia Daugherty, JD; and Connie M. Payne have disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.

Disclosures

• All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

• The following planners/managers have the following to disclose:– John J. Dreyzehner, MD, MPH, FACOEM – Ownership interest:

Starfish Health (spouse)– Robert DuPont – Employment: Bensinger, DuPont &

Associates-Prescription Drug Research Center

Learning Objectives

1. Identify strategies for investigating and prosecuting drug-related homicides.

2. Explain how multiple tools can be utilized to build prosecutable cases.

3. Describe how Overdose Fatality Review can make recommendations for law, policies and programs.

Drug-Related Deaths: Investigation, Prosecution, and Review Strategies

Patricia DaughertyAssistant District Attorney—Milwaukee Co.

Financial Disclosure Statement

ADA Patricia Daugherty has disclosed no relevant, real or apparent personal or

professional financial relationships with proprietary entities that produce health care

goods and services.

Learning Objectives:

1. Identify strategies for investigating and prosecuting drug-related homicides.

2. Explain how multiple tools can be utilized to build prosecutable cases.

Intro

• Assistant District Attorney for 8 years• First 2 years as Violent Crime/Felony Drug ADA• Last 5+ assigned to WI HIDTA

– Focusing on RX Drug cases, Pharmacy Robberies, Higher-level heroin trafficking, and overdose death prosecutions

Overview

• Overdose Stats/Why These Cases Matter• Investigative Techniques & Building a Case• Use of Illustrative Case Studies

Why Are We Here?

2013: 38,851 PEOPLE DIED FROM DRUG OVERDOSES IN THE US

…But what about in Wisconsin?

Milwaukee County

• 2009: 127 Fatal Drug Overdoses• 2014: 249 Fatal Drug Overdoses

• A 96% increase in deaths in 5 years• Approx. 3.5x the number of traffic deaths

38,851 US Deaths-2013

• Given the US POP 12.3 deaths/100,000

• Milwaukee has 956,406 people

• Meaning our OD death rate = 26 deaths/100,000

Legal Standard

• So-Called “Len Bias” Homicides• State Statutes Differ…so confer with your local

prosecutors about the law in your state• I’ll use Wisconsin law as an example, but the

basics should be the same…

First Degree Reckless Homicide

• 940.02(2)a• Whoever causes the death of another

– By manufacture, distribution or delivery of a controlled substance (Sch. I or II or analog or Ketamine/ flunitrazepam) if another human being uses the controlled substance and dies as a result of that use.

Len Bias Homicide

• We have to prove:– Target delivered a substance– The substance was a CS– Target knew it was a CS– Victim used that CS– And died as a result of that use

• Died as a result = Drug was a substantial factor in the death

Conclusion

• Again, your local laws likely differ• However, at the core, you will have to prove

that:1. Your target delivered a drug2. Your victim used that drug3. Your victim died from using that drug

HOW DO WE KNOW IT’S A LIKELY OVERDOSE DEATH?

OVERVIEW: Signs of Overdose

• Presence of Drugs/Drug Paraphernalia• Deceased has drug history• Evidence on phone (drug-related texts)• Witnesses report that deceased was snoring

loudly prior to death– Loud Snoring is not a positive sign, it is a sign of

respiratory distress! • Physical Appearance/Evidence…

Foam Cone

• Opiates = Central Nervous System (CNS) depressant

• Decrease in heart rate and breathing fluids gathers in lungs

• People drown in their own fluids.• “Foam Cone”

Signs of Overdose• Common features

– Pulmonary congestion and edema

– “Foam cone”

Milwaukee Deaths 2014 % of Deaths

Cocaine Only 19/249 7.6%

Cocaine Present 60/249 24.1%

Heroin Only 52/249 20.9%

Heroin Present 116/249 46.6%

Combo Heroin and Cocaine 14/249 5.6%

RX Drugs Only 96/249 38.6%

RX Drugs Present 163/249 65.5%

Combo Heroin/Cocaine/RX 11/249 4.4%

Opiates Present 223/249 89.6%

Morphine Present 31/249 12.4%

Fentanyl Present 15/249 6.0%

Oxycodone Present 82/249 32.9%

2014 OPIATES= Present in 90%Of OD Deaths

Intravenous Exposure

• “Track Marks”• Recreational drug use• Therapeutic

administration

Preliminary Investigation: DEATH SCENE

EVIDENCE RECOVERY OVERVIEW

• Scene Search: If suspected OD death, toxicology not back for 10-12 weeks

• Person and Area– Include garbage and ashtrays– Friends/Family may have “cleaned” area

• Vehicles• SEIZE PHONES and/or obtain numbers

First Steps• Treat an overdose scene as a homicide scene from

the beginning.

• All too often, evidence is lost because the scene is not secured or properly processed.

First Steps At The Scene

• Photograph and document the scene as you would with ANY homicide case.

• Take photos of:• the body as it was found and then once moved

• Frequently, items of evidence are located underneath the body (baggies, cookers, etc.)

• The scene (overalls) before, during, and after search

First Steps• Look for drug packaging (corner cuts, etc.)

• Check trash, toilet bowl, etc.• It is possible to do a quantification of a drug sample to

determine the “cut” of the drug. This can later be compared against any drugs you might obtain from your target via a controlled buy.

• Bag each item separately & wear gloves• Search everywhere

Don’t Advertise…

• Consider NOT having squads visible on the street…may try to do a CI buy later.

• Better chance of successful buy if the target isn’t aware of the death

Searching The Scene

Once you can lawfully search, what should you look for?

First Steps

• Look for method of ingestion • Syringe, mirror with residue, etc.

• Any relevant paraphernalia • cooking tins, hose clamps/ grinders, etc.

• Process items for fingerprints/ DNA

Packaging Material• It is possible to have the packaging analyzed for

prints/DNA• Also possible to have residue drug-tested

• If DNA/Prints are absent, the kind of packaging used can connect a death to your target– i.e. the target sells in plastic corner cuts, etc.

SYRINGES

• Crime Lab can do a chemical test/wash for heroin or substance used

• We can also submit for fingerprints/DNA as necessary.

NarcanNaloxone Hydrochloride

• Naloxone prevents and/or reverses the effects of opiates, especially the respiratory depression

• Needle exchange provides free doses of Narcan

• Does NOT remove the opiate from the system and users can “rebound” into an OD

Narcan

• Look for evidence of Narcan use at the crime scene

• This may be evidence that your victim was with someone prior to their death.

• Rebound ODs are common• It can also impact your timeline

Scene Search: Electronic Devices

• More on this later, but these are extremely important to take during your search.

• Look for cell phones, tablets, and other devices (watch phones, Google Glass, beepers?)

• If Apt. complex or surrounded by businesses, look for surveillance footage. May capture video of supplier and/or car.

Searches: Conclusion

• Remember: The scene may have been cleaned.

• Look in common area dumpsters, etc. • If applicable, seek consent to search the

personal property (purses/bags/cars) of anyone on scene.

• They may try to remove relevant evidence from the scene.

Interviews

INTERVIEWS OF WITNESSES

Start Immediately Record whenever possible. Build a 24-48 hour timeline Gather historic information on

Victim

Witnesses

• What did they see? Did they witness the buy/use? Who else was present? Who does Vic use with? When did they last see Vic prior?

• Are they (Witness) a user? Track marks? Did they go with the Vic to get drugs? When/Where? Can they do a buy?

• Obtain their phone #’s and consent to search if they are willing.

Interviews….

• Knowledge of Victim’s Use (Snort, IV, etc.)• Knowledge of drug combinations

• Illicit• Prescription

• Victim’s Previous Overdoses• Do they know Vic’s Source(s) of supply, friends –

phone numbers, street names, Facebook, etc. • Who are Vic’s doctors, pharmacies

CREATE TIMELINE

• Interviews• Telephone Records• Receipts

– gas, restaurant, bank…• Surveillance Videos

– often deals at public places

• Physician/Pharmacy Records

Interviewing The Suspect

• Try to be as specific as possible about their dealings with victim. When and where did the transaction occur? Amount bought and $. • Did they middle the deal? Co-user? • You don’t have to tell them that victim is deceased

if they are unaware. • Will they consent to a search of their phone,

house, car, etc.?

Interviewing The Suspect

• Ask about their business (how many people do they supply, phone numbers used, how long selling/using, how do they package their drugs)

• Who is their supplier? Photo arrays if relevant. How much do they get from supplier and how often? How is contact made? How is payment made?

• Are they willing to cooperate if approved?

Arranging for Controlled Buys

First Steps• If you have a suspect, it is advantageous to

attempt to do a recorded controlled buy ASAP. • This will give us a case against him while we wait for

the ME’s determination (and possibly keep him in custody)

• It will be extra leverage in negotiating a resolution• Can obtain a contemporaneous sample of dealer’s

drug (if not RX) which can be compared with the cut from your scene of death. Can be like a fingerprint.

First Steps

• You can get the suspect to confirm the delivery in the overdose case• For ex: “Do you have any of that stuff you gave me

and [the deceased] on Sunday night? It was really good.”

• It is best to do this ASAP, preferably before your target knows the victim has died. That tends to spook them a bit.

First Steps

• If your victim utilized text messages to contact their supplier, consider using the victim’s cell phone to send messages to the target

• You may be able to set up a buy/bust without using a CI

Buys

• If your CI has a regular pattern of ordering from their supplier, it might be advantageous to have them do an order up so as to not raise the supplier’s suspicion.

• Heroin users are creatures of habit and their suppliers will become suspicious if they miss too many “appointments.”• Be aware of this if trying to work someone after you

have had them in custody

Buys

• If you do get a buy—Video and Audio Record it. This is a homicide case. The jury will not be sympathetic to excuses

• On recording, try to have CI reference prior deal (date)

• This buy can help us establish patterns• Working off same phone # as dealer in OD• Drugs are packaged in same material (signature, etc.)

• It is also good leverage

Tying your suspect to the phone used in the homicide is crucial

•Buys can help with this•Better than “subscriber info” because it puts the target in physical control of the device.

Can’t Get a CI/Buy

• If you can’t get someone to do a buy or it doesn’t work out:• Consider garbage pulls, surveillance of

target/pretext stop when we believe he has scored, etc.

• If it is a known target or we have a phone number, check with HIDTA to see if they have had any contact or intel.

Can’t Get a CI/Buy

• With Target’s phone records, develop “Top 10” list of customers

• Build case on customers (traffic stops, drug paraphernalia, etc.)

• Flip the customers on their supplier

Court Orders and Records

This section will detail the kinds of orders/evidence/data we can get

The following section will discuss what analysis is available once we lawfully obtain the evidence/records/data

Cell Phones

Often the Most Important Piece of Evidence

Cell Phones

• In many cases, you will locate cell phones at the scene of the death.

• Phones can be invaluable in building your case and identifying your suspect(s)

Phones & Timelines

• Once we ID a target who delivered drugs to our victim: • We want to show that the victim did not obtain

also drugs from ANOTHER source

• Phone records can show that the victim did not have drug contacts AFTER getting drugs from the target.

Phone Searches

• Often, you may need to get a warrant to search the victim’s telephone.

• I recommend a sealing motion/order

Passcodes• HIDTA, etc. can defeat some passcodes, but

not all. THIS IS ALWAYS CHANGING• Ask the family/friends if they know the

passcode• Importance of preservation letters

First Steps- Send preservation letters for text messages and

cell tower information ASAP

- Obtain SW to search any relevant phone recovered and obtain subpoena/warrant for call records and subscriber information as needed- Request that records be provided with a certification

from the phone company. This will save a lot of headaches at trial.

Content

• Supplier’s phone/phone records will reveal their other contacts (customers, etc.) from the incident date. You can locate and interview those people to establish your target’s possession of the target phone

• The physical phone search is your best shot at getting useful text message content.

For Example:From: Victim To: Supplier

From: Victim To: Supplier

From: Supplier To: Victim

Court Orders For Records

• Your state statutes will differ, but…

• The phone company will require a court order to produce these records.

• What follows references WI statutes, but is applicable to all orders

Text Messages…• Call company immediately

• How long are messages kept ?• Preservation Letter (on letterhead)• Need a warrant for text content/cell tower data

Retention Periods Vary

Some companies don’t keep text content at all, while others keep it

for only a few days

Other Court Orders

Other Orders• GPS on your suspects’ cars. • Trap/Trace/Cell Tracker• Warrant for computers• Warrant for Social Media • Order for PDMP

Cell Tracker

• Track the location of the phone (similar to a ping order)

• Useful if you know the number used by your dealer, but not their location/identity

GPS

• A warrant allowing for the installation/monitoring of a tracking device

• Can lead to the identification of your target’s stash houses

• Can also show target travelling to re-supply

Social Media

• Many social media platforms have chat and/or email features

• Won’t be accessible to the public• Warrant for Content

• Preserve publically available social media/YouTube content

PDMP Records

• PDMP = Prescription Drug Monitoring Program

• Basically, every time a RX for a Scheduled CS is filled, a record is transmitted to a state database

• We can get that info with a valid court order**** You may not need an order in your state

AUTOPSY AND TOXICOLOGY

I am not a doctor, but…

Toxicology

• Cause of Death can be 1 drug or a “Mixed Drug” overdose

• Three Common Examples• Mixed Drug• Heroin OD• “Morphine” OD

Toxicology Examples

• 7 different substances

• Don’t have to prove Heroin = Sole cause, only SUBSTANTIAL FACTOR in the death

• Presence of Morphine & 6-MAM = Heroin OD

• Nothing but Heroin metabolizes into 6-MAM

• Codeine frequently found too

EVEN WITHOUT 6-MAM, WE CAN STILL PROVE IT WAS HEROIN

…a look at “Morphine” overdoses

• Morphine OD NOT Heroin OD• Absence of 6-MAM, but presence of

Morphine• We prove the Morphine came from heroin

through other evidence• Testing of drug paraphernalia, text messages, etc.

Case Studies

• Not just “war stories”• Included here to illustrate implementation of

the strategies discussed earlier

**All defendants not yet convicted are presumed innocent of all charges

State v. Defendant TJ

• Two Deaths (VD. and TS.)• 25 days apart• Both “Morphine” ODs

Implementation of Investigative Strategies

• Store (Walgreens) Security Footage• ALPRS• Phone Dumps• Phone Mapping• Jail Calls• Utilities Searches• Phone Frequency Charts + Common Calls• Facebook

TS Death

• Early December 2013 • Uncle visiting his Nephew and Nephew’s

friend in the dorms• Bought heroin from “Playboy” at 414-841-

6135• Nephew & Friend testified at trial for the State• “Playboy” only sold $50 bags and only sold

knotted topped baggies

TS Death

• Deal took place at Walgreens in parking lot• Video showed Playboy arriving in dark 2 door

car with hubcaps• We brought in a car expert who could ID it as a

late 90’s Olds Achieva.

• ALPRS found a car listing to TJ.

Still Photo of Target Vehicle

Mapping Put Playboy’s Phone at Walgreens at the time the Achieva is on camera

Witness IDs

• Both Nephew & Friend ID Def. as the supplier that night known to them as Playboy

• Both ID his phone number (burner phone) as 414-841-6135

• Phone records from Nephew & Friend show hundreds of calls to this number in the months leading up to death…corroborating their connection to Playboy/ID of Def.

Victim VD

• About 25 days later, VD is found deceased• Body not found for about a week

VD

• Military Vet, injured overseas…became addicted to pain pills at the VA

• At the VA, met another Vet (AB) who would later middle the fatal deal between VD and Def. TJ

VD was found approximately 7 days after her death, by a roommate…

Date of Death

• ME can give an approximation, but not 100%• Look at phone patterns:

– She sent 100s of texts every day, but they stopped entirely within an hour of her contact with TJ. Same with Facebook

– Missed calls started piling up at the same time• Med taker…pill calendar--SMTWTHFS

VD

• Phone Dump Texts between VD and ABRemember: College witnesses said their dealer only sold $50 bags. Same thing here.

Additional texts set up AB picking VD up

AB’s phone records show her calling her dealer thereafter

VD

–AB provided information on her heroin supplier known to her as “Memphis” at phone number 414-722-5218

• Dump of her phone Contact = Def. TJ• Admitted to buying the heroin from Def. TJ at

his residence

Mapping

Utilities

• WE Energies records list TJ as the subscriber for the address ID’d by AB as the location of the deal

• Mapping puts the “Memphis” phone in that area at the time of the contact with AB/VD

Facebook Photos

Two Phones

• Two Different Phones were used in the two deaths. – “Playboy” is 841-6135– “Memphis” is 722-5218

• 18 common contacts• AB’s number in both phones• CLEARLY not two unrelated #s!

Two Phones

• Also showed that there were numbers that would call 1 phone, get no answer, and then call the other

• Clearly connected, notwithstanding both are “burner” phones

Jury Trial

• West Allis and UW-Milwaukee witnesses testified (proffer agreements)

• Expert Witness testified on suspect vehicle • Officer/Investigators testimony• HIDTA Analyst – cell phone mapping• West Allis Analyst – frequency and common

calls• Medical Examiner testified to cause of death

Jury deliberated after a week-long trial and finds TJ guilty of

all charges…

…in about 45 minutes

Sentencing

Thank You - Family

Take Aways…

• Shows that lots of little things can add up to build a very solid case

• When you have “users” who will testify, juries want CORROBORATION…

• Why should they believe this “heroin addict”? • Because all of these phone records, utility

records, store video, cell tower data, etc. backs them up.

Email me if you want…

• “Cheat Sheet” for OD investigations • Longer “Best Practices” Guide• Telco Info & Retention Periods• Sample Preservation Letter• Sample WI Warrant for Cell Records

Thanks/Questions

CONTACT INFO:

A.D.A. Patricia I. DaughertyMilwaukee County District Attorney's OfficeT: (414) 278-5183Patricia.Daugherty@da.wi.gov

Thanks again to Det. Nick Stachula

Overdose Fatality Review in Maryland

Michael BaierOverdose Prevention Director

Maryland Department of Health and Mental Hygiene

Erin Haas, MPHOverdose Prevention Local Programs Manager

Maryland Department of Health and Mental Hygiene

Michael Baier has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.

Erin Haas, MPH, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.

Learning Objectives:

1. Identify strategies for investigating and prosecuting drug-related homicides.2. Explain how multiple tools can be utilized to build prosecutable cases.3. Describe how Overdose Fatality Review can make recommendations for law, policies and programs.

Overdose Fatality Review Background• 2011-2012: State tracks significant rise in OD deaths (Rx opioid

& heroin-related)• Jan. 2013: Maryland Opioid Overdose Prevention Plan

o Implement Prescription Drug Monitoring Programo Surveillance of problematic prescribing/dispensingo Overdose education & naloxone distributiono Continue access expansion for opioid replacement therapy

(methadone & buprenorphine)o Local overdose prevention planso Pilot local overdose fatality review teams (LOFRT)

Overdose Fatality Review Overview• Modeled after existing mortality review programs

(Child Fatality Review)• Multi-agency/multi-disciplinary team assembled at

local (county/Balt. City) level to conduct confidential reviews of overdose death cases

• Goal to prevent future deaths by:o Identifying missed opportunities for prevention and gaps in system

o Building working relationships b/t local stakeholders on OD prevention

o Recommending policies, programs, laws, etc. to prevent OD deaths

o Informing local overdose prevention strategy

Overview Ctd.• Implementation supported by 2013 DOJ Harold Rogers PDMP grant

• DHMH interagency collaboration to provide T/A & data to teams, including:

o Death investigation records from Office of Chief Medical Examiner

o Confirmed decedent info from death certificateo Coded toxicology datao Substance use disorder treatment records from statewide

database• Team members bring info from respective agencies about decedents

to inform review

• 2014: 3 Pilot Teams → Baltimore City, Cecil County, Wicomico County

• Currently 18 teams active (out of 24 total jurisdictions)

• 200+ cases reviewed to date

OFR Legal Authority• Pilot phase: Existing state “medical review committee” statute

provided authority for local health depts. to establish teams

• OFR law effective October 2014:

– Direction on team structure and operations (membership, goals, etc.)

– Requires healthcare providers & gov. agencies to provide decedent records on request from team

– Civil liability protection for team members and those that provide information

– Confidentiality requirements– Establishes DHMH oversight and team reporting requirements

Social-Ecological Model

Sample Case: Mr. Leighman

• OCME Data: – 48 AA Male– DOD: 10/1/2015– COD: Heroin Intoxication – Autopsy? Yes– Other substances in toxicology screen: Benzoyle,

Cocaine, Codeine, Freemorphine, Morphine– Manner of death: undetermined – Location of residence: Somerset County – Location of incident: Wicomico County

OCME Activity CommentsStewart Gilbert Leighman, B/M, DOB 7/29/1967, lives in a wooded area in a small tent near Salisbury, Wicomico County, Md. on 10-1-15 at 0830 hrs. He met his girl friend, Lesha in Salisbury, Md. And they walked to PRMC where Lesha visited with her mother and apparently borrowed some money from her mother, thirty dollars of which she gave to Mr. Leighman. The two parted ways at 1200 pm and Mr. Leighman said he would see her back at the tent. Lesha did not return to the tent because of the heavy rain, instead, she called Robert Lewis, Mr. Leighman’s cousin, to check on him. Mr. Lewis went to the tent at 1845 hrs. And discovered Mr. Leighman lying on his back in the tent with just his shorts on, he was unresponsive and Mr. Lewis could not awaken him. Mr. Lewis called 911 and he says he started CPR. Arriving EMS found him in asystole and transported him to PRMC ED. He was given life saving treatment to no avail. He was determined dead at 1942 hrs. Mr. Leighman has a history of Diabetes and stomach problems. He has a history of Cocaine use and Heroin use. The family requested Smith funeral home and they were called and agreed to respond. OCME was notified of this case and autopsy was ordered by the F.I.

Sample Case : Mr. Leighman

• EMS: day of death only • Hospital: Yes (multiple ER visits for stomach pain)• Social Services: Yes (food stamps and MA)• Sherriff's Office: Yes • State’s Attorney’s Office: Yes • Court System: Yes (3 open cases, all drug related)• Community supervision: Yes • Drug Treatment: Yes• Pain Management: Unknown• Pharmacy records: Unknown

Team Conclusions: Mr. Leighman

• Mr. Leighman had open cases in different bordering counties on the Eastern Shore of MD

• Spent the better part of the past 25 years incarcerated

• Lived in 3 different counties, homeless at the time of death, did not have a good system of care

• No known referrals for Diabetes case management

• No cell phone made it difficult to provide follow up care

Team Conclusions: Mr. Leighman

• Risk factors: transience/homelessness, history of addiction, co-occurring chronic illness, older adult, possible long period of abstinence

• System-level implications: need for improved coordination of healthcare services for transient population, overdose prevention and substance use disorder treatment access for incarcerated individuals, community naloxone trainings targeting homeless population

Reach Points/Interactions

Agencies Total Of Cases PercentageCommunity Supervision 46 27%Court System (Drug Court, Family Court, etc.) 37 22%Department of Social Services (inc. Human Services) 60 35%Department of Juvenile Services 4 2%Detention Center 30 18%Substance Use Disorder Treatment 92 54%Emergency Medical Services (EMS) 107 63%Hospital 64 37%Insurance Coverage 13 8%Mental Health Treatment 44 26%Pharmacy 20 17%Law Enforcement 143 84%Syringe Services Program Baltimore City 14 8%State's Attorney's Office 53 31%Total interactions: 727 171 cases

Notable LOFRT FindingsDecedent factors:• Prior overdose(s)• DUI/DWI • Suicide attempts/ideation• Intimate partner violence (as victim or perpetrator)• Heavy social services & criminal justice involvement• Poly-pharmacy• Pain management• Occurrence of trauma just before death (loss of a loved one, struggles with child custody,

etc.)• Older drug users with many co-occurring chronic health issues• Involvement w/ treatment services, but poor care coordination & follow through on

referrals

Incident factors:• Deaths at home, often w/ family/housemates at home too• Hotels and motels• Recent release from jail• Alcohol along w/ opioids in COD

Statewide Impacts/Outcomes to DateLocal:• Training organization staff to use naloxone (Tx providers, LE, etc.)

• Increased attention to care coordination and referrals b/t service providers

• Changes to intake questionnaires to include questions about overdose history

• Promoting addiction education and assessment at all levels of the organization

• More direct outreach to families on overdose prevention and wraparound services by those that serve people at risk of overdose

State:• System to monitor SUD provider reporting of patient OD deaths

• Research project investigating suicide overdose deaths

• Potential project to identify and provide services to decedents’ family

Considerations for Team Development• Identify legal authority

• Important to have multidisciplinary approach• Utilize existing relationships• Heavy reliance on collaboration• Encourage ongoing participation from members

• Social-ecologic vs. individual focus

• Task oriented• Establish processes and expectations early on• Consistently and frequently review goals of the team

• Formalize your observations and recommendations• Allows for agencies to improve their practices based on

evidence

Drug-Related Deaths: Investigation, Prosecution and Review Strategies

Presenters:• Patricia Daugherty, JD, Assistant District Attorney, Milwaukee

County (WI) District Attorney's Office• Michael Baier, Overdose Prevention Director, Maryland

Department of Health and Mental Hygiene• Erin Haas, MPH, Overdose Prevention Local Programs Manager,

Maryland Department of Health and Mental Hygiene

Law Enforcement Track

Moderator: Connie M. Payne, Executive Officer, Department of Specialty Courts, Kentucky Administrative Office of the Courts, and Member, Operation UNITE Board of Directors